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Constrained resources under universal health coverage (UHC) necessitate a balance between medication costs and essential health system requirements. Policymakers practice priority-setting, as either implicit or explicit rationing, embedded in evidence-informed decision-making processes to guide funding decisions. Health technology assessment (HTA) is a method that may assist explicit evidence-informed priority setting. South Africa developed an official HTA methods guide in 2022, however before this, commissioning and performing economic evaluations was not standardized.
Methods
We conducted a descriptive collective case study to explore the impact of economic analyses on the selection of, and access to, essential medicines in South Africa. Four cases were purposefully selected, and both official information and secondary data, including media reports, were reviewed. Data elements were extracted and organized in a matrix. Cases were reported narratively with a positivist epistemological approach, presenting the authors’ reflections.
Results
We found economic analyses that reflected methodologies described in the HTA guide: international reference pricing, cost-minimization, cost-effectiveness, cost-utility, and budget impact analyses. Economic analyses informing the ‘resource-use’ domain in the GRADE evidence-to-decision framework supported decision-making, influenced market-shaping with price reductions of interventions through benchmarking (fosfomycin, flucytosine), improved equitable access nationally (flucytosine), and prioritized a defined patient group in a justifiable and transparent manner (bortezomib).
Conclusion
A standardized HTA evaluation process guided by a nationally accepted framework is necessary for evidence-informed decision-making. Economic analyses (cost-effectiveness, affordability, and resource use) should be consistently included when making decisions on new interventions.
This article analyzes the question of how the size of bribes should impact criminal sanctions. In contrast to the commonly held view that punishment should increase with the size of the bribe, we argue to the contrary: that the punishment of the bribee should decrease with the size of the bribe. Our conclusion is based both on a philosophical argument and an economic argument. We argue that all else being equal, as an agent’s reservation price for selling public interests decreases, the culpability of the agent willing to receive a bribe increases. In addition, from an economic perspective, the expected social harm of an official acting with a low reservation price for bribes is much greater than one acting with a high reservation price: both the susceptibility of being bribed as well as the potential for social harm is much greater when the reservation price is low.
We reviewed economic and environmental studies on global plastic pollution and we estimate the global cost of actions toward zero plastic pollution in all countries by 2040 to be US$ 18.3–158.4 trillion (cost of a 47% reduction of plastic production included). If no actions are undertaken, we estimate the cost of damages caused by plastic pollution from 2016 to 2040 to be US$ 13.7–281.8 trillion. These ranges suggest it is possible that the costs of inaction are significantly higher than those of action. Plastic product sales will also generate a global benefit in the form of incomes (salaries, dividends etc.) estimated to be US$ 38.0 trillion over 2016–2040 in the case of inaction, and US$ 32.7–33.1 trillion in case of action. Calculating benefit minus costs provides the net benefits: US$ −120.4 to 19.7 trillion in case of action and US$ −243.8 to 24.3 trillion in case of inaction. Net benefit ranges suggest action and inaction will both be beneficial when considering the high estimates. However, the low estimates show net benefits might be negative, which suggests inaction might generate a net cost for society that will be twice the cost of action. Our estimates are preliminary (several cost and benefit data are lacking).
Recent meta-analyses demonstrate that small-quantity lipid-based nutrient supplements (SQ-LNS) for young children significantly reduce child mortality, stunting, wasting, anaemia and adverse developmental outcomes. Cost considerations should inform policy decisions. We developed a modelling framework to estimate the cost and cost-effectiveness of SQ-LNS and applied the framework in the context of rural Uganda.
Design:
We adapted costs from a costing study of micronutrient powder (MNP) in Uganda, and based effectiveness estimates on recent meta-analyses and Uganda-specific estimates of baseline mortality and the prevalence of stunting, wasting, anaemia and developmental disability.
Setting:
Rural Uganda.
Participants:
Not applicable.
Results:
Providing SQ-LNS daily to all children in rural Uganda (> 1 million) for 12 months (from 6 to 18 months of age) via the existing Village Health Team system would cost ∼$52 per child (2020 US dollars) or ∼$58·7 million annually. SQ-LNS could avert an average of > 242 000 disability-adjusted life years (DALYs) annually as a result of preventing 3689 deaths, > 160 000 cases of moderate or severe anaemia and ∼6000 cases of developmental disability. The estimated cost per DALY averted is $242.
