GDP Threshold Research Articles

Cost-Effectiveness of Itopride Hydrochloride for the Treatment of Functional Dyspepsia in Vietnam

Background/Objectives: Functional dyspepsia is associated with abdominal pain and nausea, which leads to reduced quality of life, loss of productivity, and economic loss for patients. Itopride hydrochloride (itopride) stimulates the gastrointestinal smooth muscles, thereby promoting gastric emptying. It has been shown to significantly improve symptoms in patients with functional dyspepsia without severe side effects. Itopride has been available in Vietnam for many years; however, the cost-effectiveness of the drug has not been established. The aim of this study is to estimate the cost-effectiveness of itopride for the treatment of functional dyspepsia in Vietnam. Methods: A 3-stage Markov model with the following health states—controlled functional dyspepsia, uncontrolled functional dyspepsia, and dead—was developed. Functional dyspepsia was used to assess itopride over 10 years using 8-week cycles. A broader Vietnamese societal perspective was assumed for the analysis. Input was retrieved from the literature and through local clinical input from physicians in Vietnam. Output was reported as an incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALY). A GDP/capita threshold (very cost-effective: 1 × GDP = Vietnamese Dong (VND) 64.1 M, cost-effective: 3 × GDP = VND 192.2 M) was used as recommended by the WHO in Vietnam. One-way and probabilistic sensitivity analyses were performed. Results: Itopride use resulted in an additional 0.28 QALYs at an extra cost of VND 11.2 M. This resulted in an ICER of VND 39.7 M per QALY, which is lower than the threshold of VND 192.2 M. One-way sensitivity analyses showed that the ICER was sensitive to varying the efficacy VND 31.8 M to VND 88.3 M), cost of itopride (ICER: VND 43.1 M to VND 56.5 M), and the health utility values (ICER: VND 45.2 M to VND 55.3 M). More than 80% of the simulations in the probabilistic sensitivity analysis were cost-effective at the 1 × GDP (VND 64.1 M) threshold, and 91.3% were cost-effective at the 3 × GDP (VND 192.2 M) threshold. Conclusion: This study shows that itopride hydrochloride is a very cost-effective treatment for functional dyspepsia in Vietnam, with the ICER (VND 39.7 M/QALY) being even lower than the 1 × GDP (VND 64.1 M) threshold.

Towards Sustainability: Understanding Norway’s Ecological Footprint Through the Framework of the Environmental Kuznets Curve

With rising concerns about environmental sustainability, examining the economic-environmental nexus is essential. This study investigates the relationship between economic growth (GDP), renewable energy consumption (RENC), urbanization (URB), and foreign direct investment (FDI) with Norway’s ecological footprint from 1990 to 2023. Guided by the Environmental Kuznets Curve (EKC) hypothesis, we aim to understand how these factors influence Norway’s environmental impact over time. Using an Autoregressive Distributed Lag (ARDL) model, the study captures both the short- and long-term effects of these variables on the ecological footprint, and model stability is confirmed through the Cumulative Sum of Squares (CUSUM) test. The findings reveal a U-shaped EKC pattern, where initial economic growth reduces the ecological footprint, but beyond a certain GDP threshold, environmental pressures increase. Renewable energy consumption is shown to lower the ecological footprint significantly, supporting Norway’s sustainability goals. Conversely, FDI is associated with increased environmental impact, potentially due to resource-intensive projects. These insights underscore the need for balanced policies that harmonize economic development with environmental preservation. Policymakers are encouraged to foster green FDI, prioritize renewable energy investments, and implement sustainable urban planning to maintain Norway’s trajectory toward ecological sustainability.

