We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Substance use disorder (SUD) is a public health crisis in the United States associated with significant economic costs including healthcare, criminal justice, productivity, and mortality and morbidity costs. In this paper, we present a tool for a customizable economic analysis that can be utilized by different recovery program owners and operators within the SUD continuum of care that considers these program’s operating and capital costs, location, size, and success rate. The goal of this tool is to provide owners and operators with an accessible tool that can estimate their individual program’s economic costs, benefits, and return on investment. In applications of the tool, we find that there are significant benefits associated with SUD recovery-oriented services, even with more conservative modeling of recovery benefits. Specifically, we find that a representative recovery housing program in Florida yields a net benefit of $143 million over 20 years with an associated return on investment of $22.19 per dollar invested. Further, we find that the net benefits of different recovery-oriented modalities including a recovery house, a recovery campus, and a residential inpatient program are positive, with returns on investment varying from nearly $22 per dollar invested to $1 per dollar.
This chapter examines ‘Regulatory Policy’ by addressing various questions that arise in considering ‘whether’ and ‘how’ to regulate. Regulatory policy includes a range of methodologies such as cost-benefit analysis and regulatory impact assessment. This chapter focuses on the methodologies used by public regulators. This chapter discusses the methods that help regulators assess who will be impacted by regulation, whether a regulation is effective, and what its costs and benefits will be. The chapter discusses the history of regulatory policy and delves into cost-benefit analysis, regulatory impact assessment, and consultations. The chapter includes a brief analysis of better regulation policies.
There is a need to value health technologies in a way that accommodates their broader economic impacts and competing approaches for doing so have emerged. The Pareto principle (PP) requires policymakers to resolve intrapersonal trade-offs by deferring to the preferences of the individuals facing those trade-offs. Many broad value frameworks such as cost-utility analysis and its extensions, health-centric multicriteria decision analysis, and poverty-free life expectancy are not sufficiently deferential to these preferences, violating PP. I propose using the health-augmented lifecycle model (HALM) to value health technologies in a way that flexibly incorporates the interactions among health and economic factors – specifically mortality and morbidity risks, paid and unpaid work, consumption, leisure, and public and private transfer inflows and outflows--over the life course. It relies on individual preferences, satisfying PP. It is compatible with cost-benefit analysis, social welfare functions, and equivalent income approaches. I calibrate the HALM for the US setting and apply it to a pediatric vaccine.
Animal welfare is often ignored in decision-making, despite widespread agreement about its importance. This is partly because of a lack of quantitative methods to assess the impacts of policies on humans and nonhumans alike on a common scale. At the same time, recent work in economics, philosophy, and animal welfare science has made progress on the fundamental theoretical challenge of estimating the well-being potential of different species on a single scale. By combining these estimates of each species’ well-being potential with assessments of how various policies impact the quality of life for these species, along with the number of animals affected, we can arrive at a framework for estimating the impact of policies on animal health and well-being. This framework allows for a quantifiable comparison between policies affecting humans and animals. For instance, it enables us to compare human QALYs to animal QALYs tailored to specific species. Hence, the intrinsic value of animal welfare impacts of policies can be monetized on the same scale as market and non-market impact for humans, facilitating benefit–cost analysis. Many challenges remain though, including issues of population ethics, political feasibility, and new complexities in addressing equity and uncertainty.
As the world has become more digitally dependent, questions of data governance, such as ethics, institutional arrangements, and statistical protection measures, have increased in significance. Understanding the economic contribution of investments in data sharing and data governance is highly problematic: outputs and outcomes are often widely dispersed and hard to measure, and the value of those investments is very context-dependent. The “Five Safes” is a popular data governance framework. It is used to design and critique data management strategies across the world and has also been used as a performance framework to measure the effectiveness of data access operations. We report on a novel application of the Five Safes framework to structure the economic evaluation of data governance. The Five Safes was designed to allow structured investigation into data governance. Combining this with more traditional logic models can provide an evaluation methodology that is practical, reproducible, and comparable. We illustrate this by considering the application of the combined logic model-Five Safes framework to data governance for agronomy investments in Ethiopia. We demonstrate how the Five Safes was used to generate the necessary context for a more traditional quantitative study, and consider lessons learned for the wider evaluation of data and data governance investments.
