Drug Prices After Patent Expirations in High-Income Countries and Implications for Cost-Effectiveness Analyses.

Importance: Understanding how patent expirations affect drug prices is crucial because price changes directly inform accurate cost-effectiveness assessments. This study investigates the association between patent expirations and drug prices in 8 high-income countries and evaluates how the changes affect cost-effectiveness assessments. Objective: To analyze how the expiration of drug patents is associated with drug price changes and to assess the implications of these price changes for cost-effectiveness evaluations. Design, Setting, and Participants: This cohort study performed an event study design using data from 8 high-income countries to assess the association between patent expiration and drug prices, and created a simulation model to understand the implications for cost-effectiveness analyses. The simulation cost-effectiveness model analyzed the implications of including or ignoring postpatent price dynamics. Exposure: Drug patent expiration. Main Outcomes and Measures: Change in drug prices and differences in incremental cost-effectiveness ratios when considering vs ignoring postpatent price dynamics. Results: The sample comprised 505 drugs undergoing patent expiration in Australia, Canada, France, Germany, Japan, Switzerland, UK, and US. Price decreases were statistically significant over the 8 years after patent expiration, with the fastest price declines observed in the US: 32% (95% CI, 24%-39%) in year 1 after patent expiration and 82% (95% CI, 71%-89%) in the 8 years after patent expiration. Estimates for other nations ranged from a decrease of 64% in Australia to 18% in Switzerland in the 8 years after expiration. The cost-effectiveness simulation model indicated that not accounting for generic entry into the market may produce biased incremental cost-effectiveness ratios of 40% to -40%, depending on the scenario. Conclusions and Relevance: The findings of this cohort study demonstrate that drug prices were reduced substantially after patent expirations in high-income countries. Therefore, incorporating information on patent status and pricing dynamics in cost-effectiveness assessment analyses is necessary for producing accurate economic evaluations of new drugs.

Analysis of factors related to the morphological evolution of Lingnan export mugs in the 18th-20th centuries in the context of one belt and one road.

As a significant trade item on the ancient Silk Road, the evolution of mug shapes represents a confluence of Eastern and Western economic history and cultural-artistic exchanges, also reflecting the flourishing export culture of Guangzhou. This paper analyzes the functional and social factors influencing the morphological changes of Lingnan mugs from 1616 to 1949 from the perspective of quantitative typological analysis. The overall design trend of these mugs transitioned from complex to simple, enhancing user comfort, while variations in mug scale reflect the diversity of consumer classes and regional drinking cultures. Among the 30 mugs analyzed, the average capacity was 356ml, with a range of 1588ml. Common shapes included cylindrical bodies and ear-shaped handles. Morphologically, the belly of the mugs transformed from arc-barrel bodies (emphasizing heat retention) to bulbous bodies, and eventually to cylindrical bodies (combining heat retention, practicality, and economy), with handles also showing signs of East-West integration. The analysis of the mug body' s inclination, with handle-side junction angles ranging from 34° to 53° and wall-side junction angles from 50° to 90°, indicates that these features are associated with stability in placement, aesthetic design, and practicality in liquid containment. These morphological evolutions reflect genuine responses to market demands and advancements in production technology, manifesting as products of market orientation and societal needs. By measuring changes in morphology, scale, volume, and external contour curves, this paper addresses how social factors shape material morphology in an academic context.

Climate effects on the diversification strategy of export firms: Evidence from China.

Using a multi-product trade model, this study investigates the impact of temperature on firms' diversification in the export market. Using export and meteorological data of Chinese firms from 2000 to 2016, the empirical results confirm an inverted U-shaped relationship, implying that extreme temperatures significantly reduce firms' export product diversification. The analysis shows that extreme temperatures primarily reduce the variety of both new and existing products, with a less robust effect on product exit strategies. General trade firms are more adaptable to extreme temperatures than processing trade firms, and are likely to maintain diversified strategies. Stronger regional financial markets and higher energy consumption increase the adaptability of local firms to extreme temperatures. Firms have not yet adapted to local climatic norms. Furthermore, extreme temperatures also partly inhibit diversification of export destinations and relationships. The results of the study show that as climate change intensifies, leading to more frequent extreme temperatures, firms will face significant hurdles in pursuing diversified development strategies, pointing to increasing challenges ahead.

