Henry-Jean Gathon

Measuring Technical Efficiency in European Railways: A Panel Data Approach

We estimate a factor requirement frontier for European railways using a panel data approach in which technical efficiency is assumed to be endogeneously determined. This approach has two main outcomes. On one hand, it allows the identification of factors influencing technical efficiency, and on the other hand, it allows the estimation of alternative efficiency indicators free of these influences. In the case under study, a particular attention is devoted to an autonomy indicator representing the managerial freedom, with respect to public authorities, experienced by firms, that appears to be positively correlated with technical efficiency.

Decomposing efficiency into its managerial and its regulatory components: The case of European railways

The purpose of this paper is to decompose traditional measures of productive efficiency into a management and a regulatory component. This procedure is applied to European railways. The policy implication of such a decomposition is obvious: management is responsible for just managerial inefficiency whereas governments are responsible for slacks in regulatory efficiency. Regulatory efficiency is based on indicators pertaining to managerial freedom in pricing, hiring and marketing decisions.

Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis

Abstract:

Development and Validation of a Markov Microsimulation Model for the Economic Evaluation of Treatments in Osteoporosis.

OBJECTIVE Markov models are increasingly used in economic evaluations of treatments for osteoporosis. Most of the existing evaluations are cohort-based Markov models missing comprehensive memory management and versatility. In this article, we describe and validate an original Markov microsimulation model to accurately assess the cost-effectiveness of prevention and treatment of osteoporosis. METHODS We developed a Markov microsimulation model with a lifetime horizon and a direct health-care cost perspective. The patient history was recorded and was used in calculations of transition probabilities, utilities, and costs. To test the internal consistency of the model, we carried out an example calculation for alendronate therapy. Then, external consistency was investigated by comparing absolute lifetime risk of fracture estimates with epidemiologic data. RESULTS For women at age 70 years, with a twofold increase in the fracture risk of the average population, the costs per quality-adjusted life-year gained for alendronate therapy versus no treatment were estimated at €9105 and €15,325, respectively, under full and realistic adherence assumptions. All the sensitivity analyses in terms of model parameters and modeling assumptions were coherent with expected conclusions and absolute lifetime risk of fracture estimates were within the range of previous estimates, which confirmed both internal and external consistency of the model. CONCLUSION Microsimulation models present some major advantages over cohort-based models, increasing the reliability of the results and being largely compatible with the existing state of the art, evidence-based literature. The developed model appears to be a valid model for use in economic evaluations in osteoporosis.

Cost-Effectiveness of Osteoporosis Screening Followed by Treatment: The Impact of Medication Adherence

OBJECTIVE To estimate the impact of medication adherence on the cost-effectiveness of mass-screening by bone densitometry followed by alendronate therapy for women diagnosed with osteoporosis. METHODS A validated Markov microsimulation model with a Belgian health-care payer perspective and a lifetime horizon was used to assess the cost per quality-adjusted life year (QALY) gained of the screening/treatment strategy compared with no intervention. Real-world adherence to alendronate therapy and full adherence over 5 years were both investigated. The real-world adherence scenario employed adherence data from published observational studies, and medication adherence was divided into persistence, compliance, and primary adherence. Uncertainty was investigated using one-way and probabilistic sensitivity analyses. RESULTS At 65 years of age, the costs per QALY gained because of the screening/treatment strategy versus no intervention are euro32,008 and euro16,918 in the real-world adherence and full adherence scenarios, respectively. The equivalent values are euro80,836 and euro40,462 at the age of 55 years, and they decrease to euro10,600 and euro1229 at the age of 75 years. Sensitivity analyses show that the presence of the upfront cost of case finding has a substantial role in the impact of medication adherence on cost-effectiveness. CONCLUSION This study indicates that nonadherence with osteoporosis medications substantially increases the incremental cost-effectiveness ratio of osteoporosis screening strategies. All aspects of medication adherence (i.e., compliance, persistence, and primary adherence) should therefore be reported and included in pharmacoeconomic analyses, and especially in the presence of the upfront cost of case finding (such as screening cost).

Lifetime absolute risk of hip and other osteoporotic fracture in Belgian women

OBJECTIVES To estimate the lifetime absolute risks of hip and other osteoporotic fracture in Belgian women aged 60 years and to examine the effect of changes in baseline population fracture risk and changes in life expectancy. MATERIALS AND METHODS Estimates were performed using a Markov microsimulation model and were based on the incidence of first fracture as well as life expectancy. Baseline scenario included projected mortality rates and increasing fracture incidence by 1% per year. Alternative scenarios were performed on age, life expectancy and trends in fracture incidence. Lifetime fracture risk for osteoporotic population (T-score <or= -2.5) was also estimated. RESULTS In the baseline scenario, lifetime absolute risks of hip fracture and of any major osteoporotic fracture (hip, clinical vertebral or wrist) were respectively 24.8% and 44.3%. Alternative scenarios showed that when assuming no change of age-specific fracture rates over time, these lifetime risks were 18.3% and 35.2%, while these values were 20.0% and 38.3% assuming no future mortality reductions. For osteoporotic women, these values were respectively 34.5% and 51.5%. CONCLUSION We conclude that absolute lifetime fracture risks are substantial and that trends in fracture incidence and changes in life expectancy have a marked impact on absolute lifetime fracture risks.

An Econometric Analysis of Homeownership Determinants in Belgium

In market economies, homeownership is associated with positive externalities. Increasing the levels of homeownership has been an objective of governments for the last decades. The analysis of the determinants of tenure status provides information to this end. This paper proposes an econometric analysis of housing tenure in Belgium. We review the main variables that have been considered in the literature as influencing housing tenure, after what we estimate a logit model. We observe a strong influence of income and age on the probability of homeownership. Couple relationship and the presence of dependent children have a positive influence, but this influence is less significant. Urban location is associated with lower probability of homeownership, compared with other areas. Our observations follow the trends described for other countries in the literature.