In Chapter 7, we expand on the working roles of dogs and classify current canine occupations. We introduce the theory of comparative advantage and note its important role in evolutionary science. We classify canine occupations in terms of two dimensions: the type of dog advantage (comparative, absolute, or unique) and whether the occupation requires a higher or lower level of training. These occupations include service (guide, hearing, disabled, and psychiatric assistance), emotional support, therapy, hunting, herding, racing, search & rescue, substance detection, police work, diabetic alerting, cancer detection, and seizure alerting. We explain the trade-offs between selection and training across occupations, both in terms of breeds and juvenile dogs within breeds. We examine two studies that employ cost-benefit analysis. First, we present an analysis of the social benefits of guide dogs. Second, we discuss the controversy surrounding the treatment of emotional support animals in air travel and the cost-benefit analysis the Department of Transportation used to support its rule that allowed airlines to treat emotional support animals as pets rather than as service animals.
In Chapter 5, we explain how a stated preference method, contingent valuation, is used to estimate the value of statistical dog life (VSDL). This shadow price is useful in cost-benefit analyses, included in regulatory impact analyses of rules that affect canine mortality risk. We explain how economists estimate the value of statistical life (VSL) and how to interpret it. We motivate the value of the VSDL with the melamine pet food disaster, which killed many dogs and cats and resulted in the Food and Drug Administration being given more authority to regulate pet food. The VSDL was estimated using a survey experiment presented to dog owners in a national survey. Respondents were asked about their willingness to pay for a reduction in the mortality risk that their dogs face from canine influenza. We describe the construction of the survey instrument and the experimental design, and then demonstrate how the statistical analyses of the resulting data can reduce behavioral biases that might reduce the validity of the results. We conclude by considering how the VSDL may be extended beyond regulatory analysis to tort and divorce law and public policy more generally.
Chapter 16 establishes the concept of an externality, a situation where a decision carries additional costs or benefits to a party not involved in the decision-making process. The chapter classifies several types of externalities and explores how and why they lead to undesirable outcomes. Then potential solutions to externalities as well as their strengths and weaknesses are discussed: subsidies, taxes, regulation, and the assignment of property rights. The chapter ends with a discussion of cost–benefit analysis and its role in evaluating interventions aimed at combatting externality problems.
The rift between Gifford Pinchot and John Muir, between the conservationist and preservationist movements, left an unsatisfactory state of affairs for economists working on early environmental policy questions. Moreover, midway through the 20th Century, economics was still defined as the study of material welfare. An interdiciplinary social scientist like Aldo Leopold concluded that economics thus could have little to say about the value of preserved landscapes or species. Yet economics was relevant for preservation because incentives mattered. He advocated a new interdiciplinary ecological economics to overcome these problems. Meanwhile, economists in government were beginning to confront environmental questions, such as the value of outdoor recreation, in their benefit-cost analyses of dams and other water projects. They too concluded such questions were outside their field and could not be addressed. Thus, at mid-century, the future existence of a field called environmental economics was very much in doubt.
Each year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low-income and lower-middle-income countries alone, translating to a welfare loss equivalent to $426 billion and $36 billion for neonatal and maternal deaths, respectively. The total loss was $462 billion or almost 6 % of these countries’ combined GDP. In the sustainable development goals pledge, the world promised to reduce maternal deaths to 0.07 % and neonatal mortality to below 1.2 %, saving about 200,000 women and 1.2 million children from dying annually. However, on the current trajectory, maternal mortality is expected to decline to only 0.16 % and neonatal deaths to only 1.5 % by 2030. This article analyses the most cost-effective way to reduce maternal and neonatal deaths – Increase coverage of basic emergency obstetric and newborn care from 68 to 90 % combined with increased family planning services in 55 low-income and lower-middle-income countries which account for around 90 % of the burden of maternal and neonatal mortality globally. The proposed package will require $3.2 billion per year more investment and will deliver benefits worth $278 billion per year in avoided deaths and higher economic growth. It will also yield a demographic dividend benefit equivalent to $25 billion annually. For every $1 invested, the social and economic benefits are estimated to be $87. The benefit-cost ratio is 87.
