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The article invites authors to submit papers in any field of law and economics. Any papers on this field are welcome but applied works focusing on European themes in law and economics will be better. The papers will be featured in the 20th Consecutive Workshop in Law and Economics which will be held from April 4-5, 2007 at University of Erfurt in Germany.

The canonical economic literature on path dependence provides only a limited explanation of why and how new technological pathways are created initially. The motivation of this paper is to address this gap in the literature and argue that evolutionary economics theories of path dependence need to be linked with sociological explanations of how new technological pathways are created in the first instance by knowledgeable inventors and innovators. These arguments are developed by the authors in a hybrid socio-economic theory of new path creation. In this paper these theoretical arguments are illustrated empirically by a comparative analysis of the introduction and diffusion of new wind power technologies in Britain and Germany. The empirical analysis focuses on the key research question of why the introduction of these new technologies started earlier and has diffused sooner in Germany than in Britain. [ABSTRACT FROM AUTHOR]

In this paper, we estimate the effect of different macro and micro variables on the distribution of unemployment duration in West Germany using censored quantile regressions. We analyze unemployment periods of more than 91,000 observations from the years 1981 to 1997 drawn from the IAB employment subsample. The latter is an administrative data set that is representative with respect to the socially insured workforce. Surprisingly, we find that the educational degree and variables indicating the macroeconomic environment such as the unemployment rate have a weak effect only. On the other hand, variables reflecting the (un-)employment history of an individual such as the length of tenure, recall to the same employer in the past, recent unemployment, and the position in the population income distribution before unemployment have the strongest effects on unemployment duration. We conclude that work history variables are the ones most suitable in characterizing the unemployment duration of an individual. From a methodological point of view, it is interesting that some regression coefficients have a different sign depending on the quantiles of the unemployment duration distribution. This clearly is a violation of the classical proportional hazard assumption which is very common in unemployment duration analysis. [ABSTRACT FROM AUTHOR]

We define international technological specialisation (ITS) as the technological performance of a country in a specific technology relative to its overall international technological performance. This paper uses patent applications and patent citations at the European Patent Office for five countries (US, UK, Italy, France, Germany) from 1989 to 1994 for 135 technological classes in three industrial sectors (Chemicals, Electronics and Machinery). It shows that ITS is significantly persistent and is affected by the direction of cross-sectoral knowledge spillovers within countries. In addition, the paper shows that the concentration of innovative activities, the emergence of new innovators and technological co-operation positively affect ITS. Some differences across sectors emerge. Keywords: Technological specialization; Knowledge spillover; Market structure [ABSTRACT FROM AUTHOR]

Using a dataset of 3540 economists working in 2007 in 125 of the best academic centers in 22 countries, this paper presents some evidence on spatial mobility patterns in Spain and other countries conditional on some personal, department, and country characteristics. There are productivity and other reasons for designing a scientific policy with the aims of attracting foreign talent (brain gain), minimizing the elite brain drain, and recovering nationals who have earned a Ph.D. or have spent some time abroad (brain circulation). Our main result is that Spain has more brain gain, more brain circulation and less brain drain than comparable large, continental European countries, i.e., Germany, France, and Italy, where economists have similar opportunities for publishing their research in English or in their own languages. We suggest that these results can be mostly explained by the governance changes introduced in a number of Spanish institutions in 1975–1990 by a sizable contingent of Spanish economists coming back home after attending graduate school abroad. These initiatives were also favored by the availability of resources to finance certain research-related activities, including international Ph.D. programs. [ABSTRACT FROM AUTHOR]

Landslide impacts on infrastructure and society in the Federal Republic of Germany are associated with damage costs of about US$300 million on annual average. Despite the large overall losses due to widespread landslide activity, there is a lack of historical impact assessments, not just for Germany's low mountain areas but those of entire Central Europe as well. This paper is a collection of three case studies from Germany that seek a better understanding of landslide impacts and their economic relevance at local and regional level. The first case study investigates damage types and mitigation measures at a representative landslide site in ways that support to gain insight into historical hazard interactions with land use practices. This case history is followed by a case study dealing with fiscal cost impacts of landslide damages for an example city and the highway system of the Lower Saxon Uplands, NW Germany. In addition to a cost-burden analysis for affected public budgets, an overview of the principles of disaster financing in landslide practice is given. The third case study is focused on the conflicts of urban development in hazard areas, with an economic approach to balancing safety and public welfare interests. Each case study is based on historical data sets extracted from Germany's national landslide database. This paper presents three different case studies that in combination are a first step towards assessing landslide impacts in integrated perspective. [ABSTRACT FROM AUTHOR]

The paper aims to account for the empirical stylized facts related to changes in sectoral structures that have led to the growth of services in most advanced countries over recent decades. A growth model with evolutionary micro–founded structural change is developed, which formalizes the role of technical change and changes in intermediate demand as they affect the evolution of the sectoral composition of the economy and macro-economic growth. The simulated results are based on the use of the actual data, including Input–Output coefficients in the case of Germany. Three scenarios are identified, which account for the effects of a set of key parameters on changes in the structure of the economy. [ABSTRACT FROM AUTHOR]

This paper studies the long-run relationship between consumption, asset wealth and income—the consumption–wealth ratio—based on German data from 1980 to 2003. We find that departures from this long-run relationship mainly predict adjustments in income. The German consumption–wealth ratio also contains considerable forecasting power for a range of business cycle indicators, including the unemployment rate. This finding is in contrast to earlier studies for some of the Anglo-Saxon economies that have shown that the consumption–wealth ratio reverts to its long-run mean mainly through subsequent adjustments in asset prices. While the German consumption wealth ratio contains little information about future changes in German asset prices, we report that the U.S. consumption–wealth ratio has considerable forecasting power for the German stock market. One explanation of these findings is that in Germany—due to structural differences in the financial and pension systems—the share of publicly traded equity in aggregate household wealth is much smaller than in the Anglo-Saxon countries. We discuss the implications of our results for the measurement of a potential wealth effect on consumption. [ABSTRACT FROM AUTHOR]

