A cost-effectiveness analysis of revaccination and catch-up strategies with the 23-valent pneumococcal polysaccharide vaccine (PPV23) in older adults in Japan

Objective: In Japan, the National Immunization Program (NIP) includes PPV23 as the primary vaccination for adults and catch-up cohorts. The Japanese Association for Infectious Diseases recommends revaccination for older adults who received primary vaccination ≥5 years earlier. The cost-effectiveness of adding revaccination and/or continuing catch-up vaccination in the NIP was evaluated from the public payer perspective in Japan.

Methods: The Markov model included five health states: no pneumococcal disease, invasive pneumococcal diseases (IPD), non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae, and death. Cohorts of adults aged 65–95 were followed until age 100 or death: 2014 cohort (aged 65–95, vaccinated: 2014); 2019 cohort (aged 65: 2019); and 2019 catch-up cohort (aged 70–100: 2019, unvaccinated: 2014). Strategies included: (1) vaccinate 2014 and 2019 cohorts; (2) vaccinate 2014 and 2019 cohorts and revaccinate both; (3) strategy 1 and vaccinate 2019 catch-up cohort; (4) strategy 2 and vaccinate 2019 catch-up cohort; and (5) strategy 4 and revaccinate 2019 catch-up cohort. Parameters were retrieved from global and Japanese sources, costs and QALYs discounted at 2%, and incremental cost-effectiveness ratios (ICERs) estimated.

Results: Strategy 1 had the highest number of IPD and NBPP cases, and strategy 5 the lowest. Strategies 3–5 dominated strategy 1 and strategy 2 was cost-effective compared to strategy 1 (ICER: ¥1,622,153 per QALY gained). At a willingness-to-pay threshold of ¥5 million per QALY gained, strategy 2 was cost-effective and strategies 3–5 were cost-saving compared to strategy 1.

Conclusions: Strategies including revaccination, catch-up, or both were cost-effective or cost-saving in comparison to no revaccination and no catch-up. Results can inform future vaccine policies and programs in Japan.     

The Effect of Risk Characteristics on the Willingness to Pay for Mortality Risk Reductions from Electric Power Generation

The objective of this study is to estimate willingness to pay (WTP) for the reduction of mortality risks caused by fossil fuel (natural gas, coal and oil) versus nuclear electric power generation systems and to examine the influence of risk characteristics involved with electric power generation on WTP. A choice experiment was conducted to achieve these objectives. The attributes for nuclear risks in the experiment included the probability of disasters and the expected losses if a disaster occurs. We find evidence of (i) a baseline effect (where WTP is sensitive to hypothetical versus actual baseline expected mortality); (ii) a ‘labeling effect,’ where, surprisingly, the term ‘nuclear’ has no effect on WTP, but the term ‘fossil-fueled power generation’ results in lower WTP; and (iii) disaster aversion, meaning that people focus on the conditional loss from a nuclear disaster, not the probability. We also find that the WTP for reducing deaths from a nuclear disaster is about 60 times the WTP for routine reducing fossil-fuel generation-related deaths.     

A supply chain-transport supernetwork equilibrium model with the behaviour of freight carriers

This paper presents a supernetwork equilibrium model integrating supply chain networks with a transport network, namely, a supply chain-transport supernetwork equilibrium model. The model takes into account the behaviour of freight carriers and transport network users to endogenously determine the transport costs generated in the supply chain networks. The interaction between transport network and supply chain networks can also be examined. Results of the numerical tests reveal that the improvement of transport network could enhance the efficiency of supply chain networks. The paper makes contributions to modelling of supply chain networks as well as to that of transport networks.     

Asymptotic expansions of the distributions of the estimates of coefficients in a simultaneous equation system

In this paper asymptotic expansions are derived for the density functions of the TSLS and LIML estimates of coefficients in a simultaneous equation system when the sample size increases and the effect of the exogenous variables increases along the sample size. These approximations are used to compare the asymptotic moments of the TSLS and LIML estimates and the concentration of probability around the true value of the estimates.     

Impacts of Road Access on Subjective Well‐being in Timor‐Leste

The impacts of access to roads on subjective well‐being at the household level are empirically examined using Timor‐Leste's nationally representative surveys. This paper examines not only the quantity, but also the quality of road infrastructure and, thus, extends existing studies that only consider the benefits of road accessibility. It is found that proximity to main roads may not necessarily result in improved welfare. Instead, ensuring all‐weather access to roads appears to be a more significant factor in raising household well‐being. Specifically, road accessibility during the rainy season reduces the probability of households reporting a ‘less than adequate’ (low satisfaction) response by 13–25 percent. This suggests that in Timor‐Leste, and likely in other developing economies under similar conditions, maintenance of existing roads is more essential to well‐being than building more roads.     

