Searchers vs surveyors in estimating the monetary value of a QALY: resolving a nasty dilemma for NICE

Recently, for many health economics researchers, empirical estimation of the monetary valuation of a quality-adjusted life year (QALY) has become an important endeavour. Different philosophical and practical approaches to this have emerged. On the one hand, there is a view that, with health-care budgets set centrally, decision-making bodies within the system can iterate, from observation of a series of previous decisions, towards the value of a QALY, thus searching for such a value. Alternatively, and more consistent with the approach taken in other public sectors, individual members of the public are surveyed with the aim of directly eliciting a preference-based - also known as a willingness-to-pay-based (WTP-based) - value of a QALY. While the former is based on supply-side factors and the latter on demand, both in fact suffer from informational deficiencies. Sole reliance on either would necessitate an acceptance or accommodation of chronic inefficiencies in health-care resource allocation. On the basis of this observation, this paper makes the case that in order to approach optimal decision making in health-care provision, a framework incorporating and thus, to a degree, reconciling these two approaches is to be preferred.     

Policy coherence and interplay between Zambia’s forest,energy, agricultural and climate change policies and multilateral environmental agreements

There is increasing international demand by policymakers focussed on Reduction of Emissions from Deforestation and forest Degradation for developing countries to conserve forests in the face of pressure from agriculture and energy demands. Improving forest conservation efforts requires a better understanding of how policies influence forest resources management, hence a need for better analysis of policy coherence and interaction. This study employs a content analysis of national sectoral policies in agriculture, energy and forestry, and national programmes under United Nations Rio conventions in Zambia to examine coherence and interplay between international- and national-level policies. Results show positive horizontal interplay between energy and forestry policies, while conflicts were observed between the agricultural and forestry policies despite the potential of conservation farming to provide a mutually supportive link. Policy documents show inconsistencies between national sectoral policies and national statements to the Rio conventions. Additionally, although national statements to Rio conventions share common ground on measures to address deforestation, they seem to be poorly mainstreamed into national policies and broader development policies at national level. Findings have further revealed a lack of coherence between national commitments to Rio conventions and national forest legislation. The paper concludes that although developing countries, such as Zambia, are ratifying international environmental conventions, measures are often not drafted into national policies and linkages remain largely superficial.     

Preliminary evaluation of the use of pharmacological treatment with convicted sexual offenders experiencing high levels of sexual preoccupation,hypersexuality and/or sexual compulsivity

The current study presents the preliminary evaluation of the impact of pharmacological treatment (Selective Serotonin Reuptake Inhibitors and anti-androgens) on hypersexuality, sexual preoccupation and sexual compulsivity. The participant pool comprised 64 convicted UK sexual offenders who had been voluntarily referred for pharmacological treatment to reduce their hypersexual arousal, 51 of whom agreed to take the medication (with a further five individuals on hold or under assessment at the time of data extraction). The preliminary findings were very encouraging; analysis on measures assessing sexual preoccupation, hypersexuality and sexual compulsivity indicated a significant reduction between pre- and post-medication, across both types of medication. Limitations of the current research are discussed.     

Small-scale social-environmental enterprises in the green economy: supporting grassroots innovation

To achieve a top-to-bottom growth of the “green economy”, incentives and enablers need to be identified for those micro enterprises working at the grassroots level. A three-year study of 1,300 social and environmental enterprises in developing countries reveals how they are developing new products and services for their communities, using new business models. But their scale-up is hampered by lack of access to research and technology support and gender barriers, as well as challenges with complex partnerships, progress monitoring, and financial viability. A large pool of innovative ideas remains untapped and an opportunity to build a sustainable economy is being missed.