On the substitution between saving and prevention

This work makes a joint analysis of prevention and saving decisions. First we determine the optimal levels of the two variables and we analyze substitution between them. Second we provide some comparative statics results in order to determine the effects on optimal saving and prevention of changes in exogenous present and future wealth and in possible future loss. Finally we introduce insurance into the model and we extend the separation result, derived in the literature which studies the substitution between insurance and saving, to the case where prevention is considered too.Prevention, Saving, Insurance

Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs

AIM: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. DESIGN: Cost-effectiveness analysis from a National Health Service (NHS)/health-provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. SETTING AND PARTICIPANTS: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%) INTERVENTIONS: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. MEASUREMENTS: HCV infections and cost per quality-adjusted life year (QALY) gained through NSPs over 50 years. FINDINGS: Compared with a willingness-to-pay threshold of £20 000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses, including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. CONCLUSIONS: Needle and syringe programmes are a highly effective low-cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost-saving. Needle and syringe programmes are likely to remain cost-effective irrespective of changes in hepatitis C virus treatment cost and scale-up

Attributes and weights in health care priority setting: a systematic review of what counts and to what extent

In most societies resources are insufficient to provide everyone with all the health care they want. In practice, this means that some people are given priority over others. On what basis should priority be given? In this paper we are interested in the general public's views on this question. We set out to synthesis what the literature has found as a whole regarding which attributes or factors the general public think should count in priority setting and what weight they should receive. A systematic review was undertaken (in August 2014) to address these questions based on empirical studies that elicited stated preferences from the general public. Sixty four studies, applying eight methods, spanning five continents met the inclusion criteria. Discrete Choice Experiment (DCE) and Person Trade-off (PTO) were the most popular standard methods for preference elicitation, but only 34% of all studies calculated distributional weights, mainly using PTO. While there is heterogeneity, results suggest the young are favoured over the old, the more severely ill are favoured over the less severely ill, and people with self-induced illness or high socioeconomic status tend to receive lower priority. In those studies that considered health gain, larger gain is universally preferred, but at a diminishing rate. Evidence from the small number of studies that explored preferences over different components of health gain suggests life extension is favoured over quality of life enhancement; however this may be reversed at the end of life. The majority of studies that investigated end of life care found weak/no support for providing a premium for such care. The review highlights considerable heterogeneity in both methods and results. Further methodological work is needed to achieve the goal of deriving robust distributional weights for use in health care priority setting.12 page(s

Toxics Use Reduction: Pro and Con

With the Massachusetts Toxics Use Reduction Act as an example, important issues related to the goals and effectiveness of TUR are examined. The benefits as claimed by proponents are contrasted with shortcomings outlined by opponents in point-counterpoint style. Ultimately, the authors call for more balanced analysis

Essays in Macroeconomics

This work makes a joint analysis of prevention and saving decisions. First we determine the optimal levels of the two variables and we analyze substitution between them. Second we provide some results about the effects on optimal saving and prevention of changes in exogenous present and future wealth and in possible future loss. Finally we introduce insurance into the model and we extend the separation result, derived in the literature which studies the substitution between insurance and saving, to the case where prevention is considered tooQuesto saggio presenta una funzione di produzione adatta a replicare gli effetti di un flusso migratorio in una data località sul salario reale. Un noto lavoro di Card (1989) mostra come i salari dei lavoratori cosiddetti “nativi” non rispondano negativamente a un influsso di immigrati con simili livello di educazione e esperienza. Per replicare questo risultato, si introduce una nuova funzione di produzione con due caratteristiche peculiari: complementarietà tra lavoro qualificato e capitale e adozione “factor-biased” di nuove tecniche. Il presente lavoro mostra come entrambi questi elementi siano necessari per replicare l’evidenza empirica. A supporto di questa ipotesi viene inoltre stimata la significatività del legame tra immigrazione di lavoratori non qualificati e adozione di nuove tecniche.Questo saggio pone alcune domande di tipo normativo nell’ambito della letteratura dell’economia dell’immigrazione. In particolare ci si chiede se l’immigrazione possa essere utilizzata come uno strumento adatto a ridurre le distorsioni della tassazione sul lavoro. L’ambito di analisi è quello di un pianificatore che dispone di strumenti di tassazione limitati (tasse lineari sul lavoro) da utilizzarsi per finanziare un dato ammontare di spesa pubblica (“Ramsey Planner”). Il risultato pricinpale del lavoro è che l’immigrazione può essere utilizzata come tale quando i fattori della produzione (i.e. diverse tipologie di lavoro) tendono ad essere complementari piuttosto che sostituti

