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.     

Fixed-Term Contracts and Labor Market Duality in France

The French labor market is segmented between permanent and temporary workers. The second category has difficulty in getting an open-ended contract. This paper aims at depicting workers on short-term contracts and shows the consequences on their professional career are negative and significant. A large part of the wage gap between permanent and temporary workers remains unexplained by observable characteristics. They receive less on-the-job training and their likelihood of obtaining a stable job is lower than 30% after 1 year and a half. They have also a higher probability of being the adjustment variable in case of an economic negative shock. These different findings show the importance of using public policies to encourage transitions from fixed-term to permanent employment and reducing labor-market duality.     

Information and Knowledge as Antecedents of Consumer Attitudes and Intentions to Buy and Recommend Fair-Trade Products

The authors propose and empirically test a causal model to understand how the availability of fair-trade information and consumer knowledge about this issue affect consumers’ attitudes and intentions toward fair-trade products. The model is built upon the attitude-behavior paradigm and the premises of agency theory. It is tested through structural equation modeling with a sample of 292 Spanish consumers. The findings are that consumers do not have good knowledge about fair trade and that this is significantly determined by the lack of information about this in the market. It is also observed that consumers’ perceptions about the availability of fair-trade information have negative effects on their concern about this issue and that such information as is available is not effective in reducing consumer skepticism. The research represents an extension of previous fair-trade literature because the role of information and communication in improving consumer attitudes and buying intentions has rarely been explored in the case of ethical products.     

Do pensions foster education? An empirical perspective

The paper examines the effect of population ageing on public education spending. On the one hand, ageing is expected to have a negative effect on education, as an increasing number of retirees results in ‘intergenerational conflict’ and, hence, the condemnation of education expenditure. On the other hand, ageing, in combination with pay-as-you-go pension systems, offers incentives for the working-age generation to invest in the public education of the young in order to ‘reap’ the benefits (that is, higher income tax/contributions) of their greater future productivity. Empirical evidence derived from the application of a fixed effects approach to panel data for OECD countries shows that the increasing share of elderly people has a non-linear effect on education spending. This indicates a certain degree of intergenerational conflict. Nevertheless, we find that future population ageing, which reinforces the mechanism linking public education and pensions, reflects positively on education expenditure. Furthermore, by disaggregating total education expenditure by educational levels, we observe that this effect is led by levels of non-compulsory education, probably as a reflection of the direct connection to labor productivity.     

Determinants of Fair Trade Product Purchase Intention of Dutch Consumers According to the Extended Theory of Planned Behaviour

The study reported in this paper investigated the determinants of fair trade (FT) product purchase intention among Dutch consumers according to the extended Theory of Planned Behaviour and determined whether the effects of those determinants differ between male and female consumers. To test the various research hypotheses, an online survey with 499 respondents from a Dutch research panel was employed. Results of the multi-group analysis using a structural equation modelling approach reveal that FT product purchase intention of both male and female consumers are predicated on moral obligation and self-identity. The impact of subjective norm on purchase intention is statistically significant for male consumers only. Analyses reveal that, indeed, the impact of subjective norm on FT product purchase intention is moderated by consumers’ gender.     

Revisiting the expatriate failure concept: A qualitative study of Scandinavian expatriates in Hong Kong

This article advances the understanding of expatriate failure, which remains a contested social phenomenon in international work life as well as scholarly research. The study challenges the definition of expatriate failure and its inherent biases, i.e., the epistemological primacy of the firm level and the failure/success binary. We argue that this qualitative study of 51 Scandinavian expatriates in Hong Kong can contribute to advancing theory on the expatriate failure concept by asking individual expatriates what constitutes failure to them. By applying social constructionist and social anthropological ideas to the expatriate failure concept debate, we develop the internationality thesis which demonstrates a discrepancy between the expatriates’ perceptions of successful international assignments and the actual nature of their lived lives; many expatriates desire to enrich their lives through experiencing an international/intercultural and adventurous lifestyle, but, in fact, living lives with limited intercultural exposure and interaction. We conclude by proposing a reconceptualisation of expatriate failure in terms of offering both a new definition and approach to researching expatriate failure in which time/duration, context, and geographical location need to be taken into account. We believe the new approach can overcome some of the empirical unsoundness of mainstream definitions.     

Reconciling Alternative Theories for the Safety of Owner–Operators

Motor carrier safety is an important concern of shippers, carriers, policy makers, consignees, insurance providers, and the motoring public. One aspect of carrier safety that has garnered substantial attention is whether carriers making greater use of owner–operators are more or less safe vis‐à‐vis carriers making greater use of employee drivers. Currently, conflicting theoretical predictions exist regarding the direction of this relationship. In this article, we offer a reconciliation of the alternative theoretical predictions by developing a coherent theory that merges sociological rational choice theory and theory regarding motor carrier safety. We subject our theory to empirical testing by fitting a series of seemingly unrelated regression models to a vector of safety measures tracked as part of the Federal Motor Carrier Safety Administration's Compliance, Safety, and Accountability program. Our results are consistent with our proposed theory of owner—operator safety and provide meaningful theoretical and managerial implications and directions for future research.