Educational Screening and Occupational Earnings

The educational screening hypothesis states that beyond a certain point schooling functions as a signaling device to identify pre-existing talents. We test for the presence of screening by comparing the schooling and earnings of self-employed workers and of those employed by others in a sample set of occupations. We expect those employed by others to pursue additional schooling to signal prospective employers. We expect self-employed managers to acquire no additional schooling for signaling purposes. We expect other self-employed workers to obtain additional schooling to signal potential customers. Our empirical results, based on 1970 Census data, strongly support the case for screening. However, the relative magnitude of the screening portion of schooling is relatively modest, lying between approximately 5 and 10 percent.

Football\u27s world cup and its fans - reflections on national styles : a photo essay on Germany 2006

The football World Cup is the greatest multicultural sporting extravaganza of modern times. The notion of post-fandom tries to capture the ways in which fans now participate in and engage in self-aware and reflexive strategies to obtain their desired outcomes from attendance at or viewing such major events. This illustrated photo-essay on the World Cup looks at the experiences and behaviour of fans in three countries, Scotland, Germany and Australia, during the tournament with a view to extending our understanding of the relationships between fans and others temporarily interested in the World Cup and the promoters of such mega-events. It argues that the participants brought a wide range of expectations to the tournament and engaged in highly flexible and innovative approaches to ensure that they gained the maximum benefit, individually and collectively, from the experience. <br /

Cost and Utilization Impacts of Oral Antihistamines in the California Medi-Cal Program

AbstractObjectivesNewer oral allergic rhinitis (AR) medications, the second-generation antihistamines (SGAs) have gained widespread acceptance because of their efficacy and reduced side effects relative to first-generation antihistamines (FGAs). There are no empirical studies comparing the costs of treatment of SGAs relative to FGAs.MethodsWe analyzed data from a 20% beneficiary sample (approximately 120,000 continuously enrolled beneficiaries per year) for the Medi-Cal Fee-for-Service program during 1999 to 2000. AR medications available under Medi-Cal included three SGA medications (loratadine, fexofenadine, and cetirizine) and over 200 FGA products containing either diphenhydramine or chlorpheniramine or both. Because multiple medications were evaluated, a sample selection model was estimated using a two-stage multinomial logistic—variance components regression framework.ResultsSGA medications have significantly lower total direct health-care treatment costs per patient than FGA medications with costs ranging from $347 to$448 less (P < 0.001), despite higher AR medication costs. Total drug expenditures were also not significantly different for patients using SGA or FGA medications despite SGA prescriptions averaging $47 higher than FGAs. Emergency department visits, inpatient admissions and physician office visits were also significantly lower for patients using SGA medications.ConclusionsSignificant cost and utilization reductions were associated with all of the SGA medications relative to FGA drugs, despite their higher acquisition costs. If facing higher copayments for prescription AR drugs, many patients, particularly lower income patients, may choose cheaper over-the-counter (OTC) FGAs rather than SGAs. Our analysis finds this might lead to increased overall health-care treatment costs, unless Medicaid and health insurance plans subsidize OTC AR medications

When intuition falters: repeated testing accuracy during an epidemic

Widespread, repeated testing using rapid antigen tests to proactively detect asymptomatic SARS-CoV-2 infections has been a promising yet controversial topic during the COVID-19 pandemic. Concerns have been raised over whether currently authorized lateral flow tests are sufficiently sensitive and specific to detect enough infections to impact transmission whilst minimizing unnecessary isolation of false positives. These concerns have often been illustrated using simple, textbook calculations of positivity rates and positive predictive value assuming fixed values for sensitivity, specificity and prevalence. However, we argue that evaluating repeated testing strategies requires the consideration of three additional factors: new infections continue to arise depending on the incidence rate, isolating positive individuals reduces prevalence in the tested population, and each infected individual is tested multiple times during their infection course. We provide a simple mathematical model with an online interface to illustrate how these three factors impact test positivity rates and the number of isolating individuals over time. These results highlight the potential pitfalls of using inappropriate textbook-style calculations to evaluate statistics arising from repeated testing strategies during an epidemic

Characterizing the Validity and Real-World Utility of Health Technology Assessments in Healthcare: Future Directions; Comment on “Problems and Promises of Health Technologies: The Role of Early Health Economic Modelling”

With their article, Grutters et al raise an important question: What do successful health technology assessments (HTAs) look like, and what is their real-world utility in decision-making? While many HTAs are published in peer-reviewed journals, many are considered proprietary and their attributes remain confidential, limiting researchers’ ability to answer these questions. Models for economic evaluations like cost-effectiveness analyses (CEAs) synthesize a wide range of evidence, are often statistically and mathematically sophisticated, and require untestable assumptions. As such, there is nearly universal agreement among researchers that enhancing transparency is an important issue in health economic modeling. However, the definition of transparency and guidelines for its implementation vary. Model registration combined with a linked database of model-based economic evaluations has been proposed as a solution, whereby registered models and their accompanying technical and nontechnical documentation are sourced into a single publicly-available repository, ideally in a standardized format to ensure consistent and complete representation of features, code, data sources, results, validation exercises, and policy recommendations. When such a repository is ultimately created, modelers will not have to reinvent the wheel for every new drug launched or new treatment pathway. These more open and transparent approaches will have substantial implications for model accuracy, reliability, and validity, improving trust and acceptance by healthcare decision-makers