The Nexus Between De‐Globalization and OFDI From Emerging Economies: Moderating Roles of Institution and Government

ABSTRACTThe recent wave of de‐globalization has slowed the outward foreign direct investment (OFDI) process globally, with varying effects across countries. Using panel data from 25 emerging economies between 1980 and 2018, we examine the impact of de‐globalization on OFDI. Our findings show that higher de‐globalization pressure from developed countries drives emerging economies to invest more globally. Threshold regressions reveal that this positive effect is significant only when a minimum GDP threshold is met. Moreover, better institutional quality and increased government involvement strengthen the positive impact of de‐globalization on OFDI.

The effect of eco-friendly and financial technologies on renewable energy growth in emerging economies

Successfully integrating renewable energy sources depends on eco-friendliness, financial technology, and economic growth (GDP). This paper examines the dynamic effect of innovative financial and green technology on renewable energy for 38 emerging economies from 2006 to 2021. Using the dynamic First-difference Generalized Method of Moments (FD-GMM) model, the analysis identifies a critical GDP threshold of 1831.772 US dollars, significant at the 1 % confidence level. Below this threshold, GDP negatively affects green energy adoption, while above it, GDP positively influences the shift to greener energy, supporting the predicted U-shaped relationship in the data. The results conclude that eco-friendly and financial technology positively and significantly influence renewable energy adoption, where the dynamics and barriers to adopting eco-friendly and financial technologies in emerging countries may differ from those in developed nations. Based on the findings, relevant energy policies have been recommended for energy stakeholders, Tech firms and decision-makers.

The cost-utility analysis of adding ocrelizumab to the treatment plan for primary progressive multiple sclerosis in Iran

ABSTRACT Background This study evaluates the cost-effectiveness of adding ocrelizumab to supportive care for primary progressive multiple sclerosis (PPMS) in Iran. Research design and methods Using a lifetime horizon from the payer’s perspective, we developed a decision analytic model with Expanded Disability Status Scales (EDSS) as Markov health states while taking transition probabilities and treatment effects into account. Data were sourced from clinical trials and other literature. The target population was PPMS patients receiving either supportive care or ocrelizumab. We assessed cost- effectiveness through total costs, quality-adjusted life-years (QALYs), and the incremental cost- effectiveness ratio (ICER). Sensitivity analyses addressed uncertainties. Results The addition of ocrelizumab to supportive care provided an incremental gain of 0.89 QALYs and an additional cost of US$76,771.34, resulting in an ICER of US$86,220.35 compared to supportive care, which is 5.2 times Iran’s GDP per capita (US$16,557). Thus, ocrelizumab is not cost-effective at the threshold of one time GDP per capita. However, the probability of cost-effectiveness increases at higher thresholds. Sensitivity analyses confirmed the robustness of the results. Conclusion While ocrelizumab is not cost-effective at the threshold of one-time GDP per capita, its clinical benefits are significant. Formulating healthcare policies for high-cost medications with low alternatives like ocrelizumab is essential.

Pharmacogenetic guided versus standard warfarin dosing for routine clinical care with its pharmacoeconomic impact: a randomized controlled clinical trial.

