Costs of hospital visits among patients with deep vein thrombosis treated with rivaroxaban and LMWH/warfarin

Background:

For many years, the standard of care for patients diagnosed with deep vein thrombosis (DVT) has been low-molecular-weight heparin (LMWH) bridging to an oral Vitamin-K antagonist (VKA). The availability of new non-VKA oral anticoagulants (NOAC) agents as monotherapy may reduce the likelihood of hospitalization for DVT patients.

Objective:

To compare hospital visit costs of DVT patients treated with rivaroxaban and LMWH/warfarin.

Methods:

A retrospective claim analysis was conducted using the MarketScan Hospital Drug Database for care provided between January 2011 and December 2013. Adult patients using rivaroxaban or LMWH/warfarin with a primary diagnosis of DVT during the first day of a hospital visit were identified (i.e., index hospital visit). Based on propensity-score methods, historical LMWH/warfarin patients (i.e., patients who received LMWH/warfarin before the approval of rivaroxaban) were matched 4:1 to rivaroxaban patients. The hospital-visit cost difference between these groups was evaluated for the index hospital visit, as well as for total hospital-visit costs (i.e., including index and subsequent hospital visit costs).

Results:

All rivaroxaban users (n?=?134) in the database were well-matched with four LMWH/warfarin users (n?=?536). The mean hospital-visit costs were $5257 for the rivaroxaban cohort and $6764 in the matched-cohort of patients using LMWH/warfarin. The $1508 cost difference was statistically significant between cohorts (95% CI?=?[?$2296; ?$580]; p-value?=?0.002). Total hospital-visit costs were lower for rivaroxaban compared to LMWH/warfarin users within 1, 2, 3, and 6 months after index visit (significantly lower within 1 and 3 months, p-values <0.05)

Limitations:

Limitations were inherent to administrative-claims data, completeness of baseline characteristics, adjustments restricted to observational factors, and lastly the sample size of the rivaroxaban cohort.

Conclusion:

The availability of rivaroxaban significantly reduced the costs of hospital visits in patients with DVT treated with rivaroxaban compared to LMWH/warfarin.     

Equilibrium in Insurance Markets: An Empiricist’s View

Empirical models of insurance markets would greatly enhance our ability to understand policy-relevant questions. Yet they are still quite rare. This paper sketches such a model and surveys its basic elements. While much progress has been made in recent years in our understanding of insurance demand in particular, the most crying need is for market-wide data.     

Cost (In)Efficiency and Institutional Pressures in Nursing Home Chains

Over the past 10 years, merger activities in the private for-profit nursing home industry have been increasing in Europe. In this paper, we investigate chain affiliation’s influence on the performance of lucrative nursing homes. We measure performance using a cost frontier estimated by stochastic analysis on a sample of 370 French for-profit nursing homes. We find that cost efficiency decreases with the number of facilities in a chain. We also identify different external actor types in nursing homes’ institutional environment and test their influence. We show that nursing home chains’ cost efficiency improves when local governments and shareholders exert pressure. Our results are robust to alternative model specifications and another definition of costs. Overall, our findings inform researchers, as well as standards setters, of the relevance of chain affiliation and of the role of institutional pressures regarding cost containment at the nursing home level.     

Green supply chains and the missing link between environmental information and practice

Within the field of green supply chain management (GSCM), an interest in supply chain cooperation to create sustainable competitive advantage, i.e. the collaborative paradigm, has made researchers turn their attention to information related aspects of the supply chain. This study contributes to an understanding of a suboptimal use of environmental information, which is critical for all collaborative efforts aiming at sustainable competitive advantage. The aim of this article is to describe the use of environmental information at different stages of the Swedish food supply chain. The results from this case study of the Swedish food supply chain indicate that environmental information is perceived and used differently by purchasers in the supply chain depending on where (in the supply chain) they are situated in relation to other chain actors. The main contribution of this study is the suggestion of a stage‐dependent connection between perceived environmental cost and perceived environmentally informed consumer demand, which are barriers to GSCM practice discussed in recent GSCM literature. The missing link between information sharing and (environmental) performance of supply chains is explained as distance to end‐consumer in terms of supply chain stages. Implications for GSCM practice and theory are discussed. Copyright © 2009 John Wiley & Sons, Ltd and ERP Environment.     

