Kidney function, future health costs, and quality-adjusted life-years in kidney transplant recipients transplanted during the SARS-Cov-2 lockdown in Denmark - An observational study.

BACKGROUND: It is unknown whether lockdown due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect both clinical outcome in kidney transplant recipients and health care economics in Denmark. METHODS: We compared kidney transplant data at a tertiary university hospital before and during the lockdown period from March 13, 2020 until March 31, 2021, as well as kidney transplant data from Scandiatransplant for entire Denmark. Outcome variables included fall of plasma creatinine during the first postoperative day, and graft function three months posttransplant. We calculated the quality-adjusted life-years (QALYs) and costs which were caused by the lockdown recommendations. FINDINGS: The portion of living donation kidney transplantation was largely reduced during the lockdown period compared to before the lockdown: AB0-incompatible living donation declined from 14% to 7% (P < 0.01), and AB0-compatible living donation declined from 34% to 20% (p < 0.01).In entire Denmark during the lockdown period 78 living donor kidney transplants out of 268 kidney transplants (29%) were performed, whereas there were 878 living donor kidney transplants out of 2218 kidney transplants (39%) before the lockdown (P = 0.01).The observed reduction of living donor kidney transplants and consecutive reduction of graft survival will cause a loss of 5.04 QALYs.The additional costs in kidney transplant recipients who received a kidney transplant during the lockdown period will be 277,298 EUR. INTERPRETATION: SARS-CoV-2 lockdown period largely reduced living donation kidney transplants which will lead to reduced QALY as well as higher costs in kidney transplant recipients.

The Cost-Effectiveness of a COVID-19 Vaccine in a Danish Context.

BACKGROUND AND OBJECTIVES: Covid-19 vaccines approved by the EU, UK and USA have been found to be safe and effective. The cost effectiveness of these vaccines depends upon a number of factors. The aim of this paper is to explore the cost effectiveness of a COVID-19 vaccine and to analyse how the price of the vaccine and the cost of administrating it influence its cost effectiveness. METHODS: We considered an epidemiological model developed by an expert group within 'Statens Serum Institut', which is a unit under the auspices of the Danish Ministry of Health. The model allowed us to differentiate between two population groups, those aged ≥60 years and those aged <60 years. We used the model to consider four scenarios: (i) vaccination of 25% of the total population (corresponding to approximately 1.5 million persons) but targeting vaccines towards the population aged ≥60 years, (ii) vaccination of 25% of the total population, targeting vaccines only towards the population aged <60 years, (iii) vaccination of 40% of the total population where 15% are aged <60 years and 25% are aged ≥60 years (corresponding approximately to the full Danish population aged >60 years), and (iv) 40% of the total population is vaccinated but vaccines are targeted solely towards those aged <60 years. The time horizon of the analysis was six months, and the perspective was that of the Danish healthcare sector. RESULTS: The results show that inclusion of the elderly population aged ≥60 years was more cost effective than a vaccination strategy that targeted a population aged <60 years old only, when productivity losses were not included. Furthermore, the results show that an extension of the target group from the elderly population only, to also include the younger population comes with an increasing cost per life-year gained. The incremental cost-effectiveness ratio depends on the price of the vaccine, hereunder also the administration costs, and the discount rate used for the estimation of life-years or quality-adjusted life-years gained from a vaccine. Furthermore, inclusion of productivity losses in the analyses influenced the cost effectiveness of vaccination of the population aged <60 years of age. CONCLUSION: The cost effectiveness of a COVID-19 vaccine is sensitive to whether or not productivity losses are included in the analyses. Without productivity losses, the elderly population should always be part of the target group for a COVID-19 vaccination programme. Taking productivity losses into account, at least in the case of low vaccine prices, vaccinating the younger population first can actually be cost effective.

On international fisheries agreements, entry deterrence, and ecological uncertainty.

A prerequisite for an international fisheries agreement (IFA) to be stable is that parties expect the benefits from joining the agreement to exceed the benefits from free riding on the agreement, and parties only comply with the agreement as long as this is true. The agreement, therefore, implicitly builds on an expectation of the ecological condition of the natural resource. Game theoretical models often assume that all parties have the same (often perfect) information about the resource and that the exploitation is an equilibrium use of the stock. As stated by experts in natural science, the fish ecology still has many open questions, for example how to predict population dynamics, migration patterns, food availability, etc. In some cases, parties disagree about the state, abundance, and migration of a stock, which can reduce the possibilities of reaching an agreement for exploitation of the stock. This paper develops a model and applies it to the North-East Atlantic mackerel fishery, in order to analyze an IFA under different ecological scenarios, and also combines the model with the economic theory of entry deterrence. The model is used empirically to determine whether the parties with original access to the resource have an advantage when forming an agreement with a new party in having the ability to fish the stock down to a smaller size and thereby prevent another party from entering into the fishery. With a basis in entry deterrence, combined with lack of information, the paper illustrates the obstacles that have made an agreement for the North-East Atlantic mackerel so difficult to achieve.