The economic burden of tuberous sclerosis complex in UK patients with renal manifestations: a retrospective cohort study in the clinical practice research datalink (CPRD)

Background: Tuberous sclerosis complex (TSC) is a multi-system genetic disorder in which renal manifestations occur in ～50% of children and 80% of adults. Since these often present alongside other manifestations, renal TSC is likely to incur significant costs. This study aims to quantify healthcare resource use (HCRU) and costs for renal TSC patients in the UK.

Methods: TSC patients in the Clinical Practice Research Datalink (CPRD) linked to Hospital Episodes Statistics were identified from January 1987–June 2013. Clinical data were extracted over the entire history and costs were reported over the most recent 3-year period. HCRU was compared with a matched comparator cohort. Incremental costs were reported and the key cost drivers by primary manifestation category were identified by regression modeling.

Results: A total of 79 renal TSC patients were identified with manifestations including chronic kidney disease stage 3–5 (with prevalence increasing with age) and renal angiomyolipoma. Renal TSC patients consistently reported greater HCRU than the comparator. Inpatient hospitalizations were more frequent for renal TSC patients (3.2 vs 1.6), but length of stay was comparable; however, 70.9% of renal TSC patients recorded no kidney-related procedures ever and averaged <1 test per year in the 3-year period. Average costs for renal TSC patients were nearly 3-fold greater than the comparator (£15,162 vs £5672). Costs increased with additional manifestation categories (£3600: only renal; £27,531: renal with ≥4 additional manifestation categories [25% of patients]). Additional nervous system and dermatology/psychiatric manifestations significantly (p?Conclusions: Renal TSC patients have greater HCRU than the general CPRD population, likely to result from progression of renal disease and additional manifestations; however, surveillance for disease progression appears to be deficient. Inadequate monitoring may contribute to a lack of co-ordinated care and increased healthcare-associated costs. Efforts should be made to follow the TSC guidelines to effectively monitor and treat patients.     

Lobbying for Education in a Two‐Sector Model

Firms specialized in two different sectors lobby to induce the government to subsidize the type of education complementary to their production. Lobbying is endogenous. We show that, if lobbying is not costly, both sectors will lobby in equilibrium and the education policy will induce the same skill composition that would be chosen by the social planner. However, if lobbying is costly and there is sufficient asymmetry between the sectors, only one sector will exert pressure on the policy‐maker in the attempt to direct resources toward the type of education required by its production. Which sector will engage in lobbying depends on relative size, productivity, and price. We also provide some preliminary evidence that lobbying activity by firms may influence the production of skills needed by those firms.     

A signalling model of school grades under different evaluation systems

We examine the role of school grades as a signal of worker productivity under different examination systems in relation to errors that may affect student performance. Firms use school grades as a signal of workers’ effective skills, taking into account that these evaluations are effected by stochastic shocks. We show that more precise evaluation systems, being associated with a higher reactivity of wages to school grades, induce students to provide more effort. Low ability students tend to react less than high ability students. Moreover, individuals with low abilities may prefer less accurate evaluation systems. Nevertheless, when productivity increases, these systems become less convenient and the number of individuals preferring them diminishes. Our analysis highlights an important trade-off between centralised and decentralised evaluation systems. On the one hand, frequent evaluations, typical of decentralised systems, weaken the impact on grades of those errors which influence student performance and, so, reduce signal noise, while, on the other hand, different teachers generally adopt different performance assessment standards, leading to noisier evaluations.     

Game Theoretic Models of Wage Bargaining

This paper aims at being a tool to help apply game theoretic bargaining models to wage negotiations. In this perspective, we review a number of articles which explicitly deal with wage determination as well as purely game theoretical models which we believe can be fruitfully extended to account for specific features of labour markets. We discuss some common shortcomings in the wage negotiation literature, and suggest possible lines of research worth pursuing to deal with such weaknesses.     

