Reimbursement models to tackle market failures for antimicrobials: Approaches taken in France,Germany, Sweden,the United Kingdom,and the United States

IntroductionThe pipeline of new antibacterials remains limited. Reasons include low research investments, limited commercial prospects, and scientific challenges. To complement existing initiatives such as research grants, governments are exploring policy options for providing new market incentives to drug developers.Materials and methodsReimbursement interventions for antibacterials in France, Germany, Sweden, US, and UK were reviewed and analysed by the authors.ResultsIn France, Germany, and the US, implemented interventions centre on providing exceptions in cost-containment mechanisms to allow higher prices for certain antibacterials. In the US, also, certain antibacterials are granted additional years of protection from generic competition (exclusivity) and faster regulatory review. The UK is piloting a model that will negotiate contracts with manufacturers to pay a fixed annual fee for ongoing supply of as many units as needed. Sweden is piloting a model that will offer manufacturers of selected antibacterials contracts that would guarantee a minimum annual revenue. A similar model of guaranteed minimal annual revenues is under consideration in the US (PASTEUR Act).ConclusionsThe UK and Sweden are piloting entirely novel procurement and reimbursement models. Existing interventions in the US, France, and Germany represent important, but relatively minor interventions. More countries should explore the use of novel models and international coordination will be important for ‘pull’ incentives to be effective. If adopted, the PASTEUR legislation in the US would constitute a significant ‘pull’ incentive.     

Trajectories of dynamic predictors of disorder: their meanings and implications

Developmental psychopathologists are increasingly focused on characterizing heterogeneity of trajectories of psychological disorders across the life course (e.g., developmentally limited vs. chronic forms of disorder). Although the developmental significance of trajectories has been highlighted, there has been little attention to relations between trajectories and their etiologically and clinically relevant time-varying covariates (dynamic predictors). Depending upon the functional relation between a disorder and a dynamic predictor, we expect to see different trajectories of dynamic predictors. Thus, we propose a taxonomy of trajectories of dynamic predictors of course of disorder and provide an initial investigation into its validity. Using a mixed-gender, high-risk sample of young adults followed over 7 years, we identified dynamic predictors that covary with the course of alcohol use disorder (AUD). Based on a logically derived classification to facilitate interpretation of findings, three comparison groups were examined: persons whose AUD "remitted" (n = 33), those with a chronic AUD (n = 29), and nondiagnosers (n = 274). We hypothesized seven patterns of dynamic prediction (stable vulnerability indicators, course trackers, deterioration markers, developmentally specific variables, developmental lag markers, course-referenced variables, and recovery behaviors) and found evidence for five of them. The interpretation of markers of risk for development and course of AUDs and their implications for prevention, early intervention and formal/self-change treatments are discussed.     

Mosquito surveillance and polymerase chain reaction detection of West Nile virus, New York State

West Nile (WN) virus was detected in the metropolitan New York City (NYC) area during the summer and fall of 1999. Sixty-two human cases, 7 fatal, were documented. The New York State Department of Health initiated a departmental effort to implement a statewide mosquito and virus surveillance system. During the 2000 arbovirus surveillance season, we collected 317,676 mosquitoes, submitted 9,952 pools for virus testing, and detected 363 WN virus-positive pools by polymerase chain reaction (PCR). Eight species of mosquitoes were found infected. Our mosquito surveillance system complemented other surveillance systems in the state to identify relative risk for human exposure to WN virus. PCR WN virus-positive mosquitoes were detected in NYC and six counties in the lower Hudson River Valley and metropolitan NYC area. Collective surveillance activities suggest that WN virus can disperse throughout the state and may impact local health jurisdictions in the state in future years.     

Standardizing ADOS Scores for a Measure of Severity in Autism Spectrum Disorders

The aim of this study is to standardize Autism Diagnostic Observation Schedule (ADOS) scores within a large sample to approximate an autism severity metric. Using a dataset of 1,415 individuals aged 2–16 years with autism spectrum disorders (ASD) or nonspectrum diagnoses, a subset of 1,807 assessments from 1,118 individuals with ASD were divided into narrow age and language cells. Within each cell, severity scores were based on percentiles of raw totals corresponding to each ADOS diagnostic classification. Calibrated severity scores had more uniform distributions across developmental groups and were less influenced by participant demographics than raw totals. This metric should be useful in comparing assessments across modules and time, and identifying trajectories of autism severity for clinical, genetic, and neurobiological research.     

Diffusion of Mental Health and Substance Abuse Treatments: Development, Dissemination, and Implementation

Theory and research regarding the diffusion of innovations and technology transfer have advanced our understanding of how new ideas and technologies are developed, disseminated, adopted, and implemented by individuals and organizations. Although diffusion has been studied in other fields, it is not often applied to mental health and substance abuse treatment. However, findings from diffusion-of-innovations research can assist in bridging research-practice gaps that lead to clients receiving treatments whose effectiveness has not been assessed or to clients not receiving the most effective treatments. This article reviews theory and research regarding the diffusion of innovations and highlights areas for application to mental health treatment, including the transportability of treatments into real-world settings, strategies to disseminate treatments, attributes of treatments that affect their adoption, and organizational change factors that affect implementation.     

Depression and disability in Parkinson's disease: a follow-up of 132 cases

Patients with Parkinson's disease, 132 in number, were followed up after approximately one year, and measures of depression and disability re-administered. Depression was common on both occasions, and was characterized by dysphoria, pessimism and somatic symptoms, but not guilt or self-blame. Depression and disability were associated on both occasions. The relationship between changes in disability and depression across time was complex. In trying to understand changes in depression, the absolute change in disability may be less important than the relative change and rate of change. The results were discussed in relation to findings from other disease groups, and the implications for the clinical management of depression in Parkinson's disease.     

Factors influencing scores on the social responsiveness scale

Background: The Social Responsiveness Scale (SRS) is a parent‐completed screening questionnaire often used to measure autism spectrum disorders (ASD) severity. Although child characteristics are known to influence scores from other ASD‐symptom measures, as well as parent‐questionnaires more broadly, there has been limited consideration of how non‐ASD‐specific factors may affect interpretation of SRS scores. Previous studies have explored effects of behavior problems on SRS specificity, but have not addressed influences on the use of the SRS as a quantitative measure of ASD‐symptoms. Method: Raw scores (SRS‐Raw) from parent‐completed SRS were analyzed for 2,368 probands with ASD and 1,913 unaffected siblings. Regression analyses were used to assess associations between SRS scores and demographic, language, cognitive, and behavior measures. Results: For probands, higher SRS‐Raw were associated with greater non‐ASD behavior problems, higher age, and more impaired language and cognitive skills, as well as scores from other parent report measures of social development and ASD‐symptoms. For unaffected siblings, having more behavior problems predicted higher SRS‐Raw; male gender, younger age, and poorer adaptive social and expressive communication skills also showed small, but significant effects. Conclusions: When using the SRS as a quantitative phenotype measure, the influence of behavior problems, age, and expressive language or cognitive level on scores must be considered. If effects of non‐ASD‐specific factors are not addressed, SRS scores are more appropriately interpreted as indicating general levels of impairment, than as severity of ASD‐specific symptoms or social impairment. Additional research is needed to consider how these factors influence the SRS’ sensitivity and specificity in large, clinical samples including individuals with disorders other than ASD.