Empirical use of pharmacogenetic test(PGT) is advocated for many drugs, and resource-rich setting hospitals are using the same commonly. The clinical translation of pharmacogenetic tests in terms of cost and clinical utility is yet to be examined in hospitals of low middle income countries (LMICs). The present study assessed the clinical utility of PGT by comparing the pharmacogenetically(PGT) guided- versus standard of care(SOC)- warfarin therapy, including the health economics of the two warfarin therapies. An open-label, randomized, controlled clinical trial recruited warfarin-receiving patients in pharmacogenetically(PGT) guided- versus standard of care(SOC)- study arms. Pharmacogenetic analysis of CYP2C9*2(rs1799853), CYP2C9*3(rs1057910) and VKORC1(rs9923231) was performed for patients recruited to the PGT-guided arm. PT(Prothrombin Time)-INR(international normalized ratio) testing and dose titrations were allowed as per routine clinical practice. The primary endpoint was the percent time spent in the therapeutic INR range(TTR) during the 90-day observation period. Secondary endpoints were time to reach therapeutic INR(TRT), the proportion of adverse events, and economic comparison between two modes of therapy in a Markov model built for the commonest warfarin indication- atrial fibrillation. The study enrolled 168 patients, 84 in each arm. Per-protocol analysis showed a significantly high median time spent in therapeutic INR in the genotype-guided arm(42.85%; CI 21.4-66.75) as compared to the SOC arm(8.8%; CI 0-27.2)(p < 0.00001). The TRT was less in the PG-guided warfarin dosing group than the standard-of-care dosing warfarin group (17.85 vs. 33.92 days) (p = 0.002). Bleeding and thromboembolic events were similar in the two study groups. Lifetime expenditure was ₹1,26,830 in the PGT arm compared to ₹1,17,907 in the SOC arm. The QALY gain did not differ in the two groups(3.9 vs. 3.65). Compared to SOC, the incremental cost-utility ratio was ₹35,962 per QALY gain with PGT test opting. In deterministic and probabilistic sensitivity analysis, the base case results were found to be insensitive to the variation in model parameters. In the cost-effectiveness-acceptability curve analysis, a 90% probability of cost-effectiveness was reached at a willingness-to-pay(WTP) of ₹ 71,630 well below one time GDP threshold of WTP used. Clinical efficacy and the cost-effectiveness of the warfarin pharmacogenetic test suggest its routine use as a point of care investigation for patient care in LMICs.

Why cost-effectiveness thresholds for global health donors should differ from thresholds for Ministries of Health (and why it matters).

Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision-makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.

Driving towards net zero emissions: The role of natural resources, government debt and political stability

Countries worldwide are pursuing measures for reducing emissions in response to the unprecedented impacts of climate change. Several crucial aspects need to be addressed for a carbon neutral future. This study investigates the influence of natural resources, government debts and political stability on achieving net zero carbon emissions. Utilizing cross-country data from 2001 to 2021, the analysis focuses on China, India, Pakistan, and Kazakhstan. The Westerlund panel cointegration test revealed a long-term equilibrium relationship between the variables, suggesting self-correction over time to maintain equilibrium. Our results showed a positive but statistically insignificant relationship between GD and transition to net-zero emissions. Political stability has a negative and statistically significant association with CO2 emissions. GDP has a non-linear impact on CO2 emissions, with increases leading to higher emissions until a certain GDP threshold. Natural resources show a direct relationship with CO2 emissions, indicating that natural resource exploitation adversely affects the transition to net-zero emissions. The Iterated Generalized Least Squares (IGLS) analysis confirmed the robustness of these findings, highlighting the complex interplay between economic, political and environmental factors in the transition to net-zero emissions and the need for balanced, sustainable approaches to economic growth and natural resource management. By shedding light on the critical factors influencing net zero emissions, this study provides insights for policymakers and stakeholders seeking to develop effective strategies for sustainable and environmentally responsible practices.

Mapping the value for money of precision medicine: a systematic literature review and meta-analysis.

This study aimed to quantify heterogeneity in the value for money of precision medicine (PM) by application types across contexts and conditions and to quantify sources of heterogeneity to areas of particular promises or concerns as the field of PM moves forward. A systemic search was performed in Embase, Medline, EconLit, and CRD databases for studies published between 2011 and 2021 on cost-effectiveness analysis (CEA) of PM interventions. Based on a willingness-to-pay threshold of one-time GDP per capita of each study country, the net monetary benefit (NMB) of PM was pooled using random-effects meta-analyses. Sources of heterogeneity and study biases were examined using random-effects meta-regressions, jackknife sensitivity analysis, and the biases in economic studies checklist. Among the 275 unique CEAs of PM, publicly sponsored studies found neither genetic testing nor gene therapy cost-effective in general, which was contradictory to studies funded by commercial entities and early stage evaluations. Evidence of PM being cost-effective was concentrated in a genetic test for screening, diagnosis, or as companion diagnostics (pooled NMBs, $48,152, $8,869, $5,693, p < 0.001), in the form of multigene panel testing (pooled NMBs = $31,026, p < 0.001), which only applied to a few disease areas such as cancer and high-income countries. Incremental effectiveness was an essential value driver for varied genetic tests but not gene therapy. Precision medicine's value for money across application types and contexts was difficult to conclude from published studies, which might be subject to systematic bias. The conducting and reporting of CEA of PM should be locally based and standardized for meaningful comparisons.

