Economic Evaluation Of Health Care Technologies Research Articles

Multinational cost-effectiveness analysis of empagliflozin for heart failure patients with ejection fraction >40.

Heart failure is a chronic progressive condition, with considerable burden on patients' quality of life and economic burden for the healthcare systems. Before the approval of empagliflozin, there were no proven effective treatments for patients with heart failure with left ventricular ejection fraction (HF LVEF)>40%. The aim of this study was to evaluate the cost-effectiveness of empagliflozin+standard of care (SoC) compared with SoC alone for patients with HF LVEF>40%, from the perspective of the healthcare systems of the United Kingdom (UK), Spain, and France, and to quantify the healthcare costs for these patients. A lifetime Markov cohort state-transition model was developed based on discrete health states defined by Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score quartiles to track disease severity. Model inputs relied primarily on the EMPEROR-Preserved trial data or obtained from published literature or country-specific databases, as well as local guidelines for the requirements for the conduct of the economic evaluation of healthcare technologies. The total lifetime cost of receiving SoC per patient was £10092, €15765, and €14958 in the UK, Spain, and France, respectively, which increased by £1407, €1148, and €1485, respectively, with the addition of empagliflozin to the SoC. Empagliflozin+SoC was associated with significantly reduced number of hospitalization for HF or cardiovascular death compared with SoC alone, which was a key driver offsetting its drug acquisition costs. The incremental cost-effectiveness ratio per quality-adjusted life year (QALY) gained was consistently favourable at £14851, €11706, and €15447 in the UK, Spain, and France, respectively. Scenario analysis using the New York Heart Association functional class showed similar results. Probabilistic sensitivity analyses showed more than 50% probability for cost-effectiveness for a willingness-to-pay (WTP) threshold of £/€20000/QALY for the three countries. Empagliflozin was found to be the first targeted treatment option that is clinically effective and cost-effective for patients with HF LVEF>40%. Prescribing empagliflozin with SoC to patients with HF LVEF>40% is expected to improve clinical outcomes and patients' quality of life and substantially below accepted WTP threshold for the healthcare systems in the UK, Spain, and France.

SA45 Dealing with Uncertainty in Cost-Effectiveness and Affordability to Inform Risk-Averse Healthcare Decision Makers

Decision makers are increasingly concerned about both cost-effectiveness and affordability, resulting in the use of willingness-to-pay (WTP) and budget impact thresholds. The cost-effectiveness acceptability curve (CEAC) is widely used to summarize uncertainty in cost-effectiveness analysis (CEA) results. As CEAC ignores the resources necessary to fund the intervention and assumes a risk neutral attitude for decision makers, cost-effectiveness affordability curves (CEAFC), and since 2021, cost-effectiveness risk-aversion curves (CERAC) have been proposed to complement CEACs. We aim to assess whether the use of CEAFC has increased and where CERAC has been applied in economic evaluations of healthcare technologies.

Economic Evaluation for Pricing and Reimbursement of New Drugs in Spain: Fable or Desideratum?

BackgroundThe economic evaluation of healthcare technologies has become in many countries a basic tool for reimbursement, pricing and purchasing decisions. ObjectiveThe objective of this article is to examine the institutional, legal, and political factors that have impeded the application of economic evaluation and the criterion of efficiency in the process of pricing and reimbursement of new medicines in Spain. MethodsNarrative description of the current institutional framework for the use of economic evaluation in pricing and reimbursement in Spain, legal and policy framework in the field of evaluation of new medicines, and stakeholder initiatives and policies related to the use of economic evaluation outside of the pricing and reimbursement process. ResultsSpain has an institutional framework created and established over the last years that could have facilitated a formal use of economic evaluation in the process of pricing and reimbursement. Nevertheless, the real use of economic evaluation at the central or regional level is still unknown, although application of the efficiency criterion, linking to cost-effectiveness, has been clearly required by Spanish laws and regulations at the national level. We highlight a certain degree of moral hazard from the central government that is not directly responsible for the budget impact of reimbursement and pricing decisions. There are currently a number of ongoing initiatives in the field of economic evaluation by various agents, but they remain uncoordinated. ConclusionsPoor governance at the highest level of decision making is the main reason for the lack of interest in economic evaluation. A profound political change, supported by transparency and accountability, is required before the criterion of efficiency can be fully considered in the process of pricing and reimbursement of new medicines in Spain.

