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Background: The EuroQol Group has extended the severity levels of the EQ-5D from three to five (EQ-5D-5L). There are valuation studies worldwide planned in order to convert the EQ-5D-5L health states into a single preference-based summary score based on country-specific value sets of social health status preference valuations. The EuroQol Group developed an internationally standardised EQ-5D-5L valuation protocol. Based on the experiences of the first wave of valuation studies applying the protocol, a number of modifications to the implementation of composite time trade-off (cTTO) were proposed and tested in an exploratory study in Germany. Methods: The aim of the study is to test the improved EQ-5D-5L valuation protocol 1.1 and the implementation of three modifications: (1) introduction of ranking task, (2) separating time trade-off (TTO) tasks for health states "Better Than Dead"(BTD)/"Worse Than Dead" (WTD), (3) allow for removal of problematic valuations from the cTTO data (the feedback module). Data were collected in computer assisted personal interviews with 200 members of the German general public. Results: In comparison to the first wave of valuation studies a higher data quality can be observed in both study arms: increasing number of WTD valuations, reduced inconsistencies for health state 55555 as well as higher values for mild health states. Comparing both study arms, mean observed cTTO value for severity 6 is higher in the test arm. The proportion of inconsistent cTTO responses is lower in the test arm than in the control arm and is further reduced by the feedback module. The ranking task prolongs the interview without the desired effect. Conclusions: Both study arms yielded higher data quality in comparison to the first wave of EQ-5D-5L valuation studies. The valuation protocol combined with an intensive interviewer training and close data monitoring showed a high feasibility and acceptability to the respondents of the general population as well as the interviewers in Germany. Based on the results of this study and other countries, the separation of TTO tasks for health states BTD/WTD and the feedback module will be implemented in the valuation study for the EQ-5D-5L for Germany. EuroQol Research Foundation Department of Health Economics and Health Care Management at the Bielefeld University CHERH

BACKGROUND: Identifying patient priorities and preference measurements have gained importance as patients claim a more active role in health care decision making. Due to the variety of existing methods, it is challenging to define an appropriate method for each decision problem. This study demonstrates the impact of the non-standardized Analytic Hierarchy Process (AHP) method on priorities, and compares it with Best-Worst-Scaling (BWS) and ranking card methods. METHODS: We investigated AHP results for different Consistency Ratio (CR) thresholds, aggregation methods, and sensitivity analyses. We also compared criteria rankings of AHP with BWS and ranking cards results by Kendall's tau b. RESULTS: The sample for our decision analysis consisted of 39 patients with rare diseases and mean age of 53.82 years. The mean weights of the two groups of CR

Recently the sequencing of the human genome has become a major biological and clinical research field. However, the public health impact of this new technology with focus on the financial effect is not yet to be foreseen. To provide an overview of the current health economic evidence for genome sequencing, we conducted a thorough systematic review of the literature from 17 databases. In addition, we conducted a hand search. Starting with 5 520 records we ultimately included five full-text publications and one internet source, all focused on cost calculations. The results were very heterogeneous and, therefore, difficult to compare. Furthermore, because the methodology of the publications was quite poor, the reliability and validity of the results were questionable. The real costs for the whole sequencing workflow, including data management and analysis, remain unknown. Overall, our review indicates that the current health economic evidence for genome sequencing is quite poor. Therefore, we listed aspects that needed to be considered when conducting health economic analyses of genome sequencing. Thereby, specifics regarding the overall aim, technology, population, indication, comparator, alternatives after sequencing, outcomes, probabilities, and costs with respect to genome sequencing are discussed. For further research, at the outset, a comprehensive cost calculation of genome sequencing is needed, because all further health economic studies rely on valid cost data. The results will serve as an input parameter for budget-impact analyses or cost-effectiveness analyses. Marsilius Kolleg DFG

The pharmacy sector in many European countries continues to be subject to strict governmental regulations. This consists - depending on the country - of regulations on ownership, business operations, opening hours, personnel, pricing, prohibiting certain sales methods (e.g. mail order), and specifying product ranges. Indeed, Germany has a particularly strong conglomeration of regulations. Specific governmental interventions on the marketplace, i.e. interventions additionally to general legislation governing the organisation of markets in terms of regulatory policy, are frequently justified as being peculiarities of the market, which actually or allegedly prevent the market mechanism from achieving optimal results. The aim of specific interventions is to eliminate the negative consequences of free competition. However, the resulting benefits always have to be offset by the costs of regulation. These costs consist first of direct costs due to the regulation itself, since they restrict the freedom of potential suppliers and/or customers. Secondly, they have indirect welfare effects, referred to by the term excess burden. This can be illustrated by the example of taxation: taxes are used to fund the affairs of the country. However, they place a direct burden on the taxpayers, but they also cause taxpayers to adapt, e.g. by being less willing to work, thereby costing the national economy the excess burden. This study analyses these benefits and costs of regulation in the German pharmacy sector. It then describes the deregulation measures needed to avoid regulation-costs to the national economy. The main outcome lies in the conclusion that partial deregulation is capable of improving efficiency and quality in drug distribution. Based on the principle of value for money, quality improves with a given investment in drug distribution. In contrast to the present situation, Germany could be a pioneer with regard to the regulation of the pharmacy sector, focusing on the interests of consumers and patients - and not just on particular interests specific to the profession. On basis of economic theory of production and transaction-cost regarding economies of scale and economics of scope as well as on basis of welfare economics regarding oligopoly models, this analysis is coming to the result that particularly ownership and management regulations of German pharmacy sector are not only obsolete, but impose high costs on society. Together with a partial relaxation in the field of business operations and product ranges - in this part less regulatory interventions and thus the power of free competition can cause at least the same results as the present strong regulation. And this without raising a danger for customers - a wide deregulation can develop positive economic effects. Additional or even stronger effects will be possible, if price regulations and mail-order-regulations are deregulated, too. However, the analysis also shows that not every regulatory measure in the pharmacy sector should be discarded. This includes pharmacy-only and prescription-only rules, the duty that a pharmacy must be managed by a pharmacist (which must be distinguished from the ownership of a dispensary) and some of the business regulations as well as minimum opening hours. Economic potential can be realised by allowing more competition in the pharmacy sector. The more of mentioned deregulation can be realised, the larger positive economic effects can be attained. Long-term consequence of initiated trial and discovery procedures with different concepts of vertical or horizontal cooperation could be a coexistence of owner-operated pharmacies and those owned by larger joint-stock companies, which increases national welfare by meeting society-s preferences.

In our article we consider insurance as a means of allocating terrorism risk. Terrorism poses a significant challenge for insurers worldwide. In terms of possible losses it fits into the same category as earthquakes and hurricanes. Yet as a result of the uncertainty surrounding these risks private markets face significant difficulties in providing insurance for it. In the insurance industry costly risk bearing can explain the supply of capacity risks. Corporate risk management theory provides reasons why transaction costs can motivate firms to purchase insurance. In the context of these tightly connected theories we derive models for both the supply of terrorism reinsurance and the demand for terrorism insurance. Using two datasets from the German terrorism insurer we estimate models on how corporations in Germany employ government sponsored insurance to manage their terrorism risk and on the factors that determine the supply for private market terrorism reinsurance.

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