Measuring health expenditures and outcomes in saarc region: health is a luxury?

The objective of the study is to investigate the link between health care expenditures (HCE), economic growth and health outcomes (i.e., life expectancy (LE), infant mortality and the share of elderly people) for a panel of South Asian Association for Regional Cooperation (SAARC) countries; namely, Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka; over the period of 1995–2010. The developed panel cointegration technique is employed for analysis of short and long-run relationship between the variables. The results of panel cointegration found that there is a long-run relationship between health expenditures, economic growth and health outcomes in SAARC region. The estimated results indicate that both, LE and share of elderly people in population have a negative relationship related to the HCEs which signifies that HCEs are luxury goods in SAARC countries. The burden of aging population can be lowered by provision of quality health services and utilization of their experience and knowledge in dynamics of economic development forecasting. Furthermore, there is no significant relationship found between infant mortality rate (IMR) and HCEs which implies that HCEs do not provide sufficient benefits to reduce infant mortality. Similarly, HCEs are not enough in generating GDP, lowering IMR and increasing LE in SAARC region. The implementation of appropriate tax reform, stable food prices and trade promotion for low transaction cost medical equipment is required for the SAARC region.     

Globalization and female labor force participation: The role of trading partners

This paper uses industrial level data from 21 developing and emerging economies over the period of 1995–2013, to analyze the impact of globalization, in particular, trade orientation of industries onto female employment share. The fractional probit estimation reveals that taking cumulative measures of export and import share often camouflages the impact of trade on female employment. The disintegration of export and import share according to their trading partners reveals that exports and imports from the developed world alone contribute to higher female employment. Moreover, it is the low-tech exports to developed countries and high-tech imports from developed countries which results in an increase in female employment. These findings call for the strengthening of trade ties with the developed world, especially when it comes to promoting low-tech exports and high-tech imports. Our results also reveal that the trading links with the developed world can further enhance female employment if developing country possesses a greater pool of educated female labor force.     

Foreign direct investment and its impact on real wages: evidence from Turkish micro-level data

This paper analyzes the role of foreign direct investment (FDI) on wages, using Turkish firm-level data from 2003 to 2010, a period which coincides with significant FDI inflows both in manufacturing and service sector firms in the region. We explore the possibility of increased foreign presence translating into shifts in either labor demand or supply curves thereby resulting in changing the total wage bill or wage per worker in the host country. To empirically test this relationship we employ a dynamic specification of the wage equation. After addressing endogeneity concerns, the results reveal that foreign presence measured in terms of intra- and inter-sectoral linkages is related to higher wage bills in the host economy, hence strengthening the argument for attracting greater foreign investment to enhance labor welfare.     

Death from drowning: defining a new challenge for child survival in Bangladesh

The study focuses on children less than 5 years old and explores the epidemiological profile and correlates of drowning as a challenge to child survival in Bangladesh. Two data sources from Bangladesh, a cohort of 8,070 children followed for 2 years in a rural area and a nation-wide survey conducted in 1996–97 have been used. In addition, a systematic review of the literature has been conducted spanning the past two decades for analysis of drowning in children. Seventy drowning deaths were reported in the cohort and 726 deaths were reported in the national survey. Verbal autopsy and semi-structured interviews were conducted on all deaths. Drowning accounted for 43% of deaths in the cohort and 20% of deaths in 1–4-year-old children in the national survey. Most drowning deaths were in 12–23 month old children from falling into ditches and ponds. Communities provided valuable insights on possible interventions to reduce deaths due to drowning. Drowning is a newly recognized challenge for Bangladesh. Considerable research and programmatic work is required to understand the nature of the problem and develop appropriate interventions. This paper calls on aid agencies to create opportunities for drowning research and action in their work plans for the country.     

Globalization and technology adoption: evidence from emerging economies

This paper examines the role of globalization in the creation and dissemination of technology across firms operating in 30 emerging and developing economies. Firm-level data from four rounds of Business Environment and Enterprise Performance Surveys from 2002 to 2014 is pooled to assess whether international exposure translates into greater propensity for firms to innovate. The viability of different channels of international technology transmission, i.e. exporting and importing activities, foreign licensing agreements and foreign direct investment are studied to analyze whether they indeed succeed in delivering the push to the firms operating in developing countries to innovate and as a result push them closer to the world's technology frontier. The empirical results endorse the view that exporting and importing activities and foreign licensing agreements are important channels for technology transfer. This study also acknowledges country, sector and firm specific characteristics and their differential capacity to benefit from foreign exposure.     

