Rivaroxaban for non-valvular atrial fibrillation and venous thromboembolism in the Netherlands: a real-world data based cost-effectiveness analysis

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) have been included in international guidelines as important alternatives to vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE) and stroke prevention in non-valvular atrial fibrillation (NVAF). Meanwhile, in the Netherlands, NOACs are widely used next to VKAs. The objective of this study is to estimate the cost-effectiveness of treatment with rivaroxaban compared to VKAs in NVAF and VTE patients in the Netherlands, using data from international prospective observational phase IV studies.

Methods: Two models were developed to represent NVAF and VTE patients, populated with patients from the XANTUS (NCT01606995) and XALIA (NCT01619007) international prospective observational studies. The 1-year cost-effectiveness of rivaroxaban use, compared to VKAs, was explored in a population consisting of NVAF and VTE patients (base case) as well as for four scenarios with sub-populations: NVAF patients only, VTE patients only, NVAF patients with unstable international normalized ratio (INR), and NVAF patients using an INR self-measuring device.

Results: In the base case, rivaroxaban saved €72,350 and gained 21 quality-adjusted life-years (QALYs) in a simulation of 2,000 patients over the use of VKAs. Ergo, rivaroxaban was dominant over VKAs. The probabilistic sensitivity analysis showed a probability of 85% for rivaroxaban being dominant and 100% at a willingness-to-pay threshold of €20,000/QALY. Rivaroxaban appeared to be dominant in all scenarios as well, except for the NVAF-patients-only scenario where the incremental cost-effectiveness ratio (ICER) was €157/QALY.

Conclusions: In patients with NVAF or VTE, rivaroxaban treatment is likely to be cost-effective and a potentially cost-saving alternative to VKA in the Netherlands.     

The relevance of commuting zones for regional spending efficiency

We use data envelopment analysis (DEA) efficiency scores to show that clustering municipalities into encompassing regional clusters improves spending efficiency of single stand-alone municipalities. We propose a new geographic aggregation based on municipalities-to-municipalities commuting flows, defined using hierarchical cluster analysis. Our example for Portugal shows that from an output-oriented perspective between 83% and 98% of municipalities would increase their efficiency scores, while from an input-oriented perspective between 86% and 98% of municipalities would also be better off in terms of efficiency. Then using a linear regression model, we find that population increases positively affects the efficient scores (via scale economies). Also, increases in the share of high-educated and poorer residents leads to higher efficiency scores.     

Loss and damage: a critical discourse analysis of Parties’ positions in climate change negotiations

The years-long negotiations on loss and damage (L&D) associated with climate change impacts reached a milestone with the adoption of the Paris Agreement, sanctioning the permanence of the Warsaw International Mechanism (WIM) created in 2013. The WIM aims at advancing knowledge gathering, coordination and support to address L&D associated with extreme and slow onset events in vulnerable developing countries (Decision 2/CP.19). Despite being among the most controversial issues to be recently treated in climate change negotiation, L&D has attracted little attention in the field of international relations. This paper aims at addressing this gap by reconstructing the emergence and evolution of the negotiating positions on L&D of developing and developed countries. It employs a critical discourse analytical approach and builds on Fairclough’s three-dimensional framework for critical discourse analysis, taking decision 2/CP.19 as the core communicative event. Consistently, the decision is analysed at three different levels: as a text (micro-scale); as a discursive practice (meso-scale); and as a social practice (macro-scale). The analysis makes use of a wide range of materials including previous decisions, High Level Segment statements and Parties submissions. It reconstructs Parties’ conflicting views on the positioning of L&D vis-à-vis the adaptation space (L&D as a part of, or as beyond adaptation) and the scientific, ethical and legal arguments employed to support these standpoints. It highlights, in particular, the strategic importance which the ‘compensation argument’ had in determining developing countries’ capacity to influence the UNFCCC process up to the inclusion of a specific article on L&D in the Paris Agreement. While calls for compensation might have lost momentum as a result of the Warsaw and Paris talks, the paper argues that their potential is far from exhausted. They in fact imply a more general request for climate justice which the UNFCCC has not yet addressed.     

Persistence,mean reversion and non-linearities in the US housing prices over 1830–2013

The objective of this study is to provide a direct estimate of the degree of persistence of measures of nominal and real house prices for the US economy, covering the longest possible annual sample of data, namely 1830–2013. The estimation of the degree of persistence accommodates for non-linear (deterministic) trends using Chebyshev polynomials in time. In general, the results show a high degree of persistence in the series along with a component of non-linear behaviour. In general, if we assume uncorrelated errors, non-linearities are observed in both nominal and real prices, but this hypothesis is rejected in favour of linear models for the log-transformation of the data. However, if autocorrelated errors are permitted, non-linearities are observed in all cases, and mean reversion is found in the case of logged prices, though given the wide confidence intervals, the unit root null hypothesis cannot be rejected in these cases.     

