Do some prefer to pay? Identifying bias against free COVID-19 tests

Objectives

In the United States, a federal emergency program has made SARS-CoV-2 self-test kits available at no cost. It is unclear how widely free tests are preferred. We conducted a survey to estimate the proportion of respondents who do not prefer a free test. We hypothesized that free tests would not be preferred universally, and that a preference for paying would be more common among those with conservative politics than with liberal politics, regardless of income.

Design

Observational study design.

Methods

A national sample of US adults completed an online survey. To reduce potential enrollment bias, the survey's focus was not specified beforehand. To prioritize a high-risk group, participation was limited to those who were unvaccinated or were incompletely vaccinated in the primary series against COVID-19. Participants reported their testing preferences and socio-demographic characteristics, including political affiliation. The main outcome assessed if a participant preferred to pay for a self-test or receive a free one (subsidized by the US government).

Results

Among 1215 participants, (73%, n = 886) preferred free self-testing, while 27% (n = 329) preferred to pay for the same testing. After adjusting for income, the odds of preferring to pay for self-testing were 66% higher in "strong" Republicans compared to "strong" Democrats (odds ratio = 1.66, 95% confidence interval = 1.07-2.62).

Conclusions

More than a quarter of individuals preferred paying for these tests. This preference was more likely among those with right-wing politics. Policy implications are discussed, along with future research directions.

Fluctuations and disparity in broiler and carcass price before during and after covid-19 pandemic in Indonesia

This study aims to analyze fluctuations and disparity in broiler and carcass prices before, during, and after COVID-19 pandemic in five broiler-producing regions in Indonesia, including North Sumatra, West Java, Central Java, East Java, and South Sulawesi. Weekly data series were used to analyze fluctuations and disparity before (2017-February 2020), during (March 2020-2022), and after (January-June 2023) COVID-19 pandemic. Furthermore, Coefficient of variation (CV) and convergence models were also used during the analysis. The results showed that broiler price fluctuations in the five study areas were categorized as "medium" before and during pandemic. After pandemic, the majority of the areas were in the "low" category, except for South Sulawesi province, where CV was 10.02%. Carcass price fluctuations were categorized as "low" and "moderate" before and during COVID-19 pandemic. After the viral outbreak, all the provinces investigated in this study were classified as "low". This indicated that the variability in carcass price decreased across all provinces after pandemic. The coefficient value of β1 was less than 1 indicating that broiler and carcass price did not show significant disparity between regions at all periods. The primary drivers of fluctuations and disparity were related to production and availability factors, and the government played a role in maintaining stability in producing areas.

Impact of cigarette price and tobacco control policies on youth smoking experimentation in Albania

BACKGROUND

Albania has one of the highest smoking prevalence in Europe especially among the youth. There is a lack of evidence in Albania, as well as in most of Eastern Europe and middle-income countries, regarding the effect of price on smoking experimentation.

OBJECTIVE

The study aims to assess the effect of price and tobacco control policies on youth smoking experimentation in Albania.

METHODS

We used microdata from the Global Youth Tobacco Survey in Albania for 2004, 2009, 2015 and 2020. We constructed a pseudo-longitudinal dataset and estimated a split-population model to assess the hazard of smoking experimentation.

RESULTS

Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females (p<0.001). Being male increases the odds for smoking experimentation by more than 50% as compared with females (p<0.001), whereas females appear to be more price sensitive. Peer and parent smoking are also important determinants for smoking experimentation. Introducing penalties for smokers and legal entities violating smoke-free policies implemented in 2014 is also associated with a lower hazard of smoking experimentation.

CONCLUSION

Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females. A combination of increasing taxes and strengthening the rule of law to control tobacco use in public spaces, in addition to public awareness campaigns targeting both youth and smoking parents, could help to significantly reduce the probability of smoking experimentation.

Global Economic Evaluation of the Reported Costs of Deep Brain Stimulation

INTRODUCTION

Despite the known benefits of deep brain stimulation (DBS), the cost of the procedure can limit access and can vary widely. Our aim was to conduct a systematic review of the reported costs associated with DBS, as well as the variability in reporting cost-associated factors to ultimately increase patient access to this therapy.

METHODS

A systematic review of the literature for cost of DBS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Embase databases were queried. Olsen & Associates (OANDA) was used to convert all reported rates to USD. Cost was corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022.

RESULTS

Twenty-six articles on the cost of DBS surgery from 2001 to 2021 were included. The median number of patients across studies was 193, the mean reported age was 60.5 ± 5.6 years, and median female prevalence was 38.9%. The inflation- and currency-adjusted mean cost of the DBS device was USD 21,496.07 ± USD 8,944.16, the cost of surgery alone was USD 14,685.22 ± USD 8,479.66, the total cost of surgery was USD 40,942.85 ± USD 17,987.43, and the total cost of treatment until 1 year of follow-up was USD 47,632.27 ± USD 23,067.08. There were no differences in costs observed across surgical indication or country.

CONCLUSION

Our report describes the large variation in DBS costs and the manner of reporting costs. The current lack of standardization impedes productive discourse as comparisons are hindered by both geographic and chronological variations. Emphasis should be put on standardized reporting and analysis of reimbursement costs to better assess the variability of DBS-associated costs in order to make this procedure more cost-effective and address areas for improvement to increase patient access to DBS.

Association of Launch Price and Clinical Value With Reimbursement Decisions for Anticancer Drugs in China

BACKGROUND

To investigate the association of launch price and clinical value with reimbursement decisions for anticancer drugs after the implementation of reimbursement-linked price negotiation in China.

METHODS

Anticancer drugs approved by the NMPA of China from January 2017 to June 2022 were eligible for inclusion. Approval and reimbursement dates of included drug indications were retrieved from publicly available resources. We collected measures of clinical value, including survival, quality of life, and overall response rate from pivotal clinical trials and calculated treatment price at launch. Univariate and multivariate Cox proportional hazards models were employed to estimate the association between launch price, clinical value, and reimbursement decisions of anticancer drugs in China.

RESULTS

The median reimbursement lag was 579 days (IQR: 402 - 936) for 93 indications supported by randomized controlled trials and 637 days (IQR 373 - 858) for 42 indications supported by single-arm clinical trials. Reimbursement was granted to 60 (65%) and 23 (55%) indications supported by randomized controlled and single-arm clinical trials, respectively. The launch price of anticancer drugs was not associated with reimbursement decisions in multivariate regression analyses. Indications supported by randomized controlled trials with higher clinical value were more likely to be reimbursed (HR for survival=1.07, 95%CI: 1.00 -1.15, p = 0.037), while the overall response rate of indications supported by single-arm clinical trials was not associated with the likelihood of being reimbursed (HR = 2.09, 95%CI: 0.14 - 32.28, p = 0.595).

CONCLUSION

The launch price of anticancer drugs may not have a significant impact on reimbursement decisions, while the implementation of reimbursement-linked price negotiation in China has prioritized anticancer drugs with higher clinical value, but only for indications supported by randomized controlled trials. Efforts are needed to prioritize indications supported by single-arm clinical trials that have higher value during the process of price negotiation.

Availability, price, and affordability of anti-hepatitis B virus drugs: a cross-sectional study in China

BACKGROUND

The global prevalence of hepatitis B virus (HBV) has presented a persistent challenge for public health prevention and treatment. However, studies that assess the public's access to anti-HBV drugs are absent.

AIM

To examine the availability, pricing, and affordability of anti-HBV drugs in Jiangsu province, China and provide recommendations for improvement.

METHOD

An enhanced methodology developed by the World Health Organization (WHO) and Health Action International was applied in a cross-sectional study that included 1026 healthcare facilities distributed in 13 prefectural-level cities in Jiangsu province.

RESULTS

Since almost all drugs had an availability of less than 30%, the accessibility of anti-HBV drugs was notably low. Primary healthcare facilities had the lowest availability, reporting 1.4% for Original Brands (OBs) and 1.7% for lowest-priced generics (LPGs). Furthermore, the northern Jiangsu region recorded the lowest availability at 0.7%. LPGs demonstrated higher availability than OBs, with median availability probabilities of 2.6% and 1.4%, respectively. The drugs listed on the WHO Essential Medicines List exhibited higher availability than those on other lists. The median price ratios for OBs, LPGs, and volume-based purchasing drugs were 0.83, 0.50, and 0.27, respectively, less than 1.5 times the international reference price. Despite favorable pricing, affordability rate was 23% for urban residents and 0% for rural residents, which was discouraging.