Robust portfolio estimation under skew-normal return processes

In this paper, we study issues related to the optimal portfolio estimators and the local asymptotic normality (LAN) of the return process under the assumption that the return process has an infinite moving average (MA) (∞) representation with skew-normal innovations. The paper consists of two parts. In the first part, we discuss the influence of the skewness parameter δ of the skew-normal distribution on the optimal portfolio estimators. Based on the asymptotic distribution of the portfolio estimator ? for a non-Gaussian dependent return process, we evaluate the influence of δ on the asymptotic variance V(δ) of ?. We also investigate the robustness of the estimators of a standard optimal portfolio via numerical computations. In the second part of the paper, we assume that the MA coefficients and the mean vector of the return process depend on a lower-dimensional set of parameters. Based on this assumption, we discuss the LAN property of the return's distribution when the innovations follow a skew-normal law. The influence of δ on the central sequence of LAN is evaluated both theoretically and numerically.     

Ethical Perceptions of Business Students: Differences Between East Asia and the USA and Among “Confucian” Cultures

This paper reports the results of a survey of 842 undergraduate business students in four nations – the United States of America (the USA), the Peoples’ Republic of China (the PRC), Japan, and the Republic of Korea (the ROK). This survey asked students to respond to four scenarios with potentially unethical business behavior and a string of questions related to the importance of ethics in business strategy and in personal behaviors. Based on arguments related to differences in recent historical experiences, the authors suggest that student responses may be as different within the East Asian (Confucian) environment as they are between this environment as a whole and the USA. Survey results indicate a greater perception of ethical problems and more importance placed on ethics per se in business practices, as well as less of an emphasis on social harmony (a key distinguishing characteristic of Confucian values identified in prior research) on the part of USA students. At the same time, substantial national differences in response are also witnessed within the set of East Asian students. A priori expectations as to the manner in which these East Asian responses should vary based on differences in recent historical experiences are partially, but not fully, supported. The authors argue that the key value of the reported research rests on a demonstration that national differences within a common cultural (e.g., East Asian or Confucian) area can be as great as differences across cultural (East vs. West) areas and that practitioners of global business must fine-tune their expectations as to acceptable business and personal actions to accommodate specific national historical experiences to be effective. Professors Chung and Eichenseher are professor of accounting at their respective universities. Professor Taniguchi's primary field of study is economics.     

Budget impact analysis of long acting injection for schizophrenia in Japan

Abstract

Aims: To estimate the budgetary impact of providing additional reimbursement for long acting injections for schizophrenia patients in psychiatric hospital settings in Japan to improve patient outcomes in schizophrenia.

Methods: Budget impact analysis of change in reimbursement policy using a prevalence-based model over a five-year time horizon. The results are reported as net change in expenditure and consequent cost/savings in Japanese yen at the time of analysis.

Results: The budget impact analysis shows that an increase in reimbursement for LAIs could lead to cumulative savings of an estimated 36.6 billion JPY over five years. These savings result from a decrease in hospitalization costs and an increased usage of LAI (assumed to be 10%). Based on the sensitivity analysis, the saving estimates are most sensitive to change in market share of generic and branded oral antipsychotics.

Limitations: Historical data were used to estimate the future costs of drug and hospitalization; however, it is not the best predictor of future, hence a source of potential bias. A good level of treatment adherence with oral antipsychotics was assumed, which is generally not the case; therefore, we might have overestimated the effectiveness of oral atypical antipsychotics. Additionally, the drug cost due to reimbursement might have also been overestimated because in clinical setting, the increase of LAI use may not have reached 10% of the market share. Lastly, patients’ behavior was derived from models, which may have loosely approximated the reality.

Conclusions: An additional reimbursement for the use of LAI in schizophrenia patients is likely to be cost neutral/cost saving and should be considered as a policy option to improve patient outcomes and budget sustainability.     

The new main bank system

We develop a main bank model where the main bank decides whether or not to raise additional funds from the capital market to continue to invest in a borrowing firm when nonmain banks withdraw funds. We show that the threat of withdrawal of nonmain banks is more likely to force the main bank to perform efficiently in handling troubled loans, thereby preventing problems with zombie firms, if the potential cash flow (liquidation value) of the firm decreases (increases) relative to the amount funded by nonmain banks. The theoretical results provide both efficiency evaluations for the renewal of the main bank relation in Japan after the end of the 1990s and empirical implications for the renewed main bank system.     

Bi-objective decision support system for routing and scheduling of hazardous materials

This paper presents a Pareto-based bi-objective optimization of hazardous materials vehicle routing and scheduling problem with time windows and shows its application to a realistic hazardous material logistics instance. A meta-heuristic solution algorithm is also proposed, which returns a set of routing solutions that approximate the frontier of the Pareto optimal solutions based on total scheduled travel time and total risk of whole transportation process. It works in a single-step fashion simultaneously constructing the vehicle route and selecting the optimal paths connecting the routed locations from a set of non-dominated paths obtained in terms of travel time and risk value.