The impact of introducing patient co-payments in Germany on the use of IVF and ICSI:a price-elasticity of demand assessment

BACKGROUND: Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact of this pricing policy on the utilization of reproductive treatments in Germany. METHODS: Using aggregated annual in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycle data in Germany, we evaluated the relationship between changes in the number of cycles in relation to changes in costs faced by consumers following the introduction of a patient co-payment from 'no fees' to (sic)1500-2000 by estimating the short-run price-elasticity of demand. The impact of introducing patient co-payments for IVF/ICSI on the likelihood of switching to other low-cost fertility treatments was evaluated using the cross-price elasticity methodology. RESULTS: The reduction in demand for IVF and ICSI cycles in the year following the introduction of patient co-payments resulted in elasticities of -0.41 and -0.34, respectively. The price-elasticity for the combined reduction of IVF/ICSI in relation to the co-payment was estimated to be -0.36. The cross-price elasticity for clomifene was close to zero (-0.01) suggesting that demand for these interventions are independent of each other and no substitution occurred. CONCLUSIONS: We report price elasticities for IVF and ICSI of -0.41 and -0.34 after introducing a (sic)1500-2000 co-payment. These findings likely represent short-run elasticities that are likely to vary over time as factors that influence the supply and demand for fertility treatments change

PUK12 COST-EFFECTIVENESS OF ACE INHIBITOR THERAPY TO PREVENT DIALYSIS IN NON-DIABETIC NEPHROPATHY—INFLUENCE OF THE ACE INSERTION / DELETION POLYMORPHISM

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Spin effects in transport through non-Fermi liquid quantum dots

The current-voltage characteristic of a one dimensional quantum dot connected via tunnel barriers to interacting leads is calculated in the region of sequential tunneling. The spin of the electrons is taken into account. Non-Fermi liquid correlations implying spin-charge separation are assumed to be present in the dot and in the leads. It is found that the energetic distance of the peaks in the linear conductance shows a spin-induced parity effect at zero temperature T. The temperature dependence of the positions of the peaks depends on the non-Fermi liquid nature of the system. For non-symmetric tunnel barriers negative differential conductances are predicted, which are related to the participation in the transport of collective states in the quantum dot with larger spins. Without spin-charge separation the negative differential conductances do not occur. Taking into account spin relaxation destroys the spin-induced conductance features. The possibility of observing in experiment the predicted effects are briefly discussed.Comment: 15 pages, 16 figures, accepted for publication on Physical Review

Cost-effectiveness analysis and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent venous thromboembolism

ObjectivesIn the 'Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism' (SELECT-D) trial, rivaroxaban showed relatively low venous thromboembolism (VTE) recurrence but higher bleeding compared with dalteparin in patients with cancer. We aim to calculate the cost-effectiveness and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent VTE.SettingWe built a Markov model to calculate the cost-effectiveness from a societal perspective over a 5-year time horizon for the Dutch healthcare setting.ParticipantsA hypothetical cohort of 1000 cancer patients with VTE entered the model with baseline characteristics based on the SELECT-D trial.InterventionSix months of treatment with rivaroxaban (15mg two times per day for first 3weeks followed by 20mg once daily) was compared with 6months of treatment with dalteparin (200IU/kg daily during month 1 followed by 150IU/kg daily).Primary and secondary outcome measuresThe primary outcome of the cost-effectiveness analysis was the incremental cost-effectiveness ratio (ICER). The robustness of the model was evaluated in probabilistic and univariate sensitivity analyses. A budget impact analysis was performed to calculate the total annual financial consequences for a societal perspective in the Netherlands.ResultsIn the base case and all scenarios, rivaroxaban were cost-saving while also slightly improving the patient's health, resulting in economically dominant ICERs. In the probabilistic sensitivity analysis, 77.8% and 98.7% of the simulations showed rivaroxaban to be cost-saving and more effective for a 5-year and 6-month time horizon, respectively. Rivaroxaban can save up to Euro11326763 (CI Euro5164254 to Euro17363231) in approximately 8000 cancer patients with VTE per year compared with dalteparin based on a 1-year time horizon.ConclusionsTreatment with rivaroxaban is economically dominant over dalteparin in patients with cancer at risk for recurrent VTE in the Netherlands. The use of rivaroxaban instead of dalteparin can save over Euro10 million per year, primarily driven by the difference in drug costs

Correlated tunneling in intramolecular carbon nanotube quantum dots

We investigate correlated electronic transport in single-walled carbon nanotubes with two intramolecular tunneling barriers. We suggest that below a characteristic temperature the long range nature of the Coulomb interaction becomes crucial to determine the temperature dependence of the maximum G_max of the conductance peak. Correlated sequential tunneling dominates transport yielding the power-law G_max ~ T^{\alpha_{end-end}-1}, typical for tunneling between the ends of two Luttinger liquids. Our predictions are in agreement with recent measurements

The cross section minima in elastic Nd scattering: a ``smoking gun'' for three nucleon force effects

Neutron-deuteron elastic scattering cross sections are calculated at different energies using modern nucleon-nucleon interactions and the Tucson-Melbourne three-nucleon force adjusted to the triton binding energy. Predictions based on NN forces only underestimate nucleon-deuteron data in the minima at higher energies starting around 60 MeV. Adding the three-nucleon forces fills up those minima and reduces the discrepancies significantly.Comment: 11 pages, 6 figure

Neutron Resonance Spectroscopy of 106Pd, and 108Pd from 20–2000 eV

Parity nonconserving asymmetries have been measured in p-wave resonances of 106Pd and 108Pd. The data analysis requires knowledge of the neutron resonance parameters. Transmission and capture γ-ray yields were measured for En=20–2000 eV with the time-of-flight method at the Los Alamos Neutron Science Center (LANSCE). A total of 28 resonances in 106Pd and 32 resonances in 108Pd were studied. The resonance parameters for 106Pd are new for all except one resonance. In 108Pd six new resonances were observed and the precision improved for many of the resonance parameters. A Bayesian analysis was used to assign orbital angular momentum for the resonances studied

Control of spin in quantum dots with non-Fermi liquid correlations

Spin effects in the transport properties of a quantum dot with spin-charge separation are investigated. It is found that the non-linear transport spectra are dominated by spin dynamics. Strong spin polarization effects are observed in a magnetic field. They can be controlled by varying gate and bias voltages. Complete polarization is stable against interactions. When polarization is not complete, it is power-law enhanced by non-Fermi liquid effects.Comment: 4 pages, 4 figure