Model to evaluate the cost-effectiveness of different antibiotics in the management of acute bacterial exacerbations of chronic bronchitis in Germany

Summary

This study investigated the primary cost-drivers and determinants of the cost-effectiveness of antibacterial treatment of acute bacterial exacerbations of chronic bronchitis (ABECB) in Germany. It assessed the health care costs and consequences related to treatment initiated in the community using macrolides, fluoroquinolones, penicillins, and cephalosporins. Patients were categorised according to disease severity. Decision analysis was used to consider the clinical and economic consequences of various treatment options from first-line treatment initiated by a primary care physician in the community until success or failure after third-line treatment in hospital.

The key cost drivers were the clinical success/failure rates of first-line treatment and the cost per day of hospitalisation. Antibiotics with the cheapest purchase price are not necessarily the most cost-effective first-line treatment. In more severe ABECB, drug acquisition costs are only a small proportion of the total healthcare costs because the extra costs associated with treatment failure are much greater than the acquisition costs of the first-line antibiotics. Thus the most cost-effective first-line treatment is one which results in consistently high clinical effectiveness due to its broad spectrum of activity, low rate of bacterial resistance, and high patient compliance. Of the antibiotics considered, none was consistently found to be the most cost-effective treatment across the full range of scenarios investigated. However, the fluoroquinolones and cephalosporins were generally more cost-effective than the macrolides and penicillins.     

The recognition and valuing of patient knowledge: a way forward

The health care that patients receive, particularly in acute care settings, is mainly based in biomedical knowledge. The scientific method of investigating health conditions has directly contributed to the development of this knowledge. This has made a significant contribution to increased survival rates, reduced recovery periods and extending the duration of life. The influence of consumerism on health‐care management has led to an expectation of increased patient involvement when making decisions about their treatment options. This assumes that the provision of information helps improve patients' understanding of the diagnosed health condition and assists them to make ‘good’ decisions. Accordingly, there is a greater focus on providing information to patients. The information provided to patients mostly involves explanation about the biomedical aspects of their health condition. However, patients also desire information about how the health condition will affect their everyday life. We call the understanding of the implications of this information ‘everyday knowledge’. Provision of this information can assist patients by helping them realize their expectations and providing reassurance to both patients and their significant others. Unfortunately, everyday knowledge that assists patients to understand and manage their daily life has not been as systematically researched or examined. While biomedical knowledge has been extensively developed and promoted through funding regimes, everyday knowledge has not benefited from the same support. The interactions in health‐care settings are influential in the generation and use of knowledge. Practises that encourage sensitivity by health professionals to each patient's situation need to be identified and implemented. An increased focus on the inclusion of everyday knowledge alongside biomedical knowledge is likely to enhance the relevance of the information that patients currently receive.     

An Evaluation of the Impact and Effectiveness of Environmental Legislation in Small and Medium‐Sized Enterprises: Experiences from the UK

With small‐ and medium‐sized enterprises (SMEs) accounting for 99.7% of the 4.7 million UK businesses, they can have a huge collective impact on the environment, which in turn is being increasingly regulated. This study investigated the impact and effectiveness of environmental legislation on UK SMEs as well as determining if ‘compliance’ results in improved environmental protection. Interviews were conducted with SME management, site staff, regulators, policy officials and support organisations. Forty‐four SMEs from the north‐west of England participated in the study, and overall a total of 99 individuals were interviewed. The study clearly indicates that the impact of environmental legislation on SMEs is overstated and impact increased commensurate with effort to comply and enforcement action. Only one of the SMEs studied had been prosecuted and only two had been inspected. Compliance issues identified in those SMEs subject to direct regulation did not correlate with previous compliance audits conducted. In general, SMEs had poor awareness of compliance issues; non‐compliance was only really recognised and acknowledged if identified by a regulator and only regarded as serious if prosecuted. Regulation of the environment is clearly only effective if complied with; understanding compliance levels can help measure the link between legislation and environmental protection. The effectiveness of environmental legislation can only be understood if SMEs are subject to regular regulatory contact. Recommendations to improve SME compliance control systems are provided. Copyright © 2011 John Wiley & Sons, Ltd and ERP Environment.     

经济快速增长、社会福利函数和公共投资项目绩效审计

通过社会福利函数，将经济快速增长和公共投资项目绩效审计联系起来，探讨了绩效审计在实践中可能存在的一些困难。这些困难既与公共投资的性质相关，更与我国快速增长的经济环境相关。经济快速增长引起的经济社会的快速变化对绩效审计标准的制定和证据的获取产生了重要影响，妨碍了绩效审计的开展。因此，我国当前公共投资项目审计应以合规性审计为主，探索性地进行一些绩效审计。     

Economic impact of compliance to treatment with antidiabetes medication in type 2 diabetes mellitus: a review paper

Abstract

Objectives: Suboptimal compliance and failure to persist with antidiabetes therapies are of potential economic significance. The present research aims to describe the impact of poor compliance and persistence with antidiabetes medications on the cost of healthcare or its components for patients with type 2 diabetes mellitus (T2DM).