Economic evaluation of five first-line PD-(L)1 inhibitors for treating non-squamous non-small cell lung cancer in China: A cost-effectiveness analysis based on network meta-analysis.

Background and objective: Non-small cell lung cancer (NSCLC) is one of the most malignant cancer types that causes substantial economic burden in China. This study aimed to evaluate the cost-effectiveness of five first-line anti-PD-(L)1 treatments, including sintilimab, camrelizumab, atezolizumab, pembrolizumab and sugemalimab with each combined with chemotherapy, for treating advanced non-squamous NSCLC (nsq-NSCLC) from Chinese healthcare system perspective. Methods: Clinical data were obtained from the following clinical trials, namely, ORIENT-11, CameL, IMpower132, KEYNOTE-189 and GEMSTONE-302. A network meta-analysis was performed based on fractional polynomial models. We constructed a partitioned survival model with a three-week cycle length and a lifetime horizon to derive the incremental cost-effectiveness ratio (ICER). We performed one-way sensitivity analysis and probablistic sensitivity analysis to test the robustness. Additionally, two scenario analyses were undertaken to investigate the impact of Patient Assistant Program on the economic conclusion and to explore potential uncertainty associated with population representativeness of the global trial. Results: Compared with camrelizumab + chemotherapy, sugemalimab + chemotherapy and atezolizumab + chemotherapy were dominated, and the ICERs generated from sintilimab + chemotherapy and pembrolizumab + chemotherapy were $15,280.83/QALY and $159,784.76/QALY, respectively. Deterministic sensitivity analysis showed that uncertainty around ICERs was mainly driven by HR related parameters derived from NMA and drug price. The probablistic sensitivity analysis suggested that camrelizumab treatment was cost-effective at a willingness-to-pay threshold of 1-time GDP per capita. When the threshold was set as 3-time GDP per capita, sintilimab strategy demonstrated the excellent cost-effective advantage. Sensitivity analysis proved the reliability of base-case results. Results from two scenario analyses indicated that the primary finding was robust. Conclusion: In current context of Chinese healthcare system, sintilimab + chemotherapy appeared to be cost-effective for the treatment of nsq-NSCLC compared with sugemalimab, camrelizumab, pembrolizumab as well as atezolizumab combined with chemotherapy.

Shared-care models are highly effective and cost-effective for managing chronic hepatitis B in China: reinterpreting the primary care and specialty divide

We evaluate the impact and cost-effectiveness of shared primary-specialty chronic hepatitis B (CHB) care models in China. We constructed a decision-tree Markov model to simulate hepatitis B virus (HBV) disease progression in a cohort of 100,000 CHB individuals aged ≥18 years over their lifetime (aged 80). We evaluated the population impacts and cost-effectiveness in three scenarios: (1) status quo; (2) shared-care model with HBV testing and routine CHB follow-ups in primary care and antiviral treatment initiation in specialty care; and (3) shared-care model with HBV testing, treatment initiation and routine CHB follow-up in primary care and treatment for predetermined conditions in specialty care. We evaluated from a healthcare provider's perspective with 3% discounting rate and a willingness-to-pay (WTP) threshold of 1-time China's GDP. Compared with status quo, scenario 2 would result in an incremental cost of US$5.79-132.43m but a net gain of 328-16,993 quality-adjusted life years (QALYs) and prevention of 39-1935 HBV-related deaths over cohort's lifetime. Scenario 2 was not cost-effective with a WTP of 1-time GDP per capita, but became cost-effective when treatment initiation rate increased to 70%. In contrast, compared with status quo, secnario 3 would save US$144.59-192.93m in investment and achieve a net gain of 23,814-30,476 QALYs and prevention of 3074-3802 HBV-related deaths. Improving HBV antiviral treatment initiation among eligible CHB individuals substantially improved the cost-effectiveness of the shared-care models. Shared-care models with HBV testing, follow up and referring of predetermined conditions to specialty care at an appropriate time, especially antiviral treatment initiation in primary care, are highly effective and cost-effective in China. National Natural Science Foundation of China.

