Number needed to treat based on real-world evidence for non-vitamin K antagonist oral anticoagulants versus vitamin K antagonist oral anticoagulants in stroke prevention in patients with non-valvular atrial fibrillation

Aims: Non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) are used to prevent stroke in patients with atrial fibrillation (AF). This paper aimed to evaluate the clinical efficacy and safety of NOACs when compared to VKAs by calculating the number needed to treat (NNT) at 2 years using incidence rates and hazard ratios (HRs) derived from a meta-analysis of studies conducted in real-world settings.

Materials and methods: HRs were sourced from a published systematic literature review and a meta-analysis of real-world evidence on the use of NOACs vs VKAs. Rivaroxaban, dabigatran, and apixaban vs VKAs were investigated. The efficacy outcomes included: a composite of ischaemic stroke and systemic embolism (IS/SE), ischaemic stroke (IS), and all-cause mortality. The safety analysis assessed major bleeding and intracranial haemorrhage (ICH).

Results: Superiority of NOACs vs VKAs was observed in 10/15 comparisons. Treating patients with rivaroxaban and dabigatran was associated with a reduced risk of IS and all-cause mortality compared to VKAs, with one death prevented every 22 and 32 patients, respectively, and one IS prevented every 206 and 166 patients, respectively. Rivaroxaban was significantly associated with a reduced risk of IS/SE compared to VKA (NNT: 107). No significant differences were observed between apixaban and VKAs. Dabigatran and apixaban were associated with a reduced risk of major bleeding compared to VKA (NNT: 59 and 38, respectively). No significant difference was observed between rivaroxaban and VKAs regarding major bleeding. Rivaroxaban, dabigatran, and apixaban were significantly associated with a reduced risk of ICH (NNT: 205, 115, and 108, respectively).

Limitations: Heterogeneity in definitions of major bleeding across studies.

Conclusions: The NNT calculation, when approached and interpreted properly, is a practical measure of the effectiveness of a treatment. The calculation based on HRs showed that NOACs are safe and effective alternatives to VKAs in real life.     

REGIONALISM AND FREE-MARKET REFORM: THE CASE OF POLAND

In Poland, there is a widening gap between well-developed core regions and depressed peripheral ones. This article argues, on the one hand, that any EU- or government-funded assistance to less developed areas should be accompanied by nationwide liberalisation and, on the other, that lack of reform and increasing regional disparities might fuel discontent in the worst-off regions, which, in turn, might make politicians adopt a fully-blown interventionist policy.     

Motivations for enterprise system adoption in transition economies: insights from Poland

Enterprise system (ES) adoption can bring many benefits, but may also put tremendous strain on an organisation or business, sometimes with disastrous outcomes. The specific motivations and expectations that lead to ES adoption may impact the success or failure of these endeavours, and understanding these motivations may be useful in predicting the success of ES projects. Most of the published research on ES adoption motivation has been in the context of highly developed countries. The social, cultural, economic and political conditions in developing, emerging and transition economies make for a different business environment, and insights obtained from developed countries may not always transfer to these settings. This study seeks to identify and help understand the motivations for ES adoption specifically in transition economies, as these economies play a significant role in the global market, but have not been receiving adequate research attention. Drawing on the experience of 129 ES adopters in Poland, a transition economy, this study categorises motivations into coherent groups of issues and evaluates the influence of discovered motivations on ES adoption success. Further, motivations revealed by this study are compared with motivations reported by prior research conducted in developed countries.     

Selecting Your Inflation Targeters: Background and Performance of Monetary Policy Committee Members

Abstract. This paper starts by describing the composition of monetary policy committees (MPCs) in inflation‐targeting and non‐targeting countries. The experience of MPC members on their inflation performance is then compared, opposing inflation targeters with non‐targeters. Our sample covers the major Organization for Economic Cooperation and Development countries, in the period 1999–2008. Our results first show that MPCs are different in inflation‐targeting (versus non‐targeting) countries. They also reveal that policy‐makers' backgrounds influence inflation, and that the influence of MPCs' experience is much greater in inflation‐targeting countries, while size effects are more important for committees that do not target inflation.     

