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1.
Value Health ; 24(3): 317-324, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641764

RESUMO

OBJECTIVES: To investigate the impact of public health insurance coverage, specifically the New Cooperative Medical Scheme (NCMS), on childhood nutrition in poor rural households in China, and to identify the mechanisms through which health insurance coverage affects nutritional intake. METHODS: Longitudinal data on 3291 children were taken from four time periods (2004, 2006, 2009, and 2011) from the China Health and Nutrition Survey (CHNS). Panel data analysis was performed with the fixed-effect model and the propensity score matching with difference-in-differences (PSM-DID) approach. RESULTS: The introduction of the NCMS was associated with a decline in calories, fat, and protein intake, and an increase in the intake of carbohydrates. The NCMS had the greatest negative effect on children aged 0 to 5 years, particularly girls. Out-of-pocket medical expenses were identified as the main channel through which the NCMS affected the nutritional intake of children. CONCLUSIONS: The study showed that the NCMS neither significantly improved the nutritional status of children nor enhanced intake of high-quality nutrients among rural poor households. These findings were attributed to the way in which health-seeking behavior was modified in the light of NCMS coverage. Specifically, NCMS coverage tended to increase healthcare utilization, which in turn increased out-of-pocket medical expenditures. This encouraged savings to aid financial risk protection and resulted in less disposable income for food consumption.


Assuntos
Ingestão de Energia/fisiologia , Financiamento Pessoal/estatística & dados numéricos , Estado Nutricional/fisiologia , População Rural/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , China , Dieta , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Modelos Econométricos , Inquéritos Nutricionais , Pontuação de Propensão , Saúde Pública , Fatores Sexuais
2.
Value Health ; 24(3): 336-343, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641766

RESUMO

OBJECTIVES: To model the potential impact on obesity of removing butter, cheese, and sugar subsidies in the Canary Islands. METHODS: A simulation model was applied based on a local data set of subsidies and retail prices (2007-2016), data on own-price elasticity estimates, and representative nutritional and health surveys. We estimated marginal obesity prevalence and population attributable fraction to assess the potential impact of the butter, cheese, and sugar subsidies intervention. RESULTS: The intervention was predicted to avoid 10 363 obese adults over the study period, because of the reduction of the obesity prevalence by -0.7 percentage points. Overall, the predicted effect was largest in elderly and male groups, although females with a low socioeconomic status experienced the greatest decrease in the prevalence. The population attributable fraction predicted that 4.0% of population with obesity were attributable to the existence of these subsidies. CONCLUSIONS: This analysis provides policy makers with the predicted impact on obesity of the butter, cheese, and sugar subsidies disposal, enabling them to incorporate this health impact into decision making across policy areas in the economic and health field. This study aims to model the potential impact on obesity of removing industrial subsidies for butter, cheese and sugar in the Canary Islands.


Assuntos
Assistência Alimentar/estatística & dados numéricos , Alimentos/economia , Obesidade/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Manteiga/economia , Queijo/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Políticas , Fatores Sexuais , Fatores Socioeconômicos , Espanha/epidemiologia , Açúcares/economia , Adulto Jovem
3.
Value Health ; 24(3): 377-387, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641772

RESUMO

OBJECTIVES: To evaluate the cost-effectiveness of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (CSCC) from a payer perspective in the United States. METHODS: A partitioned survival model was developed to assess the cost-effectiveness of cemiplimab versus historical standard of care (SOC). All inputs were identified based on a systematic literature review, supplemented by expert opinion where necessary. Clinical inputs for cemiplimab were based on individual patient data from a cemiplimab phase 2 single-arm trial (NCT27060498). For SOC, analysis was based on a pooled analysis of single-arm clinical trials and retrospective studies evaluating chemotherapy and epidermal growth factor receptor inhibitors (cetuximab, erlotinib, and gefitinib) identified via a systematic literature review (6 of the 27 included studies). Overall survival and progression-free survival were extrapolated over a lifetime horizon. Costs were included for drug acquisition, drug administration, management of adverse events, subsequent therapy, disease management, and terminal care. Unit costs were based on published 2019 US list prices. RESULTS: In the base case, cemiplimab versus SOC resulted in an incremental cost-effectiveness ratio of $99 447 per quality adjusted-life year (QALY), where incremental costs and QALYs were $372 108 and 3.74, respectively. At a willingness-to-pay threshold of $150 000/QALY, the probabilistic sensitivity analysis suggests a 90% probability that cemiplimab is cost-effective compared to SOC. Scenario analyses resulted in incremental cost-effectiveness ratios ranging from $90 590 to $148 738. CONCLUSIONS: Compared with historical SOC, cemiplimab is a cost-effective use of US payer resources for the treatment of advanced CSCC and is expected to provide value for money.