This paper analyses how fiscal adjustment comes about when both central and sub-national governments are involved in consolidation. We test sustainability of public debt with a fiscal rule for both federal and regional government. Results for the German Länder show that lower tier governments bear a relatively smaller part of the burden of debt consolidation, if they consolidate at all. Most of the fiscal adjustment occurs via central government debt. In contrast, both the US federal and state levels contribute to consolidation of public finances. [ABSTRACT FROM AUTHOR]

Since the seminal contribution of McCallum (1995) economists have tried to estimate the border effect for other countries than the United States and Canada, but have been confronted with a key data problem: data on regional trade flows are extremely rare. The different approaches put forward to overcome this lack of information have been shown to hinge crucially on certain distance measures. The main purpose of this paper is to develop a method that allows us determining border effects with a high degree of accuracy in the absence of intra-national trade data. We show how to improve the estimation of border effects with the example of France and Germany using data on regional transportation flows. Our results indicate that France trades about eight times more and Germany about three times more with itself than with other EU countries, respectively, compared to the predictions of the gravity equation. [ABSTRACT FROM AUTHOR]

The paper derives production functions designed to model the evolution of service industries. The derivation is based on specifying the output elasticities of the factors according to differential equations and asymptotic technological boundary conditions in factor space. The derived functional forms incorporate labor, capital, energy, and technology parameters, whose time changes model innovation and structural change. The model is applied to the evolution of the German market-determined services 1960–1989. [ABSTRACT FROM AUTHOR]

Objective: The goal of the present paper is to provide evidence on the behavior of physician practice cost functions.Data Sources: Our study is based on the data of 3686 physician practices in Germany for the years 2006 to 2008.Study Design: We apply a translog functional form and include a comprehensive set of variables that have not been previously used in this context. A system of four equations using three-stage least squares is estimated.Principal Findings: We find that a higher degree of specialization leads to a decrease in costs, whereas quality certification increases costs. Costs of group practices are higher than of solo practices. The latter finding can be explained by the existence of indivisibilities of expensive technical equipment. Smaller practices do not reach the critical mass to invest in certain technologies, which leads to differences in the type of health care services provided by different practice types.Conclusions: This is the first study to use physician practices as the unit of observation and to consider the endogenous character of physician input. Our results suggest that identifying factors that influence physician practice costs is important for providing evidence-based physician payment systems and to enable decision-makers to set incentives effectively. [ABSTRACT FROM AUTHOR]

This paper investigates the German car scrappage program, focusing on the incidence of the premium. We ask how much of the €2500 ($3500) buyer subsidy is actually captured by the demand side. More precisely, we analyze the program's impact on different car segments, allowing for heterogeneity in incidence at different points in the vehicle price distribution. Using a unique microtransaction data set, we find that the incidence of the subsidy strongly and significantly varies across price segments. Subsidized buyers of cheap cars paid a little more than comparable buyers who did not receive the subsidy, indicating incidence amounts slightly below 100 %. For more expensive vehicles, subsidized buyers were granted large extra discounts on top of the government premium, translating into incidence amounts considerably greater than 100 %. Taken together, this results in an aggregate incidence amount of up to plus €350 million, suggesting that the positive effect for expensive cars overcompensates the negative effect for small cars. [ABSTRACT FROM AUTHOR]

This paper contains a brief description of the methodological approach to economic fluctuations developed by Arthur F. Burns and Wesley C. Mitchell at the National Bureau of Economic Research. Applying this methodology to growth cycles of the West German economy gives rise to a large number of stylized facts which serve as the basis of Adelman tests. Growth cycle implications of two prototypical Real-Business-Cycle models are derived by simulations. Unlike most of the literature, a comparison between model and data statistics produces overwhelming evidence against the Real Business Cycle models. [ABSTRACT FROM AUTHOR]

In response to the growing burden of obesity, public primary prevention programs against obesity have been widely recommended. Several studies have estimated the cost-effectiveness of diabetes-prevention trials for different countries. Nevertheless, it is still controversial if prevention conducted in more real-world settings and among people with increased risk but not yet exhibiting increased glucose tolerance can be a cost-saving strategy to cope with the obesity epidemic. We examine this question in a simulation model based on the results of the M.O.B.I.L.I.S program, a German lifestyle intervention to reduce obesity, which is directed on the high-risk group of people who are already obese. The contribution of this paper is the use of 4-year follow-up data on the intervention group and a comparison with a control group formed by SOEP respondents as inputs in a Markov model of the long-term cost savings through this intervention due to the prevention of type 2 diabetes. We show that from the point of view of a health insurer, these programs can pay for themselves. [ABSTRACT FROM AUTHOR]