Assessing The Joint Probability Of Cost-Effectiveness And Affordability In Decision Making

Decision makers are increasingly concerned about both cost-effectiveness (CE) and affordability, which has resulted in additional price negotiations being implemented by HTA bodies, such as NICE. Cost-effectiveness plane and cost-effectiveness acceptability curves have been widely used to summarize CE analysis results under uncertainty. However, these methods ignore the resources necessary to fund the intervention. Sendi and Briggs (2001) proposed to use cost-effectiveness affordability curves (CEAFCs) to capture the joint probability that an intervention is both cost-effective and affordable. We aim to review the application of this method in the economic evaluation of healthcare technologies. We searched MEDLINE, EconLit, EMBASE, CDR and HEED databases using the terms “cost-effectiveness” and (“affordability or “cost control”). Sub-headings were not used given the breadth of the search’s scope. Studies considering both CE and affordability using CEAFCs to evaluate healthcare technologies or programs, published in English after 2010, were included. A qualitative narrative synthesis was performed. Of the 1195 records screened, only eight utilized CEAFCs. Seven referred to a vaccine and one to promotion of breastfeeding; all were in developing countries and used both the societal and payer perspective. CEAFCs were used specifically to address concerns about affordability in situations where the incremental cost-effectiveness ratio for an individual healthcare technology was low but the overall budget impact was high. All used Markov models or decision trees and included probabilistic analyses by Monte Carlo simulations. The reported joint probability of cost-effectiveness and affordability ranged from 21% to 60%. Half of the studies were funded by pharmaceutical companies. Findings indicate that CEAFCs are a useful but underused tool, especially for investigating the cost effectiveness and affordability of new treatments in developed countries. Increased use of CEAFCs may provide a beneficial framework to address affordability concerns alongside cost-effectiveness analysis.

Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression.

BackgroundA major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT).MethodsData was collected from 568 adult patients treated with ICBT for depression during 2013–2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9) before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA) was performed and the results presented as incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention.OutcomesTaking into account the complete healthcare process (from referral to follow-up assessment), treatment costs decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 < 5) during both 2013 and 2014 and an additional 35% and 33% had achieved partial remission in 2013 and 2014, respectively. At follow-up, 42% were in full remission after treatment during both 2013 and 2014; an additional 35% and 33% were in partial remission during 2013 and 2014, respectively. Confidence ellipses occupied the south-east (SE) and south-west (SW) quadrants of the incremental cost-effectiveness plane at both post-treatment and at follow-up, indicating that the ICBT treatment was less costly and equally effective after staff reallocation.ConclusionTreating patients to the target of full remission using psychologists instead of medical specialists for post-treatment assessment is cost-saving and consequently a more valuable use of limited resources. TDABC may be a useful tool for measuring resource costs, identifying quality improvement opportunities and evaluating the consequences of such initiatives. Combining TDABC with clinical outcome measures in CEA is potentially a useful approach in mental healthcare to estimate the value of process improvement initiatives.

Exploring two cost-adjustment methods for selection bias in a small sample: using a fetal cardiology dataset.

In economic evaluations of healthcare technologies, situations arise where data are not randomized and numbers are small. For this reason, obtaining reliable cost estimates of such interventions may be difficult. This study explores two approaches in obtaining cost estimates for pregnant women screened for a fetal cardiac anomaly. Two methods to reduce selection bias in health care: regression analyses and propensity scoring methods were applied to the total mean costs of pregnancy for women who received specialist cardiac advice by means of two referral modes: telemedicine and direct referral. The observed total mean costs of pregnancy were higher for the telemedicine group than the direct referral group (4,918 versus 4,311 GBP). The regression model found that referral mode was not a significant predictor of costs and the cost difference between the two groups was reduced from 607 to 94 GBP. After applying the various propensity score methods, the groups were balanced in terms of sizes and compositions; and again the cost differences between the two groups were smaller ranging from -62 (matching "by hand") to 333 GBP (kernel matching). Regression analyses and propensity scoring methods applied to the dataset may have increased the homogeneity and reduced the variance in the adjusted costs; that is, these methods have allowed the observed selection bias to be reduced. I believe that propensity scoring methods worked better for this dataset, because after matching the two groups were similar in terms of background characteristics and the adjusted cost differences were smaller.

