Cost-effectiveness of continuous subcutaneous insulin infusion in people with type 2 diabetes in the Netherlands

Aims: Up to 30% of insulin-treated type 2 diabetes patients are unable to achieve HbA1c targets despite optimization of insulin multiple daily injections (MDI). For these patients the use of continuous subcutaneous insulin infusion (CSII) represents a useful but under-utilized alternative. The aim of the present analysis was to examine the cost-effectiveness of initiating CSII in type 2 diabetes patients failing to achieve good glycemic control on MDI in the Netherlands. Methods: Long-term projections were made using the IMS CORE Diabetes Model. Clinical input data were sourced from the OpT2mise trial. The analysis was performed over a lifetime time horizon. The discount rates applied to future costs and clinical outcomes were 4% and 1.5% per annum, respectively. Results: CSII was associated with improved quality-adjusted life expectancy compared with MDI (9.38 quality-adjusted life years [QALYs] vs 8.95 QALYs, respectively). The breakdown of costs indicated that ～50% of costs were attributable to diabetes-related complications. Higher acquisition costs of CSII vs MDI were partially offset by the reduction in complications. The ICER was estimated at EUR 62,895 per QALY gained and EUR 60,474 per QALY gained when indirect costs were included. Conclusions: In the Netherlands, CSII represents a cost-effective option in patients with type 2 diabetes who continue to have poorly-controlled HbA1c despite optimization of MDI. Since the ICER falls below the willingness-to-pay threshold of EUR 80,000 per QALY gained, CSII is likely to represent good-value for money in the treatment of poorly-controlled T2D patients compared with MDI.     

Die Erwartungen der Wirtschaft für 2016

Last year saw only a moderate economic upturn, which will continue in 2016. Geopolitical risks and the loss of momentum in the emerging economies are obstacles that may hinder a positive trend in exports. However, the falling crude oil price and the low euro currency rate give hope for better prospects. On the domestic front, there is a strong focus on the digitisation of all sectors. Meanwhile, many problems result from the low level of investments and the high energy costs resulting from the energy transition. The insurance industry views the low-yield environment, which greatly intensified last year, as its main challenge in 2016.     

Gewerkschaften auf dem Rückzug? Mythen,Fakten und Herausforderungen

A comparison across 20 advanced countries shows that trade union density has fallen in most countries over the last 50 years, with substantial differences between countries. However, unions are not about to vanish everywhere, and some prominent explanations for union decline such as globalization do not hold on closer scrutiny. Current trends that pose serious problems for union membership are demographic change, the declining employment share of the public sector, the rise in atypical employment, and the decline in average firm size. Upholding union presence at the workplace is crucial for keeping and winning members, and union recruiting should focus more on young and atypically employed workers.     

ANFA – nationale Geldschöpfung als Sprengsatz für die Währungsunion?

The so called ANFA secret protocol brought to the public’s attention the previously only little noticed opportunity for national central banks of individual Eurozone members to create money through purchases of securities at their own expense. The ANFA financial assets amount to the significant share of 51% (gross) or rather 18% (net) of the Eurosystem’s balance sheet total and 41% of its total liquidity, thereby jeopardising the principle that the communities of the emitting and the money accepting countries should be congruent, which is seen as a stability condition for currency unions. There is a danger that the money creation via ANFA acts as an explosive device for the currency union. It is therefore necessary to clearly limit the own funds portfolio in order to restore the community of money emission.     

EU Agricultural Policy Reform: Evaluating the EU’s New Methodology for Direct Payments

The Common Agricultural Policy has changed significantly over time. Major changes are now introduced every seven years, with the last fundamental change agreed upon in 2013 for the period 2014-2020. Policymakers also agreed to a mid-term review in order to evaluate the performance of numerous new regulations. The Commission has elaborated a methodology for the evaluation and has already published some documents with initial results for past periods. This article reviews whether the methodology and database used by the Commission are in line with the highest standards for policy evaluation.     

Groups of companies in the Recast European Insolvency Regulation: Around and about the “group”

Regulation (EU) 2015/848 (Recast European Insolvency Regulation/Recast EIR) contains a set of articles dedicated to the insolvency proceedings relative to members of groups of companies. No substantial consolidation or any procedural nature is envisaged. Article 2(13) of Regulation 2015/848 clarifies that, for the purposes of the same, a “group of companies” must be understood as “a parent undertaking and all its subsidiary undertakings.” However, many doubts arise when one goes deeper into that definition. The author deals with some of those problems and gives some suggestions to overcome them.     

Persistent Doubt: An Examination of Hedge Fund Performance

We examine whether performance persistence is suspicious. Top quintile portfolios formed on the Sharpe ratio, alpha, and information ratio persistently outperform similarly constructed mediocre third quintile portfolios throughout our sample period, but performance is more modest and less persistent when portfolios are formed on the excess manipulation‐proof performance measure (EMPPM). By selecting funds formed on ranking by Sharpe and information ratios, investors also select funds that have persistently doubtful performance according to the doubt ratio. In contrast, portfolios formed on alphas and especially the EMPPM have much less excess and persistent doubt.     

Countercyclical Bank Capital Requirement and Optimized Monetary Policy Rules

Using BoC-GEM-Fin, a large-scale dynamic stochastic general equilibrium (DSGE) model with real, nominal, and financial frictions featuring a banking sector, we explore the macroeconomic implications of various types of countercyclical bank capital regulations. Results suggest that countercyclical capital requirements have a significant stabilizing effect on key macroeconomic variables, but mostly after financial shocks. Moreover, the bank capital regulatory policy and monetary policy interact, and this interaction is contingent on the type of shocks that drive the economic cycle. Finally, we analyze loss functions based on macroeconomic and financial variables to arrive at an optimal countercyclical regulatory policy in a class of simple implementable Taylor-type rules. Compared to bank capital regulatory policy, monetary policy is able to stabilize the economy more efficiently after real shocks. On the other hand, financial shocks require the regulator to be more aggressive in loosening/tightening capital requirements for banks, even as monetary policy works to counter the deviations of inflation from the target.