CONCLUSION

Low availability and affordability of anti-HBV drugs were observed. Policy recommendations should emphasize the improvement of LPG availability by incentivizing priority prescribing. Healthcare subsidies should be provided more effectively and equitably.

Cash critical care time prices vary substantially by region and hospital ownership: A cross-sectional study

OBJECTIVES

Emergency department (ED) patients may be billed for critical care time (current procedural terminology codes 99291 and 99292) if they receive at least 30 min of critical care services. We sought to determine the median cash (self-pay) prices for critical care time performed in the ED in the United States and assess for associations between hospital characteristics and prices.

METHODS

We performed a cross-sectional analysis of hospital cash prices for critical care time performed in the ED using the first 25 alphabetical states. For each hospital, we recorded hospital characteristics including state, control (nonprofit, governmental, or for-profit), size, teaching status, and system. We then searched for each hospital's cash prices for 99291 and 99292 using Turquoise and hospital websites. We determined the median price for 99291 nationally, regionally, and for large hospital systems. We performed multivariable quantile regression to assess for associations between hospital characteristics and prices for 99291.

RESULTS

Of the 2629 eligible hospitals, 2245 (85.4%) and 1893 (72.0%) reported cash prices for 99291 and 99292, respectively. For 99291, the cash price ranged from $45 to $84,775 with a median of $1816 (IQR: $1039-3237). For 99292, the median price was $567 (IQR: $298-1008). On multivariable analysis, hospitals had higher cash prices for 99291 if they were located in the West, for-profit, or part of a large system. In particular, hospitals owned by Tenet Healthcare charged the most for 99291 (median $28,244).

CONCLUSION

The cash prices for critical care time vary substantially based on hospital characteristics. In particular, for-profit hospitals and those in the West tend to charge the most. Given that patients who require critical care are unlikely to be able to choose the hospital to which they present, standardization of critical care time fees should be considered.

Tobacco minimum packaging policy to reduce cigarillo use among young people: results of an experimental study

OBJECTIVE

The Food and Drug Administration has the authority to set a minimum for cigar pack size, a product feature linked to price. This study examined the effects of cigarillo package size and price on young adults' smoking and purchase intentions.

DESIGN

Young adults (n=1032) 18-30 years old who smoked cigarillos in the past 12 months completed an online 3×2 within-subjects experiment testing the effects of cigarillo pack size (1, 2, 5) and price (actual price, standardised price per stick) on intentions to purchase and smoke cigarillos. We modelled the main effects and interactions of pack size and price on intentions to buy and smoke cigarillos overall and by cigarillo use frequency.

RESULTS

Intentions to buy and smoke were strongest for lower priced singles and two packs compared with higher priced five packs. Under standardised price conditions, participants preferred larger packs, but under actual pricing conditions smaller packs, especially two packs, were preferred. Participants who smoked cigarillos less than monthly were more likely to buy and smoke the least expensive products (buy: singles actual price adjusted OR (aOR)=4.51, 95% CI 3.76 to 5.42; two packs actual price aOR=9.76, 95% CI 8.11 to 11.75; five packs standardised price aOR=3.17, 95% CI 2.89 to 3.48) with the strongest preference for two packs and singles.

CONCLUSIONS

Young adult cigarillo smokers prefer smaller packs in conditions where pricing incentivises smaller packs. Minimum pack size policies may reduce the appeal of cigarillos among young adults, especially less frequent cigarillo smokers. Pack size policy should take into consideration price, and ideally these two factors should be addressed together.

Cigarette excise tax structure and cigarette prices in nine sub-Saharan African countries: evidence from the Global Adult Tobacco Survey

BACKGROUND

Economic theory predicts that the excise tax structure influences the distribution of cigarette prices. Evidence shows that uniform specific excise tax structures exhibit the least price variability relative to other tax structures. The distribution of cigarette prices under different excise tax structures has never been examined for a group of African countries.

OBJECTIVES

To examine the distribution of cigarette prices under different tax structures in nine African countries and to critically evaluate the effectiveness of African regional tax directives in promoting public health.

METHODS

Data from the Global Adult Tobacco Survey, conducted in eight African countries during 2012-2018, and data from the 2017 Gambia Tobacco Survey were used to construct survey-derived cigarette prices. The coefficients of variation and skewness of the price distribution were compared in the context of each country's cigarette excise tax structure.

RESULTS

The least price variability is found in countries with a uniform specific tax, or a mixed system with a minimum specific floor. Cigarette price variability is largest in countries with uniform ad valorem tax structures. Three of the four countries with ad valorem tax structures are in regional blocs, where the tax directives specify that they should implement an ad valorem structure.

CONCLUSIONS

Regional tax directives that require the adoption of uniform specific excise taxes, or high minimum specific floors, could be an efficient way to get multiple African countries to adopt a tax structure that reduces substitution possibilities in response to excise tax increases.

Crowding-out effect of tobacco consumption in Indonesia

BACKGROUND

Tobacco consumption is pervasive in Indonesia, with 6 out of 10 households in the country consuming tobacco. Smoking households, on average, divert a significant share (10.7%) of their monthly budget on tobacco products, which is higher than spending on staples, meat or vegetables. Nevertheless, evidence of the causal link between tobacco expenditure and spending on other commodities in Indonesia is limited.

OBJECTIVE

This study aims to estimate the crowding-out effects of tobacco spending on the expenditure of other goods and services in Indonesia.

METHOD

This research estimates the conditional Engel curve with three-stage least square regression, where the instrumental variable technique is applied to address the simultaneity of tobacco and total non-tobacco spending. The study employs a large-scale household budget survey from the Indonesian socioeconomic survey (Susenas) from 2017 to 2019, comprising over 900 000 households.

FINDING

Tobacco spending crowds out the share of a household's budget allocated for food, such as spending on staples, meat, dairy, vegetables and fruits. Moreover, tobacco spending also reduces the share of expenditure spent on non-food commodities, such as clothing, housing, utilities, durable and non-durable goods, education, healthcare and entertainment, although its effect is not as large as the crowding out on food. The analysis shows that the crowding-out effects of tobacco are observed across low-income, middle-income and high-income households. In addition, the simulation suggests that reducing tobacco expenditure will increase household spending on essential needs.

Assessing food availability and healthier options in an urban Chinese university: a case study using the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S)

Young adults (18-24 years) in universities are frequently exposed to an environment that promotes unhealthy eating behaviors. Using a validated tool, the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S), we assess the food availability and healthier options in a large, urban Chinese university. We employed C-NEMS-S for scoring criteria and weighting. A total of 52 on-campus canteen outlets were audited in an urban university located in Shijiazhuang City, China. General food outlets (n 43) and self-served food outlets (n 7) were further categorized into eight subtypes. Beverage outlets (n 2) were discussed separately from food outlets. C-NEMS-S scores were significantly different across food outlet types (P = 0.0024), especially between noodle and rice outlets (P = 0.0415). Food availability scores for starchy tubers (P < 0.001), dry beans (P < 0.001), vegetables (P = 0.0225), and fruits (P < 0.001) were significantly different across food outlet subtypes. Healthier options were scarce and only appeared in "grains" (n 2) and "meat and poultry" (n 2) categories. Further research on improving the accustomed audit tool and assessing university student diet quality is warranted.

Cigarette packaging, warnings, prices, and contraband: A discrete choice experiment among smokers in Ontario, Canada

In Canada, despite substantial decline, tobacco use remains the leading risk factor responsible for mortality and morbidity. There is overwhelming evidence that higher tobacco taxes reduce tobacco use, even if high taxes create an incentive to avoid or evade tobacco taxes. Recently, in addition to taxes, plain and standardized packaging and printing a warning on each cigarette have been lauded to reduce tobacco use. In November 2019, Canada became the country with the most comprehensive cigarette packaging regulations; and in June 2022, Canada proposed to print health warnings on individual cigarettes, the first jurisdiction to ever do so. The regulations came into force on August 1, 2023, and are being implemented through a stepwise approach. Our objective was to examine the effects of plain and standardized packaging, warning on cigarettes, price, and the availability of illicit cigarettes on intention to purchase and risk perceptions. We conducted a discrete choice experiment, and examined heterogeneity in preferences using latent class models among smokers in Ontario, Canada. We found that using latent class analyses was essential in quantifying preferences for attributes of cigarettes and cigarette packs. First, nearly half of smokers stated a preference for cheaper illicit cigarettes in a branded pack without any health warnings, regardless of the licit cigarette alternatives. For about 20% of respondents, plain packaging and especially warning on cigarette sticks decreased the probability of stating a purchasing preference for these alternatives. Third, about a third of respondents chose competing alternatives with mostly one attribute in mind, price. Lastly, none of the products and attributes seem to have significantly influenced risk perception. Our findings attest to the importance of prices and taxes, to the potential of warnings on cigarette sticks to control tobacco use, and indicate that efforts to restrict the availability of illicit cigarettes may yield substantial benefits.