Why cost-effectiveness thresholds for global health donors differ from thresholds for Ministries of Health (and why it matters)

Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.

Cost-effectiveness of population-based screening for microalbuminuria in people with type 2 diabetes mellitus in India.

Patients with diabetes have a higher risk of developing chronic kidney disease (CKD). Early detection of CKD through microalbuminuria screening, followed by treatment, delays the progression of CKD. We evaluated the cost-effectiveness of population-based screening of microalbuminuria among normotensive type 2 diabetes mellitus patients aged >40years compared with no screening scenario using a decision tree combined with the Markov model. We considered two scenarios: Scenario I - dipstick microalbuminuria followed by spot-urine albumin-creatinine ratio (ACR) and serum creatinine in sequence; Scenario II - spot urine ACR plus serum creatinine. A mathematical cohort of the target population was simulated over a lifetime horizon with an annual cycle. Data for the model were obtained from secondary resources. The incremental cost-effectiveness ratios (ICERs) were estimated for screening scenarios compared to nonscreening scenario, along with sensitivity analyses. The discounted ICER per quality-adjusted life years gained for annual microalbuminuria screening in the normotensive diabetic population in India were ₹ 24,114 (US$ 308) and ₹ 13,790 (US$ 176) for scenarios I and II, respectively. Annual screening by scenarios I and II resulted in a reduction of 180 and 193 end-stage renal disease (ESRD) cases per 100,000 population, respectively, resulting in a cost saving of ₹ 12.3 and 13.3 Crore spent on ESRD management over 10years. Both scenarios were also cost-effective even at the screening frequencies of 5 and 10 yearly. Microalbuminuria screening was cost-effective at the threshold of one-time GDP per capita in India.

Debt and economic growth in Asian developing countries

External debt levels have increased dramatically over the past decades. Many Asian developing countries are trapped in unprecedented levels of indebtedness while utilizing a high level of external debt for fiscal activities. This study empirically investigates the impact of such debt levels by estimating the appropriate threshold of external debt to GDP on economic growth for a sample of 16 Asian countries during the years 1980 to 2016. The outcomes indicate that external debt negatively and significantly impacts growth in most of these countries. Debt to GDP threshold construction revealed ten countries with a threshold below 30%, three countries in the range between 30%–60%, two countries in the range between 60%–90%, with only Thailand exceeding a 90% threshold. The fiscal discipline of targeting an appropriate debt to GDP ratio can serve as a guide to optimizing sustainable economic growth for countries in the Asian region. That is, appropriate ratios would allow flexibility in the use of fiscal instruments to counter any future incoming economic shocks.

Cost-Effectiveness Analysis of the TCM "Yupingfeng Granules" in the Treatment of Acute Exacerbations of COPD Based on a Randomized Clinical Trial.