This paper presents a new methodology for ex post assessment of direct landslide costs for transportation infrastructures. The methodology includes tools to compile, model, and extrapolate landslide losses on different spatial scales over time. A landslide susceptibility model enables regional cost extrapolation by means of a cost figure obtained from local cost compilation for a representative case study area. On a local level, cost survey is closely linked with cost modeling, a toolset for cost estimation based on landslide databases. Cost modeling uses landslide disaster management process models (LDMMs) and cost modules to simulate and monetize cost factors for certain types of landslide damage. The landslide susceptibility model provides a regional exposure index and updates the cost figure to a cost index which describes the costs per kilometer of traffic route at risk of landslides. Both indexes enable the regionalization of local landslide losses. The methodology is applied and tested in a cost assessment for highways in the Lower Saxon Uplands, NW Germany, in the period 1980 to 2010. In this 7,400-km large mountain region, 77 km of highway is located in landslide hazard area. Annual average costs of US$52,000 per km of highway at risk of landslides are identified as cost index for a local case study area. The cost extrapolation results in annual average costs for highways in the Lower Saxon Uplands of US$4.02 million. This test application as well as a validation of selected modeling tools verifies the functionality of this methodology. [ABSTRACT FROM AUTHOR]

The availability of electric power is an important prerequisite for the development or maintenance of high living standards. Global change, including socio-economic change and climate change, is a challenge for those who have to deal with the long-term management of thermoelectric power plants. Power plants have lifetimes of several decades. Their water demand changes with climate parameters in the short and medium term. In the long term, the water demand will change as old units are retired and new generating units are built. The present paper analyses the effects of global change and options for adapting to water shortages for power plants in the German capital Berlin in the short and long term. The interconnection between power plants, i.e. water demand, and water resources management, i.e. water availability, is described. Using different models, scenarios of socio-economic and climate change are analysed. One finding is that by changing the cooling system of power plants from a once-through system to a closed-circuit cooling system the vulnerability of power plants can be reduced considerably. Such modified cooling systems also are much more robust with respect to the effects of climate change and declining streamflows due to human activities in the basin under study. Notwithstanding the possible adaptations analysed for power plants in Berlin, increased economic costs are expected due to declining streamflows and higher water temperatures. [ABSTRACT FROM AUTHOR]

This paper discusses aspects related to the green technology sector (GT sector) in Germany. In a first step institutional reforms enabling diffusion of green technologies are analyzed. Cost arguments are also taken into account. In a second step a theoretical model developed by Tanguay et al. (Public Choice 120:1-27, ) is modified in order to evaluate the efficiency of the institutional setting in a political economy framework. The model is able to show that command and control policies (CCPs) are accompanied by cost-inefficiencies depending on the political weight of technology related interests groups. We further come to the result that relatively high marginal production costs may generate suboptimal high diffusion of a certain GT j. For relatively low marginal production costs policy induced demand may also be too low. [ABSTRACT FROM AUTHOR]

This paper analyzes the productivity development in the German public theater sector for the seasons 1991/1992 to 2005/2006. Using a stochastic distance frontier approach that allows decomposing total factor productivity change into different sources, we examine (a) whether Baumol's cost-disease hypothesis is valid in this sector and (b) if so, whether any negative influence of the cost-disease effect on productivity can be compensated by efficiency gains. The findings indicate an increase in real unit labor cost as a result of rising wage rates and thus do support the cost-disease hypothesis. Further, increasing returns to scale are observed for the majority of the theaters, implying that significant efficiency gains can be realized by the exploitation of scale economies. However, because of the increasing unit labor cost and an increasing scale inefficiency, we find an overall decrease in average productivity of about 8% within the sample period. [ABSTRACT FROM AUTHOR]

This paper analyzes the determinants of German exports to the euro area, which is the biggest market for German products. Three conditional error-correction models based on regionally disaggregated data are developed. One specification includes EMU industrial production and a real external value based on consumer prices, the other two use different EMU investment aggregates, the corresponding real external values and a proxy for European market integration to explain exports. The models perform equally well in a number of diagnostic tests. For short-term forecasts, however, the model using industrial production seems to be the best, since it outperforms the other models in terms of one-step ahead out-of-sample forecasts. [ABSTRACT FROM AUTHOR]

This paper examines the German cinema market using time series data covering the period 1950–2002. Applying estimation techniques such as OLS, 2SLS and SUR, we identify interrelations between the number of seats, the average real prices and the demand for movies per capita. Furthermore, we test for the long-run relationship between demand, prices and real income and estimate the elasticity of demand with respect to these variables. [ABSTRACT FROM AUTHOR]

Based on a political-economic perspective, this paper assesses the former GDR-regime's policy of obligatory exchange (Pflichtumtauschsatz). The Pflichtumtausch, one of a wide array of instruments used to collect convertible currency and restrict access to the GDR, is briefly described. Following that, a demand function, relating visits to East Germany on the one hand to the Pflichtumtauschsatz on the other, is estimated. The empirical evidence adduced suggests that visits to the East were considered a normal good. The next question considered is whether the GDR-regime, acting in its role as a monopolist, followed an optimal pricing policy. On both theoretical and empirical grounds this can be rejected. Visits to the East were underpriced. This resulted in a higher number of visits and lower revenue when seen from a profit-maximizing perspective. On the other hand the actual pricing was advantageous with respect to two goals: the deterrence of visits and the collection of convertible currency. Nonetheless, it is clear that the GDR-regime voluntarily restricted its revenue collection from the Pflichtumtausch. This restraint, however, can be seen as its input into a political bargain. As a rule, such "good manners" in the matter of the Pflichtumtausch were more than compensated by interest payments saved in the use of the Swing. The GDR-regime's generosity thus turned out to be a rather expensive good for the West Germans. [ABSTRACT FROM AUTHOR]

