Monetary policy in unknown territory: The European Central Bank in the early years

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Monetary and Fiscal Policy in the European Monetary Union

The introductory phase of the European Monetary Union (EMU) ended with the introduction of the euro currency in 2002. We present a review of the experiences with the new monetary union. Using a Taylor rule, we analyze the conduct of monetary policy by the European Central Bank (ECB). The empirical results suggest that the ECB applies similar weights to inflation and the output gap as the Bundesbank in the past, but more than proportionate weight to economic developments in Germany and France. Next, we show that the link between monetary developments and inflation in the euro area is empirically very stable. ECB monetary policy was too loose in the first four years to keep inflation below the ECB's upper limit of 2 percent defining price stability. In the last section, we analyze the fiscal framework of EMU and show that it has not succeeded in safeguarding fiscal discipline, especially in the large member states.

Decoding implicit hate speech: The example of antisemitism

This article deals with the problem and the different levels of implicity in the context of antisemitic hate speech. By means of authentic examples stemming from social media debates, we show how alluded antisemitic concepts can be inferred on the basis of conservative interpretation. We point out the role of different sources of knowledge in reconstructing the ideas implied in a statement as well as potential sources of error in the interpretation process. The article thus focuses on the methods and findings of the interdisciplinary research project "Decoding Antisemitism" conducted at the Center for Research on Antisemitism (ZfA) at TU Berlin. By doing so, it explains the procedure of qualitative content analysis as a fruitful approach to understand the actual repertoire of antisemitic hate speech online

Procedures and Criteria for the regulation of innovative non-medicinal technologies into the benefit catalogue of solidly financed health care insurances

Because great interest in an efficient range of effective medicinal innovations and achievements has arisen, many countries have introduced procedures to regulate the adoption of innovative non-medicinal technologies into the benefit catalogue of solidly financed health care insurances. With this as a background, this report will describe procedures for the adoption of innovative non-medicinal technologies by solidly financed health care insurances in Germany, England, Australia and Switzerland. This report was commissioned by the German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information

Assessments tools for risk prediction of cardiovascular diseases

Scientific background: Cardiovascular diseases have an enormous epidemiological and economic importance. For the selection of persons with increased total cardiovascular risk for individual-targeted (e. g. drug-based) prevention interventions different risk prognosis instruments (equations, point scores and table charts) were derived from studies or databases. The transferability of these prognostic instruments on the populations not examined in these data sources as well as their comparability are not clear. Research questions: The evaluation addresses the questions on the existence of instruments for risk prediction of cardiovascular diseases, their transferability and comparability. Methods: A systematic literature search was performed in the medical electronic databases in April 2008 beginning from 2004 and was completed with a hand search. Publications on the prognostic instruments for cardiovascular diseases as well as publications addressing external validity and/or comparing prognostic instruments were included in the evaluation. Results: The systematic lierature search yielded 734 hits. Three systematic reviews, 38 publications with descriptions of prognostic instruments and 29 publications with data on the validity of the prognosis instruments were identified. Most risk prognosis instruments are based on the Framingham cohort of the USA. Only the PROCAM study is completely based on the German reference population. Almost all prognostic instruments use the variables sex, age, smoking, different parameters of the lipid status and of the blood pressure. Different cardiovascular events are considered to be an end parameter in the prognosis instruments. The time span for predicted events in the studies mostly comprises ten years.Data on calibration of the prognosis instruments (a quotient of the predicted by the observed risk) are presented in nearly half of the studies on the validation, however in no study from Germany. Only single studies find the levels of calibration between 0.9 and 1.1. Many studies on the transferability of the prognosis instruments show a value of the discrimination (correct differentiation of persons with different risk levels, best value 1.0) between 0.7 and 0.8, few studies between 0.8 and 0.9 and no study over 0.9. The studies addressing the discrimination of the prognostic instruments on the German population almost always find values between 0.7 and 0.8. The comparison of the validity of different risk prognosis instruments shows a trend for a better calibration and a better discrimination for the prognosis instruments examined on the derivation and/or validation cohorts of one of the compared prognostic instruments. Comparing the prognostic instruments on other cohorts, the newly derived Framingham prognostic instruments show a better discrimination in comparison with previously derived instruments. No studies exists comparing different prognostic instruments on the German population. Discussion: The geographic variance of the cardiovascular morbidity and mortality supposed to be the most important factor limiting the transferability of the prognostic instruments. An appropriate recalibration is considered to be an approach for the improvement of the transferability. Conclusions: The identified instruments for the risk prediction of cardiovascular diseases are insufficiently validated on the German population. Their use can lead to false risk estimation for a single person. Therefore, the existing prognostic instruments should be used for the informed decision-making and for the therapy selection in Germany only with critical caution

Interventions for enhancing medication compliance/adherence with benefits in treatment outcomes