IntroductionTraditional Chinese medicine (TCM) is becoming increasingly important as it provides further options for treating many diseases worldwide. The TCM “Yupingfeng” has been used in China for over 800 years, and its clinical efficacy and safety for COPD treatment have been proven in previous studies. The objective of this study was to compare the long-term cost-effectiveness of Yupingfeng granules and the current conventional treatment for COPD patients in China.MethodsA Markov model was constructed from the perspective of the Chinese healthcare system using TreeAge Pro 2011. The model cycle length was 12 months, and the cycle time was set to 10 years. Data from a randomized controlled trial were used to generate the number of acute exacerbations, COPD assessment test (CAT) score and actual medication used. The state transition probabilities, costs and quality-adjusted life years (QALYs) were derived from available sources. A threshold of 72,447 yuan per QALY gained was used as a cost-effectiveness criterion. One-way and probabilistic sensitivity analyses were conducted to verify the model. In addition, the cost-effectiveness of a 35-year cycle was evaluated as a scenario analysis.ResultsIn the basic-case analysis, the ICER of adding Yupingfeng granules to the current conventional treatment drugs was ¥2123.04 per QALY, which was less than the threshold (one-time per capita GDP).Sensitivity analyses showed the results to be robust. Probabilistic sensitivity analysis showed that the probability of the ICER being less than the one-time per capita GDP threshold was 100%. In the scenario analysis, the incremental cost-effectiveness was ¥12,051.27 per QALY which was also under the one-time per capita GDP.ConclusionBy reducing the number of acute exacerbations of COPD, thereby correspondingly reducing the follow-up treatment cost, Yupingfeng granules combined with conventional treatment were found to provide a cost-effective therapeutic strategy for COPD.

HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost-Utility Analysis.

IntroductionHIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy “95–95–95” which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ecuador by 2020, according to the Ministry of Public Health, 45,056 persons are living with HIV, principally men between 15 and 49 years, and a mortality rate of 4.8/100,000 habitats. This study aims to determine the cost–utility of applying an early screening to a sexually active population vs. only a high-risk population and if the use of PrEP is justified depending on different contexts.MethodsFor the cost–utility evaluation, it was compared: (a) HIV screening performed only in the high-risk population vs. HIV screening in all population sexually active; and (b) the use of ART only for HIV treatment vs. ART as a treatment in diagnosed cases and the use of PrEP (only at a high-risk population of acquiring HIV). Calculation and weight of DALYs for HIV/SIDA were obtained through WHO guidelines. To generate the Markov model for HIV/AIDS, subjects were classified as symptomatic or asymptomatic, as well as the HIV deaths.ResultsCost–benefit analysis (CUA) showed that ICER for early diagnosis had a negative value which means a saving if the strategy will be implemented as a regular test (–$591, –$4,360) and −108 and −934 DALYs, in the case of ART and PrEP, ICER the $30,541–$59,410, which resulted in more than the GDP's threshold and health years between 2,511 and 10,635 in the general population. With a reduction of 70% in the assigned budget for the early diagnosis, Ecuadorian people could lose between 4 and 6 DALYs, while if the budget reduces more than 50% to ART, it will generate a loss of 10–12 years of healthy life.ConclusionCUA demonstrates that an early diagnosis in a sexually active population is cost-beneficial. This, combined with ART or PrEP, is ideal to add years of healthy life.

Causality between energy consumption and economic growth in the presence of GDP threshold effect: Evidence from OECD countries

This study aims to investigate the threshold effect of GDP on the causality between GDP and energy consumption (EC), using panel data of 26 OECD countries over the period 1971–2014. Threshold regression technique is employed to explore whether there exists a threshold of GDP in the relationship between GDP and energy consumption and Granger causality testing procedure based on panel VECM is applied to test the causality across GDP regimes. The empirical results highlight the existence of GDP threshold in which the effects of GDP on energy consumption and the direction of the energy-growth causality depend on the initial value of GDP. When real GDP per capita is less than US$ 48,170, there exists unidirectional causality from EC to GDP in both the short and long run. However, when GDP exceeds US$ 48,170 per capita, there is no causality relationship in the short run but GDP is found to Granger cause EC in the long run. The findings urge for the attention of policymakers to take the initiative in implementing energy conservation policies when the economy reaches certain high levels of development and to switch energy policies appropriately in different periods of economic growth, to foster sustainable development.

How Far Are We from the Planetary Health Diet? A Threshold Regression Analysis of Global Diets.

