Healthcare costs of stroke and major bleeding in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants

Objective: To assess long-term healthcare costs related to ischemic stroke and systemic embolism (stroke/SE) and major bleeding (MB) events in patients with non-valvular atrial fibrillation (NVAF) treated with non-vitamin K antagonist oral anticoagulants (NOACs).

Materials and methods: Optum’s Clinformatics Data Mart database from 1/2009–12/2016 was analyzed. Adult patients with ≥1 stroke/SE hospitalization (index date) were matched 1:1 to patients without stroke/SE (random index date), based on propensity scores. Patients with an MB event were matched to patients without MB. All patients had an NOAC dispensing overlapping index date, ≥12?months of eligibility pre-index date, and ≥1 NVAF diagnosis. The observation period spanned from the index date until the earliest date of death, switch to warfarin, end of insurance coverage, or end of data availability. Mean costs were evaluated: (1) per-patient-per-year (PPPY) and (2) at 1, 2, 3, and 4?years using Lin's method.

Results: The cost differences were, respectively, $48,807 and $28,298 PPPY for NOAC users with stroke/SE (n?=?1,340) and those with MB (n?=?3,774) events compared to controls. Cost differences of patients with vs without stroke/SE were $49,876, $51,627, $57,822, and $60,691 at 1, 2, 3, and 4?years post-index, respectively (p?p?Limitations: Limitations include unobserved confounders, coding and/or billing inaccuracies, limited sample sizes over longer follow-up, and the under-reporting of mortality for deaths occurring after 2011.

Conclusions: The incremental healthcare costs incurred by patients with vs without stroke/SE was nearly twice as high as those of patients with vs without MB. Moreover, each additional year up to 4?years after the first event was associated with an incremental cost for patients with a stroke/SE or MB event compared to those without an event.     

Masculinity,Testosterone, and Financial Misreporting

We examine the relation between a measure of male CEOs’ facial masculinity and financial misreporting. Facial masculinity is associated with a complex of masculine behaviors (including aggression, egocentrism, riskseeking, and maintenance of social status) in males. One possible mechanism for this relation is that the hormone testosterone influences both behavior and the development of the face shape. We document a positive association between CEO facial masculinity and various misreporting proxies in a broad sample of S&P1500 firms during 1996–2010. We complement this evidence by documenting that a CEO's facial masculinity predicts his firm's likelihood of being subject to an SEC enforcement action. We also show that an executive's facial masculinity is associated with the likelihood of the SEC naming him as a perpetrator. We find that facial masculinity is not a measure of overconfidence. Finally, we demonstrate that facial masculinity also predicts the incidence of insider trading and option backdating.     

Impediments to innovation faced by Canadian manufacturing firms

Using the findings of the 1999 Survey of Innovation in the Canadian manufacturing sector, we analyse the impediments, i.e. the problems and obstacles, that firms in the sector face when they innovate. In particular, we assess the factors which inhibit innovation, especially with regard to by small and medium enterprises (SMEs). First we try to establish the relationship between the impediments to innovation and various firm characteristics. Then we assess whether these impediments actually prevent firms from innovating or whether firms are able to overcome them.

We find that the perception of impediments to innovation vary according to firm characteristics. For example, large firms are more likely to report the high cost of developing innovation and organizational rigidities as impediments than small firms. However, they seem to have less difficulty with regard to financing innovation projects compared to SMEs. Our results also show that firms seem to be able to overcome most of the obstacles to innovation. Therefore, the impediments featured in innovation survey(s) should not be interpreted as impenetrable barriers that prevent innovation. The sole exception is organizational rigidities. Firms facing organizational rigidities are less likely to become innovative, whether they are small, medium, or large. From our results, we conclude that small firms do not face particular impediments which prevent them from becoming innovative.     

A Micro‐Decomposition Analysis of Aggregate Human Development Outcomes*

We show how differences in aggregate human development outcomes over time and space can be additively decomposed into a pure mean income (growth) component, a component attributed to differences in the distribution of income, and components attributed to ‘non‐income’ factors and differences in the model linking outcomes to income and non‐income characteristics. The income effect at the micro level is modelled non‐parametrically, so as to flexibly reflect potentially complex distributional changes. Our proposed method is illustrated using data for Morocco and Vietnam, and the results offer some surprising insights into the observed aggregate gains in schooling attainments.     

Public school availability for two-year olds and mothers' labour supply

French children start public school either the year they turn two or the year they turn three. We evaluate the impact of this unique schooling policy on maternal labour supply. Using a Regression–Discontinuity design, we show that early school availability has a significant employment effect on lone mothers, but no effect on two-parent families. Also we show that the effect grows larger as the child grows older and as the family loses eligibility for child benefits. Finally, we provide some new evidence that school enrolment at the age of two has no adverse effect on children's subsequent educational outcomes.     

The Future European Labor Supply: The Critical Role of the Family

The European employment strategy initiated in 1997 is critically dependent upon the further integration of women into the labor market. The European Union has set a specific target employment rate for women of 60 percent by 2010 and is also committed to providing more and better child care facilities. This gender focus is reinforced by the requirement for gender mainstreaming in all aspects of European employment policy. There is an implied Europe-wide, universal policy of encouraging female labor-market participation and reducing the care work performed by domestic labor. However, the European Commission continues to have limited competence in areas of family, social, and welfare policy. As a result, these common employment objectives for women are thus being pursued against a background of quite different systems of social, family, welfare, and indeed labor-market organization. These systems have different economic and employment implications, such that the outcomes of the common European employment strategy will also be highly variable.