Country-specific Tariffs Research Articles

Mapping MacNew Heart Disease Quality of Life Questionnaire onto country-specific EQ-5D-5L utility scores: a comparison of traditional regression models with a machine learning technique.

This study aims to derive country-specific EQ-5D-5L health status utility (HSU) from the MacNew Heart Disease Health-related Quality of Life questionnaire (MacNew) using both traditional regression analyses, as well as a machine learning technique. Data were drawn from the Multi-Instrument Comparison (MIC) survey. The EQ-5D-5L was scored using 4 country-specific tariffs (United States, United Kingdom, Germany, and Canada). The traditional regression techniques, as well as a machine learning technique, deep neural network (DNN), were adopted to directly predict country-specific EQ-5D-5L HSUs (i.e. a direct mapping approach). An indirect response mapping was undertaken additionally. The optimal algorithm was identified based on three goodness-of-fit tests, namely, the mean absolute error (MAE), mean error (ME) and root mean square error (RMSE), with the first being the primary criteria. Internal validation was undertaken. Indirect response mapping and direct mapping (via betamix with MacNew items as the key predictors) were found to produce the optimal mapping algorithms with the lowest MAE when EQ-5D-5L were scored using three country-specific tariffs (United Kingdom, Canada, and Germany for the former and United Kingdom, United States, Canada and Germany for the latter approach). DNN approach generated the lowest MAE and RMSE when using the Germany-specific tariff. Among different approaches been explored, there is not a conclusive conclusion regarding the optimal method for developing mapping algorithms. A machine learning approach represents an alternative mapping approach that should be explored further. The reported algorithms from response mapping have the potential to be more widely used; however, the performance needs to be externally validated.

PDB21 The Lifetime Cost-Effectiveness of Lifestyle Intervention or Metformin for Prevention of Diabetes Mellitus Type 2 in Obese Adults with Prediabetes from the Mexican Healthcare Perspective

Lifestyle interventions and metformin have been found to be both clinically effective and cost-effective in preventing the onset of diabetes mellitus type 2 (DMT2) in different settings. However, evidence is lacking for Mexico. The objective of this study was to analyze the lifetime cost-utility of lifestyle intervention and metformin compared with placebo, as well as lifestyle intervention compared with metformin in obese adults with prediabetes from the Mexican healthcare perspective. A Markov cohort simulation was used to track disease progression, direct medical costs and quality-adjusted life years (QALYs) to ultimately calculate the cost per QALY. Clinical evidence from the U.S. Diabetes Prevention Program on the progression from prediabetes to DMT2 was combined with data from the U.K. Prospective Diabetes Study on progression to common diabetes-related complications. Resource use was valued based on country-specific tariffs. Health utilities were derived from Mexican and U.S. studies. Uni- and bivariate sensitivity analyses were performed to test the robustness of the model. Uncertainty around the results was characterized in a probabilistic sensitivity analysis. All incremental cost-effectiveness ratios resulted negative. Lifestyle intervention and metformin were associated with an incremental net monetary benefit (INMB) of 1,451.57 US$ and 2,439.33 US$, respectively, compared with placebo at the threshold of once the national gross domestic product per capita per QALY. Lifestyle intervention compared with metformin was cost-saving with an INMB of 987,76 US$. The results were robust to structural changes and modifications in the lifestyle intervention group. The outcomes revealed constantly low levels of uncertainty. The results indicate that lifestyle intervention is a highly cost-effective alternative to treat prediabetes in obese adults in Mexico. However, its clinical effectiveness in Mexicans needs to be examined more thoroughly and a multi-sectoral approach to combat obesity and diabetes should be considered to overcome barriers to the successful implementation.