Assuntos
Anticorpos Monoclonais Humanizados/economia , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/economia , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Análise Custo-Benefício , Gastos em Saúde , Humanos , Modelos Econométricos , Anos de Vida Ajustados por Qualidade de Vida , Análise de Sobrevida , Estados Unidos
4.
Front Public Health ; 9: 620875, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33614586

RESUMO

The purpose of this paper is to discuss death cases on the World, exacerbated investor fears, uncertainties, and increased volatility of crude oil prices in financial markets. The reaction absorbed the epidemic gradually until January 22. Still, the market situation changed soon with a sharp drop in prices, and prices slowly recovered after that until June 14. The data of this research using an econometric model, the ARDL (Autoregressive Distributed Lag), according to the Gets methodology, using daily data, January 22 -June 14, 2020. Our ARDL shows, the death ratio has a significant negative effect on oil price dynamics. However, the death ratio has an indirect impact on volatility in Crude Oil prices. The findings show that the death toll of COVID-19 has a significant impact on oil prices in Saudi Arabia (KSA). However, the preliminary results mainly influence by the situation reported in the USA. When we assess the case outside the USA, and we see the positive effect of the COVID-19 death figures on oil prices, therefore, stress the amplification of death-related risks to the financial market and the real economy, caused by increased, policy-induced economic uncertainty in the United States.


Assuntos
/economia , Modelos Econométricos , Petróleo/economia , /epidemiologia , Humanos , Arábia Saudita , Incerteza
6.
Front Public Health ; 8: 615344, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330348

RESUMO

The COVID-19 pandemic has affected various macroeconomic indicators. Given this backdrop, this research investigates the effects of the pandemics-related uncertainty on household consumption. For this purpose, we construct a simple theoretical model to study the effects of the pandemics-related uncertainty on household consumption. To estimate the theoretical model, we consider the panel dataset of 138 countries for the period from 1996 to 2017. We also use the Pandemic Uncertainty Index to measure the pandemics-related uncertainty. The theoretical model and the empirical findings from the Feasible Generalized Least Squares (FGLS) estimations indicate that the gross fixed capital formation, government consumption, balance of trade, and the Pandemic Uncertainty Index negatively affect household consumption. The results are also valid in the panel dataset of 42 high-income economies and the remaining 96 emerging economies.


Assuntos
/economia , Características da Família , Produto Interno Bruto/estatística & dados numéricos , Pandemias/economia , Pandemias/estatística & dados numéricos , Incerteza , Humanos , Modelos Econométricos
7.
PLoS One ; 15(9): e0238683, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936815