Conclusions:
In this context, SQ-LNS may be more cost-effective than other options such as MNP or the provision of complementary food, although the total cost for a programme including all age-eligible children would be high. Strategies to reduce costs, such as targeting to the most vulnerable populations and the elimination of taxes on SQ-LNS, may enhance financial feasibility.
With its varied landscape of hills and mountains, New Zealand has an abundance of marginal land on its slopes. This land is currently used in a variety of enterprises, such as pasture and farmland. However, marginal land is typically associated with higher rates of erosion, shallow topsoil, expensive fencing, and other issues like livestock deaths from falls. There is currently interest in deploying these marginal lands to different uses to align with several environmental and production-related goals. This paper contributes to the discussion on marginal land by exploring three different scenarios related to afforestation in the Manawatu catchment area. To analyze these scenarios, we bring together several complex and spatially explicit data sets which are linked using economic modeling tools and benefits transfer methods. The combination of these tools and data sets allows us to produce several important quantitative and qualitative outputs. Where possible, quantitative predictions are monetized, allowing a benefit-cost analysis of the proposed scenarios.
This review examines key economic concepts in relation to the price and value of water for the supply and demand of household water. It responds to a series of questions about water and how it is used. These include (1) Why water is (or is not) priced and valued (or not)?; (2) What are the key economic concepts for pricing water?; (3) How is water priced and how are water supply assets valued for full cost recovery?; (4) Who bears the costs and enjoys the benefits of water use?; and (5) When is the price of water expected to change? Examples are provided to demonstrate the universality of the economic concepts while highlighting how their application must be bespoke and account for different socio-economic contexts and bio-physical conditions where water is supplied and demanded.
This study addresses the assessment of crop water stress index (CWSI) of bell pepper (Capsicum annuum L.) and net income generated under regulated deficit irrigation (RDI), conventional deficit irrigation and partial root-zone drying (PRD) and full irrigation (I100) using surface- and subsurface-drip systems (DI and SDI) during 2016 and 2017 in the Mediterranean region. The experimental design was split-plots with four replications. RDI was supplied with 50% of I100 during vegetative stage until flowering, then received 100% of crop water requirement. PRD50 received 50% of I100, but from alternative laterals each watering. The results revealed that CWSI was correlated significantly (P < 0.01) and negatively with yield, yield per plant, total soluble solid, ETa, fruit weight and plant height indicating that yield of bell pepper declined with increasing CWSI values (P < 0.01). Bell pepper should be irrigated at mean CWSI value of 0.20 without any yield reduction. CWSI in the RDI and I75 treatments were slightly greater than 0.20. Irrigation treatments had significant effect on yield and quality traits. The highest total soluble solutes were found in PRD50 and I50. The DI I100 treatment generated the highest net income followed by the SDI I100 and RDI. In conclusion, RDI and I75 appear to be good alternatives to I100 for sustainable bell pepper production in the Mediterranean region.
From an economic point of view, the substantive law is a mechanism to generate incentives towards efficient behaviour, i.e. behaviour that maximizes the social surplus. The same applies to the legal rules that the parties agree in the contracts they make. The behavioural response that legal rules aim for depends on accurate enforcement. Litigation, arbitration and other mechanisms of dispute settlement must be viewed and evaluated as tools for the accurate enforcement of legal rules. This contribution analyzes arbitration as an efficient enforcement mechanism that may be used by the parties to maximize the surplus they jointly reap from their transactions. The paper addresses the decision to be made by the parties in choosing arbitration over litigation and other tools of ADR, but also the choice between institutional and ad hoc arbitration. As it turns out, the parameters that influence these choices differ, depending on the domestic or international nature of the given transaction. However, the economics of arbitration are not only about the choices to be made by the parties. Thus, the paper also looks at the incentives faced by the arbitrators.
Industrial propylene hydroformylation (PHF) to produce butyraldehyde uses polymer-grade propylene (99.99 wt% purity) obtained from propane dehydrogenation (PDH) followed by separation of the propylene/propane mixture by distillation. Recently, it was shown that the effluent from a PDH reactor (60–70% propylene in propane) can be directly used for PHF over Rh-based complexes, eliminating the energy intensive C3 distillation step. Because only propylene reacts in the PHF reactor, an enriched propane stream results and is recycled back to the PDH reactor. At industrial conditions (2.5 MPa, 90°C), hydroformylation with mixed propylene/propane feedstock occurs in a propane-expanded liquid (PXL) phase. The capital investment for the PXL process is approximately 20% lower than the conventional process. The production cost in the PXL process is also lower, resulting in an annual savings of nearly $12M for a 300 kt/y plant. Comparative gate-to-gate environmental impact analyses shows that the PXL process results in reduced environmental impacts (greenhouse gas emission by 20%, air pollutants emission by 22% and toxic release by 21%) compared to the conventional process.