An evaluation of EQ-5D-3L health utility scores using five country-specific tariffs in a rural population aged 45\u201369\u2009years in Hua county, Henan province, China

BackgroundThis study aims to compare the performance of the recently developed Chinese (city) tariff of the EQ-5D-3L against the UK, US, Japanese and Korean tariffs in a general rural population in China.MethodsFrom November 2015 to September 2016, 12,085 permanent residents aged 45–69 from 257 villages randomly selected from Hua County, Henan Province, China, were interviewed using EQ-5D-3L, and a one-on-one questionnaire investigation was used to collect data on factors associated with HRQOL. The health utility scores were calculated using the UK, US, Japanese, Korean and Chinese (city) tariffs. The agreement, known-groups validity and sensitivity of these five tariffs were evaluated. Transition scores for pairs of observed EQ-5D-3L health states were calculated and compared.ResultsThe Korean tariff yielded the highest mean health utility score (0.963), followed by the Chinese (city) (0.948), US (0.943), UK (0.930) and Japanese (0.921) tariffs, but the differences in the scores of any two tariffs did not exceed the MCID. The Chinese (city) tariff showed higher ICC values (ICCs> 0.89, 95% CI:0.755–0.964) and narrower limits of agreement (0.099–0.167) than the Korean tariff [(ICCs> 0.71, 95% CI:0.451–0.955); (0.146–0.253)]. The Chinese (city) tariff had a higher relative efficiency and effect size statistics in 10 out of 11 variables as compared to the UK, US and Japanese tariffs. The Chinese (city) tariff (0.215) was associated with moderate mean absolute transition scores compared with the UK (0.342), US (0.230), Japanese (0.149) and Korean (0.189) tariffs for 1485 observed pairs of the EQ-5D-3L health states.ConclusionsHealth utility scores derived from the five tariffs differed. The Chinese (city) tariff was the most suitable of these tariffs and was without obvious weakness. We recommend adopting the Chinese (city) tariff when applying EQ-5D-3L to assess quality of life among the elderly in China’s agricultural region with socio-economic status similar to Hua County. Results of this study had provided a crucial basis for health surveys, health promotion projects, health intervention trials, and health economic evaluation taking HRQOL as a target in rural areas of China.

The Production, Relocation, and Price Effects of US Trade Policy: The Case of Washing Machines

We analyze several rounds of U.S. import restrictions against washing machines. Using retail price data, we estimate the price effect of these import restrictions by comparing the price changes of washers with those of other appliances. We find that in response to the 2018 tariffs on nearly all source countries, the price of washers rose by nearly 12 percent; the price of dryers—a complementary good not subject to tariffs—increased by an equivalent amount. Factoring in the effect of dryers and price increases by domestic brands, our estimates for the 2018 tariffs on washers imply a tariff elasticity of consumer prices of between 110 and 230 percent. The 2016 antidumping duties against China—which accounted for the overwhelming majority of U.S. imports—led to minor price movements due to subsequent production relocation to other export platform countries. Perhaps surprisingly, the 2012 antidumping duties against Korea led to relocation of production to China, actually resulting in lower washer prices in the United States. We find that our measure of the tariff elasticity of consumer prices may differ in sign and magnitude from conventional pass-through estimates which are based on a regression of country-specific import price changes on country-specific tariff changes. Production relocation effects, price changes by domestic brands, and price changes of complementary goods all contribute to the differences between these measures. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Converting Parkinson-Specific Scores into Health State Utilities to Assess Cost-Utility Analysis.

The aim of this study was to compare the Parkinson's Disease Questionnaire-8 (PDQ-8) with three multi-attribute utility (MAU) instruments (EQ-5D-3L, EQ-5D-5L, and 15D) and to develop mapping algorithms that could be used to transform PDQ-8 scores into MAU scores. A cross-sectional study was conducted. A final sample of 228 evaluable patients was included in the analyses. Sociodemographic and clinical data were also collected. Two EQ-5D questionnaires were scored using Spanish tariffs. Two models and three statistical techniques were used to estimate each model in the direct mapping framework for all three MAU instruments, including the most widely used ordinary least squares (OLS), the robust MM-estimator, and the generalized linear model (GLM). For both EQ-5D-3L and EQ-5D-5L, indirect response mapping based on an ordered logit model was also conducted. Three goodness-of-fit tests were employed to compare the models: the mean absolute error (MAE), the root-mean-square error (RMSE), and the intra-class correlation coefficient (ICC) between the predicted and observed utilities. Health state utility scores ranged from 0.61 (EQ-5D-3L) to 0.74 (15D). The mean PDQ-8 score was 27.51. The correlation between overall PDQ-8 score and each MAU instrument ranged from - 0.729 (EQ-5D-5L) to - 0.752 (EQ-5D-3L). A mapping algorithm based on PDQ-8 items had better performance than using the overall score. For the two EQ-5D questionnaires, in general, the indirect mapping approach had comparable or even better performance than direct mapping based on MAE. Mapping algorithms developed in this study enable the estimation of utility values from the PDQ-8. The indirect mapping equations reported for two EQ-5D questionnaires will further facilitate the calculation of EQ-5D utility scores using other country-specific tariffs.