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Background: Patient data management systems (PDMS) enable digital documentation on intensive care units (ICU). A commercial PDMS was implemented in a 25-bed ICU replacing paper-based patient charting. The ICU electronic patient record is completely managed inside the PDMS. It compiles data from vital signs monitors, ventilators and further medical devices and facilitates some drug dose and fluid balance calculations as well as data reuse for administrative purposes. Ventilation time and patient severity scoring as well as coding of diagnoses and procedures is supported. Billing data transferred via interface to the central billing system of the hospital. Such benefits should show in measurable parameters, such as documented ventilator time, number of coded diagnoses and procedures and others. These parameters influence reimbursement in the German DRG system. Therefore, measurable changes in cost and reimbursement data of the ICU were expected.Material and Methods: A retrospective analysis of documentation quality parameters, cost data and mortality rate of a 25-bed surgical ICU within a German university hospital 3 years before (2004-2006) and 5 years after (2007-2011) PDMS implementation. Selected parameters were documented electronically, consistently and reproducibly for the complete time span of 8 years including those years where no electronic patient recording was available. The following parameters were included: number of cleared DRG, cleared ventilator time, case mix (CM), case mix index (CMI), length of stay, number of coded diagnoses and procedures, detailed overview of a specific procedure code based on daily Apache II and TISS Core 10 scores, mortality, total ICU costs and revenues and partial profits for specific ICU procedures, such as renal replacement therapy and blood products.Results: Systematic shifts were detected over the study period, such as increasing case numbers and decreasing length of stay as well as annual fluctuations in severity of disease seen in the CM and CMI. After PDMS introduction, the total number of coded diagnoses increased but the proportion of DRG relevant diagnoses dropped significantly. The number of procedures increased (not significantly) and the number of procedures per case did not rise significantly. The procedure 8-980 showed a significant increase after PDMS introduction whereas the DRG-relevant proportion of those procedures dropped insignificantly. The number of ventilator-associated DRG cases as well as the total ventilator time increased but not significantly. Costs and revenues increased slightly but profit varied considerably from year to year in the 5 years after system implementation. A small increase was observed per case, per nursing day and per case mix point. Additional revenues for specific ICU procedures increased in the years before and dropped after PDMS implementation. There was an insignificant increase in ICU mortality rate from 7.4 % in the year 2006 (before) to 8.5 % in 2007 (after PDMS implementation). In the following years mortality dropped below the base level.Conclusion: The implementation of the PDMS showed only small effects on documentation of reimbursement-relevant parameters which were too small to set off against the total investment. The method itself, a long-term follow-up of different parameters proved successful and can be adapted by other organizations. The quality of results depends on the availability of long-term parameters in good quality. No significant influence of PDMS on mortality was found. [ABSTRACT FROM AUTHOR]

We provide new evidence on the efficiency of the Berlin Stock Exchange prior to World War I, when it ranked among the top few markets worldwide by market capitalization. Using a new set of monthly stock price data for a random sample of German companies between 1904 and 1910, we estimate a typical three-factor model and find that returns relate positively to risk (beta), but that book-to-market ratios enter as well (negatively). Firm size and earnings/price ratio relate positively but weakly to returns. The results indicate that the Berlin market did not suffer from unusually large pricing anomalies; thus, its performance was not substantially different from modern markets. Also supporting the conclusion of market efficiency, a momentum portfolio earns returns not different from zero, on average. [ABSTRACT FROM AUTHOR]

This article presents an analysis of whether the decision of officials at German companies to invest abroad is unpatriotic. Many companies are considering shifting parts of their production abroad, and some have already done so. This is an economic policy issue that is being hotly debated. Politicians have called the action unpatriotic and some have called the companies traitors. Generally, it is argued that shifting production in this way entails shifting jobs abroad that are then lost to the German economy. This is not only a one-sided argument, but also erroneous, because it overlooks the positive aspects of corporate expansion abroad and the international division of labor it entails, as well as the question of competition, which are all of great significance. Investment by German companies abroad can allegedly be an important way to maintain and increase competitiveness, and it can also have strong positive effects on the German economy. The foreign capital stock of German firms has risen, especially since 1995. In 2000 that was a volume totaling 570 billion euros. By comparison the capital stock of British firms abroad in the same year was 62.3% of gross domestic product.

In this article I investigate whether the presence of structural breaks affects inference on the order of integration in univariate time series. For this purpose, we make use of a version of the tests of Robinson (1994) which allows us to test unit and fractional roots in the presence of deterministic changes. Several Monte Carlo experiments conducted across the paper show that the tests perform relatively well in the presence of both mean and slope breaks. The tests are applied to annual data on German real GDP, the results showing that the series may be well described in terms of a fractional model with a structural slope break due to World War II. [ABSTRACT FROM AUTHOR]

This paper analyzes the relation between momentum strategies (strategies that buy stocks with high returns over the previous three to twelve months and sell stocks with low returns over the same period) and turnover (number of shares traded divided by the number of shares outstanding) for the German stock market. Our main finding is that momentum strategies are more profitable among high-turnover stocks. In contrast to U.S. evidence, this result is mainly driven by winners: high-turnover winners have higher returns than low-turnover winners. We present various robustness checks, long-horizon results, evidence on seasonality, and control for size-, book-to-market-, and industry-effects. We argue that our results are useful to empirically evaluate competing explanations for the momentum effect. [ABSTRACT FROM AUTHOR]

It is clear there is a shortage of evidence supporting the orthodox wisdom that the German bank based system is superior to the market-based model of firm finance. The fact is we really don't know a lot about how firms behave in these systems and this study emphasizes the need for continued research in this field. EF should note that lack of studies or evidence, is not in itself a sufficient condition to prove anything in science. It can also occur, as is likely the case here, because the topic of study, methodology, or data are relatively new or developing. Currently, the study of firm investment sensitivity to financial constraints under different institutional arrangements is feasible. Developments in economic theory, econometric methodology, and reliable panel data sets, allow us to answer these critical micro level questions about the firm directly. Firm financing and ownership information is also becoming more accessible so that the issues of financing hierarchies, ownership structure, and bank affiliations can be studied rigorously. The challenge in answering these critical questions about firm behavior in an international context is to address these important questions with the appropriate models, methods, and data. Banks, Finance, and Investment in Germany is a valuable resource which provides a comprehensive and systematic review of the orthodox view on German bank-firm relationships. It succeeds by pointing out that the actual evidence to support the orthodox view is rather weak and sometimes contradictory. It not only outlines the debate, but challenges us to extend our research goals. It clarifies what questions we should be asking and indicates some important directions for future research. [ABSTRACT FROM AUTHOR]