Scientific background: Poor compliance or adherence in drug therapy can cause increased morbidity, mortality and enormous costs in the healthcare system (in Germany annually approximately 10 billion euros). Different methods are used for enhancing the compliance or adherence. Research questions: The evaluation addresses the questions about existence, efficacy, cost-benefit relation as well as ethical-social and juridical implications of strategies for enhancing compliance or adherence in drug therapy with concomitant improvements in treatment outcomes. Methods: A systematic literature search was conducted in the medical, also health economic relevant, literature databases in January 2007, beginning from 2002. Systematic reviews on the basis of (randomised controlled trials (RCT) concerning interventions to enhance compliance or adherence with regard to treatment outcomes as well as systematic reviews of health economic analyses were included in the evaluation. Additionally, it was also searched for publications which primarily considered ethical-social and juridical aspects of these interventions for the German context. Results: One systematic review with data for 57 RCT was included in the medical evaluation and one systematic review with data for six studies into the health economic evaluation. No publication primary concerning ethical-social or juridical implications could be identified. A significant positive effect on the treatment outcome was reported for 22 evaluated interventions. For many interventions the results can be classified as reliable: counseling with providing an information leaflet and compliance diary chart followed by phone consultation for helicobacter pylori positive patients, repeated counseling for patients with acute asthma symptoms, telephone calls to establish the level of compliance and to make recommendations based on that for the therapy of cardiovascular diseases, calls of an automated telephone system with phone counseling in problem cases for diabetics, different family based interventions including repeated family counseling, education and "culturally modified family therapy" in patients with schizophrenia, repeated "compliance therapy" sessions for patients with acute psychosis. For other interventions the results should be viewed with more concern (because of the poor methodical quality of the underlying studies). The effect size of the interventions can not be estimated from the available data. From the available data, no reliable results can be provided concerning the cost-benefit relation of these strategies. Discussion: Many of the reported studies had a poor reporting and methodological quality. The reliability of the conclusions of the studies is restricted because of methodical shortcomings. Efficacy and cost estimates determined in the health economic studies are not transferable to the current situation in Germany. It has been discussed recently that the compliance or adherence enhancing interventions can restrict the autonomy and the privacy of the patients. Conclusions: In drug therapy some compliance or adherence enhancing interventions with concomitant positive effect on the treatment outcome may be used. The cost-benefit relation of these interventions is to be estimated. Using these interventions the patient’s autonomy and privacy are to be restricted as few as possible

Percutaneous coronary intervention with optimal medical therapy vs. optimal medical therapy alone for patients with stable angina pectoris

Scientific background: Stable Angina Pectoris (AP) is a main syndrome of chronic coronary artery disease (CAD), a disease with enormous epidemiological and health economic relevance. Medical therapy and percutaneous coronary interventions (PCI) are the most important methods used in the treatment of chronic CAD. Research questions: The evaluation addresses questions on medical efficacy, incremental cost-effectiveness as well as ethic, social and legal aspects in the use of PCI in CAD patients in comparison to optimal medical therapy alone. Methods: A systematic literature search was conducted in June 2010 in the electronic databases (MEDLINE, EMBASE etc.) and was completed by a hand search. The medical analysis was initially based on systematic reviews of randomized controlled trials (RCT) and was followed by the evaluation of RCT with use of current optimal medical therapy. The results of the RCT were combined using meta-analysis. The strength and the applicability of the determined evidence were appraised. The health economic analysis was initially focused on the published studies. Additionally, a health economic modelling was performed with clinical assumptions derived from the conducted meta-analysis and economic assumptions derived from the German Diagnosis Related Groups 2011. Results: Seven systematic reviews (applicability of the evidence low) and three RCT with use of optimal medical therapy (applicability of the evidence for the endpoints AP and revascularisations moderate, for further endpoints high) were included in the medical analysis. The results from RCT are used as a base of the evaluation. The routine use of the PCI reduces the proportion of patients with AP attacks in the follow-up after one and after three years in comparison with optimal medical therapy alone (evidence strength moderate); however, this effect was not demonstrated in the follow-up after five years (evidence strength low). The difference in effect in the follow-up after four to five years was not found for the further investigated clinical endpoints: death, cardiac death, myocardial infarction and stroke (evidence strength high) as well as for severe heart failure (evidence strength moderate). Two studies were included in the health economic analysis. The costs estimations from these studies are not directly transferable to the corresponding costs in Germany. The average difference in the total costs for PCI in comparison with optimal medical therapy alone, which was calculated in the modelling, was found to be 4,217 Euro per patient. The incremental cost-effectiveness ratio per life-year of a patient with avoided AP attacks was estimated to be 24,805 Euro (evidence strength moderate). No publication was identified concerning ethical, social or legal aspects. Discussion: Important methodical problems of the studies are a lack of blinding of the patients and incomplete data for several endpoints in the follow-up. The determined incremental cost-effectiveness ratio per life-year of a patient with avoided AP attacks was appraised not to be cost-effective. Conclusions: From a medical point of view the routine use of PCI in addition to the optimal medicinal therapy in patients with stable AP can be recommended for the reduction of the proportion of patients with AP attacks after one year and after three years (recommendation degree weak). Otherwise, PCI is to be performed in patients with refractory or progressing AP despite of optimal medical therapy use; in this case PCI is expected to be applied in 27% to 30% of patients in five years. From the health economic view the routine use of PCI in addition to an optimal medical therapy in patients with stable AP cannot be recommended. No special considerations can be made concerning special ethical, social or legal aspects in the routine use of PCI in addition to optimal medical therapy in patients with stable AP