Excise taxes and pricing activities of e-liquid products sold in online vape shops

BACKGROUND

Although e-cigarette excise taxes have great potential to prevent the initiation and escalation of e-cigarette use, little information is available on pricing activities of online vape shops, and how well taxation is implemented during web-based sales remains unclear.

OBJECTIVES

We examine e-liquid pricing activities in popular online vape shops that sell nationwide in the USA and present how those stores charge excise taxes based on shipping addresses in states and local jurisdictions that have e-cigarette taxation in place.

METHODS

We collect e-liquid sales prices from five online vape shops using web data extraction, standardise prices for e-liquid products, and present e-liquid price distribution in the whole sample and in each store, as well as variations of excise taxes across states/local jurisdictions and between stores. The price data were scraped from the store websites from February to May in 2021.

RESULTS

We collected data on 14 477 e-liquid products from five stores. The average price of e-liquids is $0.25/mL, and the median price is $0.20/mL in our sample. E-liquid products sold online are very affordable and the average prices are lower compared with price estimates using other sources (eg, self-reports, sales data). In addition, online stores charge state excise taxes inconsistently and fail to comply with county-level or city-level excise taxes.

CONCLUSION

E-liquid products sold online are priced low, and stricter enforcement of e-cigarette excise tax is needed in online purchasing channels.

Utilization, reimbursement, and price trends for Hepatitis C virus medications in the US Medicaid programs: 2001-2021

Background

Hepatitis C Virus (HCV) remains a challenging health problem worldwide, with increasing incidence despite being curable with Direct Acting Antiviral (DAA) agents.

Objective

This study aimed to describe the utilization, reimbursement, and price trends of HCV treatments and evaluate the influence of treatment guidelines and policies.

Methods

A retrospective, descriptive drug utilization study conducted using the outpatient pharmacy data extracted from the Centers for Medicaid and Medicare Services State Drug Utilization Data between 2001 and 2021. All HCV treatments approved in the US were included, conventional therapy (CT), and DAA agents. The annual secular trends were calculated for each medication's total number of prescriptions, reimbursements, and prices. The average reimbursement per prescription was calculated and utilized as a proxy of prices. The HCV treatment guideline and policies and legislation were evaluated overtime to measure the impact on the trends.

Results

Despite CT having a higher total utilization, DAA agents commanded significantly greater reimbursements, with 4.1 billion USD for CT and 19.45 billion USD for DAA agents. CT utilization increased rapidly and dominated the market until 2011, peaking at 379,696 prescriptions in 2003 but declining afterward. DAA agents' utilization increased rapidly in their first year: i.e., sofosbuvir reached 50,377 prescriptions with 1.3 billion USD in 2014, while ledipasvir/sofosbuvir reached 79,387 prescriptions with 2 billion USD in 2015. The average price per prescription was high for the DAA agents, like 24,992 USD for sofosbuvir and 22,787 USD for ledipasvir/sofosbuvir, compared to CT medications ribavirin, around 500 USD, and pegINF, around 3000 USD. The new DAA agents replaced CT, and initiating market competition among DAA agents.

Conclusion

The introduction of multiple DAA agents slightly changed their prescription prices but remained high during the study period. The recent increase in HCV incidence cases indicates accessibility issues for costly and effective DAA agents, with treatment guidelines and policies playing a critical role in shaping these trends.

Prices of paediatric vaccines in European vaccination programmes

Objective

To compare the vaccine prices per vaccinated child under 18 and vaccine funding and procurement systems in the national vaccination programmes (NVPs) in Europe.

Methods

The on-line survey targeted to NVP managers collected data referred to the information available on 31 December 2016. The prices of vaccines were categorised into three groups. The price per child 1) fully vaccinated comprised all vaccines and doses offered in the NVP; 2) vaccinated with standard vaccines comprised the vaccines included in the NVP in all countries; 3) vaccinated with recent vaccines comprised the pneumococcal conjugate, human papillomavirus and rotavirus vaccines.

Results

In the 23 out of 32 countries that answered the survey, 17 funded the vaccines by taxes and six by social insurance. 18 countries procured the vaccines through public tenders or negotiations. Five countries purchased the vaccines by healthcare providers and reimbursed from the health insurance system.In the countries with vaccine procurement through public tenders the price per child vaccinated with standard vaccines ranged from €59 to €117 when using pentavalent and from €98 to €220 when using hexavalent vaccines. The mean price per child vaccinated with recent vaccines was €130 for the countries that offered pneumococcal conjugate and human papillomavirus vaccines and €142 for the countries that in addition included rotavirus vaccine.In the countries that purchased the vaccines by healthcare providers and reimbursed from the health insurance system the price per child vaccinated with standard vaccines ranged from €136 to €427.

Conclusions

The vaccine prices differ notably in Europe. Prices were lower in countries where vaccines in the NVP were tax-funded and nationally or regionally procured. Improved procurement systems could lead to substantial savings or possibilities to introduce more vaccines into the NVP.

The current status of Korean native pig production

Korean native pigs (KNPs) have been one of the traditional livestock primarily raised in rural areas of Korea for centuries. KNPs have adapted to the climate and geography of the Korean Peninsula for a long time, exhibiting excellent adaptability even in challenging environments. For these reasons, the preservation and purification of KNPs are crucial in securing unique genetic resources. Therefore, this review covers the characteristics, production status, commercial value and potential breeding directions of KNPs. Unfortunately, there is still a long way to go for the improvement of KNPs. It is crucial to acknowledge the current challenges, identify the issues, and dedicate efforts to the breed's improvement. Each section of this comprehensive review will play an important role in integrating related research and data into the overall findings. In-depth discussions on the genetic diversity, productivity, genetic conservation, ecological roles, and sustainability of KNPs will be crucial components in the future of KNP business.

The impact of buying intention of global fashion on local substitute: The role of product design and price

In a competitive environment, the relationship between global and local fashion in shaping consumption behavior is under question. This study explores the antecedents of consumers' purchasing intentions for local fashions, mainly considering buying intentions for global alternatives, price, and product design while controlling for age, income, gender, geographic location, and occupation. We discovered that consumers' buying intentions for global fashion harm their intent to buy local substitutes, based on a non-probability survey of 260 young adults and hierarchical multiple regression analysis. We associate these findings with cultural identity theory, social identity theory, ethnocentrism, substitute versus complementary concepts, and cue utilization theory. International marketers can devise marketing strategies referring to these findings.

Impact of China's National Volume-Based Procurement on Drug Procurement Price, Volume, and Expenditure: An Interrupted Time Series Analysis in Tianjin

BACKGROUND

National Volume-Based Procurement (NVBP) program has been carried out in China to lower drug prices and reduce patients' medication burden. This study aims to evaluate its impact on drug purchasing in Tianjin city, one of the first 11 cities piloting NVBP in China.

METHODS

Using monthly drug procurement data from Tianjin Medical Purchasing Center between 2018 and 2020, this study identified bid-winning drugs and their alternative drugs in the pilot NVBP, and evaluated the policy impacts on their procurement price (cost of defined daily dose, DDDc), volume (the number of defined daily dose, DDDs), and expenditure, during the first (initiated at April 1, 2019) and second (initiated at April 25, 2020) procurement cycles of pilot NVBP, applying interrupted time series (ITS) analysis. Included drugs were classified into 12 pharmacological subgroups for further analysis.

RESULTS

Decrease in DDDc of NVBP-covered drugs (bid-winning and non-winning drugs) were observed in the first (level change: -CNY 3.878/DDD, P<.001; trend change: -CNY 0.068/DDD, P=.001; relative change: -61.55%) and second (level change: -CNY 0.356/DDD, P=.049) procurement cycles of pilot NVBP, while no significant change was observed for the DDDc of alternative drugs, except for the increase in antidiarrheic and anti-inflammatory/antirheumatic subgroups as more expensive drugs were purchased from new suppliers in the second procurement cycle. The DDDs of bid-winning drugs significantly increased, while decreased for the non-winning original and generic drugs. Procurement expenditure was saved for NVBP-covered drugs (level change: -CNY 7.29×107, P<.001; trend change: -CNY 5.62×106, P<.001; relative change: -62.60%). However, during the second procurement cycle, procurement volume and expenditure of alternative drugs increased significantly in 7 out of 12 subgroups.

