Prevention and control of dengue and Chikungunya in Colombia: A cost-effectiveness analysis

Background Chikungunya and dengue are emerging diseases that have caused large outbreaks in various regions of the world. Both are both spread by Aedes aegypti and Aedes albopictus mosquitos. We developed a dynamic transmission model of chikungunya and dengue, calibrated to data from Colombia (June 2014 –December 2017). Methodology/Principal findings We evaluated the health benefits and cost-effectiveness of residual insecticide treatment, long-lasting insecticide-treated nets, routine dengue vaccination for children aged 9, catchup vaccination for individuals aged 10–19 or 10–29, and portfolios of these interventions. Model calibration resulted in 300 realistic transmission parameters sets that produced close matches to disease-specific incidence and deaths. Insecticide was the preferred intervention and was cost-effective. Insecticide averted an estimated 95 chikungunya cases and 114 dengue cases per 100,000 people, 61 deaths, and 4,523 disability-adjusted life years (DALYs). In sensitivity analysis, strategies that included dengue vaccination were cost-effective only when the vaccine cost was 14% of the current price. Conclusions/Significance Insecticide to prevent chikungunya and dengue in Columbia could generate significant health benefits and be cost-effective. Because of limits on diagnostic accuracy and vaccine efficacy, the cost of dengue testing and vaccination must decrease dramatically for such vaccination to be cost-effective in Colombia. The vectors for chikungunya and dengue have recently spread to new regions, highlighting the importance of understanding the effectiveness and cost-effectiveness of policies aimed at preventing these diseases.

The price of curing cancer

Background Health care systems around the world struggle with high prices for new cancer drugs. The purpose of this study was to conduct a gedankenexperiment and calculate how much health expenditures would change if a cure for cancer through pharmaceutical treatment were made available. The cancer cure was conceived to eliminate both cancer deaths and the underlying morbidity burden of cancer. Furthermore, the cure was hypothesized to arrive in incremental steps but at infinitesimally small time intervals (resulting, effectively, in an immediate cure). Methods The analysis used secondary data and was conducted from the viewpoint of the German social health insurance. As its underlying method, it used a cause-elimination life-table approach. To account for the age distribution of the population, the study weighted age-specific increases in remaining life expectancy by age-specific population sizes. It considered drug acquisition costs as well as savings and life extension costs from eliminating cancer. All cancer drugs that underwent a mandatory early benefit assessment in Germany between 2011 and 2015/16 and were granted an added benefit were included. Data on age- and gender-specific probabilities of survival, population sizes, causes of death, and health expenditures, as well as data on cancer costs were taken from the German Federal Office of Statistics and the German Federal Social Insurance Office. Results Based on the cause-elimination life-table approach and accounting for the age structure of the German population, curing cancer in Germany yields an increase in average remaining life expectancy by 2.66 life years. Based on the current incremental cost-effectiveness ratio of new cancer drugs, which is on average €101,493 per life year gained (€39,751/0.39 life years), the German social health insurance would need to pay €280,497 per insuree to eliminate cancer. Dividing this figure by current average remaining lifetime health expenditures yields a ratio of 2.07, which represents a multiplier of current health expenditures. Conclusions Eliminating cancer at current price levels would more than triple total health expenditures in Germany. As the current price of a cure requires a drastic reduction of non-health consumption, it appears that current prices for cancer drugs already on the market (i.e., small steps towards a cure) need careful reconsideration.

The oil market will move towards balance in 2022

Significance The rebound in demand from the pandemic slump should keep the market in deficit, supporting current price levels. However, in 2022, demand growth is expected to slow, while supply from non-OPEC+ producers will accelerate. A potential return of Iranian oil exports and further pandemic reversals remain major downside risks. Impacts Forecasts suggest a return to normality in 2022, but discontinuities with the past remain powerful forces reshaping global energy markets. If pandemic concerns recede, energy transition impacts will move to the fore. Non-OPEC supply growth plus expectations of more muted demand increases mean OPEC will still have a 'free rider' problem to address. Oil services companies’ prospects should improve but margins will remain thin.