RESUMO

We report and interpret preferences of a sample of the Dutch adult population for different strategies to end the so-called 'intelligent lockdown' which their government had put in place in response to the COVID-19 pandemic. Using a discrete choice experiment, we invited participants to make a series of choices between policy scenarios aimed at relaxing the lockdown, which were specified not in terms of their nature (e.g. whether or not to allow schools to re-open) but in terms of their effects along seven dimensions. These included health-related effects, but also impacts on the economy, education, and personal income. From the observed choices, we were able to infer the implicit trade-offs made by the Dutch between these policy effects. For example, we find that the average citizen, in order to avoid one fatality directly or indirectly related to COVID-19, is willing to accept a lasting lag in the educational performance of 18 children, or a lasting (>3 years) and substantial (>15%) reduction in net income of 77 households. We explore heterogeneity across individuals in terms of these trade-offs by means of latent class analysis. Our results suggest that most citizens are willing to trade-off health-related and other effects of the lockdown, implying a consequentialist ethical perspective. Somewhat surprisingly, we find that the elderly, known to be at relatively high risk of being affected by the virus, are relatively reluctant to sacrifice economic pain and educational disadvantages for the younger generation, to avoid fatalities. We also identify a so-called taboo trade-off aversion amongst a substantial share of our sample, being an aversion to accept morally problematic policies that simultaneously imply higher fatality numbers and lower taxes. We explain various ways in which our results can be of value to policy makers in the context of the COVID-19 and future pandemics.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Política de Saúde , Modelos Econométricos , Pandemias , Pneumonia Viral/psicologia , Quarentena/psicologia , Valor da Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Altruísmo , Comportamento de Escolha , Controle de Doenças Transmissíveis/legislação & jurisprudência , Controle de Doenças Transmissíveis/métodos , Comportamento do Consumidor , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Efeitos Psicossociais da Doença , Pesquisa Empírica , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pandemias/economia , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/economia , Quarentena/legislação & jurisprudência , Quarentena/estatística & dados numéricos , Risco , Instituições Acadêmicas , Valores Sociais , Impostos , Adulto Jovem
8.
PLoS One ; 15(9): e0239132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915898

RESUMO

Herding has often been blamed as one of the possible causes of market instabilities, ultimately yielding to bubbles and crushes. On the other hand, researchers hypothesized that financial systems may benefit from the so-called wisdom of the crowd. To solve this apparent dichotomy, we leverage a novel financial market model, where the agents form their expectations by combining their individual return estimation with the expectations of their neighbors. By establishing a link between herding, sociality, and market instabilities, we point out that the emergence of collective decisions in the market is not necessarily detrimental. Indeed, when all the agents tend to conform their expectations to those of one or few leaders, herding might dramatically reduce market efficiency. However, when each agent accounts for a plurality of opinions, thus following the wisdom of the crowd, market dynamics become efficient. Following these observations, we propose two alternative control strategies to reduce market instability and enhance its efficiency.


Assuntos
Tomada de Decisões , Investimentos em Saúde/economia , Modelos Econométricos , Comportamento Social , Humanos
9.
PLoS One ; 15(8): e0237827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813743

RESUMO

It is vast significance to explore the spatial and temporal evolution characteristics and influencing factors of herbivorous animal husbandry industry based on the context of China's agriculture pursuing high-quality development. In this paper, we analyze the spatial and temporal evolution of the layout of China's herbivorous animal husbandry industry and its influencing factors based on the spatial autocorrelation analysis, standard deviation ellipse, and spatial Durbin model with data from 1980 to 2017. The results show that there are significant positive autocorrelation characteristics of "high-high" aggregation and "low-low" aggregation in the Chinese herbivorous animal husbandry industry. To be specific, in the past four decades, the spatial distribution center of China's herbivorous animal husbandry industry has moved towards the northeast, crossing the boundary between agriculture and animal husbandry in China, presenting a clear trend of moving from pastoral area to agricultural area; the gradual narrowing of the spatial distribution range indicates the gradually increased degree of aggregation within the industry; the east-west stretch of spatial distribution has been strengthened, and the azimuth angle shows clockwise change, suggesting that the industrial expansion in the northeast-southwest direction is prominent; the influencing factors of changes in the spatial distribution of the industry reveal that the quantity and production capacity of productive land, people's income and living standards, and the level of mechanization will promote the development of China's herbivorous animal husbandry industry, and are essential factors influencing industrial distribution and transfer, while policy factor has small or even not significant impact on industrial aggregation, reflecting that the policy has not played the expected role, and policy support needs to be further intensified.


