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.     

Increasing the number of black chartered accountants in South Africa: an empirical review of educational issues

South Africa has a shortage of black chartered accountants. This situation has arisen due to a combination of political, socio-economic and related educational reasons during the four decades of apartheid rule. In recent years, numerous academic ventures have commenced in an attempt to increase the number of black chartered accountants. This paper reviews and identifies, through an empirically-based exploratory study, the educational issues potentially inhibiting the development of black chartered accountants in South Africa, as well as the academic support structures which have arisen in response to these perceived educational barriers. Both academic support organizations and recently qualified black chartered accountants in South Africa were surveyed through in-depth interviews and structured self-administered questionnaires. This study found, inter alia, that role models, as a motivational factor for black accounting students, were extremely important. Cognitive factors, such as writing skills and the interpretation of numerical data, were identified as areas of primary concern, whilst issues with respect to certain study needs, such as assistance with study skills and examination techniques, also warranted attention. This study also found that the overall approach of academic support organizations to programme structure and design appears to be addressing student needs adequately. Certain improvements, however, are recommended. Of particular concern, is the general lack of studies on the effectiveness of academic support programmes.     

Transformative service research and service design: synergistic effects in healthcare

ABSTRACT

This conceptual paper answers the question: How do we design service experiences in whole to increase the well-being of all participants in the healthcare system – patients, families, and caregivers? In order to do so, we position service design as an essential tool and even a mindset needed for transformative service research success. We discuss the transformative role service design plays in improving service and consumer entities’ well-being with a focus on how this approach can lead to improved healthcare service outcomes. We also add to the conversation surrounding service and consumer entities’ well-being by broadening the concept and application of service design to consider social, existential, psychological, and physical well-being. We particularly explore how healthcare services can benefit from further consumer engagement and collaborative patient–provider relationships, two key factors essential for redesigning the industry.     

The fifth credit tranche

This paper asserts that for all practical purposes the Compensatory Financing Facility (CFF) of the IMF has been abolished except in the name by an IMF decision of 14 September 1983. Since CFF was originally intended to finance temporary and reversible deficits resulting from export shortfalls due to factors beyond a country's control, drawings were usually authorized within a month at low conditionality. The 1983 decision does away with this semi-automaticity, thereby accommodating CFF to the high-conditional upper credit tranches. This development is symptomatic of a general tendency to limit the Fund to high-conditional financing regardless of circumstances.     

The regulation of audiovisual content: quotas and conflicting objectives

Governments use a range of instruments to influence television content. The paper finds that under plausible conditions, content measures ostensibly designed to increase the production of certain programs may, paradoxically, reduce the size of the audience watching them. As well, quotas seemingly intended to boost the audience of certain programs, may in fact reduce their production and lower the number of viewers of these programs.      

How many karats is gold: Welfare effects of easing a denomination standard

Most consumers benefit from a lowering of the required amount of aurous metal which jewellers must include in products sold as gold. However, profits of producers of gold-plated adornments fall. The net welfare effect depends on whether the principal difference between consumers is their appreciation of the gold content, or their valuation of designation gold or gold-plate.     

Audit Committee Members: What Goes on Behind Closed Doors?

Using a qualitative research paradigm, this study examines audit committee effectiveness from the perspective of audit committee members of New Zealand listed companies. The findings reveal that audit committee members perform a range of overlapping tasks and justify their existence in their audit committees by fulfilling the ‘expectations’ that are placed on them. Many quantitative research studies have examined the association between different dimensions of audit committee inputs and financial reporting outputs. The empirical evidence, however, is mixed and remains far from conclusive (Bédard and Gendron 2010). One of the primary reasons for the inconsistent findings is the lack of understanding of the actual process by which audit committees perform their responsibilities. Using a qualitative research paradigm, this study examines audit committee activities, processes and effectiveness from the perspective of audit committee members of New Zealand listed companies. The study argues that performing audit committee duties is an intended process, whereby audit committee members justify their actions and the effectiveness of their audit committees. The paper contributes to the limited literature on how audit committees operate and, by doing so, provides possible explanations for the inconsistent findings of the quantitative audit committee research. In particular, the paper invites further discussion on whether audit committee members can be (or should be assumed to be) independent when discharging their role of overseeing auditing and financial reporting‐related matters.