CONCLUSION

The pilot NVBP policy in China reduced procurement price, promoted generic substitution, and saved procurement expenditure. However, the increase in procurement price, volume and expenditure of alternative drugs may reveal the significance of regulating healthcare institutions' drug purchasing behavior.

Global taxation of electronic nicotine and non-nicotine delivery systems: a cross-country evaluation

BACKGROUND

Taxation is a key component of tobacco products' regulation given its proven effectiveness to generate revenue and achieve public health goals. The diversity of the market for e-cigarettes (electronic nicotine delivery systems and electronic non-nicotine delivery systems, ENDS/ENNDS) complicates comparative analyses per unit, thus challenging efforts to assess countries' excise tax burdens for e-cigarettes. Further complicating taxes on e-cigarettes is the necessity to balance two public health priorities: (1) deterring initiation among people who have never smoked, and (2) supporting cessation efforts among people currently smoking or who previously smoked. This study evaluates and compares excise tax burdens and tax system characteristics of e-cigarettes across 54 countries.

METHODS

To determine countries' excise tax burdens per millilitre of e-liquid, we collect a unique database of tax characteristics and prices in countries where ENDS/ENNDS are currently sold. We calculate the excise tax per millilitre of e-liquid and convert e-liquid prices to a comparable price per millilitre across countries.

RESULTS

Thirty countries employ a specific excise system, 10 apply an ad valorem system, 9 apply a tiered specific system, 1 applies a tiered ad valorem system and 4 apply a mixed tax system. The excise tax burden is highest in Belarus (87.2%, specific), Norway (81.2%, tiered specific) and Egypt (74.7%, mixed), and lowest in Costa Rica (7.4%, ad valorem), Paraguay (2.9%, ad valorem) and Croatia (0%, specific).

CONCLUSION

The advantages of one tax system over another are context specific. Tax burdens tend to be much larger in countries that use a specific tax than in countries that use a value-based (ad valorem) tax.

Tobacco purchasing in Australia during regular tax increases: findings from the International Tobacco Control Policy Evaluation Project

OBJECTIVE

We examined Australian tobacco purchasing trends, the average self-reported price paid within each purchase type and the association between type of tobacco product purchased and participant characteristics, including quit intentions, between 2007 and 2020.

METHODS

We analysed data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007-2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (nsample=5452, nobservations=11 534). The main outcome measures were type of tobacco products purchased: RYO, carton, pack or pouch size and brand segment. Logistic regression, fit using generalised estimating equations, was estimated the association between the outcome and participant characteristics.

RESULTS

The reported price-minimising purchasing patterns increased from 2007 to 2020: any RYO (23.8-43.9%), large-sized pack (2007: 24.0% to 2016: 34.3%); shifting from large-sized to small-sized packs (2020: 37.7%), and economy brand (2007: 37.2% to 2020: 59.3%); shifting from large (2007: 55.8%) to small economy packs (2014: 15.3% to 2020: 48.1%). Individuals with a lower income, a higher nicotine dependence level and no quit intention were more likely to purchase RYO and large-sized packs.

CONCLUSION

RYO, large-sized packs and products with a low upfront cost (eg, small RYO pouches and small-sized economy brand packs) may appeal to people on low incomes. Australia's diverse tobacco pack and pouch sizes allow the tobacco industry to influence tobacco purchases. Standardising pack and pouch sizes may reduce some price-related marketing and especially benefit people who have a low income, are highly addicted and have no quit intention.

How has the tobacco industry passed tax changes through to consumers in 12 sub-Saharan African countries?

INTRODUCTION

Tobacco taxation is only effective in reducing consumption when it is translated into higher prices. This study aims to investigate to what extent the tobacco industry (TI) passes tax increases over to consumers by increasing the retail price of cigarettes in 12 sub-Saharan African (SSA) countries.

METHODS

African Cigarette Prices Project and WHO's Global Tobacco Epidemic Reports data were used to calculate the rate of tax pass-through by decomposing the retail price of cigarettes into tax and net prices between 2016 and 2020. Percentage change in net price was used to identify industry pricing behaviour, in both packs and single-stick sales. TI pricing strategies were examined by country, producer type, producers, and cigarette price segment.

RESULTS

There were mixed TI strategies, with taxes primarily overshifted (Botswana, Madagascar, Tanzania, Zimbabwe), undershifted (Ethiopia, Lesotho, Mozambique, Namibia, South Africa, Zambia) or a mix of both (Malawi, Nigeria). The detail varied between countries, over time, and between the different brands/segments offered. Patterns for single-stick sales were broadly similar to that of packs but with some differences observed in particular countries/years. Pricing strategies for the various transnational tobacco companies and domestic producers were similar but the changes in net price for the latter were larger. The country tax level/type and the size of tax change did not seem to be an obvious influence.

CONCLUSION

This paper provides an overview of TI pricing strategies in response to tax increases in SSA. Governments must monitor how the TI responds to tax changes to ensure that tax increases are effective in impacting price.

Price elasticity of cigarette smoking in Bangladesh: evidence from the Global Adult Tobacco Surveys (GATS)

INTRODUCTION

The overall prevalence of cigarette smoking has not changed significantly for over a decade in Bangladesh. Raising the price of cigarettes through taxation is an important policy instrument for reducing consumption and achieving public health goals. The price elasticity of cigarette demand is an important parameter for evaluating the effectiveness of raising prices through tax increases in reducing cigarette consumption. The objective of the study was to estimate the price elasticity of cigarette demand in Bangladesh using Global Adult Tobacco Survey 2009 and 2017 data.

METHODS

Smoking prevalence and smoking intensity were estimated using a two-part model. Endogeneity of prices was minimised using the average consumption-weighted cigarette price in a cluster, for both smokers and non-smokers residing in a specific cluster.

RESULTS

Cigarette demand was found to be price inelastic and ranged between -0.51 and -0.73. It is also price inelastic across wealth groups and areas of residence in Bangladesh. Although the total price elasticity did not differ considerably between rural and urban locations, it is evident that individuals in the lower-wealth group are more than twice as responsive to price increases as their high-wealth counterparts.

CONCLUSION

A significant increase in cigarette prices through a tax increase would decrease smoking prevalence and increase tax revenue in Bangladesh. The greater price sensitivity among smokers in lower-wealth groups indicates that a tax-induced cigarette price increase would provide more health benefits to them, thereby contributing to improved health equity.

Bigger, stronger and cheaper: growth in e-cigarette market driven by disposable devices with more e-liquid, higher nicotine concentration and declining prices

OBJECTIVE

Given the evolving changes in the disposable e-cigarette market, we explore patterns of sales in the USA by e-liquid volume capacity, nicotine strength and real sales-weighted average prices by both e-cigarette unit and volume of e-liquid.

METHODOLOGY

We used NielsenIQ retail scanner data from January 2017 to September 2022 to examine changes over time for average product volume capacity in millilitres, nicotine strength (%) and both sales-weighted average price per disposable unit and per millilitre of e-liquid for each 4-week period.

RESULTS

Among disposable e-cigarettes sold between January 2017 and September 2022, average volume capacity increased 518% from 1.1 mL to 5.7 mL and average nicotine strength increased 294% from 1.7% to 5%. Sales-weighted average price per disposable unit and millilitres of e-liquid both remained relatively constant until January 2020. From January 2020 through September 2022, average unit prices increased 165.7% from US$8.49 to US$14.07, while the average price of 1 mL of e-liquid decreased 69.2% from US$7.96 to US$2.45.

CONCLUSIONS

The current regulatory regime around e-cigarettes has resulted in disposable e-cigarette manufacturers providing consumers with bigger, cheaper disposable e-cigarettes that come in increasingly higher nicotine strengths. Tobacco policy recommendations such as restricting e-liquid capacity and minimum price laws as well as regulations on product characteristics that affect nicotine emissions and delivery such as nicotine strength, nicotine output, device power, and puff duration should be considered in regulating the e-cigarette market.