Assuntos
Criação de Animais Domésticos , Herbivoria/fisiologia , Indústrias , Análise Espaço-Temporal , Agricultura , Animais , China , Análise Fatorial , Geografia , Modelos Econométricos , Políticas , Análise de Regressão , Análise Espacial , Fatores de Tempo
10.
Environ Sci Pollut Res Int ; 27(35): 43987-43998, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32748355

RESUMO

This study attempts to construct an econometric model using China's natural disaster losses and macro-industry development data from 1980 to 2017 to explore the macroeconomic fluctuations caused by natural disasters. The structural vector autoregressive (SVAR) and the seemingly unrelated regression (SUR) models are employed in estimating the impact of natural disasters on China's macroeconomy and how the disasters specifically affect the three sectors of the economy: primary, secondary, and tertiary. This study concludes that even though natural disasters in China do not significantly affect the overall real GDP, they have adverse impacts on the production in the primary industry, causing a sudden reduction in the means of production in the market and directly affecting various industries, but the impact on the secondary and tertiary industries is weak. This study also shows that the effect of natural disasters on the primary sector reduced significantly following industry restructuring after China's accession to the World Trade Organization (WTO). The impact of natural disasters on the primary industry could be reduced by adjusting the industrial structure to deal with macroeconomic shocks caused by natural disasters in order to promote macroeconomic stability of both regional and national economies. Finally, national aid policy should focus on the primary industry since that sector is significantly affected by natural disasters shocks.


Assuntos
Indústrias , Desastres Naturais , China , Emprego , Modelos Econométricos
11.
Value Health ; 23(8): 1003-1011, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828211

RESUMO

OBJECTIVES: The prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing. METHODS: A Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold. RESULTS: In the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher. CONCLUSIONS: Emergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Programas de Rastreamento/organização & administração , Análise Custo-Benefício , Serviço Hospitalar de Emergência/economia , Custos Hospitalares , Humanos , Cadeias de Markov , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Modelos Econométricos , Reino Unido
12.
Value Health ; 23(8): 1027-1033, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828214

RESUMO

OBJECTIVES: In many countries, future unrelated medical costs occurring during life-years gained are excluded from economic evaluation, and benefits of unrelated medical care are implicitly included, leading to life-extending interventions being disproportionately favored over quality of life-improving interventions. This article provides a standardized framework for the inclusion of future unrelated medical costs and demonstrates how this framework can be applied in England and Wales. METHODS: Data sources are combined to construct estimates of per-capita National Health Service spending by age, sex, and time to death, and a framework is developed for adjusting these estimates for costs of related diseases. Using survival curves from 3 empirical examples illustrates how our estimates for unrelated National Health Service spending can be used to include unrelated medical costs in cost-effectiveness analysis and the impact depending on age, life-years gained, and baseline costs of the target group. RESULTS: Our results show that including future unrelated medical costs is feasible and standardizable. Empirical examples show that this inclusion leads to an increase in the ICER of between 7% and 13%. CONCLUSIONS: This article contributes to the methodology debate over unrelated costs and how to systematically include them in economic evaluation. Results show that it is both important and possible to include future unrelated medical costs.


Assuntos
Análise Custo-Benefício/métodos , Gastos em Saúde/estatística & dados numéricos , Projetos de Pesquisa , Medicina Estatal/organização & administração , Fatores Etários , Inglaterra , Humanos , Expectativa de Vida , Modelos Econométricos , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Medicina Estatal/economia , País de Gales
13.
Value Health ; 23(8): 1072-1078, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828220

RESUMO

Although it is generally accepted that human tissue biobanks are important to facilitate progress in health and medical research, many academic biobanks face sustainability challenges. We propose that biobank sustainability is challenged by a lack of available data describing the outputs and benefits that are produced by biobanks, as reflected by a dearth of publications that enumerate biobank outputs. We further propose that boosting the available information on biobank outputs and using a broader range of output metrics will permit economic analyses such as cost-consequence analyses of biobank activity. Output metrics and cost-consequence analyses can allow biobanks to achieve efficiencies, and improve the quality and/or quantity of their outputs. In turn, biobank output measures provide all stakeholders with explicit and accountable data on biobank value, which could contribute to the evolution of biobank operations to best match research needs, and mitigate some threats to biobank sustainability.


