Energy Efficiency Analysis of Water and Wastewater Utilities Based on the IBNET Database

A víz- és szennyvíz-szolgáltató vállalatok működési költségeinek jelentős hányadát teszi ki a villamosenergia-költség. Elemzésünk az IBNET (International Benchmarking Network for Water and Sanitation Utilities) adatbázisa alapján vizsgálja a közép-kelet-európai és a FÁK országokban működő víziközművek energiahatékonyságát. Többváltozós statisztikai elemzés segítségével tárjuk fel a különböző működési jellemzők energiahatékonyságot befolyásoló hatását. A Világbank által kezdeményezett IBNET programról bővebb információ a www.ib-net.org oldalon található, angol nyelven.

A közbeszerzés jogi és hatékonysági aspektusai (The legal and efficiency aspects of public procurement)

A közpénzelköltés hatékonyságát hazai viszonylatban az éves közpénzköltés nagyságával és az alkalmazott eljárástípusok, beszerzési tárgyak számával, értékével kapcsolatosan van lehetősége a hivatalos statisztikák elemzése során az érdeklődőnek vizsgálni. A törvény preambulumában található „a közpénzek ésszerű felhasználása átláthatóságának és széles körű nyilvános ellenőrizhetőségének megteremtése, továbbá a közbeszerzések során a verseny tisztaságának biztosítása” célrendszer csak részben érvényesül. A tanulmány arra kíván rávilágítani, hogy a hazai közbeszerzés-kutatás eredményei alapján milyen elképzelés van a GDP közel 5%-án hatékony elköltéséről Magyarországon. Vajon valódi akadálya-e a közbeszerzés a tisztességtelen versenynek, s elősegíti-e a piaci folyamatok érvényesülését annak szabályozása. A szerző válaszai rávilágítanak a közbeszerzési piaci folyamatok, gyengeségek, kevésbé hatékony megnyilvánulások és kritikus vélemények okaira, melyek közvetlen kapcsolatban vannak a közbeszerzés válságos helyzetével, s azonosítják azokat a kritikus pontokat, melyeken érdemes változtatni egy reménybeli hatékonyabb állapot, piaci egyensúlyi helyzet kialakítása érdekében. _______ The analysis of public spending can be based on official statistics showing the figures of annual public spending and the value and number of different procedures and purchased items. However, public procurement spending an annual amount of 1600-1800 billion HUF of public money in an ever changing legal environment, are intended to ensure not only some efficiency in public spending, but to reach several other aims as well. Although the preamble of the public procurement law states, that “a legal environment ought to be created, where the transparency and public accountability of spending public money and fair competition regarding public procurement procedures is ensured”, these requirements are only partially met. This study, based on the results of recent analyses concerning public procurement, wishes to represent our ideas about how to spend efficiently nearly 5% of the Hungarian GDP. Is it really true, that public procurement can be regarded as a genuine means against unfair competition, and can we really foster market processes by regulating public procurement? The author answers highlight the causes of the weaknesses of public procurement procedures, inefficient practices and critical opinions, which are closely connected to the present dire state of public procurement. This study also identifies the crucial elements to be changed in order to achieve a hopefully more efficient state and a preferable market balance.

Systematic review and analysis of evidences on clinical efficacy and cost-effectiveness of biological drugs for the treatment of Ankylosing Spondylitis

Technology: Infliximab and comparator biological such as adalimumab, etanercept, golimumab. Conditions: Ankylosing spondylitis (AS) Issue: Infliximab is registered to be used in patients with AS. The aim of the Report is to evaluate the clinical efficacy and safety of infliximab and comparator biologicals for the treatment of adult AS. Methods: Systematic literature review and analysis as well as meta-analysis (direct and indirect comparison) of published randomised controlled clinical trials (RCT) were performed, all relevant health economics literature were identified ad analysed. Results: Clinical efficacy of biological therapies is based on good clinical evidences regarding to all clinical efficacy endpoints (ASAS20, ASAS40, ASAS 5/6, and BASDAI 50% response). Altogether, 22 trials are included in our meta-analysis, 12 infliximab, 3 adalimumab studies, 6 etanercept and 1 golimumab. Efficacy of biological treatments for the treatment of AS has been established by clinical scientific evidences, significant improvement at all outcomes considered was confirmed. According to the results of indirect comparison, there were no significant difference between biological treatments and placebo in terms of safety and tolerability endpoints. We found no significant difference between the clinical efficacy and safety of infliximab, adalimumab, etanercept and golimumab therapies. Cost-utility analysis of adalimumab and/or infliximab, etanercept and golimumab treatment for AS were performed in the UK, Canada, The Netherlands, Germany, Spain and France. There are no cost-utility studies from Eastern Central Europe. Implications for decision making: Efficacy of infliximab and comparator biologicals for the treatment of Ankylosing Spondylitis (AS) was proved by clinical evidence, significant improvement at all outcomes considered was confirmed. We found no significant differences in efficacy and safety of different biological treatments. Health economics results suggest that biological therapies are cost-effective alternatives for the treatment of AS in group of developed high income countries. There is a lack of health economics results in Central-Eastern European countries however these data are more and more required by governments and funders as part of the company economic dossiers.

