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.     

Easing the assessment of emerging technologies in technology observatories. Findings about patterns of dissemination of emerging technologies on the internet

This paper considers the Web as a big data container that can be used by Technology Observatories and administrations to track emerging issues and more specifically emerging technologies. It considers information that is available on the Internet for free from different sources, and proposes a framework that can be useful to characterise them and to detect patterns of dissemination. This framework is made up of 30 metrics obtained from different kinds of sources (general web, patents, scholars?…). Some of them are obtained directly as the number of hits retrieved by queries on a search engine, and other ones calculated by means of ratios. This paper contains the development of a complete case that utilises this framework to characterise emerging technologies included in the well-known Hype Cycle for Emerging Technologies, in this case the 2015 release¹ and to analyze patterns of dissemination of these technologies on the Internet.     

The equity impacts of bus rapid transit: A review of the evidence and implications for sustainable transport

The paper offers an analysis of empirical evidence on the equity impacts of operational Bus Rapid Transit (BRT) systems in the Global South. The focus is on vertical equity, i.e. whether BRT systems achieve progressive benefits for poorer segments of the population. Findings from Africa, Asia, and Latin America all suggest that BRT does offer significant benefits to low-income groups, in terms of travel time and cost savings, access enhancement, and safety and health benefits. However benefits are often skewed toward medium-income users and thus less progressive than they might be. Two primary reasons for this are insufficient spatial coverage and inappropriate fare policies. While many features of BRT potentially allow it to deliver pro-poor outcomes, such outcomes only materialize if BRT implementers pay specific and sustained attention to equity. The paper identifies key issues that need to be addressed to steer BRT implementation toward more socially sustainable outcomes—including better integration with other transit, paratransit, and nonmotorized transport services, and with the housing sector.     

The Effect of Endogenous Regulation on Telecommunications Expansion and Efficiency in Latin America

I examine the effect of reform on telecom performance using a second-generation regulatory framework index and panel data techniques to test how regulatory governance affected sector performance in 22 Latin American countries during the period 1980–1997. Sound regulatory governance in telecommunications has a positive impact on network expansion and efficiency, in both the static and dynamic specifications. Openness of markets to competition and divestment of former state-owned telco operators also contributed positively to better sector performance. The dynamic specification shows that past performance has its own strong effect on present (and perhaps future) performance.     

The Performance of Service Industries in Canada: A Real Value Analysis

The performance of service industries in Canada has been lower than that of good industries over the last four decades, with noticeable exceptions such as for railways and telecommunication carriers. Service industries were less economically (and technically) efficient in that they generated less output value (quantity) per hour worked (level and growth) or per combined unit of labour and capital (multifactor productivity growth) than good industries. The relative output price of services declined slightly over time compared with goods. At the disaggregated level, changing relative output prices were substantial and proved to be an important factor explaining the relative satisfactory economic performance of many service industries despite their low technical performance. Nevertheless, the output share of service industries increased over that period, sustained, mainly, by the growing recourse of all firms to outsourcing of services.