Addressing the Challenge for Well Informed and Consistent Reimbursement Decisions

In the context of ever-increasing healthcare expenditures and resource-limited health services, the comparative analysis of costs and benefits of competing healthcare technologies (e.g. pharmaceuticals) is essential to support public funding decisions. Australia has been at the forefront of the integration of economic evidence with reimbursement decisions to fund new pharmaceutical products through a national-level body, the Pharmaceutical Benefits Advisory Committee (PBAC). Pharmaceutical companies submit applications to have their products considered for reimbursement. The PBAC recommendations form the basis of Australian Government decisions about public funding and listing of medicines on the Pharmaceutical Benefits Scheme. The UK National Institute for Health and Clinical Excellence (NICE), amongst others, has adopted guidelines to use economic evidence for reimbursement decision processes. Decision analytic models are an expected framework for the economic evaluation of healthcare technologies submitted to national regulatory bodies such as the PBAC and NICE for public funding. They provide an explicit process for synthesising data from a variety of sources, linking intermediate outcomes to final endpoints (e.g. QALYs), extrapolating beyond the data observed in a clinical trial, and allowing for the appropriate handling and representation of uncertainty around outputs. It is now well accepted that uncertainty is inherent within any model-based economic evaluation and needs to be handled appropriately so that policy makers can have confidence in themodel’s results and/ormake decisions regarding the need for additional information. In model-based evaluations, the sources of uncertainty have been classified into three broad categories. Parameter uncertainty concerns models’ input values (e.g. probabilities of moving between states, resource use estimates) and the fact that the true values of most parameters are unknown. A further source of uncertainty, methodological, relates to the choice of analytic methods such as the perspective taken (e.g. society, government). Structural uncertainty arises from the assumptions imposed by the modelling framework and refers to the structure of the chosen model, i.e. the choice of clinical events represented in a model, and the possible transitions between them. Issues around parameter and methodological uncertainties are generally well understood and continually refined in guidelines developed by the national reimbursement bodies such as the PBAC and NICE (e.g. sensitivity analysis to address parameter uncertainty and using a ‘reference case’ to deal withmethodological uncertainty). Although concerns have been raised regarding the impact of assumptions incorporated in model structures on the quality of models, and conjecture that structural uncertainty may have a greater impact on the model’s results than other sources of uncertainty, relatively little guidance has been EDITORIAL Pharmacoeconomics 2011; doi: 10.2165/11593000-000000000-0000

Economic evaluation in cardiology

For a variety of reasons, the demand and supply of healthcare services is changing daily and expenditure on healthcare services is increasing with rates well above those of the gross domestic product in most countries, regardless of geography, economic development, and population health status. As resources are scarce, it is necessary to ensure that they are allocated in uses that maximize overall health societal benefit. Economic evaluation of healthcare technologies and interventions is a tool designed to assist decision makers in allocating budgets in ways that will maximize value for money spent. This paper explains the economic approach from the perspective of cardiology.

Understanding the effect of disease adaptation information on general population values for hypothetical health states

It has been recommended that economic evaluation of healthcare technologies should use values for hypothetical health states elicited from the general population rather than patients. The drawback is the general population may not consider the possibility of adapting to the impaired state. This study explored the extent to which the general population changes their initial values, and the factors that influenced this change, after being informed with different disease adaptation techniques. Three rheumatoid arthritis states were used for illustration. General population respondents from the United Kingdom initially valued the states. An adaptation exercise followed, where they listened to recordings of patients discussing how they adapted; they then valued the same states again. The differences between the valuations were examined using t-tests. A multivariate regression model was developed to assess the factors that impacted individuals to change their initial values. After undergoing the adaptation exercise, the respondents increased their values for the rheumatoid arthritis states. Younger and healthier individuals were more likely to increase their initial values after being informed.