Risk factors and geographical heterogeneity in unintentional home injuries incidence rate: new evidence based on Multiscopo survey in Italy

Home injuries together, with road traffic accidents, are estimated to be the third cause of death in Italy (Arokiasamy and Krishnan 1994). However, as in most other countries, in Italy there is a lack of information on home injuries and on how differences in geographical patterns may influence the scope and magnitude of this phenomenon. By analysing a multipurpose large survey (Multiscopo) carried out annually, geographical heterogeneity in home injuries incidence rate can be investigated. The aim of this study is the assessment of possible differences in geographical patterns among the Italian regions making use of a re-analysis of Multiscopo home injury data. The study results show that Italian regions differ greatly in the number of home injuries. The geographical heterogeneity may be due to the unemployment rate and the incidence of poverty that is greater in the Southern and Insular regions than in other zones. Other socio-economic variables such as alcohol consumption can increase the risk of injury in the home. To prevent them it could be useful to organize campaigns aimed at increasing the awareness among people about this problem.     

Simultaneous Adjustment of Quantities and Prices: An Example of Hamiltonian Dynamics

In a well-known essay first published in 1953, Goodwin analyzed the dynamic adjustment of quantities and prices to long-run equilibrium values, in a set ofn ‘Walrasian’ markets. He treated the crossed adjustment of prices and quantities as a linear Hamiltonian vector field. In more recent work, Goodwin introduced non-linear perturbations in his multi-sectoral adjustment model. He assumed that real consumption depends non-linearly on relative prices. This paper shows the following: (1) Goodwin's behavioural hypotheses are compatible with the assumption that agents maximize; (2) if the dynamic process is Hamiltonian, then symplectic coordinate changes are essential tools of analysis; (3) if the real wage is rigid and returns to scale are not constant, then the Hamiltonian model can generate chaotic transients or, in extreme cases, pure chaotic motions.     

The ever‐declining role of gender equality in the European Employment Strategy

This article analyses the changing position of gender in the European Employment Strategy (EES) since its 2005 relaunch. Overall, we find a picture of mixed progress towards gender equality goals across Member States. There is evidence of the EU soft law approach leading to positive developments as the use of targets in conjunction with Country‐Specific Recommendations and Points‐to‐Watch have had some influence in promoting gender equality policies among Member States. However, the weakened position of gender mainstreaming in European‐level initiatives has led to gender being marginalised or ignored in national and EU policy responses to the crisis. The prominence of gender has declined further in the 2010 revision of the EES under the 2020 banner. This introduces new risks as the emphasis on gender equality falls further down the list of priorities in the streamlining of the Lisbon Process.     

Sustaining Collusion under Economic Integration*

In this paper, we aim at investigating from a game‐theory perspective whether trade liberalization can promote a collusive two‐way trade. We show that, under Cournot competition, economic integration is anti‐competitive if collusive trade is a possible outcome of the repeated game; under price competition, the likelihood of collusive trade is a necessary but not sufficient condition for trade liberalization to be pro‐competitive. Furthermore, we show that economic integration may increase the scope for collusion irrespective of the firms’ strategic variable.     

Pass-through and Export Prices: an empirical test for the leading European countries

The paper presents an empirical investigation of the extent to which exchange rate movements affect export prices in the leading European countries. By extending the model proposed by Kasa (1992) to a context of monopolistic competition, an export price equation has been derived that allows us to clearly identify the effects of nominal exchange rate movements on the exporters' profit margins and therefore on his prices. This equation has then been estimated with reference to five different products (beer, car tyres, truck tyres, aluminium foil and cars) and six markets (United States, Germany, France, Italy, United Kingdom and Spain). The results show that the pass-through is more likely to occur and larger in absolute value for the less differentiated products, for which markets can plausibly be assumed to be more competitive. In line with previous empirical findings, the German and US markets are the ones in which it is most difficult for exporters to modify their prices expressed in local currency.