For twenty-five years now, the leading indicator "Business Climate" of the Ifo Institute has been applied in the Federal Republic of Germany. The intent of this note is to provide answers to two questions by means of econometric methods. The first question is: Is the business climate really a leading indicator? The second question is: How much time is the indicator ahead? For verification and in order to respond to both questions, the Granger causality test is used in the version of Hsiao. [ABSTRACT FROM AUTHOR]

Focuses on the argument that the double-blind refereeing process leads to a difficult choice for the author of either publishing in lower ranking journals or helping the referees' impositions in order to have her work published in leading journals. Topic discussed in this issue of the "European Journal of Law and Economics"; Symposium in Erfurt, Germany; Focus of the paper by Stefan Meier; Argument by Bruno Fey; Contrasting argument from Wolfgang Bergsdorf.

Being a victim of bullying is linked to various social, emotional and behavioral problems potentially leading to a reduced quality of life. Furthermore, victims of bullying may cause extensive costs for society, for example by an above-average need for healthcare services. The present study was designed to quantify the costs and the loss of quality of life attributable to bullying by comparing victims with a control group of non-bullied students. A cross-sectional sample of 1293 adolescents (mean age 14.07, SD = 1.36) and their parents reported on bullying victimization, quality of life (adolescents' self-report), and annual direct (medical and non-medical) as well as indirect costs (parents' self-report) from a societal perspective (all expressed in €, year 2014 and 2015). For frequent (20.6% of our sample; costs: €8461.80 p.a.) but not occasional (13.3%; costs: €2850.06) bullying, victimization was associated with significantly higher costs compared to non-bullied adolescents (costs: €3138.00; annual difference between frequently bullied students and controls: €5323.01 p.a.; p = 0.008). Cost drivers included increased direct medical costs, but mostly indirect costs caused by productivity losses of the parents. Self-reported quality of life of frequent victims was considerably reduced (T = − 10.96; p < 0.001); also occasional bullying showed significantly reduced values in global quality of life (T = − 5.73; p < 0.001). The present findings demonstrate that frequent bullying is associated with substantial cost to society and reduced quality of life of victims. This observation underscores the need for effective school-based bullying prevention and suggests a high potential of effective programs to be cost effective as well. [ABSTRACT FROM AUTHOR]

This is the first study to use stochastic frontier analysis to simultaneously estimate the technical, cost and profit efficiency of physician practices for different physician specialist groups. We base our analysis on a unique panel data set of 4964 physician practices in Germany for the years 2008 to 2010. The data contains information on practice costs and revenues, services provided, as well as physician characteristics and practice characteristics. Additionally we consider a wide range additional variables not previously analyzed in this context (e.g. sub-specialization of physician groups and environmental factors such as physician density in the area). We investigate differences in cost, technical and profit efficiency utilizing production-/cost- and profit-functions with a translog functional form. We estimated the stochastic frontier using the comprehensive one-step approach for panel data following Battese and Coelli (Empir Econ 20(2): 325-332, 10). Overall findings indicate that participation in disease management programs and the degree of specialization are associated with significantly higher technical- cost-, and profit-efficiency for most physician specialist groups, e.g. due to the standardization of processes. In addition, our analyses show that group practices perform significantly better than single practices. This may be due to indivisibilities in expensive technical equipment, which can lead to different health care services being provided by different practice types. A more thorough look at specialist groups suggests that it is important to investigate all efficiency types for different physician groups, as results may depend on the type of efficiency analyzed as well as the physician group in question. [ABSTRACT FROM AUTHOR]

Background: The impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified.Methods: In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses.Results: A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33,272, and bleeding events were associated with highest additional reimbursement (€12,839, p < 0.001), extra length of stay (14.58 days, p < 0.001), and increased likelihood of mechanical ventilation for more than 48 h (OR 17.91, p < 0.001). A more moderate complication-related impact on resource use and reimbursement was found for acute kidney injury (additional reimbursement: €5963, p < 0.001; extra length of stay: 7.92 days, p < 0.001; ventilation >48 h: OR 6.93, p < 0.001) as well as for stroke (additional reimbursement: €4125, p < 0.001; extra length of stay: 4.68 days, p < 0.001; ventilation >48 h: OR 5.73, p < 0.001). Pacemaker implantations, in contrast, were associated with comparably small increases in reimbursement (€662, p = 0.006) and length of stay (3.54 days, p = 0.006) and no impaired likelihood of mechanical ventilation more than 48 h (OR 1.22, p = 0.156). Interestingly, these complication-related consequences remain mostly unchanged after baseline risk-adjustment.Conclusions: Post procedural complications such as bleeding events, acute kidney injuries and strokes are associated with increased resource use and substantial amounts of additional reimbursement in Germany, which has important implications for decision making outside of the usual clinical sphere. [ABSTRACT FROM AUTHOR]