This book provides a simple introduction to the economic analysis of the long period by means of Oded Galor's Unified Growth Theory. This aims at making Unified Growth Theory accessible for undergraduate students in Economics and the other Social Sciences. Using simple theoretical frameworks with or without microeconomic foundations, it shows how the major concepts of Unified Growth Theory – the economic regime, the regime shift, critical thresholds, latent dynamics – can be used to study the dynamics of societies over long horizons of time. Applications to the long-run dynamics of production, inequalities, institutions and the natural environment are examined.
This book provides a non-technical introduction to Unified Growth Theory (UGT), that is, the study of history as a succession of economic regimes. It first focuses on the canonical example of regime shift: the transition from the regime of Malthusian stagnation to the modern regime of sustained economic growth. Then, it broadens the perspectives on historical change by examining other regime shifts involving institutional and environmental forces. This book fills a gap in the market by providing a more accessible treatment of UGT and invites readers to explore ideas of continuity and discontinuity in history.
Why a need should exist for hundreds of different contract laws capable of regulating a sale of goods is far from obvious. Attempts have been made to cut back and tackle the incongruities between different legal regimes. This contribution offers a conceptual framework for thinking about the variety of private laws, the need for unification, and ways to achieve it. The economics of network effects explain why standardization is often beneficial and how it can be accomplished—or missed. This chapter suggests predictions about the scope of market standardization in two particularly important areas, contract law and company law. One policy implication is that international standardization does not depend on crafting uniform law. The laws of national jurisdictions can be suitable as market standards for cross-border transactions. This adds a new perspective to the continuing debate about regulatory competition between jurisdictions: The winners of the race are decided as much by network effects as by differences in the substantive quality of their laws. Better law standardization can be a possible and desirable outcome of jurisdictional competition. It deserves careful consideration whether enacting international uniform law promises a significant improvement over jurisdictional competition that justifies the cost.
The economic costs associated with alcohol consumption are tremendous both in terms of negative health effects and negative societal outcomes. While there are many policies and treatment programs that can reduce these costs, determining which recovery programs are the most effective use of societal dollars is a complex task. This chapter summarizes the economic burden associated with alcohol use disorder (AUD) and explains why an economic perspective is important in understanding AUD recovery. The three most common types of analysis used to evaluate AUD interventions to promote recovery are reviewed: cost, cost-effective and benefit-cost analysis. The types of data typically used for economic analysis and when each type of analysis is appropriate are described. Also discussed are the general methods for each type of analysis, underlying modeling assumptions, and how economic analysis can be conducted from different perspectives.
There is a great deal of variability in estimates of the lifetime medical care cost externality of obesity, partly due to a lack of transparency in the methodology behind these cost models. Several important factors must be considered in producing the best possible estimate, including age-related weight gain, differential life expectancy, identifiability, and cost model selection. In particular, age-related weight gain represents an important new component to recent cost estimates. Without accounting for age-related weight gain, a study relies on the untenable assumption that people remain the same weight throughout their lives, leading to a fundamental misunderstanding of the evolution and development of the obesity crisis. This study seeks to inform future researchers on the best methods and data available both to estimate age-related weight gain and to accurately and consistently estimate obesity’s lifetime external medical care costs. This should help both to create a more standardized approach to cost estimation as well as encourage more transparency between all parties interested in the question of obesity’s lifetime cost and, ultimately, evaluating the benefits and costs of interventions targeting obesity at various points in the life course.
To evaluate the cost and cost-effectiveness of a farm-to-Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) intervention to promote vegetable intake and the redemption of WIC vouchers for produce purchases at farmers’ markets.
Design:
An economic analysis was undertaken using data from a pilot of the intervention. Vegetable intake was assessed with a reflection spectroscopy device (the Veggie Meter® [VM]) and via self-report. Voucher redemption was reported by WIC. Total and per participant intervention costs and cost-effectiveness ratios (expressed as cost per intervention effect) were estimated in 2019 US dollars over a 6-month period from the perspective of the agency implementing the intervention.
Setting:
A large, urban WIC agency.
Participants:
Participants were 297 WIC-enrolled adults.
