Évaluation pharmacoéconomique d'un test de prédisposition génétique aux effets secondaires musculaires reliés aux statines

Introduction : Les statines ont prouvé leur efficacité dans le traitement des dyslipidémies. Cependant, ces molécules sont associées à des effets secondaires d’ordre musculaire. Puisque ces effets peuvent avoir des conséquences graves sur la vie des patients en plus d’être possiblement à l’origine de la non-observance d’une proportion importante des patients recevant une statine, un outil pharmacogénomique qui permettrait d’identifier a priori les patients susceptibles de développer des effets secondaires musculaires induits par une statine (ESMIS) serait très utile. L’objectif de la présente étude était donc de déterminer la valeur monétaire d’un tel type d’outil étant donné que cet aspect représenterait une composante importante pour sa commercialisation et son implantation dans la pratique médicale courante. Méthode : Une première simulation fut effectuée à l’aide de la méthode de Markov, mais celle-ci ne permettait pas de tenir compte de tous les éléments désirés. C’est pourquoi la méthode de simulation d'évènements discrets fut utilisée pour étudier une population de 100 000 patients hypothétiques nouvellement initiés sur une statine. Cette population virtuelle a été dupliquée pour obtenir deux cohortes de patients identiques. Une cohorte recevait le test et un traitement approprié alors que l'autre cohorte recevait le traitement standard actuel—i.e., une statine. Le modèle de simulation a permis de faire évoluer les deux cohortes sur une période de 15 ans en tenant compte du risque de maladies cardio-vasculaires (MCV) fatal ou non-fatal, d'ESMIS et de mortalité provenant d’une autre cause que d’une MCV. Les conséquences encourues (MCV, ESMIS, mortalité) par ces deux populations et les coûts associés furent ensuite comparés. Finalement, l’expérience fut répétée à 25 reprises pour évaluer la stabilité des résultats et diverses analyses de sensibilité ont été effectuées. Résultats : La différence moyenne des coûts en traitement des MCV et des ESMIS, en perte de capital humain et en médicament était de 28,89 $ entre les deux cohortes pour la durée totale de l’expérimentation (15 ans). Les coûts étant plus élevés chez celle qui n’était pas soumise au test. Toutefois, l’écart-type à la moyenne était considérable (416,22 $) remettant en question la validité de l’estimation monétaire du test pharmacogénomique. De plus, cette valeur était fortement influencée par la proportion de patients prédisposés aux ESMIS, par l’efficacité et le coût des agents hypolipidémiants alternatifs ainsi que par les coûts des traitements des ESMIS et de la valeur attribuée à un mois de vie supplémentaire. Conclusion : Ces résultats suggèrent qu’un test de prédisposition génétique aux ESMIS aurait une valeur d’environ 30 $ chez des patients s’apprêtant à commencer un traitement à base de statine. Toutefois, l’incertitude entourant la valeur obtenue est très importante et plusieurs variables dont les données réelles ne sont pas disponibles dans la littérature ont une influence importante sur la valeur. La valeur réelle de cet outil génétique ne pourra donc être déterminée seulement lorsque le modèle sera mis à jour avec des données plus précises sur la prévalence des ESMIS et leur impact sur l’observance au traitement puis analysé avec un plus grand nombre de patients.

The Transformation Problem : an Aleternative Solution with an Identical Aggregate Profit Rate in the Labor value and the Monetary Space.

The aim of this paper is to demonstrate that, even if Marx's solution to the transformation problem can be modified, his basic conclusions remain valid. the proposed alternative solution which is presented hare is based on the constraint of a common general profit rate in both spaces and a money wage level which will be determined simultaneously with prices.

The Transformation Problem : an Aleternative Solution with an Identical Aggregate Profit Rate in the Labor value and the Monetary Space.

The aim of this paper is to demonstrate that, even if Marx's solution to the transformation problem can be modified, his basic conclusions remain valid. the proposed alternative solution which is presented hare is based on the constraint of a common general profit rate in both spaces and a money wage level which will be determined simultaneously with prices.

The Dynamic (In)efficiency of Monetary Policy by Committee

This paper develops a model where the value of the monetary policy instrument is selected by a heterogenous committee engaged in a dynamic voting game. Committee members differ in their institutional power and, in certain states of nature, they also differ in their preferred instrument value. Preference heterogeneity and concern for the future interact to generate decisions that are dynamically ineffcient and inertial around the previously-agreed instrument value. This model endogenously generates autocorrelation in the policy variable and provides an explanation for the empirical observation that the nominal interest rate under the central bank’s control is infrequently adjusted.

Did Gold Remain Relevant in the Post-1971 International Monetary System?

The central hypothesis to be tested is the relevance of gold in the determination of the value of the US dollar as an international reserve currency after 1971. In the first section the market value of the US dollar is analysed by looking at new forms of value (financial derivative products), the dollar as a safe haven, the choice of a standard of value and the role of SDRs in reforming the international monetary system. Based on dimensional analysis, the second section analyses the definition and meaning of a numéraire for international currency and the justification for a variable standard of value based on a commodity (gold). The second section is the theoretical foundation for the empirical and econometric analysis in the third and fourth sections. The third section is devoted to the specification of an econometric model and a graphical analysis of the data. It is clear that an inverse relation exists between the value of the US dollar and the price of gold. The fourth section shows the estimations of the different specifications of the model including linear regression and cointegration analysis. The most important econometric result is that the null hypothesis is rejected in favour of a significant link between the price of gold and the value of the US dollar. There is also a positive relationship between gold price and inflation. An inverse statistically significant relation between gold price and monetary policy is shown by applying a dynamic model of cointegration with lags.