The impact of price promotions on confectionery and snacks on the energy content of shopping baskets: A randomised controlled trial in an experimental online supermarket

Overconsumption of foods high in fat, sugars, and salt (HFSS) poses a significant risk to health. The government in England has passed legislation that would limit some price promotions of HFSS foods within supermarkets, but evidence regarding likely impacts of these policies, especially in online settings, is limited. This study aimed to determine whether there were any differences in the energy and nutrient content of shopping baskets after removing promotions on HFSS foods in an online experimental supermarket. UK adults (n = 511) were asked to select food from four categories with a £10 budget in an online experimental supermarket: confectionery; biscuits and crackers; crisps, nuts and snacking fruit; cakes and tarts. They were randomly allocated to one of two trial arms: (1) promotions present (matched to promotion frequency seen in a major UK retailer) (n = 257), or (2) all promotions removed from all products within the target food categories (n = 254). The primary outcome analysis used linear regression to compare total energy (kcal) of items placed in shopping baskets when promotions were present vs. absent, while secondary analyses investigated differences in nutrients and energy purchased from individual food categories. Mean energy in food selected without promotions was 5156 kcal per basket (SD 1620), compared to 5536 kcal (SD 1819) with promotions, a difference of -552kcal (95%CIs: -866, -238), equivalent to 10%. There were no significant differences in energy purchased for any individual category between groups. No evidence was found of other changes in nutritional composition of baskets or of significant interactions between the impact of promotions and participant characteristics (gender, age, ethnicity) on energy purchased. Removing promotions on HFSS foods resulted in significantly less total energy selected in an online experimental supermarket study.

An overlooked market: loose cigarettes, informal vendors and their implications for tobacco taxation

OBJECTIVE

To examine the features of markets for loose cigarettes in several low-income and middle-income countries and their effects on tobacco control policies, particularly taxation.

DESIGN

An analysis of survey data targeting people who smoke in two African, one Southeast Asian and two South Asian countries and retailers across 16 African countries to study loose cigarette markets and examine how prices in these markets move relative to the prices for cigarette packs.

RESULTS

Markets for loose cigarettes are large, and their consumer base tends to differ from the wider population of people who smoke. Loose cigarette prices are on average higher than those of cigarettes bought in packs, and they respond differently to tax increases, at least partially due to a denomination effect.

CONCLUSIONS

The features of the loose cigarette markets present a challenge for tobacco control policy, especially tobacco tax policy. One way to overcome this challenge is to aim for large, rather than incremental, tax increases.

What types of e-liquid products were more likely to offer price promotions?

INTRODUCTION

The present study empirically examined the association between price discounts and product attributes of e-liquids sold by online retailers.

METHODS

We analysed 14 000 e-liquid products from five major online e-cigarette retailers between April and May 2021 to determine the association between price discounts and product attributes such as nicotine level and form, flavour and vegetable glycerine/propylene glycol ratio. A fixed-effects model was used in the analysis and discounts were calculated in US cents/mL of e-liquid volume.

RESULTS

Out of 14 407 e-liquid products, 92.5% were offered at a discounted price. On average, the price discount for the 13 324 products that had discounts was 16.84 cents/mL across the five stores. Among the three forms of nicotine (salt, freebase and nicotine free), salt e-liquids had the highest average price discount.

CONCLUSION

Our findings suggest that e-liquids with salt nicotine have a higher average price discount when sold online, which may influence consumer purchasing behaviour. Further research is needed to assess the potential impact of these discounts on youth and adult tobacco use. Policymakers may consider implementing measures to limit online price discounts for e-liquids as a means of reducing sales among young people.

Impact of tobacco spending on intrahousehold resource allocation in Montenegro

BACKGROUND

The main goal of this study is to estimate the crowding out impact of tobacco expenditures on the household budget allocation to other mutually exclusive commodity groups in Montenegro.

METHODOLOGY

The analysis uses the Household Budget Survey data from 2005 to 2017 to estimate a system of Engel curves using a three-stage least squares approach. As the tobacco expenditure variable is endogenous to budget shares on other consumption items, instrumental variables were included to obtain consistent estimates.

RESULTS

Overall, the results confirm the existence of the crowding out effect of tobacco spending on various commodities, such as some food items (eg, cereals, fruits and vegetables and dairy products), clothing, housing and utilities, education and recreation while a positive effect of tobacco consumption was estimated on budget shares on bars and restaurants, alcohol, coffee and sugary drinks. These results are consistent throughout the income groups of households. The estimates indicate that an increase in tobacco expenditures leads to reduction in budget shares on essential goods, which is likely to have negative impacts on the household living standard.

CONCLUSIONS

Tobacco expenditure crowds out household spending on necessities, especially in case of the poorest households, thus increasing inequality, hampering human capital development and potentially causing long-term adverse effects on the households in Montenegro. Our results are similar to evidence from other low and middle-income countries. This paper contributes to the analysis of the crowding out effect of tobacco consumption, which was conducted for the first time in Montenegro.

The role of perceived service quality and price competitiveness on consumer patronage of and intentions towards community pharmacies

BACKGROUND

When consumers choose a service provider, they trade-off their perceptions of service quality with their perceptions of the cost of engaging with the service provider. For community pharmacy owners and managers, it is important to understand the relative impact on loyalty of providing the extra resources to improve service quality versus forsaking gross profit by discounting prices. The aim of this study was to explore the relative effects of consumers' perceptions of service quality (pSQ) and price competitiveness (pPC) on patronage loyalty (patronage history of the rated pharmacy), patronage disloyalty (patronage history at other pharmacies) and loyalty intentions.

METHODS

This was a cross-sectional study conducted within Australia using an online survey administered to members of a consumer marketing panel. Eligible participants were adults taking 2 or more prescription medicines and had attended a community pharmacy within the past 4 weeks. Participants were asked to rate the pharmacy they had last visited, self-report patronage history of that and other pharmacies and report the brand of pharmacy visited. Previously validated scales were used for consumers' perceptions of service quality (pSQ) and loyalty intentions. New scales were developed for pPC and self-reported patronage loyalty and disloyalty. Confirmatory Factor Analysis (CFA) was used to validate the measurement model. Structural Equation Modelling (SEM) with robust estimator (EQS) was used to test the relationships between the variables. Sensitivity analysis, in the presence of covariates were performed with multivariate regression analysis with bootstrapping.

RESULTS

Surveys were completed by 303 participants. Most consumers had visited the rated pharmacy more often than once monthly and most had visited only 1 or 2 pharmacies in the past 12 months for prescription medicines. Overall, participants rated pSQ, pPC highly and expressed high loyalty intentions. The SEM was a good fit for the data. The model predicted 12%, 15% and 69% of the variation in patronage loyalty and patronage disloyalty and loyalty intentions, respectively. The effect of pSQ on patronage was 0.38 (p < 0.05) for loyalty and -0.38 (p < 0.05) on disloyalty whereas the effect of pPC was marginal. The total effect of pSQ and pPC on loyalty intentions was 0.64 (<0.05) and 0.20 (p < 0.05) and in sensitivity analyses, no other covariate, including pharmacy brand was significant.

CONCLUSION

In order to drive loyalty behavior and generate loyalty intentions, providing a high-quality service appears to be far more effective than creating perceptions that the pharmacy has competitive prices. This finding affords a motivation for both discount AND non-discount brand pharmacies to undertake the steps needed to improve service quality.

Response of legal and illegal cigarette prices to a tax increase in Ethiopia

BACKGROUND

In 2020, Ethiopia passed a landmark tax proclamation implementing an evidence-based mixed excise system aimed at curbing tobacco use. This study evaluates the impact of the tax increase of more than 600% on both legal and illegal cigarette prices in order to gauge the impact of the tax reform in the presence of a sizeable illicit cigarette market.

METHODS

Data on 1774 cigarette prices were obtained from retailers during Empty Cigarette Pack Surveys in the capital and major regional cities conducted in 2018 and 2022. Packs were categorised as 'legal' or 'illicit' using criteria from the tobacco control directives. Descriptive and regression analyses were used to study the cigarette price changes during the period of 2018-2022, capturing the impact of the 2020 tax increase.

RESULT

Prices of both legal and illegal cigarettes increased in response to the tax increase. In 2018, the stick prices ranged from ETB0.88 (Ethiopian birr) to ETB5.00 for legal cigarettes while they ranged from ETB0.75 to ETB3.25 for illegal ones. In 2022, a legal stick sold for ETB01.50-ETB2.73 and an illegal stick for ETB1.92-ETB8.00. The average real price of legal and illegal brands increased by 18% and 37%, respectively. The multivariate analysis confirms that prices of illicit cigarettes grew faster compared with the legal ones. By 2022, illicit brands were on average more expensive compared with their legal counterparts. This result is statistically significant at p<0.01.