A Better Alternative to a Trade War

Reducing the US-China trade deficit through the imposition of tariffs on Chinese exports to the US risks retaliatory tariffs by China. The net result may be an involuntary reduction of trade between them which lowers the aggregate welfare in both countries. It will be lose-lose. Moreover, the most likely net outcome of these new country-specific tariffs is the substitution of imports from China by imports from other countries on the part of US importers. Thus, while the US trade deficit with China falls, its trade deficit with other countries will rise. The overall US trade deficit with the rest of the world will not be significantly altered. Almost all economists agree that the aggregate US trade deficit with the rest of the world cannot be reduced without a corresponding reduction in the US investment-saving imbalance, taking the US real GDP as given. However, there is an exception: if there is an autonomous (unanticipated) increase in the demand for exports from the US which increases the real GDP of the US in the process, it is possible for the US trade deficit to be reduced. Indeed, a huge potential exists for the US to substantially increase its exports of agricultural commodities, energy, and education and tourism services to China. Finally, we address the question of what constitutes “fair trade”. There does not seem to be a generally accepted economic definition of “fairness”. Any completely voluntary and non-coercive trade at the prevailing market price should be regarded as “fair”.

Abstract WP299: Patient-centered Quality of Life Utility Values Are Superior to Modified Rankin Scale Outcomes in Stroke- Experience From the Artss-2 Trial (Randomized, Multi-center Trial of Argatroban With Recombinant Tissue Plasminogen Activator for Acute Stroke)

Background and Purpose: Although the modified Rankin Score ( mRS ) is broadly used as a measure of stroke outcome, patients’ valuation of each mRS category has been understudied. Stroke patient/caregiver quality of life ( QOL ), expressed in 0-1 numerical utility scores, more accurately reflect patient-centered health states. We hypothesized that QOL utility values would not be linearly associated with mRS. Rather, clinically-meaningful transitions with large utility differences would occur among certain mRS scores. Methods: Utilities were obtained from ischemic stroke patients or proxy family members in the ARTSS-2 randomized trial; clinicaltrials.gov/NCT01464788. A societal perspective for health-state assessments was performed using Time-Trade-Off methodology (EuroQol-5D). Utilities were converted using country-specific tariffs as ARTSS-2 had US & UK sites. Death was assigned a utility=0. Certified raters blinded to utility data assessed 90-day mRS. Mean (SD) utilities were mapped across mRS categories. mRS 5 & 6 were collapsed as 5, bedbound and dependent for all bodily needs, is accepted to be equal or worse than death (mRS=6). Results: 86 of 90 (96%) patients had utilities at 90-days. Excluding missing and deaths, 70 patients had utilities generated by either the patient (N=48; 70%) or the proxy (N=22; 30%). Of the 22 proxy assessments, 20 (91%) were aphasic, 1 had severe neglect, and 1 remained mechanically ventilated. Utility vales declined in a non-linear fashion with increasing mRS; the largest difference between 3-4 and 4-5+6 (Figure). Conclusions: Although the mRS is analyzed under a linear assumption that each numerical transition is equal, stroke patient QOL utilities demonstrate important transitions between mRS scores. Future stroke trials should consider replacing mRS with direct patient utilities or convert mRS into utility-weighted scores established by patient-generated values that reflect clinically important health states.

