Economic impact of onabotulinumtoxinA for overactive bladder with urinary incontinence in Europe

Background: Overactive bladder (OAB) is a common condition that has a significant impact on patients’ health-related quality-of-life and is associated with a substantial economic burden to healthcare systems. OnabotulinumtoxinA has a well-established efficacy and safety profile as a treatment for OAB; however, the economic impact of using onabotulinumtoxinA has not been well described.

Methods: An economic model was developed to assess the budget impact associated with OAB treatment in France, Germany, Italy, Spain and the UK, using onabotulinumtoxinA alongside best supportive care (BSC)—comprising incontinence pads and/or anticholinergic use and/or clean intermittent catheterisation (CIC)—vs BSC alone. The model time horizon spanned 5 years, and included direct costs associated with treatment, BSC, and adverse events.

Results: Per 100,000 patients in each country, the use of onabotulinumtoxinA resulted in estimated cost savings of €97,200 (Italy), €71,580 (Spain), and €19,710 (UK), and cost increases of €23,840 in France and €284,760 in Germany, largely due to day-case and inpatient administration, respectively. Projecting these results to the population of individuals aged 18 years and above gave national budget saving estimates of €9,924,790, €27,458,290, and €48,270,760, for the UK, Spain, and Italy, respectively, compared to cost increases of €12,160,020 and €196,086,530 for France and Germany, respectively. Anticholinergic treatment and incontinence pads were the largest contributors to overall spending on OAB management when onabotulinumtoxinA use was not increased, and remained so in four of five scenarios where onabotulinumtoxinA use was increased. This decreased resource use was equivalent to cost offsets ranging from €106,110 to €176,600 per 100,000 population.

Conclusions: In three of five countries investigated, the use of onabotulinumtoxinA, in addition to BSC, was shown to result in healthcare budget cost savings over 5 years. Scenario analyses showed increased costs in Germany and France were largely attributable to the treatment setting rather than onabotulinumtoxinA acquisition costs.     

Hungry for Food or Hungry for Love?

Despite recent progress in reducing poverty, the fight against hunger remains a challenge in the United States. Charities have set up soup kitchens in order to reach out to the poor and hungry. Unfortunately, the way in which some soup kitchens are run is not appealing. One may wonder if waiting in line for a bowl of soup provided out of a van contributes to self-esteem. Beyond hunger, the poor suffer from isolation and a lack of respect from society. It may be worth looking at the experience of other countries that provide hunger relief in a more humane manner. In this paper, we analyze the experience of a soup kitchen in Namur, Belgium, whose cozy atmosphere has led its customers to come as much for socialization as for food.     

Dynamic panel data estimation of an integrated Grossman and Becker–Murphy model of health and addiction

We propose a dynamic panel data approach to estimate a model that integrates the Becker–Murphy theory of rational addiction with the Grossman model o     

Menu Costs, Nominal Wage Revisions, and Intracontract Wage Behavior

We use data from indexed and nonindexed Canadian wage agreements to study the intracontract profile of nominal and real wages. Allowing for endogenous switching between the two indexation categories, we conclude that the number of nominal wage revisions depends on contract duration, expected inflation, and the cost of adjusting wages. Our results have implications for the menu cost, overlapping contracts, dynamic monopoly union, and efficient bargain literatures.     

Effects of Crop Prices,Nuisance Costs,and Wetland Regulation on Saskatchewan NAWMP Implementation Goals

Current Saskatchewan wetland regulation may be insufficient to meet North American Waterfowl Management Plan (NAWMP) preservation and restoration goals in a climate of increasing demand for grains and nuisance costs. Therefore, the purpose of this paper is to ascertain the effects that crop prices, nuisance costs, and alternate wetland regulation have on these goals. An integrated geographic information system and economic farm‐level model that assesses the net present value of drainage projects in the Whitesand River Watershed is employed. If prices eventually reach historical highs observed in the early 1970s, more than 85% of the wetland area in the study area could be drained, making NAWMP goals impossible to achieve. In this scenario, nuisance costs have little effect on drainage outcomes because they are dwarfed by the magnitude of agricultural revenue. If prices remain at the current higher levels observed from 2007 to 2012, the use of a binding permit could help achieve NAWMP goals. In this case, nuisance costs play a large role in determining the drainage of marginal, comparatively larger wetlands. If prices return to the recent lower levels observed from 1999 to 2006, current Saskatchewan regulation is sufficient. In this scenario, agricultural returns are low and nuisance costs are not high enough to cause wetland drainage. Both wetland regulation and nuisance costs can play an important role in agricultural wetland drainage, but that role depends critically upon the price of agricultural products.     