Introduction: Most asthma patients have mild disease, although the burden of mild asthma is not well understood nor studied. Some evidence suggests that many patients with mild asthma experience suboptimal symptom control and exacerbations. This study characterizes the burden of illness and treatment patterns among patients with a confirmed diagnosis of mild asthma, defined as GINA Step 1 or Step 2, and residing in China, France, Germany, Italy, Japan, Spain, the United Kingdom, or the United States.Methods: The Respiratory Disease-Specific Programme prospective cross-sectional survey was conducted with primary care and specialty physicians in each of the eight countries. Physician and patient surveys assessed demographic and clinical characteristics, frequency and timing of asthma symptoms, exacerbations, and rescue inhaler usage, the most recent FEV1% predicted, and healthcare utilization. GINA Step was determined by prescribed treatment regimen. GINA Step 1 patients were prescribed as-needed reliever medication and Step 2 required treatment with a low-dose inhaled corticosteroid, leukotriene receptor antagonist, or theophylline. Treatment adherence was assessed with the Morisky Medication Adherence scale, disease control with the Asthma Control Test, and work and activity impairments with the Work Productivity and Activity Impairment scale.Results: The sample included 1115 GINA Step 1 and 2 patients, with 53% classified as Step 2. Overall asthma control was suboptimal, with reports of nocturnal symptoms (40.6%), symptom worsening (10.5%), and rescue inhaler usage in the last 4 weeks (33.6%). 25% of patients were uncontrolled. The overall mean number of exacerbations in the last 12 months was 0.4, with a higher frequency of exacerbations in Step 2 patients who also experienced more exacerbations requiring treatment intensification, an emergency department visit, or hospitalization.Conclusion: Mild asthma imposes a substantial burden on patients, establishing the need for comprehensive management plans and ongoing support for treatment adherence.Funding: AstraZeneca. [ABSTRACT FROM AUTHOR]

Background: In 2009, the European Medicines Agency granted approval for two higher-valent pneumococcal conjugate vaccines. This study aims to evaluate the cost-effectiveness of universal infant (<2 years old) vaccination with a 13-valent pneumococcal conjugate vaccine (PCV13) in comparison with a 10-valent pneumococcal conjugate vaccine (PCV10) for the prevention of pneumococcal disease in Germany.Methods: A population-based Markov model was developed to estimate the impact of PCV13 and PCV10 on invasive pneumococcal disease (IPD), non-invasive pneumonia (PNE), and acute otitis media (AOM) over a time horizon of 50 years. The model included the effects of the historical vaccination scheme in infants as well as indirect herd effects and replacement disease. We used German epidemiological data to calculate episodes of IPD, PNE, and AOM, as well as direct and indirect effects of the vaccination. Parameter uncertainty was tested in univariate and probabilistic sensitivity analyses.Results: In the base-case analysis, the ICER of PCV13 versus PCV10 infant vaccination was EUR 9826 per quality-adjusted life-year (QALY) gained or EUR 5490 per life-year (LY) gained from the societal perspective and EUR 3368 per QALY gained or EUR 1882 per LY gained from the perspective of the German statutory health insurance. The results were particularly sensitive to the magnitude of indirect effects of both vaccines.Conclusions: Universal infant vaccination with PCV13 is likely to be a cost-effective intervention compared with PCV10 within the German health care system, if additional net indirect effects of PCV13 vaccination are significant. [ABSTRACT FROM AUTHOR]

Background: Information on costs of managing adverse events (AEs) associated with current treatments in metastatic melanoma is limited. This study estimates costs of AEs in eight countries: Australia (AU), Canada (CA), France (FR), Germany (GE), Italy (IT), the Netherlands (NL), Spain (ES), and the UK.Methods: A literature search was conducted to identify grade 3/4 AEs from product label, published trials, conference abstracts, and treatment guidelines. Resource utilization for the management of each type of AE was determined via interviews with 5 melanoma clinicians in each country. Outpatient and inpatient costs were estimated for each type of AE using country-specific tariffs or government/published sources.Results: In outpatient settings, the most costly AEs per incident included cutaneous squamous cell carcinoma (CSCC) (€1063, £720; NL/UK), anemia (€1443, €1329, €1285; ES/IT/FR), peripheral neuropathy (€1289; ES), and immune-related diarrhea (AUS$1,121; AU). In inpatient settings, the most costly AEs per hospitalization included hypophysitis (€10,265; €5316; CAN$9735; AUS$7231: ES/FR/CA/AU), dyspnea (€9077; GE), elevated liver enzymes (€6913, CAN$8030, AUS$6594; FR/CA/AU), CSCC (CAN$8934; CA), peripheral neuropathy (€6977, €4144, CAN$9472; NL/ES/CA), and diarrhea (£4284, €4113; UK/ES).Conclusions: Costs of managing AEs can be significant, and thus effective treatments with lower rates of severe AEs would be valuable. [ABSTRACT FROM AUTHOR]