CONCLUSION

The prices of both legal and illegal cigarettes increased following the 2020 tax increase, with the average real cigarette price increasing by 24%. As a result, the tax increase likely had a positive impact on public health despite a sizeable illicit cigarette market.

Smokers' strategies to reduce tobacco spending: self-reported use and differences across subgroups. Findings from the International Tobacco Control (ITC) Netherlands Survey

BACKGROUND

The cost of tobacco is one of the most reported reasons for smoking cessation. Rather than quitting, smokers can use also strategies to reduce tobacco expenditure while continuing smoking, such as smoking less or using price-minimising strategies. The Netherlands announced to increase the price of a pack cigarettes from seven (2018) to ten euros (2023), to reduce tobacco prevalence and consumption. This study explores the self-reported strategies to reduce tobacco spending among Dutch smokers, and whether this differed per age, income, and education. Additionally, we analysed among quitters in these subgroups whether price played a role in their decision to quit.

METHODS

Cross-sectional survey data from the International Tobacco Control (ITC) Netherlands Wave 2 (September-November 2020, N = 1915) was used. Strategies to reduce spending among smokers (N = 1790) were: reducing consumption, bulk buying, switching to cheaper products or buying from low-taxed sources. These were collapsed into: reducing consumption (solely or in combination with other behaviours), solely price-minimising behaviours (such as buying cheaper brands), or no strategies to reduce spending. Associations between strategies and characteristics were analysed through multinomial and binary logistic regression models. Second, we explored which subgroups were more likely to report that price played a role in their decision to quit among quitters (N = 125).

RESULTS

The majority of smokers used strategies to reduce tobacco spending: 35.6% reduced consumption and 19.3% used solely price-minimising strategies. 82.1% of quitters reported that price played a role in their decision to quit. Low-income individuals were more likely to report price as a reason for quitting and reduce consumption, but also to buy cheaper products. Highly nicotine dependent smokers were more likely to use price-minimising behaviours, and less likely to reduce consumption.

CONCLUSIONS

The majority reported using strategies to reduce spending or that price played a role in their decision to quit. Reducing consumption was the most reported strategy. Low-income smokers were more likely to reportedly reduce consumption, buy cheaper products, or quit. Price policies have the potential to reduce socioeconomic inequalities in smoking. To discourage price-minimising behaviours, such as switching to cheaper products, reducing price differences between products should be prioritized.

A South African beef quality survey

In this study a survey of various meat quality characteristics of beef loin cuts was conducted in the City of Tshwane Metropolitan Municipality (Gauteng Province of South Africa) to determine the variation and consistency of beef quality of products purchased over time. Four hundred and twenty beef loin samples were collected on 20 occasions over 308 days from 13 outlets of 2 supplier types (butcher and supermarket). Packaging type, label information and price were considered for the evaluation of meat tenderness, colour, cooking loss, tissue composition and steak thickness. The results demonstrate that large variation in characteristics relevant to consumers' choice and satisfaction among and within different products sold as porterhouse steak in South Africa. In particular, muscle tenderness varied (P < 0.0001) across the 20 products and also showed significant inconsistency over the 20 purchasing events for certain products.

Do increases in the price of fuel increase levels of fuel theft? Evidence from England and Wales

Fuel prices have increased sharply over the past year. In this study we test the hypothesis that increases in the price of fuel are associated with increases in motorists filling their fuel tank and driving off without paying. We use weekly crime data from six police forces in England and Wales for the period January 2018 to July 2022, combined with regional data on the number of fuel sales and average fuel prices. Our results demonstrate an overall weak price-theft relationship for the 238 week study period, less so than in previous studies. However, we find strong evidence that the recent spike in fuel prices was associated with elevated levels of fuel theft. The implications of our findings for future research and crime prevention are discussed.

Rapid-response surveillance of the first US test market for VLN cigarettes

INTRODUCTION

VLN King menthol and non-menthol are the first combustible cigarettes to receive US Food and Drug Administration (FDA) authorisation as modified risk tobacco products. Focusing on the first retail test market, this study characterised VLN advertising, product placement, discounts and price.

METHODS

All Chicago-area Circle K stores (n=133) were telephoned to assess whether they sold VLN. Single-pack price of non-menthol was obtained in 57 of 100 stores that sold VLN. In fall 2022, trained data collectors visited those 57 stores to assess VLN product placement, advertising, discounts and prices. Paired t-tests compared observed VLN price with telephone price and to price of other cigarette brands.

RESULTS

Nearly all stores (91.1%) displayed exterior advertisements for VLN, and 41.1% displayed interior advertising, with 8.9% of stores advertising VLN in the power wall but never in the header row. VLN cigarettes were displayed in the power wall exclusively and among high-nicotine cigarettes. Some VLN marketing claims were not FDA-authorised. VLN advertised a sweepstakes offer and rewards programme. Most stores (85.7%) offered VLN discounts. VLN was priced like a premium brand (mean=$10.90, SD=$1.53), and prices obtained by telephone did not differ from observed prices several months later.

CONCLUSIONS

Retail marketing strategies for VLN mimic those for high-nicotine cigarettes. Deviations from FDA-authorised marketing claims were evident. Surveillance in future test markets is recommended to assess compliance with marketing claims and examine relative price and discount offers. Of interest is how premium-priced, low-nicotine cigarettes stand to compete in a market dominated by cheaper high-nicotine cigarettes.

Trends in utilization, reimbursement, and price for DOACs and warfarin in the US Medicaid population from 2000 to 2020

The use of direct oral anticoagulants (DOACs) is widely increasing in the United States (US). Warfarin has been the conventional anticoagulant used in the past few decades, but it has been gradually replaced by DOACs. The objective of the study was to analyze trends in utilization, reimbursement, and price for those anticoagulants in the US Medicaid population. Retrospective data analysis was conducted using the National Summary Files for the Medicaid State Drug Utilization Data. Study drugs included dabigatran, rivaroxaban, apixaban, edoxaban and warfarin. The study assessed secular trends of utilization, reimbursement, and per-prescription price. The data was collected from the first quarter of 2000 through to the second quarter of 2020 restricted for outpatient prescriptions only. During the 21-year study period, a substantial rise in total expenditures on warfarin and DOACs was observed from $144 million in 2000 to $694 million in 2020. Moreover, the utilization of DOACs has increased significantly since the first approval of Xarelto in 2010 from 1079 in 2011 to 1.5 million in 2019. The per-prescription price of DOACs increased from an average of $200 in 2011 to $407 in 2020. Conversely, the total number of prescriptions of Warfarin and branded Coumadin decreased from 2.4 million to 1.4 million and from 3.9 million to less than a million, respectively. The present study demonstrated a change in the trends of US expenditure and utilization for warfarin and DOACs with DOACs representing the majority of market share of both spending per prescription and reimbursement.

Expensive seems better: The price of a non-effective drug modulates its perceived efficacy

Previous studies have shown that the price of a given product impacts the perceived quality of such product. This finding was also observed in medical contexts, showing that expensive drugs increase the placebo effect compared to inexpensive ones. However, addressing a drug's efficacy requires making causal inferences between the drug and the healing. These inferences rely on the contingency between these two events, a factor that is difficult to control in the placebo research. The present study aimed to test whether the price of a given drug modulates its perceived efficacy using a proper (though fictitious) non-effective drug, so that not only the objective contingency, but also the probability of the cause and the probability of the effect could be adequately controlled for. We expected higher efficacy judgements for the expensive non-effective drug than for the inexpensive one. To test this hypothesis, 60 volunteers participated in a contingency learning task that was programmed so that 72% of the patients healed regardless of whether they took the drug. Approximately one-half of the participants were told that the drug was expensive, whereas the other half were told that it was inexpensive. As expected, the efficacy judgements of participants who saw the expensive drug were significantly higher than those who saw the inexpensive one. Overall, our results showed that the price of a non-effective drug modulates its perceived efficacy, an effect that seems to be mediated by the estimated number of doses administered. This result parallels findings in the placebo literature but using a laboratory methodology that allows stronger control of the variables, suggesting that the illusory overestimation produced by the more expensive treatments might be on the basis of the greater efficacy of the more expensive placebos.