A Better Alternative to a Trade War

Reducing the U.S.-China trade deficit through the imposition of tariffs on Chinese exports to the U.S. risks retaliatory tariffs by China. The net result may be an involuntary reduction of trade between them, which lowers the aggregate welfare in both countries. It will be lose-lose. Moreover, the most likely net outcome of these new country-specific tariffs is the substitution of imports from China by imports from other countries on the part of U.S. importers. Thus, while the U.S. trade deficit with China falls, its trade deficit with other countries will rise. The overall U.S. trade deficit with the rest of the world will not be significantly altered. Almost all economists agree that the aggregate U.S. trade deficit with the rest of the world cannot be reduced without a corresponding reduction in the U.S. investmentsaving imbalance, taking the U.S. real GDP as given. However, there is an exception: if there is an autonomous (unanticipated) increase in the demand for exports from the U.S. which increases the real GDP of the U.S. in the process, it is possible for the U.S. trade deficit to be reduced. Indeed, huge potential exists for the U.S. to substantially increase its exports of agricultural commodities, energy, and education and tourism services to China. Finally, we address the question of what constitutes “fair trade”. There does not seem to be a generally accepted economic definition of “fairness”. Any completely voluntary and non-coercive trade at the prevailing market price should be regarded as “fair”.

Does the choice of tariff matter?: A comparison of EQ-5D-5L utility scores using Chinese, UK, and Japanese tariffs on patients with psoriasis vulgaris in Central South China.

There is an increasing trend globally to develop country-specific tariffs that can theoretically better reflect population's preferences on health states for preference-based health-related quality-of-life instruments, also known as multiattribute utility instruments. This study focused on the most recently developed 5-level version of EuroQol-5 Dimension (EQ-5D) questionnaire, 1 of the world's most well-known multiattribute utility instruments, and aimed to empirically explore the agreements and known-group validities of applying the country-specific tariff versus tariffs developed from other countries using a sample of psoriasis vulgaris patients in Mainland China.A convenience sampling framework was adopted to recruit patients diagnosed with psoriasis vulgaris from Xiangya Hospital, Central South University, China, between May 2014 and February 2015. The 5-level EuroQol-5 dimensions (EQ-5D-5L) utilities were scored by using the Chinese, Japanese, and UK tariffs. Health state utilities were compared using a range of nonparametric test. The intraclass correlation coefficients and Bland-Altman plots were used to examine the agreements among the 3 EQ-5D-5L scores. Health state utility decrements between known groups were investigated using both effect size and a regression analysis.In all, 350 patients (aged 16 years or older) were recruited. There were significant differences among the 3 national tariff sets. Overall, 3 tariffs showed excellent agreements (intraclass correlation coefficient >0.90); however, the wide limits of agreement from the Bland-Altman plots suggest that these tariffs cannot be used interchangeably. The EQ-5D-5L scores using the Chinese-specific tariff showed the best known-group validity than the other 2 tariffs in this Chinese patient sample. The evidence from this study supports the choice of the country-specific tariff to be used in Mainland China.

Comparison of EQ-5D-5L health state utilities using four country-specific tariffs on a breast cancer patient sample in mainland China.