Assuntos
Bancos de Espécimes Biológicos/organização & administração , Pesquisa Biomédica/organização & administração , Modelos Econométricos , Bancos de Espécimes Biológicos/economia , Pesquisa Biomédica/economia , Custos e Análise de Custo , Humanos
14.
Value Health ; 23(8): 1096-1108, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828223

RESUMO

OBJECTIVES: Several evidence-based interventions exist for people who misuse opioids, but there is limited guidance on optimal intervention selection. Economic evaluations using simulation modeling can guide the allocation of resources and help tackle the opioid crisis. This study reviews methods employed by economic evaluations using computer simulations to investigate the health and economic effects of interventions meant to address opioid misuse. METHODS: We conducted a systematic mapping review of studies that used simulation modeling to support the economic evaluation of interventions targeting prevention, treatment, or management of opioid misuse or its direct consequences (ie, overdose). We searched 6 databases and extracted information on study population, interventions, costs, outcomes, and economic analysis and modeling approaches. RESULTS: Eighteen studies met the inclusion criteria. All of the studies considered only one segment of the continuum of care. Of the studies, 13 evaluated medications for opioid use disorder, and 5 evaluated naloxone distribution programs to reduce overdose deaths. Most studies estimated incremental cost per quality-adjusted life-years and used health system and/or societal perspectives. Models were decision trees (n = 4), Markov (n = 10) or semi-Markov models (n = 3), and microsimulations (n = 1). All of the studies assessed parameter uncertainty though deterministic and/or probabilistic sensitivity analysis, 4 conducted formal calibration, only 2 assessed structural uncertainty, and only 1 conducted expected value of information analyses. Only 10 studies conducted validation. CONCLUSIONS: Future economic evaluations should consider synergies between interventions and examine combinations of interventions to inform optimal policy response. They should also more consistently conduct model validation and assess the value of further research.


Assuntos
Analgésicos Opioides/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Análise Custo-Benefício , Redução do Dano , Humanos , Cadeias de Markov , Modelos Econométricos , Naloxona/economia , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/economia , Antagonistas de Entorpecentes/provisão & distribução , Uso Indevido de Medicamentos sob Prescrição/economia , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida
15.
Value Health ; 23(8): 979-984, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828225

RESUMO

BACKGROUND: Discrete choice experiments (DCEs) are commonly used to elicit patient preferences as marginal rates of substitution (MRSs) between treatment or health service attributes. Because these studies are increasing in importance, it is vital that uncertainty around MRS estimates is reported. OBJECTIVE: To review recently published DCE studies that elicit patient preferences in relation to MRS reporting and to explore the accuracy of using other reported information to estimate the uncertainty of the MRSs. METHODS: A systematic literature review of DCEs conducted with patients between 2014 and July 2019 was performed. The number of studies reporting coefficients, MRSs, standard errors (SEs), and confidence intervals was recorded. If all information was reported, studies were included in an analysis to determine the impact of estimating the SEs of MRSs using coefficients and assuming zero covariance, to determine the impact of this assumption. RESULTS: Two hundred and thirty-two patient DCEs were identified in the review; 34.1% (n = 79) reported 1 or more MRS and, of these, only 62.0% (n = 49) provided an estimate of the uncertainty. Of these studies, 16 contained enough information for inclusion in the analysis, providing 116 datapoints. Actual SEs were smaller than estimated SEs in 75.0% of cases (n = 87), and estimated SEs were within 25% of the actual SE in 59.5% of cases (n = 69). CONCLUSION: Uncertainty of MRS estimates is unreported in a substantial proportion of recently published DCE studies. Estimating the SE of a MRS by solely using the SEs of the utility coefficients is likely to lead to biased estimates of the precision of patient trade-offs.