Organising migrant workers: the living wage campaign at the University of East London

This critical case study looks at the campaign led by Citizens UK and Unison to get the University of East London (UEL) to sign up to the London living wage (LLW). UEL agreed to pay the LLW after a brief campaign in November 2010 and it was subsequently implemented in August 2011. The study charts the course of the campaign and draws on mobilisation theory and new primary research to account for its success. What our findings suggest is that community organisers and union activists were able to organise and mobilise a largely apolitical group of migrant workers. This, we suggest, can be explained by the successful mobilisation of the community and augurs well for future broad‐based campaigns.     

World Human Development: 1870–2007

How has wellbeing evolved over time and across regions? How does the West compare to the Rest? What explains their differences? These questions are addressed using a historical index of human development. A sustained improvement in world wellbeing has taken place since 1870. The absolute gap between OECD and the Rest widened over time, but an incomplete catching up—largely explained by education—occurred between 1913 and 1970. As the health transition was achieved in the Rest, the contribution of life expectancy to human development improvement declined and the Rest fell behind in terms of longevity. Meanwhile, in the OECD, as longevity increased, healthy years expanded. A large variance in human development is noticeable in the Rest since 1970, with East Asia, Latin America, and North Africa catching up to the OECD, and Central and Eastern Europe and Sub‐Saharan Africa falling behind.     

Crowdsourcing and work: individual factors and circumstances influencing employability

The development of a fast and reliable Internet, new technologies online payment systems, and changes in work structure that enable and demand flexible working patterns have driven a move to a new form of Internet‐enabled labour exchange called crowdsourcing. Evidence from an in‐depth qualitative study is presented, focusing on selected users' interactions and experiences of working on two UK‐based crowdsourcing platforms. The paper shows that workers engaged in this form of labour exchange need to deploy existing employability skills and networks to effectively meet the challenges, and take advantage of the opportunities, that crowdsourcing presents. Individual factors and circumstances emerge as paramount for workers' continued engagement in this form of employment. Using selected components from an employability framework, the findings suggest that crowdsourcing can offer new pathways to practising skills and enhancing employability for some workers.     

Surplus distribution and characteristics of social enterprises: Evidence from microfinance

The issue of surplus distribution has hardly been analyzed in the context of the social economy. This paper highlights the main drivers of distribution between various stakeholders of microfinance institutions (MFIs), which are an example of social enterprises. We focus on three major variables: size, governance structure and subsidies. Our results show that the size of the institution is the main indicator of the surplus that the organization keeps as a self-financial margin. Moreover, MFIs with a cooperative ownership structure allocate a larger part of their surplus to their employees, whereas non-profit organizations and shareholder-firm MFIs do not allocate their surplus in a significantly different way among their main stakeholders. Finally, we do not find any clear-cut effect of subsidies on the surplus allocation process.     

Modelling innovation support systems for regional development – analysis of cluster structures in innovation in Portugal

The present article offers a concise theoretical conceptualization and operational analysis of the contribution of innovation to regional development. The latter concepts are closely related to geographical proximity, knowledge diffusion and filters and clustering. Institutional innovation profiles and regional patterns of innovation are two mutually linked, novel conceptual elements in this article. Next to a theoretical framing, the article employs the regional innovation systems concept as a vehicle to analyse institutional innovation profiles. Our case study addresses three Portuguese regions and their institutions, included in a web-based inventory of innovation agencies which offered the foundation for an extensive database. This data-set was analysed by means of a recently developed principal coordinates analysis followed by a Logistic Biplot approach (leading to a Voronoi mapping) to design a systemic typology of innovation structures where each institution is individually represented. There appears to be a significant difference in the regional innovation patterns resulting from the diverse institutional innovation profiles concerned. These profiles appear to be region specific. Our conclusion highlights the main advantages in the use of the method used for policy-makers and business companies.     

Behaviour‐Based and Outcome‐Based Control Systems: A Meta‐Analytic Study

Sales control systems are instruments used by firms to improve performance and other organizational outcomes. To understand their antecedents and consequences, this paper conducts a meta‐analysis based on 104 studies. The results showed significant relationships between behaviour‐ and outcome‐based control systems and the complexity of the products, bonuses, financial performance, sales innovation, organizational support and satisfaction with supervisors. The outcomes revealed that behaviour‐based control systems were the most effective mechanism in turbulent markets and for determining financial performance. However, outcome‐based control systems were the most efficient instrument for complex products.