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Light rail transit (LRT) is increasingly accompanied by overlay zoning which specifies the density and type of future development to encourage landscapes conducive to transit use. Neighbourhood type (based on land use mix) is used to partition data and investigate how pre-existing land use, treatment with a park-and-ride (PAR) versus walk-and-ride (WAR) station and overlay zoning interrelate. Hedonic models estimate capitalisation effects of LRT-related accessibility and overlay zoning on single-family houses and condos in different neighbourhoods for the system in metropolitan Phoenix, Arizona. Impacts differ by housing and neighbourhood type. Amenity-dominated mixed-use neighbourhoods— predominantly WAR communities—experience premiums of 6 per cent for single-family houses and over 20 per cent for condos, the latter boosted an additional 37 per cent by overlay zoning. Residential neighbourhoods—predominantly PAR communities—experience no capitalisation benefits for single-family houses and a discount for condos. The results suggest that land use mix is an important variable to select comparable neighbourhoods.

Sustaining elimination of malaria in areas with high receptivity and vulnerability will require effective strategies to prevent reestablishment of local transmission, yet there is a dearth of evidence about this phase. Mauritius offers a uniquely informative history, with elimination of local transmission in 1969, re-emergence in 1975, and second elimination in 1998. Towards this end, Mauritius's elimination and prevention of reintroduction (POR) programs were analyzed via a comprehensive review of literature and government documents, supplemented by program observation and interviews with policy makers and program personnel. The impact of the country's most costly intervention, a passenger screening program, was assessed quantitatively using simulation modeling.On average, Mauritius spent $4.43 per capita per year (pcpy) during its second elimination campaign from 1982 to 1988. The country currently spends $2.06 pcpy on its POR program that includes robust surveillance, routine vector control, and prompt and effective treatment and response. Thirty-five percent of POR costs are for a passenger screening program. Modeling suggests that the estimated 14% of imported malaria infections identified by this program reduces the annual risk of indigenous transmission by approximately 2%. Of cases missed by the initial passenger screening program, 49% were estimated to be identified by passive or reactive case detection, leaving an estimated 3.1 unidentified imported infections per 100,000 inhabitants per year.The Mauritius experience indicates that ongoing intervention, strong leadership, and substantial predictable funding are critical to consistently prevent the reestablishment of malaria. Sustained vigilance is critical considering Mauritius's enabling conditions. Although the cost of POR is below that of elimination, annual per capita spending remains at levels that are likely infeasible for countries with lower overall health spending. Countries currently embarking on elimination should quantify and plan for potentially similar POR operations and costs.

This study examines how chimeric antigen receptor T-cell (CAR-T) therapy’s incremental effectiveness and cost–effectiveness profile fits into the recent history of anticancer treatments. We conducted graphical and multivariable analyses using data from the Cost–Effectiveness Analysis Registry of the Tufts Medical Center and the Institute for Clinical and Economic Review’s analysis of CAR-T therapies. We collected additional information including the US FDA approval years for pharmacologic innovations. CAR-T provided 5.03 (95% CI: 3.88–6.18) more incremental quality-adjusted life-years than the average pharmaceutical intervention and 4.61 (95% CI: 1.67–7.56) more than the average nonpharmaceutical intervention, while retaining similar cost–effectiveness. There was evidence of worsening cost–effectiveness by approval year for pharmaceutical interventions. Analysis is limited to anticancer treatments studied in cost–utility analyses, estimated to cover approximately 60% of FDA-approved antineoplastic agents. CAR-T therapy breaks a pattern of stagnant efficacy growth in pharmaceutical innovation and demonstrates significantly greater incremental effectiveness and similar cost–effectiveness to prior innovations.