Methods: Literature search was conducted in PubMed for relevant articles published in the period between 1 January 2000 and 30 April 2009. Thus, it is possible that relevant articles not listed in PubMed, but available in other databases are not included in the current review. Studies describing economic consequence of compliance and/or persistence with pharmaceutical antidiabetes treatment were identified. The variability in the studies reviewed was high, making it extremely difficult to make a comparison between them.

Results: Of 449 articles corresponding to the primary search algorithm, 12 studies (all conducted in USA) fulfilled the inclusion criteria regarding the economic impact of compliance and/or persistence with treatment on the overall cost of T2DM care or its components. Compliance was assessed via medication possession ratio (MPR) in ten studies, where it ranged from 0.52 to 0.93 depending on regimen. Persistence was assessed in one study. Mean total annual costs per T2DM patient varied between the studies, ranging from $4570 to $17338. In seven studies, medication compliance was inversely associated with total healthcare costs, while in four other studies inverse associations between medication compliance and hospitalisation costs were reported. In one study increased adherence did not change overall healthcare costs.

Conclusions: Improved compliance may lead to reductions of the total healthcare costs in T2DM, Further research is needed in countries other than the US to assess impact of compliance and persistence to pharmacotherapy on T2DM costs in country-specific settings.     

Winning the new channel war on Amazon and third-party platforms

The top online marketplaces in the world, including Alibaba, Amazon, and eBay, sold $2.7 trillion in 2020, or 62% of global web sales that year. Despite the promise of unfettered access to customers, the reality is that most sellers struggle with unprecedented and unauthorized rogue resellers. These often anonymous, third-party individuals and firms may not provide the quality experiences aligned with customers’ expectations of a brand and often market their goods in competition with trusted partners. This requires a systematic battle plan to effectively protect the seller’s brand equity, service promise, and authorized distribution network. We describe the channel war that is at work and the forces fueling its development. We explain how rogue reseller activities drive down pricing, increase channel competition and conflict, impact the customer experience, and harm brand equity. We recommend revising product policies, procedures, and agreements to begin to differentiate products from those sold by unauthorized parties. We also recommend a legal strategy to complement these efforts. Critical steps include regular and active enforcement as well as implementing services, benefits, and quality controls for the brand’s products that cannot be replicated by unauthorized sellers and requiring authorized distributors and retailers to maintain those benefits and controls.     

Corporate Governance: An Ethical Perspective

This paper discusses corporate governance issues from a compliance viewpoint. It makes a distinction between legal and ethical compliance mechanisms and shows that the former has clearly proven to be inadequate as it lacks the moral firepower to restore confidence and the ability to build trust. The concepts of freedom of indifference and freedom for excellence provide a theoretical basis for explaining why legal compliance mechanisms are insufficient in dealing with fraudulent practices and may not be addressing the real and fundamental issues that inspire ethical behavior. The tendency to overemphasize legal compliance mechanisms may result in an attempt to substitute accountability for responsibility and may also result in an attempt to legislate morality which consequently leads to legal absolutism. The current environment of failures of corporate responsibility are not only failures of legal compliance, but more fundamentally failures to do the right (ethical) thing. Surendra Arjoon is an Associate Professor of Business Ethics at the University of the West Indies, Trinidad. He served as Chair, Department of Management Studies (2002–2005) and as Associate Dean, Faculty of Social Sciences (1996–2002). He is also the Vice-President of the Trinidad and Tobago Economics Association. His work has appeared in the Journal of Business Ethics, Journal of Markets and Morality, Global Development Studies, Applied Financial Economics, and Social and Economic Studies.     

A study of intellectual property protection policies and innovation in the Indian pharmaceutical industry and beyond

We study the relationship between Trade Related Intellectual Property rights (TRIPS) and innovation. Using export data, this paper aims at assessing the relative impact of TRIPs on innovation, namely the ability of the Indian pharmaceutical industry to enter new markets with existing or new drugs. It examines whether India’s decision to comply with TRIPS influenced its innovation, and develops a theoretical model, where innovation, being measured by the likelihood of exports of one product from one identified country to partner countries, is influenced by factor, demand and trade conditions. The paper draws on quantitative data, using Probit and Logit techniques. The model is illustrated using empirical evidence from the Indian pharmaceutical industry. We find statistically significant evidence that India’s compliance with TRIPS is associated with new trade flows from India to partners. However we do not find statistically significant evidence of a relation between TRIPS compliance and value of exports. The interpretation is that TRIPS compliance has different effects: it is a necessary condition to favor innovation but it is not sufficient to increase exports value (competitiveness). Finally, we study to what extent this model can be generalized to other developing countries and/or industries.