Search

Abstract: Aims: To inform the transferability of tobacco control‐related economic evidence to resource‐poor countries. Methods: We ran a univariate sensitivity analysis on a return on investment (ROI) model, the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), to identify key input values to which the ROI estimates were sensitive. The EQUIPTMOD used a Markov‐based state transition model to estimate the ROI of several tobacco control interventions in five European countries (England, Germany, Spain, Hungary and the Netherlands). Base case ROI estimates were obtained through average values of model inputs (throughout the five countries), which were then replaced one at a time with country‐specific values. Tornado diagrams were used to evaluate the significance of sensitivity, defined as a ≥ 10% difference in ROI estimates from the base case estimates. Results: The ROI estimates were sensitive to 18 (of 46) input values. Examples of model inputs to which ROI estimates were sensitive included: smoking rate, costs of smoking‐related diseases (e.g. lung cancer) and general population attributes. Conclusion: Countries that have limited research time and other resources can adapt EQUIPTMOD to their own settings by choosing to collect data on a small number of model inputs. EQUIPTMOD can therefore facilitate transfer of tobacco control related economic evidence to new jurisdictions. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. Methods: The EQUIPTMOD, a Markov‐based economic model, was used to assess the cost‐effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group‐based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life‐time costs and quality‐adjusted life years (QALYs) were calculated from a health‐care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost‐effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. Results: Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health‐care cost‐savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost‐savings increased to €14.1598 per smoker. Doubling the reach of existing group‐based behavioural support therapies and proactive telephone support resulted in health‐care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. Conclusions: According to the EQUIPTMOD modelling tool, it would be cost‐effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group‐based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess the cost‐effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). Design: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov‐based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self‐helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life‐time costs and benefits. Setting: Spain. Participants: Adult smoking population (16+ years). Measurements: Health‐care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality‐adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. Findings: The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life‐time benefit–cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost‐saving: less expensive to run and generated more QALYs) from the life‐time perspective, compared with the current provision. The life‐time benefit–cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline‐standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. Conclusions: According to the EQUIPTMOD modelling tool it would be cost‐effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro‐active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany. Design: A Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. Setting: Germany. Participants: Cohort of current smoking population (18+ years) in Germany. Interventions: Interventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. Measurements: EQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment. Findings: The highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1. Conclusions: Increasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective. [ABSTRACT FROM AUTHOR]

The electric utility industry is in transition but needs to move even faster if the country is to meet its emissions goals. The industry has historically moved cautiously, but policies and regulatory approaches must avoid unintentionally reinforcing the status quo. Incentive‐oriented policies and redesigned regulations must balance environmental sustainability with economic sustainability. The authors draw on well‐established corporate finance principles to guide more effective policies. Shareholder‐focused utility executives must make investments conditioned by three elements: (1) the return on equity the utility can expect to make on each project; (2) the investors' required return on equity capital for each project; and (3) the size of the investment. The well‐established economic value added (EVA) model can assist policy analysis: V=(r‐k)I; where V is the shareholder value created, r is the return on equity, k is the return investors require if they are to invest in the stock, and I is the scale of the project. Any new incremental V translates into higher stock prices. All three elements of their model (i.e., risk, return, and scale) require attention by regulators and policymakers to create value for shareholders. The authors show how the right state policies could create powerful incentives for shareholder focused utility executives to support such transitions. [ABSTRACT FROM AUTHOR]

This paper examines the impacts of agricultural cooperative membership on output price, gross income, farm profit, and return on investment (ROI) utilizing a recent household survey data of 481 apple producers in China. We employ a treatment effects model to account for potential selection bias that arises from the fact that cooperative members and nonmembers are systematically different in terms of both observable and unobservable factors. Our analysis reveals that cooperative membership has a positive and statistically significant impact on apple price, gross income, farm profit, and ROI. In addition, we find that the highest profit effect of cooperative membership does not in fact result in the highest ROI effect of the membership, revealing differences in farm income and profitability of investment. [EconLit citations: C35, D71, Q12, Q13]. [ABSTRACT FROM AUTHOR]

We compare effects of research quality and quantity on the salary of academics in agricultural economics and economics departments of the same universities. Agricultural economists get a significantly lower payoff to research quality, whether measured by quality-weighted journal articles (based on nine different weighting schemes) or by citations. Instead, salary depends on the quantity of journal articles, while article counts have no independent effect on economist salaries. These differences in the reward structure for research are not due to either the extension focus of agricultural economists or to disciplinary differences in publishing with students and instead may reflect institutional factors that govern incentives within universities. One-third of academics in the agricultural economics departments studied here have doctoral training in economics; the very different disciplinary reward structures may cause frustration for these faculty due to the muted returns to research quality that agricultural economics departments seem to offer. [ABSTRACT FROM AUTHOR]

We transform financial return series into its frequency and time domain via wavelet decomposition to separate short-run noise from long-run trends and assess the relevance of each frequency to value-at-risk (VaR) forecast. Furthermore, we analyze financial assets in calm and turmoil market times and show that daily 95% VaR forecasts are mainly driven by the volatility that is captured by the first scales comprising the short-run information, whereas more timescales are needed to adequately forecast 99% VaR. As a result, individual timescales linked via copulas outperform classical parametric VaR approaches that incorporate all information available. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In an endogenous growth model with information asymmetry between the government and the bureaucracy, the bureaucrats can falsely report of high-quality high-cost procurement, while providing low-quality low-cost product. This reduces the quality of public services, but inflates the public spending, which in effect reduces growth. We test our results by using three-stage least squares method in a panel set up for a system of four equations on growth, public investment, corruption and private investment. Our primary results are twofold. First, corruption increases public investment. Second, corruption reduces the returns to public investment and makes it ineffective in raising economic growth. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision‐makers need tools to assess the Return on Investment (ROI)/cost‐effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. Methods: EQUIPTMOD uses a Markov model to estimate life‐time costs, quality‐adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country‐specific rates. Results: For illustration, over a life‐time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease‐related health care costs than if the smoker ceased smoking in the next 12 months. For all age–sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued. Conclusions: EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Estimating ‘return on investment’ (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool ( http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. Methods: Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. Findings: Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single‐form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster‐acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face‐to‐face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self‐help materials (1%). There was insufficient evidence to obtain reliable, country‐specific estimates for interventions such as websites, smartphone applications and e‐cigarettes. Conclusions: Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions. [ABSTRACT FROM AUTHOR]