Stress testing a complement of value-a-risk.

Rapport de stage (maîtrise en finance mathématique et computationnelle)

How Important Are Intergenerational Transfers of Time? a Macroeconomic Analysis.

This paper examines the implications of intergenerational transfers of time and money for labor supply and capital accumulation. Although intergenerational transfers of time in the form of grandparenting are as substantial as monetary transfers in the data, little is known about the role and importance of time transfers. In this paper, we calibrate an overlapping generations model extended to allow for both time and monetary transfers to the US economy. We use simulations to show that time transfers have important positive effects on capital accumulation and that these effects can be as significant as those of monetary transfers. However, while time transfers increase the labor supply of the young, monetary transfers produce an income effect that tends to decrease work effort. We also find that child care tax credits have little impact on parental time and money transfers, but that a universal child tax credit would increase the welfare of the rich while the poor would benefit from a means-tested program.

Some Implications of the Zero Lower Bound on Interest Rates for the Term Structure and Monetary Policy

In an economy where cash can be stored costlessly (in nominal terms), the nominal interest rate is bounded below by zero. This paper derives the implications of this nonnegativity constraint for the term structure and shows that it induces a nonlinear and convex relation between short- and long-term interest rates. As a result, the long-term rate responds asymmetrically to changes in the short-term rate, and by less than predicted by a benchmark linear model. In particular, a decrease in the short-term rate leads to a decrease in the long-term rate that is smaller in magnitude than the increase in the long-term rate associated with an increase in the short-term rate of the same size. Up to the extent that monetary policy acts by affecting long-term rates through the term structure, its power is considerably reduced at low interest rates. The empirical predictions of the model are examined using data from Japan.

Habit Formation and the Persistence of Monetary Shocks

This paper studies the persistent effects of monetary shocks on output. Previous empirical literature documents this persistence, but standard general equilibrium models with sticky prices fail to generate output responses beyond the duration of nominal contracts. This paper constructs and estimates a general equilibrium model with price rigidities, habit formation, and costly capital adjustment. The model is estimated via Maximum Likelihood using US data on output, the real money stock, and the nominal interest rate. Econometric results suggest that habit formation and adjustment costs to capital play an important role in explaining the output effects of monetary policy. In particular, impulse response analysis indicates that the model generates persistent, hump-shaped output responses to monetary shocks.

The Wage Rate and the Profit Rate in the Price of Production Equation: a New Solution to an Old Problem

The aim of this paper is to demonstrate that, even if Marx's solution to the transformation problem can be modified, his basic concusions remain valid.

Uncovering Financial Markets Beliefs About Inflation Targets

This paper exploits the term structure of interest rates to develop testable economic restrictions on the joint process of long-term interest rates and inflation when the latter is subject to a targeting policy by the Central Bank. Two competing models that econometrically describe agents’ inferences about inflation targets are developed and shown to generate distinct predictions on the behavior of interest rates. In an empirical application to the Canadian inflation target zone, results indicate that agents perceive the band to be substantially narrower than officially announced and asymmetric around the stated mid-point. The latter result (i) suggests that the monetary authority attaches different weights to positive and negative deviations from the central target, and (ii) challenges on empirical grounds the assumption, frequently made in the literature, that the policy maker’s loss function is symmetric (usually a quadratic function) around a desired inflation value.

Population Ethics and the Value of Life

Public policies often involve choices of alternatives in which the size and the composition of the population may vary. Examples are the allocation of resources to prenatal care and the design of aid packages to developing countries. In order to assess the corresponding feasible choices on normative grounds, criteria for social evaluation that are capable of performing variable-population comparisons are required. We review several important axioms for welfarist population principles and discuss the link between individual well-being and the desirability of adding a new person to a given society.

The Backing of Government Debt and the Price Level

This paper studies the interdependence between fiscal and monetary policies, and their joint role in the determination of the price level. The government is characterized by a long-run fiscal policy rule whereby a given fraction of the outstanding debt, say d, is backed by the present discounted value of current and future primary surpluses. The remaining debt is backed by seigniorage revenue. The parameter d characterizes the interdependence between fiscal and monetary authorities. It is shown that in a standard monetary economy, this policy rule implies that the price level depends not only on the money stock, but also on the proportion of debt that is backed with money. Empirical estimates of d are obtained for OECD countries using data on nominal consumption, monetary base, and debt. Results indicate that debt plays only a minor role in the determination of the price level in these economies. Estimates of d correlate well with institutional measures of central bank independence.

Nonlinear Monetary Policy Rules: Some New Evidence for the U.S.

This paper derives optimal monetary policy rules in setups where certainty equivalence does not hold because either central bank preferences are not quadratic, and/or the aggregate supply relation is nonlinear. Analytical results show that these features lead to sign and size asymmetries, and nonlinearities in the policy rule. Reduced-form estimates indicate that US monetary policy can be characterized by a nonlinear policy rule after 1983, but not before 1979. This finding is consistent with the view that the Fed's inflation preferences during the Volcker-Greenspan regime differ considerably from the ones during the Burns-Miller regime.