Discounting and decision making in the economic evaluation of health-care technologies

Discounting costs and health benefits in cost-effectiveness analysis has been the subject of recent debate - some authors suggesting a common rate for both and others suggesting a lower rate for health. We show how these views turn on key judgments of fact and value: on whether the social objective is to maximise discounted health outcomes or the present consumption value of health; on whether the budget for health care is fixed; on the expected growth in the cost-effectiveness threshold; and on the expected growth in the consumption value of health. We demonstrate that if the budget for health care is fixed and decisions are based on incremental cost effectiveness ratios (ICERs), discounting costs and health gains at the same rate is correct only if the threshold remains constant. Expecting growth in the consumption value of health does not itself justify differential rates but implies a lower rate for both. However, whether one believes that the objective should be the maximisation of the present value of health or the present consumption value of health, adopting the social time preference rate for consumption as the discount rate for costs and health gains is valid only under strong and implausible assumptions about values and facts.

Assessing the value of atomoxetine in treating children and adolescents with ADHD in the UK

Economic evaluation of healthcare technologies is becoming increasingly relevant, enabling decision makers to assess and compare treatments within the context of costs and outcomes. Moreover, it is increasingly important for clinicians and prescribers to have some understanding of economic evaluation. For attention-deficit/hyperactivity disorder (ADHD), economic evaluations have largely focused on pharmacotherapy, and results indicate that such treatments are cost-effective compared with other interventions. This review provides an overview of ADHD, its consequences and pharmacotherapy; describes the principles of health economic analysis, health-related quality of life (HRQL) and a cost-effectiveness model of atomoxetine for ADHD treatment; and outlines guidance from the National Institute for Health and Clinical Excellence on ADHD pharmacotherapy. The cost-effectiveness of atomoxetine for children with ADHD in the UK was compared with treatment alternatives using an economic model with Markov processes. The model evaluated atomoxetine in five patient subgroups according to treatment history and comorbidities precluding stimulants. Incremental cost per quality-adjusted life-year (QALY) was calculated and compared between treatment algorithms. The Markov process incorporated 18 health states, representing a range of outcomes across the treatments. Utility values were derived from a survey of 83 parents of children with ADHD, and treatment efficacy and safety were based on a review of controlled clinical trials and literature, and validated by international experts. Costs and outcomes were estimated using Monte Carlo simulation over 1-year. Atomoxetine was a cost-effective treatment across the whole ADHD population, with incremental cost-effectiveness ratios ranging from pound 11,500 to pound 15,900 per QALY, compared with alternative pharmacotherapies, which are within UK and rest of Europe acceptability limits. Higher utility values achieved treating ADHD with atomoxetine, compensate for the relatively higher acquisition cost compared with stimulants. Atomoxetine is cost-effective and may have advantages over stimulants, including benefits to HRQL and no abuse liability and is the only treatment in the UK licensed for continued treatment into adulthood in adolescents who have shown a response from treatment.

Economic evaluation of healthcare technologies using primary research

Clinicians and policy makers are often required to make difficult decisions regarding which health technologies they use. Increasingly, government bodies, such as the National Institute of Health and Clinical Excellence...

Decision analytic economic paliperidone ER in relapsing schizophrenic patients in Italy

Schizophrenia, with its typical chronic and relapsing course, is very burdensome, both clinically and economically. Its pharmacological management relies on two main drug classes: the older, or typical, antipsychotics, which are quite effective on positive symptoms, but limited by low tolerability and poor efficacy on negative symptoms, and atypical antipsychotics, which are better tolerated and effective on a wider range of psychotic symptoms. In this article, the authors briefly discuss current management options for patients with schizophrenia and highlight some unmet clinical needs in the field. After outlining the main clinical features shown by paliperidone ER, a novel antipsychotic, in its clinical development program, a decision analytic economic appraisal of its use in relapsing schizophrenic patients in Italy, as compared to the other available atypical antipsychotics, is presented. Under base-case assumption and after applying national costs and tariffs, the model predicts paliperidone ER to be associated with better clinical outcomes, expressed in terms of stable days, and lower costs; this means that paliperidone is dominant over the alternatives, according to the principles of economic evaluation of healthcare technologies. One-way sensitivity analyses conducted on structural and cost parameters indicated robustness of base-case estimates, which remain to be confirmed by “real world” national data.