Forecasting the Malmquist productivity index

The Malmquist Productivity Index (MPI) suggests a convenient way of measuring the productivity change of a given unit between two consequent time periods. Until now, only a static approach for analyzing the MPI was available in the literature. However, this hides a potentially valuable information given by the evolution of productivity over time. In this paper, we introduce a dynamic procedure for forecasting the MPI. We compare several approaches and give credit to a method based on the assumption of circularity. Because the MPI is not circular, we present a new decomposition of the MPI, in which the time-varying indices are circular. Based on that decomposition, a new working dynamic forecasting procedure is proposed and illustrated. To construct prediction intervals of the MPI, we extend the bootstrap method in order to take into account potential serial correlation in the data. We illustrate all the new techniques described above by forecasting the productivity index of 17 OECD countries, constructed from their GDP, labor and capital stock.     

Trends in occupational mobility in France: 1982–2009

Are labor markets more turbulent now than thirty years ago? Most job and worker flows imply that the answer is “no”, with one exception: occupational mobility, which increased substantially in the United States. This paper remedies the lack of comparable evidence by focusing on France for the years 1982 to 2009. After correcting for various statistical biases and discrepancies that affect the measurement of occupational mobility, it documents this reallocation process overall and in different subgroups. The data reveal that, over the period considered, the fraction of workers switching occupation exhibits no trend in the aggregate because changing demographics mask increases in mobility within several age and education groups. After taking these composition effects into account, occupational mobility increased sharply in France as well.     

Identifying News Shocks from SVARs

This paper investigates the reliability of SVARs in identifying the dynamic effects of news shocks. Using a simple but insightful model with a non-fundamental representation, we show analytically under which conditions SVARs are likely to be successful at identifying news shocks. We find that the dynamic responses to news shocks identified using a short-run restriction are biased. However, this bias is smaller if news shocks account for most of the variability of the endogenous variable and the economy exhibits strong forward-looking behavior. Our simulation experiments confirm this finding and further suggest that the number of lags in the VAR and the anticipation horizon are key ingredients for the success of the VAR setup.     

Labor Law in China: How Does It Contribute to the Economic Security of the Workforce? A Commonsian Reading

By adopting the “reasonable value” notion applied to the labor relationship as proposed by John R. Commons, I study the way in which labor legislation in China can be understood as the search for a status of employment security for rural migrant workers. However, the Chinese labor market is experiencing growth in a particular form of informal labor: delegated and temporary labor. I analyze this contradiction not as a failure of the legislation itself, but as the product of a particular institutional context which provides a way to skirt the law, and thereby diminish its effectiveness. Finally, in a non-democratic state, labor law — which has been instrumentalized and mobilized within a form of state corporatism — reveals that very significant challenges exist for building a truly secure status for employees.     

Pleasure and the Control of Food Intake: An Embodied Cognition Approach to Consumer Self‐Regulation

Consumers try to avoid temptation when exposed to appetizing foods by diverting their attention away from their senses (e.g., sight, smell, mouthfeel) and bodily states (e.g., state of arousal, salivation) in order to focus on their longer term goals (e.g., eating healthily, achieving an ideal body weight). However, when not including sensations in their decision‐making processes, consumers risk depleting their self‐regulatory resources, potentially leading to unhealthy food choices. Conversely, based on the concept of “embodied self‐regulation,” the suggestion is made that considering bodily states may help consumers regulate their food choices more effectively. A new model is proposed that facilitates understanding observed consumer behavior and the success or failure of self‐control in food intake. It is argued that bodily states and sensory information should be considered when modeling consumer behavior and developing health‐related advocacy and communication campaigns. The model proposed here leads to new perspectives on consumer consumption behavior and health policy research and strategies.     

Pricing Dynamic Investment Fund Protection

Abstract

We consider an investment fund whose unit value is modeled by a geometric Brownian motion. Different forms of dynamic investment fund protection are examined. The basic form is a guarantee that instantaneously provides the necessary payments so that the upgraded fund unit value does not fall below a protected level. A closed form expression for the price of such a guarantee is derived. This result can also be applied to price a guarantee where the protected level is an exponential function of time. Moreover, it is explicitly shown how the protection can be generated by construction of the replicating portfolio. The dynamic investment fund protection is compared with the corresponding put option, and it is shown that for short time intervals the ratio of the prices approaches 2. Finally, a more exotic guarantee is considered, where the protected level is a given percentage of the maximal observed fund unit value. Assuming that the protected level remains constant once the payments have started, we obtain a surprisingly simple formula for the price of a perpetual guarantee. Several numerical and graphical illustrations show how the theoretical results can be implemented in practice.