Results:
Post-intervention, VM scores, self-reported vegetable intake and voucher redemption were higher in the intervention as compared with the control study group. Over the 6-month period, intervention costs were $31 092 ($194 unit cost per participant). Relative to the control group, the intervention cost $8·10 per increased VM score per participant, $3·85 per increased cup/d of vegetables consumed per participant and $3·29 per increased percentage point in voucher redemption per participant.
Conclusions:
Intervention costs and cost-effectiveness ratios compared favourably with those reported for other interventions targeting vegetable intake in low-income groups, suggesting that the programme may be cost effective in promoting vegetable purchases and consumption. As there is no benchmark against which to compare cost-effectiveness ratios expressed as cost per unit of effectiveness, conclusions regarding whether this is the case must await further research.
Mineral deposits of base metals, precious metals, and rare earth elements have been discovered on deep seabeds, and the commercial exploitation of these resources seems poised to begin after faltering for many years. The development of seabed resources could be socially beneficial if all goes well, but the industry faces daunting challenges and uncertainties. Emerging regulations and contracting mechanisms are the principal means for managing these uncertainties. This article recommends a complementary approach: the use of ex ante benefit–cost analysis of proposed seabed mining contracts that incorporates a fundamental uncertainty evaluation. We argue that such an ex ante evaluation will improve the state of information for the decision-making, reducing the risk of regulatory noncompliance or costly contract disputes after seabed mining begins.
This study estimates the maximum price at which mesenchymal stem cell (MSC) therapy is deemed cost-effective for septic shock patients and identifies parameters that are most important in making treatment decisions.
Methods
We developed a probabilistic Markov model according to the sepsis care trajectory to simulate costs and quality-adjusted life years (QALYs) of septic shock patients receiving either MSC therapy or usual care over their lifetime. We calculated the therapeutic headroom by multiplying the gains attributable to MSCs with willingness-to-pay (WTP) threshold and derived the maximum reimbursable price (MRP) from the expected net monetary benefit and savings attributable to MSCs. We performed scenario analyses to assess the impact of changes to assumptions on the study findings. A value of information analysis is performed to identify parameters with greatest impact on the uncertainty around the cost-effectiveness of MSC therapy.
Results
At a WTP threshold of $50,000 per QALY, the therapeutic headroom and MRP of MSC therapy were $20,941 and $16,748, respectively; these estimates increased with the larger WTP values and the greater impact of MSCs on in-hospital mortality and hospital discharge rates. The parameters with greatest information value were MSC's impact on in-hospital mortality and the baseline septic shock in-hospital mortality.
Conclusion
At a common WTP of $50,000/QALY, MSC therapy is deemed to be economically attractive if its unit cost does not exceed $16,748. This ceiling price can be increased to $101,450 if the therapy significantly reduces both in-hospital mortality and increases hospital discharge rates.
Based on a thorough analysis of the BIS Annual Reports from the early 1970s to the late 2010s, this chapter traces the evolution of the BIS’s thinking on the international monetary and financial system. It demonstrates how – as a result of the growth of the Eurocurrency markets in the 1970s and of the sovereign debt crisis of the 1980s – the BIS’s traditional focus on exchange rates and their potential impact on monetary stability gradually shifted to global capital flows and to the risks posed by an increasingly complex and interconnected banking system. The 1995 Mexico crisis and 1997–8 Asian crisis reinforced this shift and led to an overriding concern with the procyclicality of the financial system as a potential threat to financial stability. While recognising that the focus of the BIS on a macro-financial stability framework has contributed a lot to advancing the work of the Basel-based committees and standard-setting bodies, the chapter also concludes that not much progress has been made in coordinating monetary policies or in addressing the fundamental problem of excessive elasticity of the financial system.
Obtaining a level of consensus over the definition, construction and measurement of the concept of quality of life would allow for an improved degree of standardization in the assessment of clinical intervention for people with mental health problems. One of the many benefits of this standardization would be the ability to make valid and reliable comparisons between various interventions and across different groups or settings, which is of particular interest to economists. There are, however, a host of sociocultural issues that present fundamental obstacles to the satisfactory attainment of consensus over definitions and domains of quality of life. This paper considers the arguments pertinent to each of these two alternative perspectives, the economic and the sociocultural (or anthropological), and draws out the lessons that these perspectives — despite the apparent polarity that exists between them — can offer to the improved measurement of quality of life for those with mental health problems.
Economic analysis is a theoretical approach, not an empirical one. It is a way of thinking, not a way of testing. An analysis that has an empirical component can be economic without being quantitative: economics is not statistics. An atheoretical analysis can never be economic, no matter how impressive its regressions: statistics is not economics.