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.     

When does economic model type become a decisive factor in health technology appraisals? Learning from the expanding treatment options for relapsing–remitting multiple sclerosis

Objectives: Specific economic model types often become de facto standard for health technology appraisal over time. Markov and discrete event simulation (DES) models were compared to investigate the impact of innovative modeling on the cost-effectiveness of disease-modifying therapies (DMTs) in relapsing–remitting multiple sclerosis (RRMS). Fingolimod was compared to dimethyl fumarate (DMF; in highly active [HA] RRMS), alemtuzumab (in HA RRMS) and natalizumab (in rapidly evolving severe RRMS). Comparator DMTs were chosen to reflect different dosing regimens.

Materials and methods: Markov and DES models used have been published previously. Inputs were aligned in all relevant respects, with differences in the modeling of event-triggered attributes, such as relapse-related retreatment, which is inherently difficult with a memoryless Markov approach. Outcomes were compared, with and without different attributes.

Results: All results used list prices. For fingolimod and DMF, incremental cost-effectiveness ratios (ICERs) were comparable (Markov: £4206/quality-adjusted life year [QALY] gained versus DES: £3910/QALY gained). Deviations were observed when long-term adverse events (AEs) were incorporated in the DES (Markov: £25,412 saved/QALY lost, versus DES: £34,209 saved/QALY lost, fingolimod versus natalizumab; higher ICERs indicate greater cost-effectiveness). For fingolimod versus alemtuzumab, when relapse-triggered retreatment was included in the DES, large cost differences were observed (difference between incremental cost is £35,410 and QALY is 0.10).

Limitations: UK payer perspective, therefore societal approach was not considered. Resource utilization and utilities for both models were not derived from the subpopulations; as the focus is on model type, input limitations that apply to both models are less relevant.

Conclusions: Whilst no model can fully represent a disease, a DES allows an opportunity to include features excluded in a Markov structure. A DES may be more suitable for modeling in RRMS for health technology assessment purposes given the complexity of some DMTs. This analysis highlights the capabilities of different model structures to model event-triggered attributes.     

The BoP business paradigm: what it promotes and what it conceals

The Bottom of the Pyramid (BoP) is a popular paradigm within management circles concerning those in poverty. In this paper, we develop a critical analysis of BoP discourse and practice, drawing particularly on the works of Laclau and Mouffe, and enriched by post-development thinking as expressed in the works of Esteva and Escobar, among others. We argue that the BoP paradigm functions to reinforce market capitalist hegemony and – vitally – to conceal economic alternatives. Using the concepts of ‘discourse’, ‘hegemony’ and ‘performativity’, we analyse the politics of language and representation in the BoP discourse. Finally, we point to modes of scholarship that contribute to the nurturing and performance of diverse, non-capitalist economic worlds.     

The Effectiveness of Unconventional Monetary Policy in Japan

Since the global financial crisis of 2007–2008, central bankers around the world have been forced to abandon conventional monetary policy tools in favor of unconventional policies such as quantitative easing, forward guidance, and even lowering the interest rate paid on bank reserves into negative territory. Japan, which faced a crisis in its banking sector and came up against the theoretical zero lower bound on interest rates nearly a decade earlier, was a pioneer in the use of many of these unconventional policy tools. This article analyzes the effectiveness of Japan’s bold experiment with unconventional monetary policy. Using a panel of bi-annual bank data covering the full universe of Japanese commercial banks over a fifteen-year period, this study analyzes the effectiveness of quantitative easing policy on the bank lending channel of monetary policy transmission. Our findings suggest that Japan’s unconventional monetary policy worked: there is a bank lending channel of monetary policy transmission in Japan. These results are robust to the inclusion of time fixed effects and generalized method of moments analysis.     

