Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan

Abstract

Objective:

The cost-effectiveness of renal replacement therapy (RRT) is affected by the composition of treatment. This study aimed to estimate the costs and outcomes associated with changing the composition of RRT modality over time.

Methods:

By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the four main treatments available for RRT in Japan. The model included direct health service costs and quality-adjusted life years (QALY). Sensitivity analyses were performed to assess the robustness of the results.

Results:

Over the 15-year period of the model, the current composition of RRT (i.e., the base composition of RRT) was $84,008/QALY. The most cost-effective treatment was when the likelihood of a living donor transplant was increased by 2.4-times ($70,581/QALY). Compared with the base composition of RRT, dominant treatments with respect to cost-effectiveness were when the likelihood of a deceased donor transplant was increased by 22-times and when the likelihood of a pre-emptive living donor transplant was increased by 2.4-times. Little difference was found between these two treatments. One-way sensitivity analysis did not change the cost effectiveness except for costs of chronic hemodialysis and a living donor transplant in subsequent years.

Limitations:

It is difficult to increase the rate of transplant overall in the shorter term nationally and internationally.

Conclusions:

Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution.     

基于“家电以旧换新”回收数据评估电子废物产生量估算方法

比较了基于史坦福(Stanford)模型和保有量系数法对我国电子废物产生量的预测,并与中国家电以旧换新活动试点区域的实际回收统计数据进行对比,结果显示除电视机以外,两种估计方法的预测结果都显著高于以旧换新的实际回收数据.其原因首先是产品废弃量的变化深受产品技术变化影响,平板显示技术的快速普及导致CRT电视机废弃量出现短期激增,成为“家电以旧换新”实际回收品的主体,而洗衣机、电冰箱等传统大家电的产品实际使用寿命相对较长;其次是废旧产品回收面临非正式回收部门的竞争,以旧换新以较高的政府补贴引导一定数量的废弃产品流向正规处理企业,但还有相当数量的废旧产品流入了非正式的翻新加工和二手销售渠道.特别是空调和电脑,家庭消费占总消费量的比重较小,产品废弃后的材料回收价值和翻新维修价值都较高,补贴对提升回收量的影响相对较小;最后不同区域之间,预测结果与实际回收情况对比也存在明显的差别.考虑到家电以旧挟新政策停止以后,新颁布实施的废弃电器电子产品回收处理基金的补助力度大幅下降,有资质的回收处理企业重新陷入发展困境.有必要遵循生产者责任延伸制度的原则,积极鼓励扩大生产者的参与,从产品设计和废弃产品回收的逆向物流两方面提高回收利用系统的效率.同时,合理规划再生处理设施的区位和处理规模,需要根据区域和产品特点,对现有预测方法进行优化调整.     

中小民营企业融资创新研究：融资路径依赖与内生性契约构建

中小民营企业融资难问题的实质是中小民营企业不能在较高层次的货币市场和资本市场上如愿地获得资金支持。目前解决中小民营企业融资难问题的关键在于,创新金融制度安排,构建一种能够使外部投资者与中小民营企业建立起横向信用联系的内生性融资契约。在我国既有的金融契约框架下,通过适当的融资结构设计和制度安排,信托私募融资能够最小化中小民营企业融资的代理成本和信息成本,从而使中小民营企业能够沿着既有的融资路径有效地获得所需的资金。     

目标替代率下企业年金缴费率测算——基于个人、企业负担能力的实证分析

企业和个人是否有能力负担企业年金缴费是年金制度得以推广的关键所在。首先在前人定性研究的基础上,结合我国居民2003-2012年收入支出数据和企业1995-2012年投入产出数据,运用回归分析的方法,构建回归模型对职工个人和企业的经济能力进行测算,结果显示个人可负担的平均缴费率上限为26.95%,企业可负担8.19%,即个人和企业均有负担年金缴费的经济能力。然后运用精算平衡的方法,通过模型构建和参数设定,计算在20%的目标替代率下职工的年金缴费率,其中男职工为3.68%,女职工为4.09%。结果表明,企业和个人能够在可承受范围内参与年金计划,实现年金目标替代率,缓解基本养老金支付压力。最后为企业年金制度的逐步推行提出可行建议。     

