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- W399086507 abstract "The subject of this thesis is an economic assessment of alternative means of treating end-stage renal disease. More specifically, an answer to following question is being sought: which of alternative methods of treating end-stage renal disease (home dialysis, hospital dialysis, transplantation from cadaver or living donors) maximises difference between social benefits and social costs?” The technique of cost-benefit analysis is employed to answer this question. Chapter 1 demonstrates that cost-benefit analysis is a technique that, although first used by engineers, finds its justification in theory of welfare economics. Emphasis is placed on assumptions of fact and that underlie technique. The theoretical bases of Chapters 7 and 8 are to be found in Chapter 1. Chapter 2 considers question of appropriate rate of discount to be used in evaluating investment projects in public sector. It is shown that when capital markets are perfect rates of time preference and opportunity cost coincide. When imperfections in capital market are introduced time preference and opportunity cost rates drift apart. Thus a choice has to be made. An evaluation of these alternative concepts is made and conclusion is reached that notion of opportunity cost should over-ride time preference concepts in determining right rate of discount. It is argued in Appendix 6 that Rawls, in his recent book Theory of Justice, provides no case for changing conclusion of Chapter 2. In Chapter 3 analytical framework developed in Chapter 2 is employed to consider question of specific investment criterion to be invoked in empirical analysis of thesis. It is shown that internal rate of return and net present rules give equivalent answers with perfect capital markets, This simple situation becomes complex when imperfections in capital markets are introduced, It is concluded that net present rate will be employed in empirical analysis. A description of four alternative methods of treating end-stage renal disease is given in Chapter 4. Chapter 5 develops estimates of benefits for four alternatives. Building on cohort analyses of Appendices 1-4, benefit streams are defined as labor income plus of household production. Benefits are referred to as the of livelihood as opposed to lithe of life. The latter term connotes more than is being measured in this economic study. Upper and lower estimates of value of livelihood are specified because of a problem in measurement of labor income. This problem arises because of existence of unincorporated income. Chapter 6 presents estimates of costs of achieving results measured in Chapter 5. In Chapter 7 results of previous tw6 chapters are brought together and net benefit streams are obtained. The net benefit streams of alternatives are discounted at a range of discount rates into net present values. Both dialysis alternatives are found to be non-viable economic propositions at all discount rates. Transplantation from living donors has a higher net present than cadaver transplantation at all discount rates. Both transplantation alternatives have positive net present values at a rate of discount of 10%, rate that was considered appropriate in Chapter 2. The results of Chapter 7 are re-worked in Chapter 8. It had been argued in Chapter 1 that of all methods proposed to integrate efficiency and equity in a cost-benefit analysis, weighting of benefits and costs for differing marginal utilities of income was subject to least criticism. Such a procedure involves a different assumption of fact whereas other methods involved a judgement additional to those necessary for a conventional cost-benefit analysis based on Kaldor-Hicks test. Marginal utility weights for different income groups were derived from implicit values of marginal utility in Australian income tax system. It was found that this procedure did not alter rankings nor economic viability of four alternatives as described in Chapter 7. In Chapter 9 consideration is given to legal status of transplantation from cadaver and living donors. It is shown that law relating to organ donation is restrictive on transplantation technique. It is proposed that law be changed in such a way to give living donor transplantation an unambiguous legal position, to institute a system of contracting out for cadaver donation and to define death using criterion of irreversible coma. An estimate of increased net economic benefits that will accrue if law is changed is then presented for both transplantation alternatives." @default.
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- W399086507 title "A cost-benefit study of alternative methods of treating end-stage renal disease" @default.
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