Economic impact of contrast-induced acute kidney injury associated with invasive cardiology: role of iso-osmolar contrast media in Germany,Italy, Poland,and Spain

Objective:

Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiography (CA) with or without percutaneous coronary intervention (PCI) in German, Italian, Polish and Spanish hospitals.

Methods:

This budget impact analysis (BIA) compared a scenario with iodixanol to a scenario without, where only LOCM were used, in patients at increased risk of CI-AKI over a 3-year horizon. A meta-analysis based on a systematic review observed a lower rate of CI-AKI with iodixanol compared to LOCM (Risk Reduction?=?0.46) in patients with underlying impaired renal function (serum creatinine ≥1.6?mg/dl and estimated glomerular filtration rate ≤50?ml/min/1.73 m²). Contrast media and CI-AKI hospitalization costs were included in the analysis and unit costs were obtained from published literature, official sources or, when available, from hospital data. In the absence of country-specific data, resource utilization for a CI-AKI hospitalization was obtained by interviews with local clinicians in each country. The percentage of patients who received iodixanol was assumed to increase over time.

Results:

Based on a percentage of patients at increased risk of CI-AKI equal to 20% in Germany, 24% in Italy, 23% in Poland and 10% in Spain, results showed that the introduction of iodixanol would bring a 3-years cumulative net percentage saving on the total hospital budget of 29%, 34%, 25%, and 33% in the four countries respectively.

Conclusion:

The results of the analysis for the four countries showed that iodixanol use in patients at increased risk of CI-AKI undergoing CA with or without PCI may bring considerable savings on the hospital’s budget, due to the associated reduction in CI-AKI incidence.     

Public managers’ perception of performance information: the evidence from Polish local governments

ABSTRACT

Performance management requires wise utilization of performance information to generate expected results. The framework of Performance Information Utilization (PIU) explains why and how performance information is used in the public sector, although it does so without recognizing the role of the information user’s perception. This article adapts the information system theories to conceptualize perception of performance information (PPI). Statistical analysis confirmed the validity of the construct and showed a significant relationship between quality and usefulness of performance information, and usefulness of multiple performance information systems. Tested model offers new insights in explaining the use of performance information in local governments.     

Employability and the psychological contract in European ICT sector SMEs

This article explores the employability of information and communication technology (ICT) professionals from the perspective of small- and medium-sized enterprises (SMEs). The first stage of analysis, based on over 100 interviews with managers of ICT supplier companies in seven European countries (Germany, Greece, Italy, the Netherlands, Norway, Poland and the UK), showed most SMEs to have a generally ad hoc approach to managing the employability of their ICT professionals. Assessment and development plans were used primarily to keep skills current to business needs; however, the more developed northern European markets showed greater awareness of the ‘high commitment’ benefits of a more sophisticated approach towards career management (e.g. through mentoring or career planning). A second stage of analysis based only on UK interviews builds on this to propose a model of positive employer influence on psychological contracts through career and employability management practices.     

The Satellite Insurance Market and Underwriting Cycles

This research analyses whether underwriting cycles are present in an important but often overlooked line of insurance, satellite insurance. Unlike previous underwriting cycle studies, this study uses rates-on-line and capacity devoted to satellite insurance as well as loss ratios to determine the applicability of cycles. The sample period encompasses virtually the entire history of the satellite insurance industry, 1968–2010. The results indicate that cycles are present in the minimum and average rates-on-line and in capacity, but not the loss ratio. Regression analysis is carried out on the rate-on-line and capacity variables, and the regression results support the rational expectations/institutional intervention hypothesis and the capacity constraint (capital shock) hypothesis.     

Panel Data Evidence on the Effects of Fiscal Policy Shocks in the EU New Member States

We identify fiscal policy shocks in the EU new member states using four different methods. We use panel data techniques to estimate the output response to these shocks. We find that investment and export growth increase after fiscal consolidation and decelerate after fiscal stimulus when the shocks are expenditure‐based. In contrast, private consumption does not respond to fiscal policy shocks. Expenditure‐based fiscal consolidations reduce wages, supporting the view that fiscal consolidation of such composition enhances the competitiveness and profitability of domestic enterprises. In contrast, we do not find evidence of fiscal shocks affecting households' confidence.