Acceptability and usability of HIV self-tests in two European countries: findings from surveys of clients at non-governmental organisations in Lithuania and Italy

Background Uptake of HIV self-tests (HIVST) remains low in Europe. We conducted two separate surveys to understand facilitators and barriers to the use of HIVST in two European countries, as part of the EU INTEGRATE Joint Action. In both countries, HIV has been legal since 2016. In Lithuania, where HIVST sales have been low, the survey primarily assessed acceptability whilst in Italy, with better HIVST uptake, usability was the focus. Methods Participants were recruited through community HIV testing sites, and in Lithuania also through social media. In Lithuania, participants self-completed a survey on their testing history, and attitudes toward and experiences with self-testing. In Italy participants performed an HIVST (Mylan Autotest) while being observed by a community health worker (CHW). Both participants and CHW completed a self-administered survey evaluating the experience of the participant. Results In Lithuania, awareness of HIV self-testing (75%) was high among the 138 people who completed the survey. Privacy and confidentiality (70%) was the most common reason to use an HIVST whilst cost was reported as the main barrier by 60%, only 15% were willing to pay the current price. Almost half (42%) were concerned about doing the test incorrectly and 36% preferred that a trained person could discuss their result. Purchasing HIVST at a pharmacy (70%) or online (61%) was favoured and 68% would opt to simultaneously test for other infections. In Italy, 28 people who had never used an HIVST before were observed using one. 43% found the test easy to use but CHWs reported that 36% of participants failed at least one step. The quick result (68%) was the most common reason to use one again, yet the main concerns were the lack of counselling (50%) and reading result alone (32%). Conclusions HIVST are acceptable and usable, however cost is a major barrier. Local and national strategies are needed to increase awareness of and access to HIVST and target HIVST campaigns toward key risk groups such as MSM. Meanwhile, steps can be taken to improve testing instructions and support for self-testers. Offering multiplex testing for other infections would also likely increase uptake.

Global Wheat Market Dynamics: What Is the Role of the EU and the Black Sea Wheat Exporters?

Over the last two decades, three countries in the Black Sea Region—Russia, Ukraine, and Kazakhstan—became global leaders in grain production and trade, and replaced the USA and France as the most previous largest wheat exporting countries. In this study we investigate world wheat price linkages and identify the current “price leaders” of the global wheat market. This empirical analysis is focused on the price relationships between eight of the largest wheat exporting countries and uses a cointegration framework and a vector error-correction model. The results show that, regarding price formation on the world wheat market, the French price is more important for transmitting price signals to other wheat export markets compared to the USA. Furthermore, our results indicate that, despite being leaders in wheat export volumes, the Black Sea wheat prices in Russia and Ukraine adjust to price changes in France, the USA, and Canada. Albeit unrealistic in the short run, the creation of the futures market in the Black Sea region might significantly improve the participation of Black Sea markets in price formation of the global wheat market.

Financial Feasibility and Competitiveness Levels of Soybean Varieties in Rice-Based Cropping System of Indonesia

This research was conducted to determine the financial feasibility of growing soybean varieties and their competitiveness in the rice-based cropping system of Indonesia. The research was conducted at two locations in 2020. The results showed that the use of improved varieties of soybean yielded 2.24 t/ha and 2.09 t/ha, which was higher than using local (non-improved) varieties. The use of improved varieties was financially feasible with Revenue Cost (R/C) ratios of 1.88–1.98 and Benefit Cost (B/C) ratios of 0.88–0.98. The competitiveness of soybeans in Mojokerto and Pasuruan was lower compared to maize and mungbean. Soybean could compete with competing crops if the productivity and price were higher than the current conditions. To be able to compete with maize, the soybean productivity should be 5.14–5.22 t/ha if the current soybean price per kg is IDR 7200 (about US $ 0.51). To compete with mungbean, the soybean productivity should reach 3.05 t/ha with the current price per kg of IDR 7200 (about US $ 0.51). When measured by the price level, to be able to compete with maize, the soybean selling price per kg should be IDR 14,428–IDR 14,893 (about USD 1.06) with a productivity level of 2.24 t/ha.