ObjectiveThe objective of this study was to compare the differences in the five-level EuroQol-5 dimensions (EQ-5D-5L) health state utility scores derived from Chinese, Japanese, Korean, and UK tariffs.MethodsSix hundred and twenty-one breast cancer patients were invited for a face-to-face interview in Qingdao Municipal Hospital, China. EQ-5D-5L was scored using tariffs from China, Japan, Korea, and the UK. The null hypothesis of normal distribution of the EQ-5D-5L utility score was tested by the Shapiro–Wilk test. Nonparametric Friedman test and Wilcoxon signed-rank test were used to determine the difference among the four tariffs. The intraclass correlation coefficients (ICCs) and Bland–Altman plots were used to study the agreement among the four EQ-5D-5L scores. Known-groups validity was studied using a regression framework.ResultsThere were 608 participants in the final analysis, with a mean ± standard deviation (SD) age of 48.0±9.6 years. EQ-5D-5L utility scores were non-normally distributed. The means (median) ± SD of EQ-5D-5L utilities derived from Chinese, Japanese, Korean, and UK tariffs were 0.828 (0.879) ±0.184, 0.802 (0.823) ±0.164, 0.831 (0.829) ±0.137, and 0.838 (0.866) ±0.154, respectively. Among pairwise comparisons, the difference of median EQ-5D-5L utility scores was only insignificant between Chinese and UK tariffs. Excellent agreements (with ICCs >0.9) were found among the four tariffs albeit the limits of agreement between each pair of tariffs were wide. Known-groups validity was supported.ConclusionAlthough four country-specific EQ-5D-5L tariffs have shown an overall high level of correlation and agreement, none of them could be regarded as interchangeable. The higher correlation and agreement between Chinese and UK tariffs may be due to the similar functions that were used in the tariff development. In the absence of Chinese-specific tariff, the UK tariff is the second-best option to be applied in the Chinese population. Results of this study further contribute to the explanation of variations among country-specific tariffs.

PRM160 - The Impact of Country-Specific Utility Tariffs on the Outcome of Cost-Utility Analyses; A Case Study

Countries generally use their own utility tariff to convert EQ-5D-3L health states to utility scores. However, it is unclear what the impact of these country-specific tariffs on the outcome of a cost-utility analysis is. Therefore, the aim of the current study was to evaluate this issue. Because the EQ-5D-3L mainly focusses on physical aspects of HRQOL, we evaluated this using data from two studies; a randomized controlled trial in patients with a physical disorder (low back pain) and a randomized controlled trial in patients with a mental disorder (depression). A literature search was done to identify EQ-5D-3L utility tariffs derived using the Time Trade Off method. Missing data was imputed using Multiple Imputation by Chained Equations (MICE). Incremental Cost-Utility Ratios (ICURs), cost-effectiveness planes and cost-effectiveness acceptability curves (CEA curves) were estimated. Thirteen utility tariffs were identified. In the low back pain study, the ICUR using the Dutch tariff was 11,600 €/QALY, and ranged from 8,278 €/QALY for the Taiwanese tariff to 18,355 €/QALY for the Polish tariff. The probability of cost-effectiveness at a ceiling ratio of 30,000 €/QALY was 0.77, and ranged from 0.61 for the Polish tariff to 0.83 for the UK tariff. In the depression study, the ICUR using the Dutch tariff was 50,574 €/QALY, and ranged from 36,124 €/QALY for the US tariff to 96,551 €/QALY for the Japanese tariff. The probability of cost-effectiveness at a ceiling ratio of 30,000 €/QALY was 0.39, and ranged from 0.30 for the Japanese tariff to 0.45 for the US tariff. The results show that depending on the utility tariff that is chosen, the intervention may be considered cost-effective in comparison with usual care in one country and not cost-effective in another country. This suggests that results from cost-utility analyses cannot be unthinkingly transferred from one country to another.

EQ-5D Scores for Diabetes-Related Comorbidities.

A single-source catalogue of nationally representative EuroQol five-dimensional questionnaire (EQ-5D) scores for chronic conditions in the United States and the United Kingdom from the Medical Expenditure Panel Survey (MEPS) has been published and has been used extensively for public health and cost-effectiveness modeling. To estimate EQ-5D scores for diabetes-related chronic conditions that are consistent with the previous catalogue. The MEPS is a nationally representative survey of the US civilian population. EQ-5D-3L questionnaire responses were mapped from short-form 12 health survey responses in 2000 to 2011 MEPS data using multinomial logistic regression. Country-specific tariffs were applied to the mapped EQ-5D responses for the United Kingdom, the United States, France, and Spain. EQ-5D scores were regressed on diabetes-related comorbidities controlling for sociodemographic characteristics, body mass index, and comorbidity using robust (median) regression. Methods were consistent with the previously published catalogue of EQ-5D scores for the United States. There were 20,705 individuals with diabetes and a valid mapped EQ-5D score in the 2000 to 2011 MEPS data. Unadjusted mapped EQ-5D scores for individuals with diabetes varied by country-specific tariff from 0.70 (France) to 0.79 (United States). Regression results reflecting marginal disutility estimates for EQ-5D scores are provided for 17 diabetes-related comorbidities and body mass index categories for US, UK, French, and Spanish tariffs. The estimates provided in this research may be useful for analysts attempting to model the impact of diabetes and diabetes-related comorbid conditions on utility. They are derived from a single-source, nationally representative population and augment the existing "off-the-shelf" catalogue of EQ-5D scores for chronic conditions.