Economic cost of cigarette smoking in Bosnia and Herzegovina

BACKGROUND

Cigarette use is one of the major risk factors for non-communicable diseases in Bosnia and Herzegovina, with 41.1% of adults being current smokers in 2019 and almost half of current smokers using more than 20 cigarettes per day.

METHODS

This study applies the prevalence-based, cost-of-illness approach to estimate the annual economic cost of smoking in Bosnia and Herzegovina in 2019.

RESULTS

The study estimates that cigarette use by adults in Bosnia and Herzegovina caused between 24.4% and 42.8% of all deaths in 2019 and a total economic cost of between €367.5 and €635.1 million (2.0%-3.5% of gross domestic product). The direct costs represent the largest share of the total cost (between 1.0% and 1.7% of gross domestic product).

CONCLUSION

Cigarette use imposes a significant health and economic burden in the society of Bosnia and Herzegovina. Various tobacco control measures can be implemented to prevent and reduce tobacco consumption and the negative health consequences of tobacco use. Numerous studies have shown taxes on tobacco products are very effective in reducing tobacco use, especially among certain demographic groups, such as youth and low-income individuals. Smoke-free laws have also shown benefits. Other policy measures that can be implemented include restrictions to advertising, limitations on who can purchase tobacco products, how and where they can be purchased, etc. In addition, governments could also implement various education programmes on the negative health consequences of smoking. The results of this study provide information that calls for prompt and strengthened implementation of tobacco control measures to reduce cigarette consumption in the country and improve the health outcomes and productivity of its inhabitants.

Do cigarette prices near secondary schools vary by area-level socioeconomic status? Findings from a field study in Ontario and Québec, Canada

OBJECTIVES

To examine, in the context of youth smoking, whether cigarette prices near secondary schools varied by area-level socioeconomic status in Southwestern and Central Ontario, and the greater Montréal region.

METHODS

We collected cigarette prices four times between 2016 and 2019 from stores near secondary schools and used mixed-effects and ordinary least squares regressions.

RESULTS

We found consistent evidence that cigarette prices near secondary schools were lower in neighbourhoods with lower area-level household income, and that differences were large enough to be meaningful. In Ontario and Québec, our results indicate a Can$0.26 [0.04, 0.47] to Can$0.51 [0.33, 0.69] and Can$0.10 [-0.04, 0.24] to Can$0.37 [0.22, 0.52] difference in prices for a pack of 25 cigarettes between neighbourhoods with a median household income standard deviation below/above the provincial median, respectively.

CONCLUSION

Policy changes that limit area-level cigarette price differences without lowering cigarette prices may reduce inequities in youth smoking.

The Utilization, Expenditure, and Price of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the US Medicaid Programs: Trends Over a 31 Year Period

BACKGROUND

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are used for several indications including hypertension. Our aim is to evaluate the utilization, expenditure, and drug price of ACEIs and ARBs in the US Medicaid population.

METHODS

A retrospective descriptive trend analysis was conducted using Medicaid State Drug Utilization outpatient pharmacy summary files managed by the Centers for Medicare and Medicaid Services from 1991 to 2021. Study drugs included ACEIs (e.g., captopril) and ARBs (e.g., losartan). Annual reimbursement and utilization were calculated for both classes. The average reimbursement per prescription was calculated as a proxy for drug prices. Market share competition between ACEIs and ARBs was analyzed over time.

RESULTS

ACEI and ARB utilization rose by 25% from 1991 to 2021. Brand ACEIs utilization peaked in 2002 with 28 million prescriptions while brand ARBs utilization continued to increase until 2005 with over 23 million prescriptions. However, generic products took the lead and exceeded brand ACEI and ARB utilization in 2006 and 2012 respectively. Medicaid spent over $ 33.7 billion on ACEIs and ARBs over 31-year. Brand ACEIs and ARBs average prices increased sharply to $8,104 and $6,908 respectively in 2021. The total prescription market share for ACEIs was 68% compared to 32% of ARBs over the entire study.

CONCLUSION

ACEIs and ARBs utilization increased over the last 31 years. Brand utilization switched over to generic resulting in less reimbursement. The average prices of brand ACEIs and ARBs continue to increase even after generics were introduced to the market.

Developed multiple-layer perceptron neural network based on developed search and rescue optimizer to predict iron ore price volatility: A case study

In economic investment, the role of forecasting is very important because in an economic project, the investor must carefully examine the dimensions of the work such that one of the most important and perhaps the main factor of a future investor and an economic enterprise is the work done by Costs and revenues are determined. Due to the fact that the volatility of iron ore price is affected by various factors, so it is not possible to determine a simple and general function to predict its price. There are several methods for predicting price, but the most appropriate of these is a method that examines variables in a nonlinear and dynamic manner that is closer to reality. Therefore, in this research, an improved and optimized neural network is proposed to facilitate this task. The idea is to employ a developed version of Search and Rescue optimization algorithm to enhance the training ability of the neural network to present an efficient forecasting tool for iron ore price volatilities. Different variables are used for the method verification and its results are compared with basic neural network, particle swarm optimization-based, Intelligent Integrated Optimizer, Genetic Neural Network to show its superiority. Simulation results demonstrate that by the proposed method has a satisfying and better fitting with the data compared with the other methods.

Pricing Services: An Underutilized Policy Instrument for Access and Quality

We aim to introduce the readers of this special collection to the importance of pricing health and long-term care services, a topic covered in 2 recent joint World Health Organization/Organization for Economic Co-operation and Development (WHO/OECD) publications. The special issue will focus on country experiences in pricing setting and regulation, best practices, and areas for future research.

Effect of cigarette prices on cigarette consumption in Ghana

Introduction

Noncommunicable diseases are on the rise globally, with tobacco consumption being a major risk factor. Reducing tobacco consumption is an important step towards reducing the incidence and prevalence of many noncommunicable diseases. Tax and price measures have been proposed as tobacco control tools. This study investigated the link between cigarette prices and cigarette consumption in Ghana.

Methods

Annual time series data for the period 1980-2016 were used. The data came from diverse sources, including WHO, World Bank, and tobacco industry documents. Dynamic Ordinary Least Squares (DOLS), cointegration techniques, and three-stage least squares (3SLS) were used to analyze the data.

Results

After controlling for education, income, and population growth, we estimated that the price elasticity of cigarette demand is between -0.35 and -0.52 and statistically significant at 1% level. In the short run, the price elasticity is -0.1. Another variable that significantly reduced cigarette consumption during the period was education, with an elasticity between -1.7 and -2.7.

Conclusion

Cigarette demand in Ghana is influenced by cigarette prices and education. We conclude that tobacco taxes that significantly raise retail prices of cigarettes and higher education (including health education) will help reduce cigarette consumption.

Uncertainty measures and inflation dynamics in selected global players: a wavelet approach

This study investigates the dynamic relationship between economic policy uncertainty (EPU), geopolitical risks (GPR), the interaction of EPU and GPR (EPGR), and inflation in the USA, Canada, the UK, Japan, and China. We employ the continuous wavelet transform (CWT) to track the evolution of model variables and the wavelet coherence (WC) to examine the co-movement and lead-lag status of the series across different frequencies and time. To strengthen the WC, we apply the multiple wavelet coherence (MWC) to determine how good the linear combination of independent variables co-moves with inflation across various time-frequency domains. The CWT reveals heterogeneous characteristics in the evolution of each variable across frequencies. Inflation across samples shows strong variance in the short-term and medium-term while the volatility fizzles out in the long-term. For the explanatory variables, a similar pattern holds for EPU except for Japan and China, where coherence is evident in the short-term. The USA's and Canada's GPR reveal strong coherence in the short- and medium-term. Also, the UK and China reflect strong coherence in the short-term but weak significance in the medium-term, while Japan's GPR reflects only strong coherence in the short-term. The EPGR shows strong variation in the short-and-medium-term in the samples except in China. The WC's phase-difference reflects bidirectional causalities and switches in signs among series across different scales and periods in the samples, while the MWC reveals the combined intensity, strength, and significance of both EPU and GPR in predicting inflation across frequency bands among the countries. Findings also show significant co-movement among series at date-stamped periods, corroborating critical global events such as the Asian financial crisis, Global financial crisis, and COVID-19 pandemic. The paper has policy implications.