Leisure,international retirement migration,and retirement adjustment: insights from the best exotic marigold hotel movies

ABSTRACT

International retirement migration (IRM) is a growing phenomenon linked to increased longevity, early retirement, and improved financial status. Encompassing both travel and leisure experiences, IRM is a topic relevant to both tourism and leisure studies. By analysing the fictional movie series The Best Exotic Marigold Hotel (2012) and The Second Best Marigold Hotel (2015) from psychological, gerontological, and sociological theoretical perspectives, this paper examines motivation, goal setting, continuity and change, and identity development in IRM experiences within tourism and leisure contexts. This paper (a) identified motivations for IRM as finance, romantic relationships, social relations, self-esteem, self-fulfilment, and social norms; (b) in turn, time perception and attitude influence IRM emigrants’ priority and emotional fulfilment; (c) innovation extricates IRM emigrants from role loss and facilitates role change; and (d) IRM emigrants experience various identity development processes. A conceptual framework for IRM is proposed that purports to explain the IRM experience process and indicates that such an understanding of IRM should incorporate psychological, gerontological, and sociological perspectives.     

Urban Warfare Ecology: A Study of Water Supply in Basrah

This article assesses the impact of armed conflict on the drinking water service of Basrah from 1978 to 2013 through an ‘urban warfare ecology’ lens in order to draw out the implications for relief programming and relevance to urban studies. It interprets an extensive range of unpublished literature through a frame that incorporates the accumulation of direct and indirect impacts upon the hardware, consumables and people upon which urban services rely. The analysis attributes a step‐wise decline in service quality to the lack of water treatment chemicals, lack of spare parts, and, primarily, an extended ‘brain‐drain’ of qualified water service staff. The service is found to have been vulnerable to dependence upon foreign parts and people, ‘vicious cycles’ of impact, and the politics of aid and of reconstruction. It follows that practitioners and donors eschew ideas of relief–rehabilitation–development (RRD) for an appreciation of the needs particular to complex urban warfare biospheres, where armed conflict and sanctions permeate all aspects of service provision through altered biological and social processes. The urban warfare ecology lens is found to be a useful complement to ‘infrastructural warfare’ research, suggesting the study of protracted armed conflict upon all aspects of urban life be both deepened technically and broadened to other cases.     

Forecast combinations under structural break uncertainty

This paper proposes two new weighting schemes that average forecasts based on different estimation windows in order to account for possible structural change. The first scheme weights the forecasts according to the values of reversed ordered CUSUM (ROC) test statistics, while the second weighting method simply assigns heavier weights to forecasts that use more recent information. Simulation results show that, when structural breaks are present, forecasts based on the first weighting scheme outperform those based on a procedure that simply uses ROC tests to choose and forecast from a single post-break estimation window. Combination forecasts based on our second weighting scheme outperform equally weighted combination forecasts. An empirical application based on a NAIRU Phillips curve model for the G7 countries illustrates these findings, and also shows that combination forecasts can outperform the random walk forecasting model.     

Choice and the Internet: From Clickstream to Research Stream

The authors discuss research progress and future opportunities for modeling consumer choice on the Internet using clickstream data (the electronic records of Internet usage recorded by company web servers and syndicated data services). The authors compare the nature of Internet choice (as captured by clickstream data) with supermarket choice (as captured by UPC scanner panel data), highlighting the differences relevant to choice modelers. Though the application of choice models to clickstream data is relatively new, the authors review existing early work and provide a two-by-two categorization of the applications studied to date (delineating search versus purchase on the one hand and within-site versus across-site choices on the other). The paper offers directions for further research in these areas and discusses additional opportunities afforded by clickstream information, including personalization, data mining, automation, and customer valuation. Notwithstanding the numerous challenges associated with clickstream data research, the authors conclude that the detailed nature of the information tracked about Internet usage and e-commerce transactions presents an enormous opportunity for empirical modelers to enhance the understanding and prediction of choice behavior.     

Marketing's Interfunctional Interfaces: The MSI Workshop on Management of Corporate Fault Zones

This paper first introduces the purposes and processesof the Marketing Science Institute's Workshop on Interfunctional Interfaces: The Management of Corporate Fault Zones. The motivatingissues of value migration and market orientation are considerednext followed by discussion of marketing's paradigm shift. Thelast half of the paper deals with several management problemsand research issues which were identified during the workshop.Hopefully, these questions and research needs will help to acceleratedevelopment of research into these interface issues.