Does the establishment of Pilot Free Trade Zones promote international expansion of enterprises? Quasi-natural experimental evidence from China.

Pilot Free Trade Zones (PFTZs) are a crucial new platform for China to build a more open economic system. Existing literature primarily focuses on the 'Bring In' effect of PFTZs, often overlooking the importance of 'Going Out' aspects. To bridge this gap, this paper uses data from China's Shanghai and Shenzhen A-share listed enterprises from 2007 to 2021 and constructs a time-varying difference-in-differences (DID) model to test the impact of establishment of PFTZs on international expansion of enterprises. The study finds that establishment of PFTZs can significantly promote international expansion of enterprises, with a more pronounced effect on the scope of international expansion than on its depth. Mechanism analysis reveals that PFTZs can facilitate international expansion of enterprises by driving digital transformation, enhancing total factor productivity and management efficiency, and alleviating financing constraints. Notably, senior managers with overseas work experience play a crucial role in enhancing this relationship. Further, PFTZs not only have a linkage effect with the Belt and Road Initiative but also a radiation effect on neighboring cities. This study provides an analytical perspective and empirical evidence for evaluating policy effects of PFTZs and offers valuable insights that will enable PFTZ policies to be refined and facilitate successful implementation of the 'Going Out' strategy.

Insights from the COVID-19 perspective on the necessity of corporate social responsibility in times of crisis in the context of Pakistan.

In light of the COVID-19 pandemic, there has been a notable increase in global awareness among businesses and consumers regarding environmental preservation and health concerns. The degree to which individuals identify with an organization is influenced by the appeal of its organizational identity, which aids in fulfilling important self-definitional needs. Nevertheless, there remains a limited understanding regarding the underlying factors that contribute to the phenomenon of firm identity attraction (IA) within the framework of consumer-business interactions. This study presents a validated framework that examines the antecedents of identity attraction, with COVID-19 being considered as a moderator. The framework is developed based on established theories of social identity and organizational identification. The study in Pakistan's cities utilized a questionnaire survey as its primary research method, while the findings were evaluated through the application of structural equation modelling. The results of our study indicate that the impact of corporate social responsibility (CSR) on firm Identity Attraction (IA) is significantly more pronounced. Although the impact of COVID-19 on the intention to purchase remains unaffected, it does play a favorable role in moderating the influence of CSR on the attraction towards brand.

The impact of common language on international trade: Evidence from Korean language.

This study investigates the impact of a minority language on international trade. Using the distance to Hunchun as an instrumental variable, and transaction-level customs data from 2000 to 2015, we investigate the causal impact of common Korean language on international trade between Chinese counties and South/North Korea. The results suggest that a 1% increase in the proportion of population speaking Korean will increase value share and transactions share in trade by 1.8% and 2.3%, respectively. These effects are more pronounced in trade with North Korea and in higher trade share regions. Furthermore, we show that the common Korean language exerts its influence through reducing communication barrier. The impact is mainly observed at the extensive margin rather than the intensive margin. These findings highlight the potential of leveraging minority languages to boost bilateral trade in developing countries.

Scaling training facilities for patent and proprietary medicine vendors in Nigeria: insights and lessons learned for policy implication and future partnerships.

