Jean-Michel Josselin

Multi-criteria Decision Analysis

Multiple criteria decision analysis is devoted to the development of decision support tools to address complex decisions, especially where other methods fail to consider more than one outcome of interest. The approach is very flexible as outcomes can be quantifiable in non-monetary terms and be expressed in ordinal or numerical terms (Sect. 11.1). Basically speaking, it starts with the construction of a value tree and the identification of relevant criteria (Sect. 11.2). The approach then proceeds with gathering information about the performance of each assessed alternative against the whole set of criteria. Values are generally normalized from 0 to 1, thereby constituting what is termed a score matrix (Sect. 11.3). Numerical weights are also assigned to criteria to better reflect their relative importance (Sect. 11.4). Weights and scores are then combined to arrive at a ranking or sorting of alternatives. Should a compensatory analysis be implemented, the approach would rely on aggregation methods to build a composite indicator (Sect. 11.5). Should a non-compensatory analysis be carried out, the approach would instead examine each dimension individually (Sect. 11.6). Furthermore, a sensitivity analysis of the weights and scores can be used to explore how changes in assumptions influence the results (Sect. 11.7).

Cost-effectiveness of colorectal cancer screening with computed tomography colonography according to a polyp size threshold for polypectomy.

Objective Computed tomography colonography (CTC) has an acceptable accuracy in detecting colonic lesions, especially for polyps at least 6 mm. The aim of this analysis is to determine the cost-effectiveness of population-based screening for colorectal cancer (CRC) using CTC with a polyp size threshold. Methods The cost-effectiveness ratios of CTC performed at 50, 60 and 70 years old, without (PL strategy) or with (TS strategy) polyp size threshold were compared using a Markov process. Incremental cost-effectiveness ratios (ICER) were calculated per life-years gained (LYG) for a time horizon of 30 years. Results The ICER of PL and TS strategies were 12 042 and 2765 &U20AC;/LYG associated to CRC prevention rates of 37.9 and 36.5%. The ICER of PL and TS strategies dropped to 9687 and 1857 &U20AC;/LYG when advanced adenoma (AA) prevalence increased from 6.9 to 8.6% for male participants and 3.8–4.9% for female participants or to 9482 and 2067 &U20AC;/LYG when adenoma and AA annual recurrence rates dropped to 3.2 and 0.25%. The ICER for PL and TS strategies decreased to 7947 and 954 &U20AC;/LYG or when only two CTC were performed at 50 and 60-years-old. Conversely, the ICER did not significantly change when varying population participation rate or accuracy of CTC. Conclusion CTC with a 6 mm threshold for polypectomy is associated to a substantial cost reduction without significant loss of efficacy. Cost-effectiveness depends more on the AA prevalence or transition rate to CRC than on CTC accuracy or screening compliance.

Constitutionalism and common knowledge: Assessment and application to a future European constitution

The purpose of the paper is to advocate that constitutions should be established through a contractarian process, rather than through conventions. To achieve it, they are studied from the perspective of the concept of common knowledge. We refer to its political philosophy and game theory dimensions. The making of common knowledge relates to communication and induction problems. The argument is applied to European constitutional integration, with a particular focus on administrative law.

The Economics of Harmonizing European Law

One of the major effects of the continual process of European integration is the growing importance of transnational institutions and the accompanying legal harmonization. Such institutional changes have led to a seemingly irreversible transformation in public decision making, whereby power at the national level is displaced to the European and regional levels. This essential book provides a law and economics analysis of the challenges arising from these shifts in authority.