The price of private dental services: results from a national representative survey of Ireland

Introduction

Dental services in Ireland are delivered in a mixed public–private system but the majority of dental care is paid for out-of-pocket by individuals. Ireland is not unusual in the global context where public subsidisation for oral healthcare is limited in many countries. This is despite the fact that oral health plays an important role in well-being and despite international evidence on the negative impact of user fees on utilisation of beneficial healthcare. However, there has been little up-to-date assessment of the prices faced by individuals for a range of non-acute care services in Ireland, including dental care. This paper presents an up-to-date assessment of private dental prices in Ireland for a range of preventive, primary, and complex services based on a nationally representative survey.

Methods

The total sample size for the desk-based survey was 103, accounting for 6% of private dentists in Ireland, weighted to reflect the geographic distribution of dentists. Dentists were selected at random from the publicly available list of dentists participating in the Dental Treatment Benefit Scheme. The adult price of 10 different services covering core preventive, primary, and complex procedures were identified from public websites for the selected dental practices.

Results

Results showed that in addition to there being an uneven supply of dentists across the country, dental prices also vary with some notable variations by region and type of service. In particular, dental practices located in border counties, and those in rural areas typically show lower mean prices relative to non-border counties and urban areas. These factors need to be considered when planning how to reduce inequalities in access to oral health services in Ireland.

Pharmaceutical pricing in Europe: time to take the right direction

A price stems from the intersection between supply and demand curves in any common market. However, there are special markets where consumers do not pay for goods directly, and prescription drugs are a well-known example in healthcare. Drugs are mainly funded by public expenditure in well-established welfare systems like those of the Western European countries. However, the present era of austerity in public funding has made financial resources scarce in most European nations. Currently, the leading tendency for pharmaceutical pricing in Europe is direct negotiation with pharma companies. However, these negotiations are administratively burdensome, with costs not necessarily offsetting savings. Moreover, since any trade negotiation implies some degree of confidentiality to be effective these strategies are scantily transparent. When prices are set for many products through unavoidably arbitrary decisions, the final consequence is an irrational allocation of financial resources. Here, we raise a proposal to restore a reasonable balance between public equity objectives of health authorities and private profit incentives of the pharma industry in Europe, switching from pricing to budgeting. The underlying rationale of our proposal is to stop setting arbitrary prices in a context of market failure.

Bibliometric study of refractive surgery and dry eye scientific literature

OBJECTIVE

Currently, refractive surgery is a safe and effective procedure, and considered as a risk for development of dry eye. The aim of study is to analyze the scientific publications in the field of ocular dryness secondary to refractive surgery through a bibliometric approach. The temporal period goes since 2001-2019, years in which first references appeared and search limited selection is done, respectively. The set of publications ranges from the first publication appeared in 2001, to the last one selected in 2019.

METHODS

A search of references was made through Scopus, using "refractive surgery" as main descriptor, and «dry eye» as secondary one; both descriptors were limited to those available in the chosen field for the title, abstract, and keywords. The most common indicators and bibliometric maps were applied for to the selected publications.

RESULTS

A total of 78 original articles were collected from the timeframe 2001-2019. According to the Price's law, the growth of literature production was linear turned out in a linear growth of literature production. The annual growth rate was 8.6% with a literature doubling time of 8.4 years. The Bradford core, preferred journals chosen by authors were 4 with offered four preferred journals by the authors, all of them with an impact factor >2. These were Ophthalmology, Investigative Ophthalmology & Visual Science, Journal of Glaucoma and British Journal of Ophthalmology. Regarding geographical distribution, the United States had the highest production.

CONCLUSIONS

The scientific production of dry eye after refractive surgery follows a linear growth. In this instance, postulates of the Price's growth law of science are not fulfilled. In addition, there is a high rate of transience. That may indicate low productivity or presence of researchers from other related subjects disciplines, who have published occasionally in this topic.

Cannabis flower prices and transitions to legal sources after legalization in Canada, 2019-2020

BACKGROUND

The post-tax price of legal cannabis has the potential to influence whether consumers transition from the illegal to legal cannabis market. The aims of the study were to: 1) estimate the percentage who report purchasing dried flower at different sources; 2) estimate the unit price of dried flower; and 3) examine the association between price and legality of purchase source.

METHODS

Repeat cross-sectional survey data come from Canadian respondents from the International Cannabis Policy Study conducted in 2019 and 2020. Respondents were recruited through online commercial panels, of legal age to purchase cannabis (up to 65 years), and purchased dried flower in the past 12-months (n = 4923). Weighted binary logistic regression models examined the association between price and legality of source.

RESULTS

The proportion of consumers last purchasing dried flower from legal sources increased from 2019 to 2020 (45.7% vs 58.1%) and in the past 12-months, the average percent of dried flower consumers reported purchasing from legal sources increased from 2019 to 2020 (55.7% vs 67.5%). The mean price of legal dried flower decreased in 2020 ($12.63 vs $11.16; p < 0.001), but remained more expensive than illegal dried flower in both years ($12.63 vs $9.04 in 2019; p < 0.001, $11.16 vs $9.41 in 2020; p < 0.001).

CONCLUSIONS

Two years after legalization in Canada, the price of dried flower from legal sources decreased, along with a greater percentage of consumers purchasing from legal sources than after one year. Price and retail policies must continue to encourage the transition to the legal market in Canada.

A fair and progressive carbon price for a sustainable economy

The principle of "common but differentiated responsibility", as a key concept of the United Nations Framework Convention on Climate Change (UNFCCC), acknowledges the conditions for a generally acceptable and differentiated pricing mechanism on carbon emissions. With reference to this principle, carbon price determination has become a necessary instrument for sustainable policies. Considering the development gaps and the historical responsibility of the OECD's countries, a single carbon price would raise a major issue of equity between "developed" and "developing" countries. Although from a climate perspective each molecule of CO₂ produces the same level of damage despite the nature or the location of the activity generating the emissions, all CO₂ emissions are not on an equal footing. Indeed, some are necessary to improve the lives of people in "developing" countries when others can be considered not indispensable, especially beyond a certain level of development. In this policy paper, we explain how the price of carbon should be fixed according to a reference price depending on the Human Development Index (HDI) and CO₂ emissions per capita. The HDI criterion enables to integrate progressivity into taxation while distinguishing what is essential from what is not. By taking a reference price based on the HDI, countries with low HDIs should pay a lower carbon price. However, with same HDI levels, countries with higher CO₂ emissions should pay a penalty on the reference price. Our policy paper analyses the benefits of a differentiated and progressive carbon pricing mechanism to facilitate intergovernmental cooperation for a more sustainable economy.

Anaphylaxis: Access to Epinephrine in Outpatient Setting

Epinephrine is a lifesaving medication to treat systemic allergic reactions including anaphylaxis. Epinephrine autoinjectors (EAIs) are expensive, not available everywhere in the world, and shortages can limit their access. Epinephrine prefilled syringes and epinephrine kits are lower-cost alternatives to EAIs. Advantages, disadvantages, and costs of available products are discussed and the socioeconomic factors impacting access to EAIs described. EAIs designed for infants also are discussed.

Effectiveness of price-reduced meals on purchases among university young adults

University food environments influence dietary behaviours of attending young adults (aged 18–35 years). The present study aimed to determine if price-reduced meals are associated with high purchase volumes at food outlets (n 5) in a large urban university. The university food outlet customers: university staff and students (n 244) were surveyed about their food choice determinants and their awareness of a price-reduced meal initiative called ‘Budgie Meals’. Itemised sales of ‘Budgie Meals’ and other meals across 3 years were collected. The ‘Budgie Meals’ were nutritionally analyzed. The χ² and Mann–Whitney U tests were used to analyze quantitative survey responses. An open-ended item was thematically analyzed. Itemised sales of ‘Budgie Meals’ were measured across 3 years and were analyzed using the analysis of variance. The ‘Budgie Meals’ were nutritionally analyzed and categorised as ‘green,’ ‘amber’ or ‘red’ using the National Healthy Food and Drink Policy. Price was considered the most significant barrier to healthy food purchases. The awareness of the ‘Budgie Meal’ initiative was poor. The ‘Budgie Meal’ had higher sales volumes at each outlet than other items, but the sales showed a downward trend across the years. Nutritional analyses revealed that ‘Budgie Meals’ could be improved. The researchers suggested nutritional improvements to food retailers. Further research is required to assess the viability of implementing such nutritional improvements across food outlets. Specifically, collaboration with retailers and customers is needed to establish the economic feasibility, any potential revenue losses and testing taste acceptability of recipe alterations to these price-reduced meals.