Patent and proprietary medicine vendors in Nigeria play a very integral role in providing primary health care services and are an important source of care for the poor. They are located close to communities and are often the first source of care for hygiene and family planning (FP) products and treatment of child illnesses. Since 2017, Pharmacy Council of Nigeria (PCN) has partnered with Society for Family Health through the IntegratE project to address the poor quality of services by patent and proprietary medicine vendors (PPMVs) and reposition them for better service delivery through piloting the three-tier accreditation system. The partnership has engendered innovation for human resource for health, and considering the peculiarity of their situation, new emerging methods and arrangements to deliver the training to PPMVs in diverse geographical locations within their catchment areas are developed. In this study, we aimed to discuss the role of patent and proprietary medicine vendors in the provision of quality health delivery and provide key lessons and recommendations which have been learned from the pilot scaling of training facilities for PPMVs in Nigeria through the IntegratE project. From the lessons learnt, we propose that, for a successful scale-up of implementation of the three-tier accreditation of PPMVs, PCN will have to establish a budget line for accreditation. In addition, the government should also consider supporting this training through the Basic Healthcare Provision Fund as a way of strengthening human resources at the primary healthcare level. Other alternative sources of funding include licensing and registration fees and other dues generated internally by PCN.

It's not who you know, but who you are: Explaining income gaps of stigmatized-caste business owners in India.

Scholars across disciplines and around the world have diverted research attention to rising income inequalities across groups and strategies to reduce them. The literature has broadly identified human capital and social capital as two potential tools to facilitate economic mobility and to reduce inequalities. However, it is not known whether these tools work equally well for stigmatized groups, particularly in societies with systemic inequalities. Analyzing data from a pan-India survey, we show that business owners from stigmatized groups (i.e., Dalits in India, who are stigmatized as untouchables) experience a business income gap of around 16% compared to others, including those business owners who are from communities that are disadvantaged but are not similarly stigmatized. We find that, instead of being reduced, this gap in fact increases at higher levels of social capital, especially bridging social capital, illustrating the social processes of stigmatization that limit the benefits that Dalits can reap from social capital. By contrast, Dalits can reap similar income benefits as others from human capital. Our results show that human capital helps stigmatized groups mitigate the implications of stigma, but social capital does not.

A Systems Innovation Perspective on Implementation and Sustainment Barriers for Healthy Food Store Interventions: A Reflexive Monitoring in Action Study in Dutch Supermarkets.

BACKGROUND: Healthy food store interventions (HFIs) are an important health-promotion tool, but face implementation and sustainment barriers. This paper aims to explore the underlying factors that produce these barriers using an innovative systems innovation perspective, through the case study of a multi-component HFI. The HFI was implemented in a minor, national, cooperative supermarket chain, in the Netherlands, a competitive market where price-based competition is the norm. METHODS: The HFI was implemented for 6-12 months, in six stores. It was implemented by the researchers, and maintained by store employees. The study applied a Reflexive Monitoring in Action (RMA) approach, meaning that the researchers monitored stores' adherence to the HFI, via store visits, to identify potential issues. Subsequently, the researchers interviewed the store managers responsible for the intervention, to have them reflect upon the barriers leading to these adherence issues, underlying systemic factors, and potential solutions. The stores implemented these solutions, and during the next monitoring visit the researchers evaluated whether the barrier had been resolved. RESULTS: We found that the HFI often clashed with regular activities of the stores (eg, competing over the same spaces) and that store managers generally prioritized these regular activities. This prioritization was based on the greater commercial value of those regular activities (eg, selling unhealthy products) according to store managers, based on their beliefs and assumptions about commerce, health, and consumer preferences. Due to the limited resources of supermarkets (eg, people, time, space), and the HFI often not fitting within the existing structures of the stores as easily as traditional practices, store managers often neglected the HFI components in favor of regular store activities. CONCLUSION: Our findings illustrate the systemic factors that produce implementation barriers for HFIs, and the dynamics by which this production occurs. These insights help future researchers to anticipate and respond to such barriers.

Differential games in the supply chain of innovative products with consumer purchase regret induced returns.