802-6 The Cost-Effectiveness of Pravastatin in Secondary Prevention of Coronary Heart Disease

To determine the cost-effectiveness of pravastatin therapy in patients with coronary heart disease, a projected risk model was developed that used the results of the three-year, double blind, placebo controlled clinical trials: Pravastatin Limitation ofAtherosclerosis in the Coronary Arteries (PLAC I) and Pravastatin, Upids and Atherosclerosis in the Carotid Arteries (PLAC II). In addition to measuring atherosclerotic progression, the PLAC studies evaluated four outcome variables: coronary heart disease death, non-coronary heart disease death, fatal myocardial infarction, and non-fatal myocardial infarction in a patient population (mean age 60 years) with established coronary heart disease and moderate low-density-lipoprotein cholesterol levels, Pooled PLAC data analysis (n=559) revealed a statistically significant (p&lt;0.05) difference in male non-fatal myocardial infarctions between the pravastatin and placebo groups. The projected risk model utilized Framingham data to project the risk of mortality 10 years post myocardial infarction. Markov Process was used to estimate the life-years saved and cost. All costs and benefits were discounted by 5%, Results are presented in the table below:Patient Risk ProfileCost per Life-Year SavedMale with CHD + 1Additional Risk Factor$19,082Male with CHD + 2 Additional Risk Factors$14,022Male with CHD + 3 Additional Risk Factors$10,630Based on this model, pravastatin monotherapy in secondary prevention of coronary heart disease has a cost-effectiveness ratio comparable to some of the widely accepted medical interventions such as breast cancer screening,$21,700, hydrochlorothiazide in the treatment of hypertension, $16,400, and pneumococcal vaccine,$12,000

Good Research Practices for Measuring Drug Costs in Cost-Effectiveness Analyses: A Managed Care Perspective: The ISPOR Drug Cost Task Force Report—Part III

AbstractObjectivesThe objective of this report is to provide guidance and recommendations on how drug costs should be measured for cost-effectiveness analyses conducted from the perspective of a managed care organization (MCO).MethodsThe International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force on Good Research Practices—Use of Drug Costs for Cost Effectiveness Analysis (DCTF) was appointed by the ISPOR Board of Directors. Members were experienced developers or users of CEA models. The DCTF met to develop core assumptions and an outline before preparing a draft report. They solicited comments on drafts from external reviewers and from the ISPOR membership at ISPOR meetings and via the ISPOR Web site.ResultsThe cost of a drug to an MCO equals the amount it pays to the dispenser for the drug's ingredient cost and dispensing fee minus the patient copay and any rebates paid by the drug's manufacturer. The amount that an MCO reimburses for each of these components can differ substantially across a number of factors that include type of drug (single vs. multisource), dispensing site (retail vs. mail order), and site of administration (self-administered vs. physician's office). Accurately estimating the value of cost components is difficult because they are determined by proprietary and confidential contracts.ConclusionEstimates of drug cost from the MCO perspective should include amounts paid for medication ingredients and dispensing fees, and net out copays, rebates, and other drug price reductions. Because of the evolving nature of drug pricing, ISPOR should publish a Web site where current DCTF costing recommendations are updated as new information becomes available

Aboveground Storage Tank Floor Corrosion Condition Assessment

The floors of aboveground storage tanks remaina most difficult part of the vessel to inspect forcorrosion damage. Generally, this section of the tankis inaccessible from the outside for conventionalnondestructive testing (NDT) and the costs ofopening the vessel and preparing it for an internalinspection including cleaning, purging and loss ofproduction availability create a significant financialburden for the tank owner or operator. An advancedNDT method with the capability of assessing thecondition of the tank floor without opening thetank is acoustic emission (AE) monitoring1. The AEmethod requires installation of sensors on the outsidewall of the tank and monitors the floor passively forcorrosion damage and its extreme case of leakingat substantially lower cost. AE monitoring is afront-line inspection method that complements theinternal inspection techniques. When it is integratedas an input to a risk-based maintenance program, itprovides both an enhanced level of tank reliabilityand significant cost savings over time-basedperiodically scheduled internal inspections2,3. Thispaper provides an overview of the AE inspectionmethod as applied to tank-bottom plate conditionassessment, a brief description of its use in a riskbasedmaintenance program including a case studyof the practical use of AE monitoring for tankbottom inspection