Assuntos
Comportamento de Escolha , Análise Custo-Benefício/métodos , Análise Custo-Benefício/normas , Técnicas de Apoio para a Decisão , Preferência do Paciente , Tomada de Decisões , Humanos , Modelos Logísticos , Modelos Econométricos , Incerteza
16.
Value Health ; 23(8): 985-993, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828226

RESUMO

OBJECTIVE: France has included health economic assessment (HEA) as an official criterion for innovative drug pricing since 2013. Until now, no cost-effectiveness threshold (CET) has been officially proposed to qualify incremental cost-effectiveness ratios (ICERs). Although the French health authorities have publicly expressed the need for such reference values, previous initiatives to determine these have failed. The study aims to propose a locally adapted method for estimating a preference-based value for a quality-adjusted life-year (QALY) based on a rational approach to public policy choices in France. METHODS: We used the official French value of statistical life (VSL) of €3 million (USD 3.25 million), proposed in 2013 by the French General Commission on Strategy and Prediction. We first estimated the value of life-year (VoLY) by age category according to life expectancy and official discounts recommended for HEA in France. We then estimated a value of statistical QALY (VSQ) by weighting VoLYs with demographic data and French EQ-5D-3L tariffs. RESULTS: The estimated average VoLYs and VSQs were €120 185 (USD 130 000) and €147 093 (USD 159 022), respectively, assuming a discount rate of 2.5% and €166 205 (USD 179 681) and €201 398 (USD 217 728), respectively, assuming a discount rate of 4.5%. CONCLUSION: Assuming that, as in other public domains, equity in access to healthcare across all disease areas and between all users is desirable, we propose an estimate of VSQ that is consistent with this goal. Our estimates of €147 093 (USD 179,681) to €201 398 (USD 217 728) should be perceived as breakeven costs for a QALY rather than a market access threshold. Such VSQs could be used as reference values for ICERs in HEA in France.


Assuntos
Análise Custo-Benefício/métodos , Análise Custo-Benefício/normas , Anos de Vida Ajustados por Qualidade de Vida , França , Humanos , Modelos Econométricos , Preferência do Paciente , Valores de Referência
17.
MMWR Morb Mortal Wkly Rep ; 69(34): 1161-1165, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32853186

RESUMO

In 2016, the World Health Organization (WHO) set hepatitis elimination targets of 90% reduction in incidence and 65% reduction in mortality worldwide by 2030 (1). Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection prevalences are high in Uzbekistan, which lacks funding for meeting WHO's targets. In the absence of large financial donor programs for eliminating HBV and HCV infections, insufficient funding is an important barrier to achieving those targets in Uzbekistan and other low- and middle-income countries. A pilot program using a catalytic funding model, including simplified test-and-treat strategies, was launched in Tashkent, Uzbekistan, in December 2019. Catalytic funding is a mechanism by which the total cost of a program is paid for by multiple funding sources but is begun with upfront capital that is considerably less than the total program cost. Ongoing costs, including those for testing and treatment, are covered by payments from 80% of the enrolled patients, who purchase medications at a small premium that subsidizes the 20% who cannot afford treatment and therefore receive free medication. The 1-year pilot program set a target of testing 250,000 adults for HBV and HCV infection and treating all patients who have active infection, including those who had a positive test result for hepatitis B surface antigen (HBsAg) and those who had a positive test result for HCV core antigen. During the first 3 months of the program, 24,821 persons were tested for HBV and HCV infections. Among those tested, 1,084 (4.4%) had positive test results for HBsAg, and 1,075 (4.3%) had positive test results for HCV antibody (anti-HCV). Among those infected, 275 (25.4%) initiated treatment for HBV, and 163 (15.2%) initiated treatment for HCV, of whom 86.5% paid for medications and 13.5% received medications at no cost. Early results demonstrate willingness of patients to pay for treatment if costs are low, which can offset elimination costs. However, improvements across the continuum of care are needed to recover the upfront investment. Lessons learned from this program, including the effectiveness of using simplified test-and-treat guidelines, general practitioners in lieu of specialist physicians, and innovative financing to reduce costs, can guide similar initiatives in other countries and help curb the global epidemic of viral hepatitis, especially among low- and middle-income countries.