Dans cet article, nous comparons les perspectives de retraite des hommes immigrants avec celles de leurs concitoyens nés au pays à partir des données de l'Enquête sur la dynamique du travail et du revenu. Nous observons d'abord un écart significatif entre les deux groupes, les revenus provenant de régimes privés de retraite étant pour les immigrants de 43% inférieurs à ceux des autres Canadiens; dans le cas des contributions à un régime privé de retraite, l'écart est de 30%. Au niveau du régime de retraite gouvernemental, l'écart des revenus est négligeable, ce qui contribue à réduire, mais en partie seulement, l'écart global des revenus de retraite. De plus, ces deux écarts sont plus élevés dans le cas des immigrants récents, ce qui s'accorde avec le fait que les revenus de ces immigrants sont plus faibles. Nous considérons ensuite l'âge, en lien avec les revenus de retraite et les contributions à un régime, et nous montrons les problèmes que pose l'interprétation des résultats obtenus si nous n'apportons pas certains ajustements. Quand nous tenons compte de l'effet de l'âge et des différences de revenus, l'écart des contributions à un régime de retraite privé est quand même de 11%; toutefois, parmi tous les hommes qui contribuent à un tel régime, il n'y a pas de différence quant au taux des contributions par rapport aux revenus. Enfin, les contributions des immigrants récents à un régime privé sont significativement inférieures; ils semblent ignorer, beaucoup plus que les autres immigrants et que les Canadiens nés au pays, les occasions qui leur sont fournies de contribuer à un tel régime, ce qui pourrait avoir des implications négatives sur les régimes publics de retraite canadiens. We compare the retirement prospects of immigrant men with their native-born counterparts. Using data from the Survey of Labour and Income Dynamics, we estimate a significant gap of 43 percent in private pension income and 30 percent in private pension contributions between immigrants and the native born. The gap in public pension incomes is negligible and reduces the overall pension gap, but only partially. Furthermore, the pension income and contribution gap is significantly larger for more recently arrived immigrant cohorts, consistent with evidence of weaker earnings for this group. We provide age profiles of pension income and contributions and discuss problems in interpreting the results without adjusting for age. Controlling for age and earnings differences, immigrants are still about 11 percent less likely to make contributions to a private pension program, but there is no difference in the contribution rates out of earnings of those who contribute. Recently arrived immigrants are significantly less likely to make contributions to a private pension program and appear to be neglecting private pension contribution opportunities more than earlier immigrants and the native born, which may have adverse implications for Canada's public retirement programs.

The provisioning and administration of social housing has been a continuous problem in the Canadian North since the 1960s, when the Canadian government began taking an active role in the welfare of Inuit. Some of these problems are quite basic and include high costs for construction and maintenance of units. An examination of the development and evolution of Canadian housing policy in the North demonstrates that changes to the administration of social housing programs and, since the mid-1980s, development of formal privatization schemes have steadily shifted housing costs onto local residents. These shifting costs, however, are borne unequally, with Inuit born and raised in the context of permanent communities (the Settlement Generation) facing the greatest burdens.

Managed competition remains untested as the basis of a national health program. However, key principles of managed competition first emerged in the military. For this study, published works on systems analysis and the planning-programming-budgeting system (PPBS), developed by Alain Enthoven and colleagues at the US Department of Defense during the 1960s, were compared with published presentations of managed competition. The influence of PPBS waned after it generated controversy and opposition. PPBS and managed competition represent similar managerial strategies of policy reform. Although the origin of managed competition in failed military policy does not ensure failure in the medical arena, this history also does not augur success.

Enthoven replies to Waitzkin's criticisms of a study on managed competition and public policy in health care. Waitzkin responds.

Background In principle, risk-stratification as a routine part of the NHS Breast Screening Programme (NHSBSP) should produce a better balance of benefits and harms. The main benefit is the offer of NICE-approved more frequent screening and/ or chemoprevention for women who are at increased risk, but are unaware of this. We have developed BC-Predict, to be offered to women when invited to NHSBSP which collects information on risk factors (self-reported information on family history and hormone-related factors via questionnaire; mammographic density; and in a sub-sample, Single Nucleotide Polymorphisms). BC-Predict produces risk feedback letters, inviting women at high risk (≥8% 10-year) or moderate risk (≥5 to < 8% 10-year) to have discussion of prevention and early detection options at Family History, Risk and Prevention Clinics. Despite the promise of systems such as BC-Predict, there are still too many uncertainties for a fully-powered definitive trial to be appropriate or ethical. The present research aims to identify these key uncertainties regarding the feasibility of integrating BC-Predict into the NHSBSP. Key objectives of the present research are to quantify important potential benefits and harms, and identify key drivers of the relative cost-effectiveness of embedding BC-Predict into NHSBSP. Methods A non-randomised fully counterbalanced study design will be used, to include approximately equal numbers of women offered NHSBSP ( n  = 18,700) and BC-Predict ( n  = 18,700) from selected screening sites ( n  = 7). In the initial 8-month time period, women eligible for NHSBSP will be offered BC-Predict in four screening sites. Three screening sites will offer women usual NHSBSP. In the following 8-months the study sites offering usual NHSBSP switch to BC-Predict and vice versa. Key potential benefits including uptake of risk consultations, chemoprevention and additional screening will be obtained for both groups. Key potential harms such as increased anxiety will be obtained via self-report questionnaires, with embedded qualitative process analysis. A decision-analytic model-based cost-effectiveness analysis will identify the key uncertainties underpinning the relative cost-effectiveness of embedding BC-Predict into NHSBSP. Discussion We will assess the feasibility of integrating BC-Predict into the NHSBSP, and identify the main uncertainties for a definitive evaluation of the clinical and cost-effectiveness of BC-Predict. Trial registration Retrospectively registered with clinicaltrials.gov ( NCT04359420 ).