Chapter 4 sketches the contemporary theory of economic welfare. It argues that welfare economics is a theoretically driven discipline, whose questions are determined more by equilibrium theory than by practical problems of economic welfare. Section 1 begins with the fundamental question: what is welfare or, synonymously, well-being? Section 2 explains why the answer that economists give has led them to eschew utilitarianism, and it links this chapter to the previous three, presenting the fundamental theorems of welfare economics, the grounds for the admiration economists have for the operation of perfectly competitive markets, the problems of markets that are not perfectly competitive, and further theorems concerning social choice and welfare. Section 3 turns to practical work in welfare economics and the foundations of cost-benefit analysis. Section 4 ends with an overview, including some remarks about alternatives to mainstream normative economics.
To assess the potential cost-effectiveness of neuromuscular electrical stimulation (NMES) for treatment of mild obstructive sleep apnea (OSA).
Methods
A decision-analytic Markov model was developed to estimate health state progression, incremental cost, and quality-adjusted life year (QALY) gain of NMES compared to no treatment, continuous airway pressure (CPAP), or oral appliance (OA) treatment. The base case assumed no cardiovascular (CV) benefit for any of the interventions, while potential CV benefit was considered in scenario analyses. Therapy effectiveness was based on a recent multi-center trial for NMES, and on the TOMADO and MERGE studies for OA and CPAP. Costs, considered from a United States payer perspective, were projected over lifetime for a 48-year-old cohort, 68% of whom were male. An incremental cost-effectiveness ratio (ICER) threshold of USD150,000 per QALY gained was applied.
Results
From a baseline AHI of 10.2 events/hour, NMES, OA and CPAP reduced the AHI to 6.9, 7.0 and 1.4 events/hour respectively. Long-term therapy adherence was estimated at 65-75% for NMES and 55% for both OA and CPAP. Compared to no treatment, NMES added between 0.268 and 0.536 QALYs and between USD7,481 and USD17,445 in cost, resulting in ICERs between USD15,436 and USD57,844 per QALY gained. Depending on long-term adherence assumptions, either NMES or CPAP were found to be the preferred treatment option, with NMES becoming more attractive with younger age and assuming CPAP was not used for the full night in all patients.
Conclusions
NMES might be a cost-effective treatment option for patients with mild OSA.
Chapter 2 defines efficiency. The efficiency criterion here is cost-benefit analysis, where cost is institution cost (including information and transaction costs) and benefit is what is called “allocative efficiency” in the literature. My efficiency criterion builds on 60 years of law-and-economics research in property law, but I believe that this is the first time that efficiency has been formulated in this way. Chapter 2 positions efficiency as a first-order value, while welfare is a second-order value that includes efficiency and other first-order values such as distribution of wealth. In addition, Chapter 2 introduces the concepts of ex ante viewpoint and the property rule versus the liability rule, both of which will be drawn on in later chapters.
Behavioural economists often claim that their policy recommendations are justified by cost–benefit analysis (CBA), but without adequate explanation of the methodology they have in mind. I sketch the outlines of a CBA methodology that is compatible with the findings of behavioural economics and is in accord with my account in Sugden (2018) of a well-functioning market as a network of opportunities for mutually beneficial transactions. The key idea is that the CBA of a project is concerned only with effects that are not transmitted through voluntary interactions. I illustrate this proposal by considering the appraisal of fuel economy mandates.