The Need for an Alternative to Culling Day-Old Male Layer Chicks: A Survey on Awareness, Alternatives, and the Willingness to Pay for Alternatives in a Selected Population of Dutch Citizens

A concerning by-product of producing laying hen chicks are the hatched male layer chicks. As a consequence of their inability to lay eggs, these male chicks are culled as day-old chicks in the hatchery. To find an alternative for this ethical dilemma (generally), three alternatives are under study, namely, in ovo sex determination, using dual-purpose breeds, and the rearing of layer cockerels. In order to assess the awareness of this practice and preference for one of the alternatives, we conducted an online survey of the Dutch public. Most of the 259 respondents completing the survey were highly educated woman (HEW, n = 143) versus others (REST, n = 86). The questionnaire was divided into six topics: (1) general knowledge of the poultry industry, (2) awareness of culling male layer chicks (CMC), and (3) its acceptability, (4) alternatives to CMC, (5) willingness to pay (WTP) for eggs without CMC, and (6) WTP for cockerel meat. Awareness about CMC was 52%, and its acceptability was rejected by 78% (HEW) and 67% (REST). The level of acceptability increased when more salient facts were given, and almost all respondents agreed that an alternative was needed (90% HEW, 84% REST). For both groups of respondents, more than 50% preferred in ovo sex determination over keeping the current practice or using dual-purpose breeds or male layers. Furthermore, the majority of respondents were willing to pay more than double the price for eggs without CMC being involved. Roughly 40% would not buy processed cockerel meat burgers, most likely due to their vegan or vegetarian diet. Of the remaining respondents, half were willing to pay the current price or 1 euro more for processed cockerel meat burgers. The most important factors when buying poultry meat or eggs without CMC were food safety, animal friendliness (welfare), and the environment; price was the least important factor. Despite the skewed respondents' background, the results of our survey show that consumers are willing to pay more for poultry products that do not require culling day-old male chicks.

How Consistent Are Consumers in Their Decisions? Investigation of Houseplant Purchasing

This paper examines the impact of intrinsic consumer attributes on decision consistency in houseplant purchasing intentions. Subjects reported their likelihood to buy (LTB) for themselves and as a gift at perceived bargain and getting expensive price levels. The sample was analyzed according to those who switched their LTB ratings to relatively lower values versus subjects who did not by using their demographic characteristics and responses to plant buying behavior questions. Secondly, subjects who had high initial purchase intents were analyzed versus those who had low initial purchase intents. The results indicate that inconsistent purchase decisions are more likely to occur at the perceived getting expensive price level than the perceived bargain price points. Additionally, there are very few demographic differences among the plant buyers who are consistent with their purchase intent versus inconsistent, indicating that external environmental cues may have more of an influence on purchase consistency than intrinsic cues. This information can be utilized by greenhouse and retail firms to understand when a consumer is less likely to change their plant purchase decision with a high initial intent. These price points can help firms optimize their current price offerings within the market and create dialogues with partnering box stores.

Why Abandon the Paradise? Stations’ Incentives to Reduce Gasoline Prices at First

The German petrol station market is characterized by strong intraday price cycles, which probably correspond to the well-known Edgeworth cycles. The prices go up strongly in the late evening or in the middle of the night, fall relatively heavily in the early morning, and then go up and down several times in the course of the day. Locally, the analysis is limited to the 26 petrol stations that plausibly form a common market in the Lueneburg region. This paper picks out the specific sequence in which, after generally rising prices during the day, a single supplier is the first to reverse the price trend and lower its price. For this purpose, current price reports are used to define the price reduction event down to the second, and to show only the valid prices of competitors prior to the event. All German petrol stations have to report price changes to the Bundeskartellamt's Market Transparency Department. Tankerkoenig then publishes the full reports. This results in one panel observation for each price reduction event. Out of nearly 300,000 price observations, just over 10,000 panel observations result. Fixed-effect logit estimates are used to test whether the theoretically and economically significant price differences of the Edgeworth cycles explain the behavior of the price cutters, or whether market structure factors, such as brand affiliation/independence of the petrol station, service offerings, or location characteristics predict price-cutting behavior. The novel recording of the price dynamics in the petrol station market by using the accurate petrol station price data to the second indicates promising research of extensive price data and avoids the enormous loss of information in the previously common calculation of average prices at certain times.