Purpose: Clostridium difficile infection (CDI) represents a significant economic healthcare burden, especially the cost of recurrent disease. Fidaxomicin produced significantly lower recurrence rates and higher sustained cure rates in clinical trials. We evaluated the cost-effectiveness and budget impact of fidaxomicin compared with vancomycin in Germany in the first-line treatment of patient subgroups with CDI at increased risk of recurrence. Methods: A semi-Markov model was used to compare the cost-effectiveness and budget impact of fidaxomicin vs. vancomycin from a payer perspective in Germany. The model cycle length was 10 days. The time horizon was 1 year. Model inputs were probability of clinical cure, 30-day probability of recurrence, and 30-day attributable mortality based on evidence from two randomized controlled trials comparing fidaxomicin and vancomycin in patients with CDI. Cost-effectiveness outcomes were cost per quality-adjusted life year gained, cost per bed-day saved, and cost per recurrence avoided. Results: Despite higher drug acquisition costs, fidaxomicin was dominant in the cancer subgroup (less costly and more effective) and cost-effective in the other subgroups, with incremental cost-effectiveness ratios vs. vancomycin ranging from €26,900 to €44,500. Hospitalization costs of the first-line treatment of CDI with fidaxomicin vs. vancomycin were lower in every patient subgroup, resulting in budget impacts ranging from −€1325 (in patients ≥65 years) to −€2438 (in cancer patients). Reductions in the cost of treating recurrence with fidaxomicin ranged from −€574.32 per patient in those receiving concomitant antibiotics to −€1500.68 per patient in renally impaired patients. Conclusions: In patient subgroups with CDI at increased recurrence risk, fidaxomicin was cost-effective vs. vancomycin, and less costly and more effective in patients with cancer. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The planning of health care management benefits from understanding future trends in demand and costs. In the case of lung diseases in the national German hospital market, we therefore analyze the current structure of care, and forecast future trends in key process indicators.Methods: We use standardized, patient-level, activity-based costing from a national cost calculation data set of respiratory cases, representing 11.9-14.1 % of all cases in the major diagnostic category "respiratory system" from 2006 to 2012. To forecast hospital admissions, length of stay (LOS), and costs, the best adjusted models out of possible autoregressive integrated moving average models and exponential smoothing models are used.Results: The number of cases is predicted to increase substantially, from 1.1 million in 2006 to 1.5 million in 2018 (+2.7 % each year). LOS is expected to decrease from 7.9 to 6.1 days, and overall costs to increase from 2.7 to 4.5 billion euros (+4.3 % each year). Except for lung cancer (-2.3 % each year), costs for all respiratory disease areas increase: surgical interventions +9.2 % each year, COPD +3.9 %, bronchitis and asthma +1.7 %, infections +2.0 %, respiratory failure +2.6 %, and other diagnoses +8.5 % each year. The share of costs of surgical interventions in all costs of respiratory cases increases from 17.8 % in 2006 to 30.8 % in 2018.Conclusions: Overall costs are expected to increase particularly because of an increasing share of expensive surgical interventions and rare diseases, and because of higher intensive care, operating room, and diagnostics and therapy costs. [ABSTRACT FROM AUTHOR]

A widely discussed shortcoming of long-term care in nursing homes for the elderly is the inappropriate or suboptimal drug utilization, particularly of psychotropic drugs. Using administrative data from the largest sickness fund in Germany, this study was designed to estimate the effect of institutionalization on the drug intake of the frail elderly. Difference-in-differences propensity score matching techniques were used to compare drug prescriptions for the frail elderly who entered a nursing home with those who remained in the outpatient care system; findings suggest that nursing home residents receive more doses of antipsychotics, antidepressants, and analgesics. The potential overprescription correlates with estimated drug costs of about €87 million per year. [ABSTRACT FROM AUTHOR]

Despite the increasing availability of routine data, no analysis method has yet been presented for cost-of-illness (COI) studies based on massive data. We aim, first, to present such a method and, second, to assess the relevance of the associated gain in numerical efficiency. We propose a prevalence-based, top-down regression approach consisting of five steps: aggregating the data; fitting a generalized additive model (GAM); predicting costs via the fitted GAM; comparing predicted costs between prevalent and non-prevalent subjects; and quantifying the stochastic uncertainty via error propagation. To demonstrate the method, it was applied to aggregated data in the context of chronic lung disease to German sickness funds data (from 1999), covering over 7.3 million insured. To assess the gain in numerical efficiency, the computational time of the innovative approach has been compared with corresponding GAMs applied to simulated individual-level data. Furthermore, the probability of model failure was modeled via logistic regression. Applying the innovative method was reasonably fast (19 min). In contrast, regarding patient-level data, computational time increased disproportionately by sample size. Furthermore, using patient-level data was accompanied by a substantial risk of model failure (about 80 % for 6 million subjects). The gain in computational efficiency of the innovative COI method seems to be of practical relevance. Furthermore, it may yield more precise cost estimates. [ABSTRACT FROM AUTHOR]

The characteristics book-to-market equity ratio, size and momentum are highly correlated with the average returns of common stocks. Fama and French (J Financ Econ 33(1):3-56, ), (J Finance 50(1):131-155, ) and (J Finance 51(1):55-84, ) argue (for size and the book-to-market equity ratio) that the relation between returns and characteristics arises because the characteristics are proxies for exposures to common risk factors. We examine the question whether the characteristics or the covariance structure of returns explain the cross-sectional dispersion in German stock market returns. Our results suggest that widely accepted factors SMB, HML or WML are not priced. [ABSTRACT FROM AUTHOR]

Empirical studies considering the location and relocation of emergency medical service (EMS) vehicles in an urban region provide important insight into dynamic changes during the day. Within a 24-hour cycle, the demand, travel time, speed of ambulances and areas of coverage change. Nevertheless, most existing approaches in literature ignore these variations and require a (temporally and spatially) fixed (double) coverage of the planning area. Neglecting these variations and fixation of the coverage could lead to an inaccurate estimation of the time-dependent fleet size and individual positioning of ambulances. Through extensive data collection, now it is possible to precisely determine the required coverage of demand areas. Based on data-driven optimization, a new approach is presented, maximizing the flexible, empirically determined required coverage, which has been adjusted for variations due to day-time and site. This coverage prevents the EMS system from unavailability of ambulances due to parallel operations to ensure an improved coverage of the planning area closer to realistic demand. An integer linear programming model is formulated in order to locate and relocate ambulances. The use of such a programming model is supported by a comprehensive case study, which strongly suggests that through such a model, these objectives can be achieved and lead to greater cost-effectiveness and quality of emergency care. [ABSTRACT FROM AUTHOR]