Cost-effectiveness of colorectal cancer screening with computed tomography colonography or fecal blood tests

Objective To assess the cost-effectiveness of colorectal cancer screening using computed tomography colonography (CTC) and immunological fecal occult blood test (iFOBT). Methods CTC and iFOBT strategies were compared with Nn screening or guaiac FOBT (gFOBT) using Markov modeling. CTC was proposed at 50, 60, and 70 years, whereas gFOBT and iFOBT were performed every 2 years beginning at 50 years until 74 years of age with a 30-year time horizon. We calculated incremental cost-effectiveness ratios and efficiency ratios (ERs). Then, we performed univariate and probabilistic sensitivity analyses. Results With gFOBT as reference, colorectal cancer prevention rate was 18% for CTC and 11% for iFOBT. The incremental cost-effectiveness ratio of CTC and iFOBT were respectively 3204 and 5458&OV0556; per life years gained (LYG), the ER for CTC was 0.22 and the ER for iFOBT was 2.08 colonoscopies per LYG. Cost-effectiveness results were sensitive to CTC cost. In the probabilistic sensitivity analysis, compared with CTC, iFOBT strategy was cost-effective for 84.6% of simulations when we assumed a willingness to pay (WTP) of 20 000&OV0556;/LYG. Conclusion CTC requires substantially less colonoscopies than iFOBT and is cost-effective for low values of WTP. However, iFOBT is the preferred screening strategy for a WTP greater than 6207&OV0556;/LYG.

From Economic to Legal Competition

The idea of legal competition as a decentralized market process of law provision in which legal clubs compete, has earned an indisputable legitimacy among economists. This book presents a debate concerning the merits of and conditions for a competitive provision of law, with a special focus on institutions in Europe.

Displacing your Principal. Two Historical Case Studies of Some Interest for the Constitutional Future of Europe

The framework of public decisions, and particularly the provision of law, is seen here as an agency contract. What distinguishes this contract is the nature of the right delegated to the agent: The capacity to make law gives the opportunity to take advantage of the incompleteness of the constitutional contract. The agency relationship may be loosened or even reversed. This article tries to draw some lessons from the English and American history in that matter and applies them to the making of the future European State.

Unitary states and peripheral regions: a model of heterogeneous spatial clubs1

Abstract Efficiency explanations of the wealth and size of nations provide useful insights into the history and current makeup of nations. We focus here on two related issues that matter, for instance, in large areas such as Western or Eastern Europe, or Canada. We develop an analytical framework for understanding the limits of constitutional unity. This microeconomic model of unitary states deals with two kinds of heterogeneity. First, preference distance or physical distance account for decreasing net benefits from expansion. Second, heterogeneity may involve a discontinuity in the spatial pattern of preferences: “peripheral behaviors” threaten unity. We integrate such behaviors into the model and draw some lessons as to the nature of an optimal constitutional area, discussing in particular the status of peripheral regions.

HTA Agencies Facing Model Biases: The Case of Type 2 Diabetes

When evaluating new drugs or treatments eligible for reimbursement, health technology assessment (HTA) agencies are repeatedly faced with cost-effectiveness analyses that evidence lack of adequate data and modeling biases. The case of type 2 diabetes illustrates this difficulty. In spite of its high disease burden, type 2 diabetes is poorly documented through existing cost-effectiveness analyses. We support this statement by an exhaustive literature review that enables us to precisely pinpoint the limitations of models used for the assessment of newly marketed (and expensive) drugs. We find that models are mostly restricted to surrogate endpoints and based on non-inferiority clinical trial data; they also show biases in the choice of comparators and inclusion criteria. Such limitations undermine the scope and applicability of HTA practice guidelines based on cost-effectiveness evidence. Nevertheless, cost-effectiveness models remain an opportunity to better inform decision makers and to reduce the uncertainty surrounding their decisions. HTA agencies are best placed to provide incentives for companies to improve the quality of the cost-effectiveness studies submitted for pricing and reimbursement decisions. One such incentive is to include stages of discussion between the company and the health authority during the evaluation process.

Federalism and Subsidiarity in National and International Contexts

A mainly European and continental notion, subsidiarity is nevertheless at the heart of federalism. Either in an international context or in order to federate a nation, the economics of constitutions provides a nuanced view of the merits of the different forms of federalism. It builds on the tools of economic analysis to try to draw some lessons from the American experience that could serve to better understand the ongoing institutional changes in Europe.