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.     

Restricted electricity use among poor urban households

For a variety of reasons, this article argues, electricity must be seen by policy‐makers in South Africa not as the sole provider of all future household energy needs, but rather as one component of an energy mix which includes such ‘transitional’ fuels as coal, gas and paraffin. The reasons for this are that electricity is expensive for poor households; it is subject to power failures and disconnections for non‐payment; the poor find it difficult to monitor and to control their consumption; appliances are expensive and several are required to make best use of electricity; people prefer other fuels because they are familiar and have strong personal and cultural associations, and because Eskom is not trusted owing to its past ties to illegitimate local authorities and misunderstanding of electricity and how its use is monitored and charged for. Further, it is mistaken to equate ‘development’ with total electrification: most developed countries have fuel mixes which include gas and coal, particularly for cooking and heating. Accepting an affordable fuel mix for the poor in particular would focus attention on the problems currently associated with paraffin, gas and coal, namely fires, poisoning and air pollution.     

Measuring Employment Security in Europe Using Surveys of Employers

Using results from surveys in which employers were questioned about their freedom to shed staff, we develop a measure of employment security in Europe. We seek to identify which institutional factors are correlated with the responses of employers and find that they appear to reflect the strength of legal restrictions and trade unions and the prevalence of atypical employment. Our results are used to compile an index of employment security that has both a temporal and a cross‐country dimension.     

Measuring Market Orientation: Exploring a Market Oriented Approach

This paper demonstrates that applications of existing approaches to measuring market orientation are myopic, non-comparative and over-reliant on the views of single respondents. Consequently, a multi-perspective, multi-informant approach for measuring market orientation is generated which focuses on gauging customers', competitors' and intra-organizational members' perceptions of the market orientation of an organization. To evaluate the psychometric properties of this approach an application of this design in a survey of manufacturing industry is subjected to tests for inter-rater reliability, scale reliability, content validity, criterion-related validity and construct validity. The conclusion of this evaluation is that the developed measure is both a reliable and valid means of gauging market orientation. The paper concludes with a series of implications for both theorists and practitioners.     

Myopic loss aversion and the equity premium puzzle reconsidered

Benartzi and Thaler [The Quarterly Journal of Economics 110 (1995) 73–92] offer a quasi-rational explanation for the equity premium puzzle. We reconsider their methodology and, making a simple modification to it, find that their analysis is not robust.     

Furthering the integration of marketing and logistics through customer service in the channel

Recent emphasis on customer service in both the academic and trade literature reveals a growing but confusing body of knowledge. Both the marketing and logistics disciplines have offered varying definitions of customer service, but have failed to offer a comprehensive framework which represents customer service and its related marketing and logistics issues. This article offers the viewpoint that customer service is a conceptual unifying factor for integrating marketing and logistics. The channel system is introduced as the vehicle by which buyer/seller relationships must be analyzed to understand formation of buyer expectations, interaction of marketing and logistics activities, and subsequent customer service performance. The institutional, behavioral, and physical dimensions of channel activity influence many of the marketing and logistics decisions made by management. The framework offered in this article differs from previous efforts in that customer service is the output of the unified activities of marketing and logistics. It considers marketing and logistics decisions jointly, re-evaluates and expands the production function in logistics, and ties customer service to customer satisfaction or dissatisfaction.     

企业家不是天生的(2)——从梦想开始

200位老板的成功秘密除非先拥有一个梦想,否则将一事无成。——卡尔·桑德伯格翻开世界历史,最引人注目的事件都是由梦想引发的。希伯来的奴隶们之所以能够从埃及大批成功逃离是因为摩西《(圣经》故事中古犹太人的领袖)受到神灵的感召,梦想他的人民会获得自由。美国革命的发生,也正是由于人们梦想着自由、民主和正义。马丁·路德·金曾用他的演讲“我有一个梦想”来激励他的人民。     

Book Reviews

Andrew MacIntyre (ed.), Business and Government in Industrialising Asia, Allen & Unwin, Sydney, 1994, pp. xii + 312. Paper: A$29.95.

John Bresnan, From Dominoes to Dynamos: The Transformation of Southeast Asia, Council on Foreign Relations, New York, 1994, pp. x + 115. $17.95.

Anthony Reid, Southeast Asia in the Age of Commerce 1450–1680: Volume Two, Expansion and Crisis, Yale University Press, New Haven and London, 1993, pp. xv + 390.

Binhadi, Financial Sector Deregulation, Banking Development and Monetary Policy: The Indonesian Experience (1983–1993), Indonesian Bankers' Institute, Jakarta, 1995.

Anwar Shah and Zia Qureshi, with Amaresh Bagchi, Brian Binder, and Heng-fu Zou, Intergovernmental Fiscal Relations in Indonesia: Issues and Reform Options, World Bank Discussion Papers 239, Washington DC, pp. xxxii + 279. $17.95; A$425.00; NZ$30.25.

Jacqueline Vel, The Uma-economy: Indigenous Economics and Development Work in Lawonda, Sumba (Eastern-Indonesia), Wageningen, pp. xiv + 283. $20.00 + $8 postage & handling.

Joao Mariano de Sousa Saldanha, The Political Economy of East Timor Development, translated by Theresia Slamet and P.G. Kattopo, Pustaka Sinar Harapan, Jakarta, 1994, pp. 414.

Jan-Paul Dirkse, Frans H$uUsken and Mario Rutten (eds), Development and Social Welfare: Indonesia's Experiences under the New Order, KITLV Press, Leiden, 1993, pp. 267.

W.G. Huff, The Economic Growth of Singapore: Trade and Development in the Twentieth Century, Cambridge University Press, Cambridge, 1994, pp. xxi + 472. A$60.

Saha Dhevan Meyanathan (ed.), Industrial Structures and the Development of Small and Medium Enterprise Linkages: Examples from East Asia, The World Bank (Economic Development Institute of the World Bank Seminar Series), Washington DC, 1994, pp. v + 158. Paper: $9.95.

Thee Kian Wie, Industrialisasi di Indonesia: Beberapa Kajian, LP3ES, Jakarta, pp. xxvi + 278 (including Introduction by Mari Pangestu).     

An Application of Keaveney's Model of Service Switching Behaviour to GP Fundholders

The introduction of competition within the National Health Service (NHS), with the purchasers having a degree of choice among providers, has raised a variety of issues for buyer-supplier relationships. Purchasers, especially GP fundholders, have power in relation to their provider in the sense that they may ultimately take their custom elsewhere and by transferring their business, or part of their business, from one trust provider to another. As GP fundholders increase in number, and in confidence, this practice seems likely to grow. Using evidence from commercial markets, this article explains why fundholders might switch provider and the implications this has for hospital trusts.