In 2011, Konnopka et al. (Eur J Health Econ 12:345-352, 2011) published a top-down cost of illness study on the health burden, and direct and indirect costs of morbidity and mortality attributable to excess weight (BMI ≥25 kg/m(2)) in Germany in 2002. The objective of the current study was to update the 2002 estimates to the year 2008. To simplify comparisons, we closely followed the methods and assumptions of the original study, using 2008 data for most input parameters (e.g. prevalence, mortality, resource use, costs). Excess weight related deaths increased by 31% (from 36,653 to 47,964) and associated years of potential life lost (from 428,093 to 588,237) and quality adjusted life years lost (from 367,722 to 505,748) by about 37%, respectively. Excess weight caused €16,797 million in total costs in 2008 (+70%), of which €8,647 million were direct costs (corresponding to 3.27% of total German health care expenditures in 2008). About 73% (€12,235 million) of total excess weight related costs were attributable to obesity (BMI ≥30 kg/m(2)). The main drivers of direct costs were endocrinological (44%) and cardiovascular (38%) diseases. Indirect costs amounted to €8,150 million in 2008 (+62%), of which about two-thirds were indirect costs from unpaid work. The great majority of indirect costs were due to premature mortality (€5,669 million). The variation of input parameters (univariate sensitivity analyses) resulted in attributable costs between €8,978 million (-47% compared to base case) and €25,060 million (+49%). The marked increase in excess weight related costs can largely be explained by increases in the prevalence of overweight and obesity, and to a lesser extent from increases in resource consumption, as well as increases in (unit) costs and wages (comprising 5.5% inflation). [ABSTRACT FROM AUTHOR]

Background: Lung cancer is among the top causes of cancer-related deaths. Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors can increase progression-free survival compared with standard chemotherapy in patients with EGFR mutation-positive advanced non-small cell lung cancer (NSCLC).Objective: The aim of the study was to evaluate the cost-effectiveness of EGFR mutation analysis and first-line therapy with erlotinib for mutation-positive patients compared with non-individualized standard chemotherapy from the perspective of German statutory health insurance.Methods: A state transition model was developed for a time horizon of 10 years (reference year 2014). Data sources were published data from the European Tarceva versus Chemotherapy (EURTAC) randomized trial for drug efficacy and safety and German cost data. We additionally performed deterministic, probabilistic and structural sensitivity analyses.Results: The individualized strategy incurred 0.013 additional quality-adjusted life-years (QALYs) and additional costs of € 200, yielding an incremental cost-effectiveness ratio (ICER) of € 15,577/QALY. Results were most sensitive to uncertainty in survival curves and changes in utility values. Cross-validating health utility estimates with recent German data increased the ICER to about € 58,000/QALY. The probabilistic sensitivity analysis indicated that the individualized strategy is cost-effective, with a probability exceeding 50 % for a range of possible willingness-to-pay thresholds.Limitations: The uncertainty of the predicted survival curves is substantial, particularly for overall survival, which was not a primary endpoint in the EURTAC study. Also, there is limited data on quality of life in metastatic lung cancer patients.Conclusions: Individualized therapy based on EGFR mutation status has the potential to provide a cost-effective alternative to non-individualized care for patients with advanced adenocarcinoma. Further clinical research is needed to confirm these results. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the budget impact and health effects of introducing rotavirus (RV) vaccination in Saxony, Germany, from a health insurance perspective. Special emphasis is given to the herd effect. We analyzed direct medical and non-medical costs of RV infection for Social Health Insurance between 2007 and 2010 based on 360,000 routine data observations from the AOK PLUS for children below 5 years of age. We compared the actual annual number of RV cases (vaccination scenario) with the number derived from 2005 (no vaccination, base case scenario). The vaccination coverage rate has increased from 5 % to 61 % between 2007 and 2010. The number of RV cases decreased by 21 % from 32,274 in 2007 to 25,614 in 2010. Based on vaccination coverage, the total cost savings per 1,000 children due to RV vaccination was estimated to be 39,686 Euros. The overall share of outpatient costs was 60 %. Mean gross cost savings were expected to be 304 Euros per avoided case. The net cost savings were expected to be 19 Euros per avoided case. About 59 % of total savings was due to herd protection resulting from increasing vaccine rates. The herd effect per avoided case increased with increasing vaccine coverage. Incidence of RV cases, vaccination costs and days absent from work were sensitive parameters. This retrospective analysis showed that the increase in RV vaccination coverage in Saxony has been budget neutral if not cost saving for sick funds. [ABSTRACT FROM AUTHOR]

The study analyses the relationship between the development of registered intellectual property and economic development in Germany. It shows a differing evidence for specific categories of intellectual property, indicating that not all intellectual property rights show a significant impact on the German Gross Domestic Product. Positive impacts have the stocks of patents, trademarks and designs. Applications for utility models surprisingly have a negative impact, what challenges developments of the economic theory. The empirical results delight also the specific structure of the technological and innovation system in the German economy, showing a national intellectual property profile with three key factors: product differentiation, complex technologies and design development. [ABSTRACT FROM AUTHOR]

This study employs information obtained from media content analyses, as well as economic and political data, to investigate negativity in unemployment news between 2001 and 2010 in Germany. The data indicate a substantial bias in terms of the amounts of negative and positive reports, compared with the actual development of unemployment. Moreover, the media tend to place negative unemployment reports more prominently than positive ones. The estimates suggest that the bias is not the consequence of journalists asymmetrically interpreting the official unemployment numbers. Instead, it is associated with the exploitation of often non-economic information and structural influences in the process of news production. [ABSTRACT FROM AUTHOR]

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