Measuring and improving the performance of customs valuation controls: An illustration with Gabon

Modern customs administrations aim to both facilitate legal trade and combat fraud. To meet this dual objective, many customs administrations in developing countries must give risk management a highly prominent role. In this context of modernisation, this paper first provides stylised facts on the performance of the customs controls carried out at the Gabon border. Then, we compare Gabon′s granular import customs data with international trade statistics. Based on this comparison, we identify undetected fraud and present a methodology to target ex post audits. Finally, we define indicators to monitor the performance of customs valuation controls.     

Guaranteeing Defined Contribution Pensions: The Option to Buy Back a Defined Benefit Promise

After a long commitment to defined benefit (DB) pension plans for U.S. public sector employees, many state legislatures have introduced defined contribution (DC) plans for their public employees. In this process, investment risk that was previously borne by state DB plans has now devolved to employees covered by the new DC plans. In light of this trend, some states have introduced a guarantee mechanism to help protect DC plan participants. One such guarantee takes the form of an option permitting DC plan participants to buy back their DB benefit for a price. This article develops a theoretical framework to analyze the option design and illustrate how employee characteristics influence the option's cost. We illustrate the potential impact of a buy‐back option in a pension reform enacted recently by the State of Florida for its public employees. If employees were to exercise the buy‐back option optimally, the market value of this option could represent up to 100 percent of the DC contributions over their work life.     

The importance of employment status in determining exit rates from nursing

To mitigate nurse shortages, health care decision makers tend to employ retention strategies that assume nurses employed in full-time, part-time, or casual positions and working in different sectors have similar preferences for work. However, this assumption has not been validated in the literature. The relationship between a nurse's propensity to exit the nurse profession in Ontario and employment status was explored by building an extended Cox Proportional Hazards Regression Model using a counting process technique. The differential exit patterns between part-time and casual nurses suggest that the common practice of treating part-time and casual nurses as equivalent is misleading. Health care decision makers should consider nurse retention strategies specifically targeting casual nurses because this segment of the profession is at the greatest risk of leaving. Nurse executives and nurse managers should investigate the different work preferences of part-time and casual nurses to devise tailored rather than "one-size fits all" nurse retention strategies to retain casual nurses.     

Ecological Goals and Wetland Preservation Choice

Canada's multilayered wetland policies promote the preservation of “significant” wetlands, but the criteria for identifying these wetlands are not clearly defined partially because wetlands are a source of multiple ecological outputs, such as abating sediment and providing wildlife habitat. This study adapts a GIS-based, hydrologic, and economic model to examine the trade-offs between agricultural interests and ecological benefits in the Eramosa Watershed, located in southwestern Ontario, Canada. While preserving a wetland enhances both water quality and wildlife habitat goals, and the costs of preservation increase at an increasing rate as expected, the ranking of wetlands, and so the choice of “significant” wetlands, varies considerably depending upon the wetland benefit chosen as the policy goal. The trade-off between wetland benefits and drainage is diminished if there is an alternative means to abate sediment. Since conservation tillage is a lower cost means of improving water quality than wetland preservation, its inclusion can achieve comparable environmental benefits at decreased agricultural cost. La politique canadienne multicouche sur les zones humides préconise la préservation des zones humides «d'importance», mais les critères d'identification de ces zones ne sont pas clairement définis, en partie parce que les zones humides offrent une foule d'avantages écologiques tels que la réduction des sédiments et la constitution d'habitats fauniques. Dans la présente étude, nous avons adapté un modèle économique et hydrologique fondé sur un système d'information géographique (SIG) pour analyser les compromis entre les intérêts agricoles et les avantages écologiques dans le bassin hydrographique de la rivière Eramosa, situé dans le sud-ouest de la province d'Ontario, au Canada. Bien que la préservation des zones humides améliore la qualité de l'eau et les habitats fauniques, et que les coûts liés à la préservation ne cessent d'augmenter, le classement des zones humides et, par conséquent, le choix des zones humides «d'importance» varient considérablement en fonction de l'avantage retenu comme objectif politique. Le compromis entre les avantages des zones humides et le drainage est diminué s'il existe une solution de rechange pour réduire les sédiments. Étant donné que, pour améliorer la qualité de l'eau, le travail de conservation du sol est un moyen plus économique que la préservation des zones humides, il peut permettre d'obtenir des avantages environnementaux comparables à des coûts agricoles moins élevés.