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.     

Non-rating revenue and conflicts of interest

Rating agencies produce ratings used by investors, but obtain most of their revenue from issuers, leading to a conflict of interest. We employ a unique data set on the use of non-rating services, and the associated payments, in India, to test if this conflict affects ratings quality. Agencies rate issuers that pay them for non-rating services higher (than agencies not hired for such services). Such issuers also have higher default rates. Both effects are increasing in the amount paid. These results suggest that issuers which hire agencies for non-rating services receive higher ratings despite having higher default risk.     

New development: China renews reform of central–local fiscal relations and provides for basic national public services

China’s reform on central–local fiscal reform has slowed down in recent years. The appointment of a new finance minister experienced in local government affairs is expected to renew the reform affirmed by the Chinese Communist Party (CCP) congress in late 2017. China has unprecedentedly identified a comprehensive list of 81 national basic public services as entitlements. Eighteen of them are subject to national and local standards, and co-financed by central and local governments. A new cost-sharing method for 10 of these services classifies sub-national jurisdictions into five tiers, in which the central government’s share declines from 80% to 10%. These measures, effective in 2019, aim at creating a ‘harmonious and moderately prosperous society’.     

Re‐Examining Advances in Occupational Licensing Research: Issues and Policy Implications

Much has changed in the realms of occupational licensing since BJIR last ran a special issue on the subject in 2010. The number of occupations subject to licensing has been growing, the data available to investigate the incidence and effects of licensing have improved immeasurably, and the policy environment surrounding licensing has changed. This issue reflects these changes with eight papers from North America and Europe covering the incidence of licensing, and its effects on wages, inequality, employment, quality of service provision and rent extraction by the organizations who undertake licensing.     

Learning patterns in early stage R&D projects: empirical evidence from the fibre raw material technology project in the Netherlands

Past research has reported that learning processes in early stage R&D are either chaotic, or absent. We challenge this finding by elaborating Van de Ven et al.’s trial‐and‐error learning model and explore an alternative conceptualization. We explored the combinations of positive and negative outcomes and action course continuation and modification. We use data gathered in an R&D setting of a 4‐years pre‐competitive knowledge generation project in the Dutch paper and board industry. Whereas the Van de Ven and Polley (1992) approach applied on our data also would lead us to conclude that ‘no learning’ would happen, our decomposed model identified three distinct learning patterns: (1) a virtuous pattern of positive outcomes resulting in continuations of action courses; (2) a vacuous pattern of negative outcomes resulting in modifications of action courses; and (3) a verification pattern of positive outcomes resulting in modifications of action courses. We observed the virtuous and verification patterns during the first 2 years and virtuous and vacuous learning in the second 2 years. These results might be useful for R&D managers since they provide insight into how an early stage R&D project can develop and where managers might intervene and adjust action courses.     

Entrepreneurship and knowledge spillovers from the public sector

A compelling body of research has found that investments in knowledge from other firms and universities spill over to enhance the performance of entrepreneurial firms. This literature has shown that firm performance is positively related to investments in new knowledge by other firms and research universities. This paper addresses a gap in the literature by positing that public sector knowledge is also conducive to enhancing performance by knowledge intensive entrepreneurial (KIE) firms. Our findings suggest that the public sector provides a fertile source of knowledge for enhancing KIE firm performance.

     

In the city: The John Lewis partnership and planned shopping centres

A defining feature of large-scale retailing during the period 1950–1980 was the emergence and evolution of planned shopping centres. During the 1950s, department stores in the United States were in the vanguard of this phenomenon. In contrast, British department stores continued operating from traditional high street sites, and had limited opportunities for expansion within planned shopping centres until the 1970s. This paper addresses the connection between department store retailing and the development of the planned shopping centre in Britain from the perspective of one enterprise: the John Lewis Partnership. The article demonstrates that the Partnership was willing to operate department stores within centrally located shopping centres, but was circumspect about operating stores in non-centrally located shopping centres.     

The Effect of Fuel Price Changes on Fleet Demand for New Vehicle Fuel Economy

New vehicle purchases by private companies and government agencies, or ‘fleet’ buyers, represent a significant percentage of overall new vehicle sales in the United States. Yet little is known about fleet demand for new vehicle fuel economy including how it responds to fuel price changes. Using unique disaggregated data on fleet and household registrations of new vehicles from 2009 to 2016, we estimate how fleet demand for new vehicle fuel economy responds to fuel price changes. We find that fleet purchases of low fuel economy vehicles fall relative to high fuel economy vehicles when gasoline prices increase, a finding that is consistent with fleet buyers’ taking into account capitalization of fuel costs in the second‐hand market. Our estimates imply that raising gasoline prices by one dollar would increase fuel economy of new vehicles acquired by fleet buyers by 0.33 miles per gallon. We estimate a similar response for household buyers during the same period. This result justifies basing fuel economy responses to fuel cost changes on household data alone, an assumption widely used in the vehicle demand literature and the fuel economy valuation literature. We also find, however, that the response to fuel price changes varies across the types of fleet buyers: rental companies respond strongly to fuel price changes, whereas commercial and government buyers are insensitive. Our estimates imply that an increase in the federal gasoline tax would modestly increase fuel economy of vehicles bought by households and rental companies but would have little to no impact on fuel economy of vehicles bought by non‐rental companies and governments.