Innovative products entering the market will cause dynamic changes in market demand, and consumers' purchase regret and their return behavior make the market environment more and more complex, which in turn affects the dynamic decision-making in the supply chain. In this paper, under the situation of discrete decision time, combining with the objective reality, we make discrete modification to the classical Bass diffusion model (Bass model), construct a manufacturer-led, retailer-followed supply chain differential game model, analyze the optimal decision-making of the manufacturer and the retailer by combining with the theory of discrete optimal control, and then verify the conclusions by numerical simulation. The results show that: when retailers purchase directly from the manufacturer and sell in the market, the optimal pricing of the innovative product can make the supply chain as a whole, realizing Pareto optimality; consumer's purchase regret will increase the amount of returns, which will lead to the decrease of product sales and the profits of the manufacturer and the retailer; when the innovative product accounts for a different share of the market, the impact of purchase regret on the wholesale price and the retail price are also different. Therefore, manufacturers need to have an extensive comprehension of the market to minimize the negative effects of consumer regret and returns, and to formulate a reasonable pricing strategy for their products to gain as much profit as possible.

Work to inform the Competition and Markets Authority investigation continues.

As the Competition and Markets Authority investigation into veterinary services for household pets presses ahead at pace, we continue to champion your interests and promote the value of veterinary care.

Road map from dirty growth to sustainable green growth in Turkiye: Management of trade and financial processes?

This study examines how business, financial, monetary, and trade freedom influence Turkiye's green growth from 1995 to 2022, utilizing the ARDL approach to cointegration. Our results confirm the long-term cointegration among the variables. Robustness tests, such as Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS), consistently show that business and trade freedom hinder Turkiye's green growth. Financial freedom and monetary freedom consistently foster it. Business freedom and heightened trade freedom lead to increased fossil fuel consumption, whereas monetary freedom stabilizes Turkiye's currency, and financial freedom promotes entrepreneurship. Enhancing eco-friendly energy sources and investing in green technologies are crucial for promoting sustainable growth, reducing production costs, fostering entrepreneurship, and encouraging competition. The fact that the impact of these variables on green growth in Turkiye has not been studied before makes the study's findings novel.

Trade networks and corporate ESG performance: Evidence from Chinese resource-based enterprises.

Trade network connects enterprises together, while its impact on corporate ESG performance is unknown. Drawing on unbalanced panel data of resource-based enterprises in China from 2009 to 2021, this study decomposes the trade network into purchasing network and sales network based on trade directions, and explores their impact on corporate ESG performance and the mechanisms involved. The findings indicate that: (1) The trade networks exhibit a negative correlation with corporate ESG performance. Meanwhile, purchasing network demonstrates a more pronounced adverse impact on corporate ESG than sales network. After a series of endogeneity tests, the above results still hold. (2) Heterogeneity analysis shows that trade networks have a more significant effect on the ESG performance of state-owned enterprises, mature enterprises and heavily polluting enterprises. And the most pronounced negative effect is observed in the governance (G) component of ESG. (3) Mechanism analysis reveals that trade networks negatively influence corporate ESG performance by impeding the progress of green innovation and internal control. (4) Accelerating digital transformation and intensifying government environmental regulations can mitigate the inhibitory impact of trade networks on corporate ESG performance. This study provides theoretical support and empirical evidence for resource-based enterprises to enhance ESG performance while reinforcing trade linkages.

The impact of digital financial development on corporate leverage ratio: The case of a-share listed non-financial enterprises in China's Shanghai and Shenzhen stock exchanges.

This study investigates the impact of digital finance on corporate leverage ratios. The study employed a large sample of China's Shanghai and Shenzhen A-share non-financial listed enterprises from 2011-2020. The study's results depict that the development of digital finance can significantly reduce the leverage ratio of enterprises. We empirically identified that digital finance affects the difference in the term structure of the corporate leverage ratio. It was found that the development of digital finance has a significant negative impact on enterprises' short-term and long-term leverage ratios. Moreover, our heterogeneity analysis shows that the negative effect of digital financial development on corporate leverage ratios is different in state-owned and non-state-owned enterprises, large-scale and small-scale enterprises, and high-leverage and low-leverage enterprises. Mechanism analysis shows that the development of digital finance can reduce corporate leverage by lowering financing costs, alleviating financing constraints, and weakening non-systemic risks. Therefore, policymakers should focus on developing and adopting digital finance by creating a supportive regulatory environment, improving access to digital financial services, and encouraging innovation in the digital finance sector. Finally, our results remain robust after addressing endogeneity issues and conducting robustness checks.