Environmental Value of Draught Animals: Saving of Fossil-fuel and Prevention of Greenhouse Gas Emission

Animal energy is a renewable and sustainable source of energy. It is renewable because the animals can be reproduced by breeding and rearing the required number of animals. It is sustainable because the animals derive their energy for work largely from agricultural by-products. In addition, there are other environmental contributions of the working animal stock — consider replacing it by agricultural machinery run on fossil-fuel. Animal energy saves natural resources, fossil fuel and prevents green house gases emission. The fossil-fuel equivalent of the animal energy used in the Indian agriculture has been found pretty large, as much as 19 million tonnes of diesel in 2003. If this much amount of fuel were to be burnt through combustion to run tractors in the absence of the working animal stock of over 60 million, it would have released about 6 million tonnes of carbon dioxide.Agricultural and Food Policy,

Smarter Programming of the Female Condom: Increasing Its Impact on HIV Prevention in the Developing World

The purpose of this study was to investigate the relative value of the female condom for HIV prevention within heterosexual relationships in the developing world. In the last ten years, the world has witnessed both historic financial commitments to HIV/AIDS and new prevention options, including biomedical prevention research, male circumcision, and a dramatic scale-up of voluntary counseling and testing. At the same time, where HIV remains at epidemic levels in many countries, there has been a growing commitment to treatment access alongside prevention programs. However, portions of populations, particularly youth and women, remain highly vulnerable to HIV infection. Accordingly, the global health community can benefit from a better understanding of how existing prevention options should be effectively and efficiently delivered to reduce HIV in the developing world. This report provides guidance for the global health community for considering how the female condom fits within the set of prevention interventions currently available

Advancing Alternative Analysis: Integration of Decision Science.

Decision analysis-a systematic approach to solving complex problems-offers tools and frameworks to support decision making that are increasingly being applied to environmental challenges. Alternatives analysis is a method used in regulation and product design to identify, compare, and evaluate the safety and viability of potential substitutes for hazardous chemicals.Assess whether decision science may assist the alternatives analysis decision maker in comparing alternatives across a range of metrics.A workshop was convened that included representatives from government, academia, business, and civil society and included experts in toxicology, decision science, alternatives assessment, engineering, and law and policy. Participants were divided into two groups and prompted with targeted questions. Throughout the workshop, the groups periodically came together in plenary sessions to reflect on other groups' findings.We conclude the further incorporation of decision science into alternatives analysis would advance the ability of companies and regulators to select alternatives to harmful ingredients, and would also advance the science of decision analysis.We advance four recommendations: (1) engaging the systematic development and evaluation of decision approaches and tools; (2) using case studies to advance the integration of decision analysis into alternatives analysis; (3) supporting transdisciplinary research; and (4) supporting education and outreach efforts

Dynamic modelling of hepatitis C virus transmission among people who inject drugs: a methodological review

Equipment sharing among people who inject drugs (PWID) is a key risk factor in infection by hepatitis C virus (HCV). Both the effectiveness and cost-effectiveness of interventions aimed at reducing HCV transmission in this population (such as opioid substitution therapy, needle exchange programs or improved treatment) are difficult to evaluate using field surveys. Ethical issues and complicated access to the PWID population make it difficult to gather epidemiological data. In this context, mathematical modelling of HCV transmission is a useful alternative for comparing the cost and effectiveness of various interventions. Several models have been developed in the past few years. They are often based on strong hypotheses concerning the population structure. This review presents compartmental and individual-based models in order to underline their strengths and limits in the context of HCV infection among PWID. The final section discusses the main results of the papers