Evaluación económica y toma de decisiones en salud. El papel de la evaluación económica en la adopción y la difusión de tecnologías sanitarias. Informe SESPAS 2008

Economic evaluation of health care technologies (EEHT) has become a basic tool in the decision-making process in health. The continuous development of methods and their direct application to reality have placed EEHT as a key item on the agenda of health policy makers across countries. The present article introduces the aims of EEHT and describes the experience of several European countries where economic evaluation studies are currently used to select the health technologies to be implemented. The role played by EEHT in Spain at the present time is then discussed. Finally, pressing tasks are identified and recommendations are made for the consolidation of EEHT as a basic element in the decision-making process of health care technologies.

Introducing Economic Evaluation as a Policy Tool in Korea: Will Decision Makers get Quality Information?

Interest in the use of economic evaluations in Korea as an aid for healthcare decision makers has been growing rapidly since the financial crisis of the Korean National Health Insurance fund and the separation in 2000 of the roles of prescribing and dispensing drugs. The Korean Health Insurance Review Agency (HIRA) is considering making it mandatory for pharmaceutical companies to submit the results of an economic evaluation when demanding reimbursement of new pharmaceuticals. The usefulness of the results of economic evaluations depends highly on the quality of the studies. The purpose of this paper, therefore, is to provide a critical review of economic evaluations of healthcare technologies published in the Korean context. Our results show that many studies did not meet international standards. Study designs were suboptimal, study perspectives and types were often stated incompletely, time periods were often too short, and outcome measures were often less than ideal. In addition, some articles did not distinguish between measurement and valuation of resource use. Capital, overhead and productivity costs were often omitted. Only half of the studies performed sensitivity analyses. In order to further rationalise resource allocation in the Korean healthcare sector, the quality of the information provided through economic evaluations needs to improve. Developing clear guidelines and educating and training researchers in performing economic evaluations is necessary.

The use of conjoint analysis to elicit willingness-to-pay values. Proceed with caution?

There is a growing interest in the potential use of conjoint analysis (CA) as a tool for estimating patient preferences within the economic evaluation of healthcare technologies. It has been suggested that where cost is included as one of the attributes within the exercise, CA can be used to estimate willingness to pay (WTP) for healthcare interventions indirectly within the framework of cost-benefit analysis. While recognizing the potential advantages of CA as a technique for the assessment of benefits in health care, this paper recommends several avenues of investigation that need to be carefully explored before an informed judgment can be made as to the validity of eliciting WTP values using the CA methodology. It is argued that much can be learned from the use of qualitative research techniques in examining individuals' understanding and interpretation of CA questions where cost is included as an attribute in the exercise. Additionally, further research is required in defining techniques for establishing the most appropriate levels for the cost attribute in a CA exercise and in determining the sensitivity of WTP estimates to the levels that are chosen for the cost attribute.

9 Health economics in rheumatology

Economic evaluations of health-care technologies are playing an increasingly central role in determining which therapies are available to clinicians in the treatment of a whole range of conditions. In rheumatology, a large body of work has already been done on the cost effectiveness of alternative non-steroidal anti-inflammatory drugs (NSAIDs), and much of the current work on disease modifying therapies incorporates economic evaluations. This chapter describes the main techniques of economic evaluation and reviews the strengths and weaknesses of each. Two published economic evaluations are discussed in order to highlight what economic evaluations can offer to the care of people with rheumatoid arthritis, as well as the current limitations of economic evaluation. The objective of this chapter is to equip readers with a critical understanding of economic evaluation that can be used in considering the increasing volume of health economic data that they encounter in their clinical work.