Food Environment After Implementation of a Healthy Checkout Policy.

Importance: In March 2021, Berkeley, California, became the world's first jurisdiction to implement a healthy checkout policy, which sets nutrition standards for foods and beverages in store checkouts. This healthy checkout ordinance (HCO) has the potential to improve customers' dietary intake if stores comply by increasing the healthfulness of foods and beverages at checkouts. Objectives: To compare the percentage of checkout products that were HCO compliant and that fell into healthy and unhealthy food and beverage categories before and 1 year after HCO implementation in Berkeley relative to comparison cities. Design, Setting, and Participants: In this cohort study in which Berkeley implemented an HCO and other cities did not, a difference-in-differences analysis was conducted of 76 258 product facings at checkouts of 23 stores in Berkeley and 75 stores in 3 comparison cities in California. Data were collected in February 2021 (approximately 1 month before implementation of the HCO) and 1 year later in February 2022 and analyzed from October 2023 to May 2024. Exposure: The HCO, which permits only the following products at checkouts in large food stores: nonfood and nonbeverage products, unsweetened beverages, and foods with 5 g or less of added sugars per serving and 200 mg or less of sodium per serving in the following categories: sugar-free gum and mints, fruit, vegetables, nuts, seeds, legumes, yogurt or cheese, and whole grains. Main Outcomes and Measures: A product facing's (1) HCO compliance and (2) category, including healthy compliant categories and unhealthy noncompliant categories, determined using a validated photograph-based tool to assess product characteristics. Results: Of the 76 258 product facings at store checkouts, the percentage that were HCO compliant increased from 53% (4438 of 8425) to 83% (5966 of 7220) in Berkeley, a 63% increase relative to comparison cities (probability ratio [PR], 1.63; 95% CI, 1.41-1.87). The percentage of food and beverage checkout facings that were HCO compliant increased in Berkeley from 29% (1652 of 5639) to 62% (2007 of 3261), a 125% increase relative to comparison cities (PR, 2.25; 95% CI, 1.80-2.82). The percentage of Berkeley food and beverage facings consisting of candy, sugar-sweetened beverages, and other sweets significantly decreased (candy: from 30% [1687 of 5639] to 6% [197 of 3261]; PR, 0.21; 95% CI, 0.10-0.42; sugar-sweetened beverages: from 11% [596 of 5639] to 5% [157 of 3261]; PR, 0.41; 95% CI, 0.23-0.75; other sweets: from 7% [413 of 5639] to 3% [101 of 3261]; PR, 0.37; 95% CI, 0.15-0.88), while the percentage consisting of unsweetened beverages (from 4% [226 of 5639] to 19% [604 of 3261]; PR, 4.76; 95% CI, 2.54-8.91) and healthy foods (from 6% [350 of 5639] to 20% [663 of 3261]; PR, 2.90; 95% CI, 1.79-4.72) significantly increased. Conclusions and Relevance: This cohort study of the first healthy checkout policy found substantial improvements in the healthfulness of food environments at checkouts 1 year after implementation of the policy. These results suggest that healthy checkout policies have the potential to improve the healthfulness of store checkouts.

Dilemma of commercial organ transplant in the Middle East.

In recent years, the Middle East has witnessed a significant rise in commercial transplantation activities. This practice is driven by a multitude of factors including economic disparities, inadequate healthcare infrastructure, and cultural attitudes towards organ donation. In this article, we try to explore the complex landscape of commercial transplantation within the Middle East, shedding light on the ethical, legal, and socio-economic dimensions of this contentious issue.