The traditional concerns about farm animal welfare have centred around the impact of intensive environments and management practices on the animal. This emphasis on the physical environment is changing, however, with greater consideration being given to animal factors and in particular to the selective breeding of farm animals. In this paper we use examples from our own research on dairy cattle and sheep breeding that have made positive and practical contributions towards reducing welfare problems by creating more balanced breeding programmes. In both examples, inclusion of health and fitness traits into breeding indexes can be shown to be more profitable than selecting on production traits alone. In addition, we propose that in principle animal breeding combined with economics research can make a more general contribution towards resolving animal welfare issues, by providing a framework for the quantitative evaluation of the costs and benefits of an animal production system. The advantage of the approaches currently used in multi-trait selection is that they transform all traits (production-based or welfare-based) to a common currency allowing direct comparisons of costs and benefits. Currently the weights applied to traits reflect their economic value to the producer. This approach is likely to underestimate non-economic welfare aspects such as the pain or discomfort associated with lameness, and new approaches are needed to more fully account for these non-economic welfare costs. We therefore propose that consideration is given to the use of approaches such as contingent valuation, which has been widely used in economics to derive values for non-economic activities. The question of who would pay for the addition of these welfare costs to a breeding index remains open, but it would seem most reasonable to treat these as a public good and pay for them as such through appropriate mechanisms.
This article examines the economic foundations of three criteria used for evaluating the costs and benefits of social programs. Some criteria do not consider the scale of programs or address the costs associated with programs that expand or contract the total government budget. A recent addition to the list of evaluation criteria – the marginal value of public funds – does not adopt a social optimality perspective. It evaluates the optimality of expenditures assuming a predetermined aggregate budget without considering the social costs of raising that budget.
Viruses and related graft-transmissible pathogens cause diseases that cost the grape industry billions of dollars annually if left uncontrolled. The National Clean Plant Network (NCPN), a USDA Farm Bill program, is an organization of clean plant centers that produce and maintain virus-tested foundation vine stocks and distribute propagation material derived thereof to nurseries and growers to minimize the introduction of viruses and virus-like diseases into the vineyard. Foundation Plant Services (FPS) is the major NCPN-grapes center. We examined the economic impacts of public investments in FPS from 2006 to 2019. By focusing on grapevine leafroll disease, our analyses revealed a benefit-cost ratio ranging from 22:1 to 96:1, with a 5% and a 20% disease infection rates in commercial vineyards, respectively. A welfare analysis was consistent with grape growers and nurseries capturing most (64–98%) of the benefits from adopting clean planting material compared with winemakers and other actors in the downstream wine supply chain system. This study provided new insights into the returns to public investments in a clean plant center and documented strong financial incentives for higher adoption of clean vines derived from virus-tested stocks, while justifying continued support of NCPN centers from public and private sectors.
Even where willingness-to-pay as a measure of welfare impact is adjusted for diminishing marginal utility, welfare economics is shown to favour policies that add to the life expectancy or that enhance the quality of life of persons who are already better-off. I propose an alternative, Equal Respect methodology, under an axiomatic claim that at the point of decision the prospective life years of all individuals are of equal intrinsic social value. This justifies equal valuation of risk mitigation across all persons; similarly, all appraised impacts should be scaled to accord equal respect to difficult but no-less-valuable lives.
There is an overwhelming case against the current regulation of AI for existential risks. The regulation would compromise the progress in AI because regulators could not tell which lines of research make existential threats. Part of the reason is that these risks are not imminent and are not probable, thus making identification even harder. Finally, regulating at the national level might empower rogue nations to threaten the national security of well-functioning democracies. But international regulation is not possible, because it is difficult, if not impossible, to verify that prohibited lines of research are not occurring within another nation’s territory. Encouraging with subsidies the development of AI that is not an existential threat is the best way forward, because it will build up knowledge of potential dangers.
This chapter examines how observers — regulated entities and third parties — perceive the decisions made in the experiments of chapter 5. Rather than studying the trustworthiness of decision-making, that is, this chapter studies how procedures affect the trust that observers place in those decisions. Do the reasoning requirements enhance observers’ trust in decision? If so, what drives any changes in trust: the substantive decision, or the procedural accompaniments of the decision? This chapter attempts to isolate these two typically confounded components that plausibly feed into notions of public sector trust and legitimacy. The analysis indicates that both the substantive decision and the procedural accompaniments enhance perceptions of trust and legitimacy.