Criteria for Public Investment: Some Simplifying Suggestions

Previous articleNext article No AccessCriteria for Public Investment: Some Simplifying SuggestionsE. J. MishanE. J. Mishan Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Journal of Political Economy Volume 75, Number 2Apr., 1967 Article DOIhttps://doi.org/10.1086/259259 Views: 4Total views on this site Citations: 22Citations are reported from Crossref Copyright 1967 The University of ChicagoPDF download Crossref reports the following articles citing this article:Giuseppe Munda, Agata Matarazzo On the impossibility of using “the correct” cost–benefit aggregation rule, Journal of Economic Studies ahead-of-print, no.ahead-of-printahead-of-print (Apr 2020).https://doi.org/10.1108/JES-06-2019-0269Douglas A. Conrad, Sean D. Sullivan Health Economics, (Sep 2014).https://doi.org/10.1002/9781118445112.stat05319Mike Paulden, Karl Claxton Budget allocation and the revealed social rate of time preference for health, Health Economics 21, no.55 (Mar 2011): 612–618.https://doi.org/10.1002/hec.1730Karl Claxton, Mike Paulden, Hugh Gravelle, Werner Brouwer, Anthony J. Culyer Discounting and decision making in the economic evaluation of health-care technologies, Health Economics 20, no.11 (May 2010): 2–15.https://doi.org/10.1002/hec.1612Colin Price Low discount rates and insignificant environmental values, Ecological Economics 69, no.1010 (Aug 2010): 1895–1903.https://doi.org/10.1016/j.ecolecon.2010.04.024Douglas A. Conrad, Sean D. Sullivan Health Economics, (Jul 2005).https://doi.org/10.1002/0470011815.b2a4a013Michael C. Jensen, Martin J. Bailey Risk and the Discount Rate for Public Investment, SSRN Electronic Journal (Jan 2003).https://doi.org/10.2139/ssrn.390110Robert C Lind Reassessing the government's discount rate policy in light of new theory and data in a world economy with a high degree of capital mobility, Journal of Environmental Economics and Management 18, no.22 (Mar 1990): S8–S28.https://doi.org/10.1016/0095-0696(90)90035-WE Kula An Empirical Investigation on the Social Time-Preference Rate for the United Kingdom, Environment and Planning A: Economy and Space 17, no.22 (Jul 2016): 199–212.https://doi.org/10.1068/a170199K.J. Stocks Discount rate for technology assessment, Energy Economics 6, no.33 (Jul 1984): 177–185.https://doi.org/10.1016/0140-9883(84)90014-8E Kula Future Generations and Discounting Rules in Public Sector Investment Appraisal, Environment and Planning A: Economy and Space 13, no.77 (Jul 1981): 899–910.https://doi.org/10.1068/a130899K. V. Nagarajan Benefit-Cost Methodology for Evaluating Peak-Load Pricing System Implementation for Electricity Rates, IEEE Transactions on Systems, Man, and Cybernetics 10, no.99 (Sep 1980): 541–547.https://doi.org/10.1109/TSMC.1980.4308558Syed M. Ahsan The Marglin-McFadden-Mishan debate on public investment criteria, European Economic Review 14, no.22 (Jan 1980): 133–144.https://doi.org/10.1016/0014-2921(80)90015-XJohn H. Noble The Limits of Cost-Benefit Analysis as a Guide to Priority-Setting in Rehabilitation, Evaluation Quarterly 1, no.33 (Sep 2016): 347–380.https://doi.org/10.1177/0193841X7700100301ROBIN POPE THE COSTING OF PUBLIC FUNDS REVISITED*, Australian Economic Papers 15, no.2626 (Jun 1976): 37–51.https://doi.org/10.1111/j.1467-8454.1976.tb00491.xRONALD E. GRIESON ON THE OPTIMAL LEVEL OF TAXATION, BORROWING, AND GOVERNMENT EXPENDITURES, National Tax Journal 28, no.22 (Mar 2021): 251–253.https://doi.org/10.1086/NTJ41862057 Daniel McFadden Criteria for Public Investment: Comment, Journal of Political Economy 80, no.66 (Oct 2015): 1295–1313.https://doi.org/10.1086/259973 Edward J. Mishan Criteria for Public Investment: Reply, Journal of Political Economy 80, no.66 (Oct 2015): 1314–1316.https://doi.org/10.1086/259974Harold M. Somers ON THE DEMISE OF THE SOCIAL DISCOUNT RATE, The Journal of Finance 26, no.22 (Apr 2012): 565–578.https://doi.org/10.1111/j.1540-6261.1971.tb00915.x William H. Oakland Criteria for Public Investment: A Comment, Journal of Political Economy 78, no.11 (Oct 2015): 175–177.https://doi.org/10.1086/259617 E. J. Mishan Criteria for Public Investment: A Reply, Journal of Political Economy 78, no.11 (Oct 2015): 178–180.https://doi.org/10.1086/259618 Bibliography, (Jan 1970): 185–194.https://doi.org/10.1016/B978-0-08-016163-1.50016-3