Economic burden of toxicities associated with treating metastatic melanoma in eight countries

BackgroundInformation 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.MethodsA 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.ResultsIn 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).ConclusionsCosts of managing AEs can be significant, and thus effective treatments with lower rates of severe AEs would be valuable.

Comparison of treatment costs of grade 3/4 adverse events associated with erlotinib or pemetrexed maintenance therapy for patients with advanced non-small-cell lung cancer (NSCLC) in Germany, France, Italy, and Spain

Objective of this indirect economic comparison was to estimate and compare management costs of grade 3/4 adverse events (AEs) reported for first-line erlotinib or pemetrexed maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC). The economic analysis was performed for Germany, France, Italy and Spain.Types and incidences of reported grade 3/4 AEs observed with erlotinib or pemetrexed maintenance therapy were retrieved from two recently published placebo-controlled trials. Country-specific estimates on standard treatment algorithms and incremental medical resource utilization associated with each of the reported grade 3/4 AEs have been obtained from clinical oncologists practicing in the four countries and co-authoring this article. The resource use items were subsequently assigned country-specific tariffs to estimate total per-patients costs associated with the AE profiles of the two compared maintenance regimens. For the economic analysis a customized economic spreadsheet model was employed.Our comparison shows lower total average per-patient AE management costs for erlotinib than for pemetrexed maintenance therapy in all four studied countries. Total estimated cost savings per patient in favour of erlotinib amount to € 121, € 237, € 106, and € 119 for Germany, France, Italy and Spain, respectively. These AE cost savings for erlotinib when compared to pemetrexed represent a decrease by 80%, 71%, 94%, and 82%, respectively. The study also discovered considerable differences in AE management costs across countries which are primarily due to differences in clinician's estimates of hospitalization referral rates.Erlotinib maintenance therapy in patients with advanced NSCLC causes lower AE management costs than pemetrexed maintenance therapy indicating a potentially superior tolerability profile.

Mapping the Modified Rankin Scale (mRS) Measurement into the Generic EuroQol (EQ-5D) Health Outcome

Mapping disease-specific instruments into generic health outcomes or utility values is an expanding field of interest in health economics. This article constructs an algorithm to translate the modified Rankin scale (mRS) into EQ-5D utility values. mRS and EQ-5D information was derived from stroke or transient ischemic attack (TIA) patients identified as part of the Oxford Vascular study (OXVASC). Ordinary least squares (OLS) regression was used to predict UK EQ-5D tariffs from mRS scores. An alternative method, using multinomial logistic regression with a Monte Carlo simulation approach (MLogit) to predict responses to each EQ-5D question, was also explored. The performance of the models was compared according to the magnitude of their predicted-to-actual mean EQ-5D tariff difference, their mean absolute and mean squared errors (MAE and MSE), and associated 95% confidence intervals (CIs). Out-of-sample validation was carried out in a subset of coronary disease and peripheral vascular disease (PVD) patients also identified as part of OXVASC but not used in the original estimation. The OLS and MLogit yielded similar MAE and MSE in the internal and external validation data sets. Both approaches also underestimated the uncertainty around the actual mean EQ-5D tariff producing tighter 95% CIs in both data sets. The choice of algorithm will be dependent on the study aim. Individuals outside the United Kingdom may find it more useful to use the multinomial results, which can be used with different country-specific tariff valuations. However, these algorithms should not replace prospective collection of utility data.

Do safeguard tariffs and antidumping duties open or close technology gaps?

