Individuals' Rates of Time Preference for Life-Saving Programs in Developing Countries: Results from a Multi-Country Study

Individuals' time preferences for mortality reductions are measured in six Less Developed Countries in Africa, Eastern Europe, and Asia using the contingent valuation method. The results indicate that individuals' discount factors are much lower than those estimated for a United States sample. Also, respondents' intertemporal preferences for saving lives are characterized by a nonexponential discount function. We conclude that the discounting practices currently used in standard economic analyses of development projects are probably poor representations of individuals' actual intertemporal preferences.Time preference

The value of preventing malaria in Tembien, Ethiopia

The authors measure the monetary value households place on preventing malaria in Tembien, Tigray Region, Ethiopia. They estimate a household demand function for a hypothetical malaria vaccine and compute the value of preventing malaria as the household's maximum willingness to pay to provide vaccines for all family members. They contrast willingness to pay with the traditional costs of illness (medical costs and time lost because of malaria). Their results indicate that the value of preventing malaria with vaccines is about US$36 a household a year, or about 15 percent of imputed annual household income. This is, on average, about two or three times the expected household cost of illness. Despite the great benefits from preventing malaria, the fact that vaccine demand is price inelastic suggests that it will be difficult to achieve significant market penetration unless the vaccine is subsidized. The authors obtain similar results for insecticide-treated bed nets. Their estimates of household demand functions for bed nets suggest that at a price that might permit cost recovery (US$6 a bed net), only a third of the population of a 200-person village would sleep under bed nets.Early Child and Children's Health,Public Health Promotion,Disease Control&Prevention,Health Monitoring&Evaluation,Economic Theory&Research,Health Monitoring&Evaluation,Economic Theory&Research,Climate Change,Environmental Economics&Policies,Early Child and Children's Health

Cost-Effectiveness of New-Generation Oral Cholera Vaccines: A Multisite Analysis

Objectives: We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, using recently collected data from four developing countries where cholera is endemic. Our analysis incorporated new findings on vaccine herd protective effects. Methods: Using data from Matlab, Bangladesh, Kolkata, India, North Jakarta, Indonesia, and Beira, Mozambique, we calculated the net public cost per disability-adjusted life year avoided for three immunization strategies: 1) school-based vaccination of children 5 to 14 years of age; 2) school-based vaccination of school children plus use of the schools to vaccinate children aged 1 to 4 years; and 3) community-based vaccination of persons aged 1 year and older. Results: We determined cost-effectiveness when vaccine herd protection was or was not considered, and compared this with commonly accepted cutoffs of gross domestic product (GDP) per person to classify interventions as cost-effective or very-cost effective. Without including herd protective effects, deployment of this vaccine would be cost-effective only in school-based programs in Kolkata and Beira. In contrast, after considering vaccine herd protection, all three programs were judged very cost-effective in Kolkata and Beira. Because these cost-effectiveness calculations include herd protection, the results are dependent on assumed vaccination coverage rates. Conclusions: Ignoring the indirect effects of cholera vaccination has led to underestimation of the cost-effectiveness of vaccination programs with oral cholera vaccines. Once these effects are included, use of the oral killed whole cell vaccine in programs to control endemic cholera meets the per capita GDP criterion in several developing country settings

Can Weak Substitution be Rehabilitated?

This paper develops a graphical analysis and an analytical model that demonstrate how weak substitution can be used for non-market valuation. Both weak complementarity and weak substitution can be evaluated as restrictions that allow quantity or quality changes in non-market goods to be described as price changes that yield equivalent changes in individual well being. They are Hicksian equivalents in that the price changes yield the same utility changes as would the quantity or quality changes. After discussion of several potential applications of weak substitution, the paper develops the parallel between the restriction and recent strategies from modeling differentiated goods.

Potent, Selective, and Membrane Permeable 2-Amino-4-Substituted Pyridine-Based Neuronal Nitric Oxide Synthase Inhibitors.

A series of potent, selective, and highly permeable human neuronal nitric oxide synthase inhibitors (hnNOS), based on a difluorobenzene ring linked to a 2-aminopyridine scaffold with different functionalities at the 4-position, is reported. In our efforts to develop novel nNOS inhibitors for the treatment of neurodegenerative diseases, we discovered 17, which showed excellent potency toward both rat (Ki 15 nM) and human nNOS (Ki 19 nM), with 1075-fold selectivity over human eNOS and 115-fold selectivity over human iNOS. 17 also showed excellent permeability (Pe = 13.7 × 10-6 cm s-1), a low efflux ratio (ER 0.48), along with good metabolic stability in mouse and human liver microsomes, with half-lives of 29 and >60 min, respectively. X-ray cocrystal structures of inhibitors bound with three NOS enzymes, namely, rat nNOS, human nNOS, and human eNOS, revealed detailed structure-activity relationships for the observed potency, selectivity, and permeability properties of the inhibitors

Identification and Development of User Requirements to Support Robust Corridor Investment Models