Complex Interventions for a Complex System? Using Systems Thinking to Explore Ways to Address Unhealthy Commodity Industry Influence on Public Health Policy.

BACKGROUND: Interventions are needed to prevent and mitigate unhealthy commodity industry (UCI) influence on public health policy. Whilst literature on interventions is emerging, current conceptualisations remain incomplete as they lack considerations of the wider systemic complexities surrounding UCI influence, which may limit intervention effectiveness. This study applies systems thinking as a theoretical lens to help identify and explore how possible interventions relate to one another in the systems in which they are embedded. Related challenges to addressing UCI influence on policy, and actions to support interventions, were also explored. METHODS: Online participatory workshops were conducted with stakeholders with expertise in UCIs. A systems map, depicting five pathways to UCI influence, and the Action Scales Model were used to help participants identify interventions and guide discussions. Codebook thematic analysis was used to analyse the data. RESULTS: Fifty-two stakeholders participated in 23 workshops. Participants identified 27 diverse, interconnected and interdependent interventions corresponding to the systems map's pathways that reduce the ability of UCIs to influence policy. These include, for example, reform policy financing; regulate public-private partnerships (PPPs); reform science governance and funding; frame and reframe the narrative, challenge neoliberalism and gross domestic product (GDP) growth; leverage human rights; change practices on multistakeholder governance; and reform policy consultation and deliberation processes. Participants also identified four potential key challenges to interventions (ie, difficult to implement or achieve; partially formulated; exploited or misused; requires tailoring for context), and four key actions to help support intervention delivery (ie, coordinate and cooperate with stakeholders; invest in civil society; create a social movement; nurture leadership). CONCLUSION: A systems thinking lens revealed the theoretical interdependence between disparate and heterogenous interventions. This suggests that to be effective, interventions need to align, work collectively, and be applied synchronously to different parts of the system, including multiple levels of governance. Importantly, these interventions need to be supported by intermediary actions to be achieved. Urgent action is now required to strengthen healthy alliances and implement interventions.

Limiting heterogeneity in cross-border data flow: Impact on domestic value chains stability and the role of innovation.

Amidst growing skepticism towards globalization and rising digital trade, this study investigates the impact of Restrictions on Cross-Border Data Flows (RCDF) on Domestic Value Chains (DVCs) stability. As global value chains participation declines, the stability of DVCs-integral to internal economic dynamics-becomes crucial. This study situates within a framework exploring the role of innovation and RCDF in the increasingly interconnected global trade. Using a panel data fixed effect model, our analysis provides insights into the varying effects of RCDF on DVCs stability across countries with diverse economic structures and technological advancement levels. This approach allows for a nuanced understanding of the interplay between digital trade policies, value chain stability, and innovation. RCDF tend to disrupt DVCs by negatively impacting innovation, which necessitates proactive policy measures to mitigate these effects. In contrast, low-income countries experience a less detrimental impact; RCDF may even aid in integrating their DVCs into Global Value Chains, enhancing economic stability. It underscores the need for dynamic, adaptable policies and global collaboration to harmonize digital trade standards, thus offering guidance for policy-making in the context of an interconnected global economy.

Interregional circulation of credit resources and company innovation.

Although the impact of interest rates, repayment periods, and loan scales on loan consequences has been extensively studied, little attention has been paid to the geographical distance involved in loan transactions. This study collects the addresses of borrowing companies, listed companies, and banks. Nonlocal loans can be distinguished because the regional segmentations in the lending industry reflect the features of provincial boundaries. Using data from Chinese A-share listed companies from 2007 to 2022, this research explores the causes of nonlocal loans and their impact on company innovation. Nonlocal loans are found to address the lack of local credit resources rather than financial constraints, supplementing disposable capital. This interregional circulation of credit resources facilitates innovation, particularly in financially undeveloped areas. This study does not detect research and development manipulation and recognizes the increase in innovation output. The findings have implications for credit resource allocation and balanced regional development.