Global diets and food system not only influence human health conditions but also have a great effect on environmental sustainability. The Planetary Health Diet (PHD) proposed by the Lancet Commission is considered as a sustainable diet that meets human’s nutritional demands yet poses less pressure on the environment. In this study, we examine how the economic condition, i.e., Gross Domestic Product per capita (GDP per capita), affects the deviations of current diets from the PHD at the country level by using a threshold regression model. The results show three dimensions regarding food consumption patterns in all 11 kinds of foods across the globe, as evidenced from the data in 147 countries as of 2018. First, the findings indicate that there exist deviations from the PHD for all kinds of foods, which could guide policymakers to make dietary improvements. Second, we find that GDP per capita impacts food consumption patterns with all kinds of foods. The results demonstrate that the changing rates of food consumption amounts decrease as the GDP per capita increases. Finally, we calculate the GDP per capita thresholds for all kinds of foods, and we find the number of thresholds ranging from zero to two. Specifically, 20,000 PPP (current international $), the GDP per capita boundary distinguishing developing and developed countries, is the first GDP per capita threshold influencing the food consumption amount. What is more, the second GDP threshold is 40,000 PPP (current international $), which is the average GDP per capita of developed countries. Thus, we identify the countries that require more financial assistance from a GDP per capita perspective.

Cost-effectiveness analysis of quadrivalent seasonal influenza vaccines in Beijing: A modeling analysis

BackgroundSince 2007, Beijing has offered a free trivalent influenza vaccine (TIV) for residents aged ≥ 60 years and school students. The quadrivalent influenza vaccine (QIV) was administered to school children in 2018 and will be administered to elderly adults in the future. In addition, health care workers (HCWs) who are involved in the prevention and control of COVID-19 were included in the program in 2020. This study aimed to analyze the cost-effectiveness of a comprehensive list of combined strategies of TIV and QIV for school children, elderly adults, and HCWs to identify the most cost-effective strategy. MethodsA decision tree was developed to compare 1-year outcomes of TIV vs. QIV in three risk groups: school children, elderly adults, and HCWs. The outcome was incremental cost per quality-adjusted life-year (QALY). Probabilistic sensitivity analyses and scenario analyses were developed to assess the robustness of the results. ResultsFrom the perspective of society, this study found that the introduction of QIVs can be cost-effective for any and all targeted groups with a willingness-to-pay threshold of 3-fold GDP per capita. Among all programs, program H (all school children, elderly adults, and HCWs received the QIV) showed a 79% probability of being cost-effective with an incremental cost-effectiveness ratio (ICER) of 13,580 (95% CI: 13,294, 13,867) US$/QALY and was the preferred option in the base case scenario. ConclusionThe introduction of QIVs to school children, elderly adults, or HCWs is likely to be cost-effective, either separately or collectively. The introduction of QIV to school children, elderly adults, and health care workers simultaneously showed the highest probability of being cost-effective and was the preferred option.

Public Debt and Economic Growth in Switzerland

Economic theory suggests that a realistic level of borrowing is beneficial for both developing and developed economies in achieving sustainable level of economic growth. However, as a result of insufficient domestic resources to fund the “development projects”, required for the economic progress, most of the countries strongly rely on internal (domestic) and external (international) capitals such as public debt, foreign direct investment (FDI) and remittances. Keeping in mind this significance, this study analyzes the role of public debt, FDI and remittances in accelerating the economic growth in Switzerland. For getting this purpose achieved, the study gathers the data from world development indicators (WDI) for the period of 1997-2016. The study uses public debt, FDI and remittances as predictors, while economic growth is taken as outcome variable. The study applies auto regressive distributive lag (ARDL) model to analyze the data. Results of the study show positive influence of public debt, FDI and remittances on the economic growth of Switzerland which is in line with the economic theory. Based on the findings, the study suggests articulating and implementing policies aimed at attracting more inflows of foreign capital that will positively contribute to economic growth in the long run. The study furthers the government of Switzerland to keep debts to the GDP threshold as low as possible.