中国企业职工养老保险替代率的实证研究——基于缴费确定型企业年金与基本养老金的对比分析

替代率是企业养老保险方案设计的关键参数,也是政府制定社会养老决策的关键因素之一.企业年金是多支柱养老保险体系的重要组成部分,关系到中国未来养老体系的健康发展.对养老保险替代率的研究发现,基本养老镏金与企业年金对参与人的经济影响并不确定,因此,制定养老金政策须考虑相关的限制条件,政策倾向应有所差异和侧重,以保证政策目标的实现.     

ADOPTION AND PRODUCTIVITY IMPACT OF MODERN RICE VARIETIES IN BANGLADESH

Technological progress has helped Bangladesh to achieve self‐sufficiency in rice production in 2001 from a heavy import‐dependence, despite doubling of population and a reduction in arable land since its independence in 1971. As the adoption of modern varieties (MV) of rice is reaching a plateau, particularly for the irrigated ecosystem, an important issue is whether the research system will be able to sustain the growth of production. The present paper addresses the following questions: (i) to what extent farmers have been replacing the old MV with the new MV, and (ii) what has been the impact of the variety replacement on productivity and profitability. How crucial is the continuous research and release of improved rice varieties toward improving farm production and income for farmers comes out as a clear message to policymakers from the current paper.     

Optimization of the machining economics problem under the failure replacement strategy

This paper presents a model for calculating the optimal cutting feed rate and spindle speed in a stand-alone cutting machine. The optimal cutting conditions are determined for three different objective functions—minimum expected cycle time, minimum expected cost per unit, and maximum expected profit-rate—under the failure replacement strategy, taking into account cutting tool constraints and machine limitations. We also examine the relationships between the optimal solutions, and present the efficiency range of feed rate.     

Structural replacement or structural inducement: government ties of Chinese business executives

We suggest that the structural replacement thesis, which proposes that managers in Chinese nonstate-owned enterprises (NSOEs) possess more government ties than managers in Chinese state-owned enterprises (SOEs), is theoretically incomplete because it considers only the motivation of managers of NSOEs. The extensiveness of social ties is influenced also by the capability and opportunity for social actors to cultivate these social ties. We introduce the structural inducement thesis, which holds that SOE managers have more government ties than do NSOE managers, as an alternative to the structural replacement thesis. Our analysis of 250 Chinese managers' ties supports this structural inducement thesis. The theoretical and applied implications of these findings are discussed. Copyright © 2009 ASAC. Published by John Wiley & Sons, Ltd.     

浅谈公路软土地基处理

主要介绍了公路软土地基处理的几种常用方法,重点介绍了砂垫层法。     

中国城乡居民社会养老保险适度水平研究——基于“生存公平”需求的测算与比较

目前,我国的城乡居民社会养老保险是由“新农保”和“城居保”合并发展而来的,已经实现制度全覆盖,但是还存在养老金给付水平过低、地区发展不平衡、缺乏科学增长机制等问题,解决这些问题的关键在于确定养老金给付的适度水平区间,并采取有效措施逐步调整。城乡居民社会养老保险立足于满足居民“生存公平”需求,给付水平不宜过高,也不能过低：给付下限是满足最低生存需要的恩格尔系数标准;给付上限是保证基本生存需求的生活必需品消费水平,目前可按农村居民人均纯收入的60％进行测算。应逐步提高城乡居民养老金待遇,建立养老金正常调整机制,以适度水平为目标平衡地区差距,并不断完善多支柱养老保险体系,促进城乡居民社会养老保险健康可持续发展。