The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

OBJECTIVES: To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. DESIGN: Decision modelling using Markov chains compared costs and effects over 5 years. SETTING: The analysis was from the perspective of the National Health Service (NHS) in England and Wales. PARTICIPANTS: The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. DATA SOURCES: We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. MAIN OUTCOME MEASURES: We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. RESULTS: Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20,000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100,000 patients compared to psychosocial support alone over the course of 5 years. CONCLUSIONS: Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public health benefits. TRIAL REGISTRATION NUMBERS: This cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941).

E-government and Public Services : a Case Study of the Inter-administrative Portal CAT365. Research report (sythesis document)

Aquest estudi analitza els usos de les TIC a l'administració autonòmica catalana. De forma més específica, l'estudi se centra en la interacció entre l'ús d'un vessant concret de les TIC, la xarxa Internet, per part de l'administració pública, i determinats aspectes centrals d'aquest tipus d'institucions: la seva organització i estructura internes, la provisió de serveis públics o la relació amb altres agents socials. Hem analitzat, doncs, el fenomen del govern electrònic en el marc particular de la Generalitat de Catalunya, estudiant-ne el grau de desenvolupament i penetració, les seves característiques més remarcables i els problemes més importants que s'hi plantegen. El projecte de recerca es concreta en un estudi de cas sobre un projecte d'innovació específic però de gran abast, que es trobava en el moment de realització de l'estudi en la seva primera fase d'implementació: el projecte Administració Oberta de Catalunya (AOC). Concretament ens hem centrat en el vessant d'aquesta iniciativa pública que es concretava en la creació d'un portal interadministratiu a Internet, el portal www.cat365.net, destinat a proveir electrònicament serveis públics de totes les administracions que operen a Catalunya. L'estudi analitza les transformacions internes de l'administració que s'hi poden trobar associades i els elements que les condicionen, tant positivament com negativa. Igualment, intentem analitzem el que aquestes transformacions poden suposar per a la relació entre els ciutadans i les institucions públiques.

The migration towards Digital Terrestrial Television: challenges for public policy and public broadcasters

This paper initially identifies the main transformations of the television system that are caused by digitalization. Its development in several broadcasting platforms is analyzed as well as the particular obstacles and requirements that are detected for each of them. Due to its technical characteristics and its historical link to the public services, the terrestrial network requires migration strategies different from those strictly commercial, and public intervention might be needed. The paper focuses on such migration strategies towards DTT and identifies the main issues for public intervention in the areas of the digital scenario: technology, business and market transformation and the reception field. Moreover, it describes and classifies the challenges that public broadcasters should confront due to digitalization. This paper finally concludes that the leadership of the public broadcasters during the migration towards DTT is an interesting tool for public policy. The need for foster the digitalization of the terrestrial platform and to achieve certain social and public goal besides the market interest brings an opportunity for public institutions and public broadcasters to work together. That leading role could also be positive for the public service to face its necessary redefinition and reallocation within the digital context.

Female stereotypes in household appliances advertising and their social role in Spain: the perpetuation of a no- longer-existing female condition

The following dissertation proposes a qualitative approach on the matter ofadvertising, society and construction of identity, based on the effect of householdappliances commercials in constructing female identity of Spanish women today.Conclusions will be drawn based on a juxtaposition of social background andadvertising content and on how Spanish women of today perceive the evolution offemale imagery depicted in advertisements. The aim is to demonstrate how muchcommercials mirrors society and how far it reinforces paradigms no longer existing

Pharmaceutical Generics, Vertical Product Differentiation, and Public Policy

This paper studies oligopolistic competition in off-patent pharmaceutical markets using a vertical product differentiation model. This model can explain the observation that countries with stronger regulations have smaller generic market shares. It can also explain the differences in observed regulatory regimes. Stronger regulation may be due to a higher proportion of production that is done by foreign firms. Finally, a closely related model can account for the observed increase in prices by patent owners after entry of generic producers.

Health Care and Public Transit; Your Ticket to Health Care Access, 2005

Transportation is an important health care issue. The majority of the population here in Iowa have ready access and typically use private automobiles to access health care and other community services. There is also a significant segment of the population that either does not have access to a personal automobile or is not currently capable of driving. This can potentially limit their access to health care, but it has greater health implications because it can also limit access to nutrition and other community services, as well as involvement in social activities. For people unable to drive themselves, the alternatives generally include reliance on family, friends, volunteer groups, and public transit. Many choose transit because it gives them a degree of independence. Public transit is often used to supplement other options even when they are available. It becomes critical in circumstances where the other options don’t exist. In many cases there may be no family available or they may not always be able to get off work when travel needs arise during the workday. Friends may be in similar circumstances and volunteer groups may be either unavailable or overwhelmed. The fact that many patients depend on public transit to get to and from health care appointments makes it beneficial for health care professionals to get to know more about public transit and how it operates here in Iowa.

Toolbox to Address Safety and Operations on School Grounds and Public Streets Adjacent to Elementary and Middle Schools in Iowa, August 2006

This study identified transportation safety issues at existing Iowa school sites through on-site observations, traffic data collection, and through interviews with schools, law enforcement, and traffic engineers. Frequently observed problems, such as crossing at unmarked crosswalks, unloading and loading students on the street side, inattentive student safety patrols, and illegal parking, were documented and solutions were recommended for implementation. The results of the study also conclude that regular communications between school officials, traffic engineers, law enforcement, parents, and school transportation personnel are all critical to promoting safe operations within school zones.

Towards equivalent health care of prisoners: European soft law and public health policy in Geneva.

Prisoners have a right to health care and to be protected against inhumane and degrading treatment. Health care personnel and public policy makers play a central role in the protection of these rights and in the pursuit of public health goals. This article examines the legal framework for prison medicine in the canton of Geneva, Switzerland and provides examples of this framework that has shaped prisoners' medical care, including preventive measures. Geneva constitutes an intriguing example of how the Council of Europe standards concerning prison medicine have acquired a legal role in a Swiss canton. Learning how these factors have influenced implementation of prison medicine standards in Geneva may be helpful to public health managers elsewhere and encourage the use of similar strategies.

Technical inefficiency and public capital in US States: A stochastic frontier approach

This paper estimates a translog stochastic frontier production function in the analysis of all 48 contiguous U.S. states in the period 1970-1983, to attempt to measure and explain changes in technical efficiency. The model allows technical inefficiency to vary over time, and inefficiency effects to be a function of a set of explanatory variables in which the level and composition of public capital plays an important role. Results indicated that U.S. state inefficiency levels were significantly and positively correlated with the ratio of public capital to private capital. The proportion of public capital devoted to highways is negatively correlated with technical inefficiency, suggesting that not only the level but also the composition of public capital influenced state efficiency.

Pharmaceutical generics, vertical product differentiation and public policy

This paper studies oligopolistic competition in off-patent pharmaceuticalmarkets using a vertical product differentiation model. This model canexplain the observation that countries with stronger regulations havesmaller generic market shares. It can also explain the differences inobserved regulatory regimes. Stronger regulation may be due to a higherproportion of production that is done by foreign firms. Finally, a closelyrelated model can account for the observed increase in prices by patentowners after entry of generic producers.