The purpose of the project was to develop useable techniques to integrate a broader range of potential impacts of transportation investments into transportation planning and decision-making. The research project described in this report developed a multi-attribute framework that can be used to assist in organizing and synthesizing information to measure costs and benefits, both monetary and non-monetary, of highway corridor investments. A modular approach was taken to developing individual techniques to quantify the potential impacts that could be utilized within the framework. The framework is flexible enough to accommodate the incorporation of additional techniques over time. To determine the range of potential impacts to consider, the values and needs of various stakeholders in highway corridors were taken into account and incorporated into variables, or indicators, to be used in a comprehensive system for evaluating impacts, costs, and benefits. Example techniques include a consideration and demonstration of the utility of geographic information systems (GIS) to organize data for use with the hedonic land valuation method. A prediction map was generated from this process, indicating the price consumers are willing to pay for a house in relation to its location with respect to highway corridors. This information is useful in analyzing the impact of competing corridor alternatives. In order to measure other indicators, the project also assessed the utility of high-resolution satellite remote sensing (RS) image data to provide highly accurate inputs necessary for economic models and as a means of measuring success after investments have been made. A methodology was developed to identify commercial and industrial origins and destinations from impervious surfaces. This, in turn, was translated into a calculation of average travel distances that could be used to quantify accessibility impacts associated with corridor alternatives. Remote sensing and GIS were assessed because of the spatial nature of transportation investments and their potential as a measuring tool for the transportation indicators. This multi-attribute framework is consistent with the Missouri Department of Transportation\u27s (MoDOT\u27s) overall planning direction of including the perspectives of more individuals/groups and potential impacts in decision making. This overall planning direction is seen in the Planning Framework and the Long-Range Transportation Plan (LRTP)

Costs of Illness Due to Typhoid Fever in an Indian Urban Slum Community: Implications for Vaccination Policy

Data on the burden of disease, costs of illness, and cost-effectiveness of vaccines are needed to facilitate the use of available anti-typhoid vaccines in developing countries. This one-year prospective surveillance was carried out in an urban slum community in Delhi, India, to estimate the costs of illness for cases of typhoid fever. Ninety-eight culture-positive typhoid, 31 culture-positive paratyphoid, and 94 culture-negative cases with clinical typhoid syndrome were identified during the surveillance. Estimates of costs of illness were based on data collected through weekly interviews conducted at home for three months following diagnosis. Private costs included the sum of direct medical, direct non-medical, and indirect costs. Non-patient (public) costs included costs of outpatient visits, hospitalizations, laboratory tests, and medicines provided free of charge to the families. The mean cost per episode of blood culture-confirmed typhoid fever was 3,597 Indian Rupees (US$ 1=INR 35.5) (SD 5,833); hospitalization increased the costs by several folds (INR 18,131, SD 11,218, p<0.0001). The private and non-patient costs of illness were similar (INR 1,732, SD 1,589, and INR 1,865, SD 5,154 respectively, p=0.8095). The total private and non-patient ex-ante costs, i.e. expected annual losses for each individual, were higher for children aged 2-5 years (INR 154) than for those aged 5-19 years (INR 32), 0-2 year(s) (INR 25), and 19-40 years (INR 2). The study highlights the need for affordable typhoid vaccines efficacious at 2-5 years of age. Currently-available Vi vaccine is affordable but is unlikely to be efficacious in the first two years of life. Ways must be found to make Vi-conjugate vaccine, which is efficacious at this age, available to children of developing-countries

A Cost-Benefit Analysis of Typhoid Fever Immunization Programmes in an Indian Urban Slum Community

Many economic analyses of immunization programmes focus on the benefits in terms of public-sector cost savings, but do not incorporate estimates of the private cost savings that individuals receive from vaccination. This paper considers the implications of Bahl et al.'s cost-of-illness estimates for typhoid immunization policy by examining how community-level incidence estimates and information on distribution of costs of illness among patients and the public-health sector can be used in the economic analysis of vaccination-programme options. The findings illustrate why typhoid vaccination programmes may often appear to be unattractive to public-health officials who adopt a public budgetary perspective. Under many plausible sets of assumptions, public-sector expenditure on typhoid vaccination does not yield comparable public-sector cost savings. If public-health officials adopt a societal perspective on the economic benefits of vaccination, there are many situations in which different vaccination programmes will make economic sense. The findings show that this is especially true when public decision-makers recognize that (a) the incidence of typhoid fever is underestimated by blood culture-positive cases and (b) avoided costs of illness represent a significant underestimate of the actual economic benefits to individuals of vaccination

Costs of Illness Due to Typhoid Fever in an Indian Urban Slum Community: Implications for Vaccination Policy

Data on the burden of disease, costs of illness, and cost-effectiveness of vaccines are needed to facilitate the use of available anti-typhoid vaccines in developing countries. This one-year prospective surveillance was carried out in an urban slum community in Delhi, India, to estimate the costs of illness for cases of typhoid fever. Ninety-eight culture-positive typhoid, 31 culture-positive paratyphoid, and 94 culture-negative cases with clinical typhoid syndrome were identified during the surveillance. Estimates of costs of illness were based on data collected through weekly interviews conducted at home for three months following diagnosis. Private costs included the sum of direct medical, direct non-medical, and indirect costs. Non-patient (public) costs included costs of outpatient visits, hospitalizations, laboratory tests, and medicines provided free of charge to the families. The mean cost per episode of blood culture-confirmed typhoid fever was 3,597 Indian Rupees (US$ 1=INR 35.5) (SD 5,833); hospitalization increased the costs by several folds (INR 18,131, SD 11,218, p&lt;0.0001). The private and non-patient costs of illness were similar (INR 1,732, SD 1,589, and INR 1,865, SD 5,154 respectively, p=0.8095). The total private and non-patient ex-ante costs, i.e. expected annual losses for each individual, were higher for children aged 2-5 years (INR 154) than for those aged 5-19 years (INR 32), 0-2 year(s) (INR 25), and 19-40 years (INR 2). The study highlights the need for affordable typhoid vaccines efficacious at 2-5 years of age. Currently-available Vi vaccine is affordable but is unlikely to be efficacious in the first two years of life. Ways must be found to make Vi-conjugate vaccine, which is efficacious at this age, available to children of developing-countries