Absorptive Capacity and FDI Spillovers: Evidence from Quantile Regressions

Using Turkish firm-level data for the period 2003–2010, we look at the relationship between foreign direct investment, absorptive capacity, and spillovers at a disaggregated level, and analyze whether firms operating in different quantiles of the productivity distribution respond differently to foreign presence and changes in absorptive capacity. The results reveal that, for a given level of foreign presence, it pays to increase the absorptive capacity of firms operating in lower quantiles. When it comes to inter-industry spillovers, it is counterproductive to increase the absorptive capacity of firms already operating in higher quantiles, as this diverts resources from other productive activities.     

Contract farmer and poultry farm efficiency in Bangladesh: a data envelopment analysis

The objective of this article is to determine the efficiency of the poultry farm in Bangladesh and to assess the influence of contract farming system, using a data envelopment analysis. Seventy-five commercial poultry farms (25 and 50 independent and contract farms, respectively) were randomly selected. The results reveal that efficiency scores vary across sample farms. To explain some of these variations, the efficiency scores were regressed on some human capital variables and farming system using a Tobit model. The study also estimates elasticities to provide the information on the magnitude of the influence of variables on Technical Efficiency (TE), Allocative Efficiency (AE) and Economic Efficiency (EE). The results show that the contracting system is positively and significantly related to the farm's TE, AE and EE. This is expected because under contractual agreement, in order to obtain sufficient supplies of the right quality of poultry meat at the right time, the company provides technical know how assistance through company's recruited supervisor, production inputs and services, and production credit along with intensive supervision, which in turn improves farm efficiency. Thus, by receiving technical know how contract farmers have gained more knowledge on their resource and practices, which enables them to use resources more efficiently. Empirical results can provide crucial information to policy makers that improve poultry farm efficiency.     

Cohort versus patient level simulation for the economic evaluation of single versus combination immuno-oncology therapies in metastatic melanoma

Abstract

Background: Model structure, despite being a key source of uncertainty in economic evaluations, is often not treated as a priority for model development. In oncology, partitioned survival models (PSMs) and Markov models, both types of cohort model, are commonly used, but patient responses to newer immuno-oncology (I-O) agents suggest that more innovative model frameworks should be explored.

Objective: A discussion of the theoretical pros and cons of cohort level vs patient level simulation (PLS) models provides the background for an illustrative comparison of I-O therapies, namely nivolumab/ipilimumab combination and ipilimumab alone using patient level data from the CheckMate 067 trial in metastatic melanoma. PSM, Markov, and PLS models were compared on the basis of coherence with short-term clinical trial endpoints and long-term cost per QALY outcomes reported.

Methods: The PSM was based on Kaplan-Meier curves from CheckMate 067 with 3-year data on progression free survival (PFS) and overall survival (OS). The Markov model used time independent transition probabilities based on the average trajectory of PFS and OS over the trial period. The PLS model was developed based on baseline characteristics hypothesized to be associated with disease as well as significant mortality and disease progression risk factors identified through a proportional hazards model.

Results: The short-term Markov model outputs matched the 1–3?year clinical trial results approximately as well as the PSMs for OS but not PFS. The fixed (average) cohort PLS results corresponded as well as the PSMs for OS in the combination therapy arm and PFS in the monotherapy arm. Over the lifetime horizon, the PLS produced an additional 5.95 quality adjusted life years (QALYs) associated with combination therapy relative to ipilimumab alone, resulting in an incremental cost-effectiveness ratio (ICER) of £6,474 per QALY, compared with £14,194 for the PSMs which gave an incremental benefit of between 2.2 and 2.4 QALYs. The Markov model was an outlier (～ £49,000 per QALY in the base case).

Conclusions: The 4- and 5-state versions of the PSM cohort model estimated in this study deviate from the standard 3-state approach to better capture I-O response patterns. Markov and PLS approaches, by modeling state transitions explicitly, could be more informative in understanding I-O immune response, the PLS particularly so by reflecting heterogeneity in treatment response. However, both require a number of assumptions to capture the immune response effectively. Better I-O representation with surrogate endpoints in future clinical trials could yield greater model validity across all models.