Comparative efficacy and safety of biosimilar infliximab and other biological treatments in ankylosing spondylitis: systematic literature review and meta-analysis.

OBJECTIVES: To compare the efficacy and safety of infliximab-biosimilar with other biological drugs for the treatment of active ankylosing spondylitis (AS). METHODS: Systematic literature review for randomized controlled trials (RCTs) with adalimumab, etanercept, golimumab, infliximab and infliximab-biosimilar in AS was performed and indirect meta-analysis (Bayesian mixed treatment comparison) was carried out. The proportion of patients reaching 20 % improvement by the assessment of Spondyloarthritis International Society response criteria (ASAS20) at weeks 12 and 24 was used as efficacy endpoints, and the occurrence of serious adverse events at week 24 was applied to compare the safety of the biologicals. RESULTS: Altogether, 13 RCTs, identified by the systematic literature search, were included in the analysis. Results on the ASAS20 efficacy endpoint were reported for week 12 in 12 RCTs involving 2,395 patients, and for week 24 in 5 RCTs comprising 1,337 patients. All the five biological agents proved to be significantly superior to placebo. Infliximab showed the highest odds ratio (OR) of 7.2 (95 % CI 3.68-13.19) compared to placebo, followed by infliximab-biosimilar with OR 6.25 (95 % CI 2.55-13.14), both assessed at week 24. No significant difference was found between infliximab-biosimilar and other biological treatments regarding their efficacy and safety. CONCLUSIONS: This is the first study which includes a biosimilar drug in the meta-analysis of biological treatments in AS. The results have proven the similar efficacy and safety profile of infliximab-biosimilar treatment compared to other biologicals.

Efficacy and safety of infliximab-biosimilar compared to other biological drugs in rheumatoid arthritis: a mixed treatment comparison.

OBJECTIVE: The aim of this meta-analysis was to compare the efficacy and safety of infliximab-biosimilar and other available biologicals for the treatment of rheumatoid arthritis (RA), namely abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab and tocilizumab. METHODS: A systematic literature review of MEDLINE database until August 2013 was carried out to identify relevant randomized controlled trials (RCTs). Bayesian mixed treatment comparison method was applied for the pairwise comparison of treatments. Improvement rates by the American College of Rheumatology criteria (ACR20 and ACR50) at week 24 were used as efficacy endpoints, and the occurrence of serious adverse events was considered to assess the safety of the biologicals. RESULTS: Thirty-six RCTs were included in the meta-analysis. All the biological agents proved to be superior to placebo. For ACR20 response, certolizumab pegol showed the highest odds ratio (OR) compared to placebo, OR 7.69 [95 % CI 3.69-14.26], followed by abatacept OR 3.7 [95 % CI 2.17-6.06], tocilizumab OR 3.69 [95 % CI 1.87-6.62] and infliximab-biosimilar OR 3.47 [95 % CI 0.85-9.7]. For ACR50 response, certolizumab pegol showed the highest OR compared to placebo OR 8.46 [3.74-16.82], followed by tocilizumab OR 5.57 [95 % CI 2.77-10.09], and infliximab-biosimilar OR 4.06 [95 % CI 1.01-11.54]. Regarding the occurrence of serious adverse events, the results show no statistically significant difference between infliximab-biosimilar and placebo, OR 1.87 [95 % CI 0.74-3.84]. No significant difference regarding efficacy and safety was found between infliximab-biosimilar and the other biological treatments. CONCLUSION: This is the first indirect meta-analysis in RA that compares the efficacy and safety of biosimilar-infliximab to the other biologicals indicated in RA. We found no significant difference between infliximab-biosimilar and other biological agents in terms of clinical efficacy and safety.