Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results

Aims: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6–12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates.

Methods: Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA).

Results: Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (–$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI]?=?–$1,454 [–$2,396, $1,231]).

Limitations: This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited “real-world” applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems.

Conclusions: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6–12 months of VTE treatment.     

Non-rating revenue and conflicts of interest

Rating agencies produce ratings used by investors, but obtain most of their revenue from issuers, leading to a conflict of interest. We employ a unique data set on the use of non-rating services, and the associated payments, in India, to test if this conflict affects ratings quality. Agencies rate issuers that pay them for non-rating services higher (than agencies not hired for such services). Such issuers also have higher default rates. Both effects are increasing in the amount paid. These results suggest that issuers which hire agencies for non-rating services receive higher ratings despite having higher default risk.     

Foreign inflows and economic growth: An emiprical study of the SAARC region

The study examines and highlights the impact of selected foreign inflows (aid, trade, FDI, debt and remittances) on the economic growth of the South Asian Association for Regional Cooperation (SAARC) countries. The existent literature lacks a comprehensive analysis of the SAARC countries as countries like Afghanistan, Bhutan and the Maldives have largely been ignored due to the shorter time periods of available data. The study is empirical in nature and utilizes panel data techniques on macroeconomic data for the period 2008–2015. Foreign aid and foreign direct investment are found to impact economic growth positively. Foreign debt and trade flows are found to adversely affect economic growth. No relationship is established between the flow of remittances and the economic growth of these countries. The obtained results are robust to different proxy variables and the addition of macroeconomic variables. For the first time, the study provides policy implications based on the data of all SAARC countries. The study recommends focusing on increasing the inflows of resources in the form of aid and foreign direct investment (FDI) from the developed world to achieve higher economic growth.     

New development: China renews reform of central–local fiscal relations and provides for basic national public services

China’s reform on central–local fiscal reform has slowed down in recent years. The appointment of a new finance minister experienced in local government affairs is expected to renew the reform affirmed by the Chinese Communist Party (CCP) congress in late 2017. China has unprecedentedly identified a comprehensive list of 81 national basic public services as entitlements. Eighteen of them are subject to national and local standards, and co-financed by central and local governments. A new cost-sharing method for 10 of these services classifies sub-national jurisdictions into five tiers, in which the central government’s share declines from 80% to 10%. These measures, effective in 2019, aim at creating a ‘harmonious and moderately prosperous society’.     

Entrepreneurship and knowledge spillovers from the public sector

A compelling body of research has found that investments in knowledge from other firms and universities spill over to enhance the performance of entrepreneurial firms. This literature has shown that firm performance is positively related to investments in new knowledge by other firms and research universities. This paper addresses a gap in the literature by positing that public sector knowledge is also conducive to enhancing performance by knowledge intensive entrepreneurial (KIE) firms. Our findings suggest that the public sector provides a fertile source of knowledge for enhancing KIE firm performance.

     

Financial Instruments and Promotional Banking in the EU are Growing — But is this Justified?

Institutions and the European Investment Bank are at the forefront of EU investment policy. Their role is expanding and it is now a widely-held position that an improvement in the economy will not eliminate the need for their intervention. The proposals for the 2021–2027 MFF launch more financial instruments and present ‘InvestEU’ as a larger more powerful version of the European Fund for Strategic Investments (EFSI). However, promotional banking is often misunderstood and so is the actual size of promotional banking in Europe in which InvestEU will operate.     

In the city: The John Lewis partnership and planned shopping centres

A defining feature of large-scale retailing during the period 1950–1980 was the emergence and evolution of planned shopping centres. During the 1950s, department stores in the United States were in the vanguard of this phenomenon. In contrast, British department stores continued operating from traditional high street sites, and had limited opportunities for expansion within planned shopping centres until the 1970s. This paper addresses the connection between department store retailing and the development of the planned shopping centre in Britain from the perspective of one enterprise: the John Lewis Partnership. The article demonstrates that the Partnership was willing to operate department stores within centrally located shopping centres, but was circumspect about operating stores in non-centrally located shopping centres.     

Advertising to the masses: the effects of crowding on the attention to place-based advertising

Advertising situated in environments where people congregate or pass through on their way to somewhere else benefit from being placed in such high traffic areas. However, these strategically placed ads also suffer from conditions of human crowding that prevents them from being noticed and processed. We undertake a study of place-based advertising in a shopping mall using facial recognition software to determine the effect of human density on the attention directed to advertising. We find that as human density increases, attention to advertising decreases, but only to a point where it begins to increase again. Our research also finds that human density plays a moderating role on the motivation to process advertising.