Assuntos
Erradicação de Doenças/economia , Saúde Global/economia , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Modelos Econométricos , Adulto , Feminino , Objetivos , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Masculino , Projetos Piloto , Prevalência , Avaliação de Programas e Projetos de Saúde , Uzbequistão/epidemiologia , Organização Mundial da Saúde
18.
PLoS One ; 15(8): e0237672, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853298

RESUMO

Climate change has become intertwined with the global economy. Here, we describe the contribution of inertia to future trends. Drawing from thermodynamic principles, and using 38 years of available statistics between 1980 to 2017, we find a constant scaling between current rates of world primary energy consumption [Formula: see text] and the historical time integral W of past world inflation-adjusted economic production Y, or [Formula: see text]. In each year, over a period during which both [Formula: see text] and W more than doubled, the ratio of the two remained nearly unchanged, that is [Formula: see text] Gigawatts per trillion 2010 US dollars. What this near constant implies is that current growth trends in energy consumption, population, and standard of living, perhaps counterintuitively, are determined by past innovations that have improved the economic production efficiency, or enabled use of less energy to transform raw materials into the makeup of civilization. Current observed growth rates agree well with predictions derived from available historical data. Future efforts to stabilize carbon dioxide emissions are likely also to be constrained by the contributions of past innovation to growth. Assuming no further efficiency gains, options look limited to rapid decarbonization of energy consumption through sustained implementation of at least one Gigawatt of renewable or nuclear power capacity per day. Alternatively, with continued reliance on fossil fuels, civilization could shift to a steady-state economy, one that devotes economic production exclusively to maintining ongoing metabolic needs rather than to material expansion. Even if such actions could be achieved immediately, energy consumption would continue at its current level, and atmospheric carbon dioxide concentrations would only begin to balance natural sinks at concentrations exceeding 500 ppmv.


Assuntos
Mudança Climática , Desenvolvimento Econômico/tendências , Fontes Geradoras de Energia/estatística & dados numéricos , Modelos Econométricos , Fontes Geradoras de Energia/economia
19.
PLoS One ; 15(7): e0235828, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649693

RESUMO

This study aims to explore the direct effect and spillover effect of innovation policy in the distribution and dynamic evolution of the regional innovation from the perspective of innovation motivation using the spatial econometric model. Substantive innovation and strategic innovation in one region could affect innovation in another region. In addition, the direct effect and spatial spillover effect of innovation policy could significantly affect innovation; however, they exert a higher impact on substantive innovation. Considering different policy tools, we found that government subsidies exert a significant positive impact on substantive innovation and strategic innovation, whereas financial institution loans exert a significant negative impact on substantive innovation and strategic innovation. And for the impact range, the government subsidies are higher than that of financial institution loans. Furthermore, this study reveals the leading environmental factors affecting regional innovation and provide a policy basis to promote the construction of an innovation-oriented country.


Assuntos
Invenções/economia , China , Financiamento Governamental , Humanos , Invenções/legislação & jurisprudência , Modelos Econométricos , Motivação
20.
Environ Sci Pollut Res Int ; 27(30): 37894-37910, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32617812

RESUMO

Under different technological innovation modes, regional energy consumption may have spatial heterogeneity. Spatial heterogeneity complicates the nexus between environmental regulation and energy consumption. Traditional spatial homogeneity analysis is hard to describe the nonlinear nexus between them. Based on the data of 30 provinces in China from 2007 to 2017, this paper employs the spatial econometric method and the nonlinear econometric method to investigate the spatial effects and nonlinearity of energy consumption, respectively. The results display that under the current level of economic development, per capita energy consumption has a significant spatial spillover effect. Environmental regulation promotes regional per capita energy consumption in the short term. On the contrary, the technological effect of environmental regulation has significantly reduced Chinese per capita energy consumption. Therefore, energy policy should be tailored to local conditions, and policymakers can strengthen the environmental regulatory system and encourage enterprises to implement green technology innovation.


Assuntos
Desenvolvimento Econômico , Invenções , China , Modelos Econométricos , Análise Espacial
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