This paper examines how the country-breadth of tariff protection can affect the technology adoption decisions of both domestic import-competing and foreign exporting firms. The contribution of the analysis is to show how firm-level technology adoption changes under tariffs of different country-breadth. I show that a country-specific tariff like an antidumping duty induces both domestic import-competing firms and foreign exporting firms to adopt a new technology earlier than they would under free trade. In contrast, a broadly-applied tariff like a safeguard can accelerate technology adoption by a domestic import-competing firm, but will slow-down technology adoption by foreign exporting firms. Because safeguard tariffs can delay the foreign firm's adoption of new technology, the worldwide welfare costs associated with using them may be larger than is generally believed.

Economic analysis of the use of contrast media during percutaneous coronary interventions in France and Spain

SummaryThe iso-osmolar contrast medium iodixanol (Visipaque™; GE Healthcare, UK) has been reported to reduce the risk of major adverse cardiac events and to have a higher success rate when used during percutaneous coronary intervention (PCI) compared with the ionic low-osmolar contrast medium ioxaglate (Hexabrix; Guerbet, France) for patients at risk of complications. This study assessed to what extent these clinical benefits translate into economic benefits for patients undergoing PCI in France and Spain using a decision tree model. Clinical data were derived from the COURT and VIP trials. Medical resource use data were obtained from panels of French and Spanish interventional cardiologists. Resource use was converted to costs using country-specific tariffs. The study results suggest that using iodixanol rather than ioxaglate confers an economic benefit in addition to the reported clinical benefit in high-risk patients undergoing PCI in both countries. For low-risk patients, iodixanol may be regarded as cost-effective when relating the extra cost to the small reported increase in angiographic success.

Do Safeguard Tariffs and Antidumping Duties Open or Close Technology Gaps?

This paper examines how the country-breadth of tariff protection can affect the technology adoption decisions of both domestic import-competing and foreign exporting firms. The analysis is novel in that shows how firm-level technology adoption changes under tariffs of different country-breadth. I show that a country-specific tariff like an antidumping duty induces both domestic import-competing firms and foreign exporting firms to adopt a new technology earlier than they would under free trade. In contrast, a broadly-applied tariff like a safeguard can accelerate technology adoption by a domestic import-competing firm, but will slow-down technology adoption by foreign exporting firms. Because safeguard tariffs can delay the foreign firm's adoption of new technology, the worldwide welfare costs associated with using them may be larger than is generally believed.

The Economics of Country-Specific Tariffs

A three country model of the world economy is used to show that when effective a country-specific tariff will have an impact on the world economy that is equivalent to the imposition of a uniform tariff plus a subsidy to the production of home importables in the favored country financed by a transfer from the home country. Lerner's symmetry theorem and the optimum tariff problem are discussed. Country-specific tariffs were a prominent feature of the Congressional debate surrounding the recent U.S. trade bill. A preliminary version of the bill which passed the House contained the well-known Gephardt Amendment that would have required increased tariffs or quotas on imports from countries running unacceptably large bilateral trade surpluses with the U.S. In addition, since 1976 the U.S. has allowed most goods produced in less-developed countries to enter duty-free under its version of the Generalized System of Preferences. The country-specific nature of these preferences runs contrary to all previous U.S. trade policy and sparked controversy in the U.S. Congress when the original legislation was passed in 1974 and again when it was extended in 1984. While country-specific tariffs are a relatively new feature of U.S. trade policy, they have an established history in other countries. Prior to joining the European Economic Community, Great Britain granted preferential tariff rates on imports from the Commonwealth countries. Moreover, these countries granted tariff preferences to less-developed countries nearly five years before the U.S. initiated its General System of Preferences program. A proper theoretical analysis of country-specific tariffs and preferential tariff reductions requires a multi-country model. However, most work on tariff policy uses the standard two country framework. Almost all of the multi-country models found in the literature consider only uniform tariffs or, as in the customs union literature, consider preferential tariffs as part of a multilateral effort to coordinate trade policies rather than as a unilateral policy instrument. An exception is the partial equilibrium analysis of McCulloch and Pinera (1977). They consider a three country world economy and examine the impact of a preferential tariff reduction