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.     

The effect of political volatility on capital markets in EU accession and neighborhood countries

Political instability has the potential to disrupt financial markets. But how do political institutions affect financial movements in an environment where all institutions are in flux? This paper looks at the effects of formal and informal political volatility in the new EU countries of central and eastern Europe, in the Eastern Neighborhood, and farther afield in Central Asia to answer this question. Using asymmetric GARCH modeling on monthly data, I find that informal political volatility has a significant negative effect on stock returns, while formal political institutions generate much higher financial volatility than changes in monetary policy.     

It's easier to contract than to pay: Judicial independence and US municipal default in the 19th century

It is well established in the literature that an independent judiciary can act as a signal of credibility by a sovereign state and as a guarantor of creditor rights. However, to date there has been little systematic work analyzing how an independent judiciary reacts to fiscal stress and public-sector default. This article addresses that very question by evaluating how and if judicial independence affects default rates using US municipal data through the nineteenth century. Overall, the results do indicate that greater judicial independence is associated with a significantly lower likelihood of default. This channel largely occurs through the method by which a member of a state's court of last resort is selected (either appointment or popular election) and term length.     

An explanation of each-way wagers in three models of risky choice

Punters may engage in betting on both a selection in an event to finish first or in one of the number of places, e.g. second, third or fourth. When the amounts staked with bookmakers at fixed odds on the win and place are equal, it is called an each-way bet. Each-way bets are apparently popular with punters but inconsistent with prominent models of wagering which assume gamblers are everywhere risk-seeking. In this note, we derive the conditions for win and place bets to be optimal in these three models of risky choice. The mathematical conditions for the each-way wager to be optimal, as opposed to a win and place wager with different stakes, are complicated and appear likely to occur rarely in practice. However, bettors obviously see the attraction in giving themselves two ways to bet on the one horse or two ways to win and betting each way. We suggest part of the ‘each-way’ betting attraction is that they are quick and easy to compute – a heuristic – to solve an otherwise complex betting strategy.     

Modelling superannuation fund management function as a two-stage process for overall and stage-level performance appraisal

We assess superannuation fund performance in a multi-dimensional framework by conceptualizing its management function as a serially linked two sub-process; operational management (OM) and portfolio management (PM). The procedure that we adopt is data envelopment analysis (DEA). We express overall efficiency as a weighted average of the two sub-process efficiencies and assess overall efficiency conditional on their relative importance. We demonstrate application of our model using a sample of Australian superannuation funds. By appraising performance in two sample periods; crisis (2008) and relatively non-crisis (2014), we show that some findings of previous studies may be explained further through the proposed multi-stage framework. The best overall performer in 2008 is public sector funds and in 2014 it is corporate funds. Decomposition of overall efficiency reveals that public sector funds, on average, outperform all other fund categories in OM. However, no specific fund category dominates PM performance in both assessment periods. The driving force behind the observed inverse association between superannuation fund size and performance appears to be PM performance. Number of investment options offered is not associated with overall, OM and PM performance. Here, we demonstrate that performance appraisal from different aspects of management provide insightful information to superannuation fund managers.     

Cross-sectional and time-series momentum returns and market dynamics: evidence from Japan

We test the behavioural theories of overconfidence and underreaction on cross-sectional (CS) and time-series (TS) momentum returns in the Japanese stock markets. Both CS and TS momentum returns are large and significant when the market continues in the same state and turns into losses when the market transitions to another state, consistent with the overconfidence but not the underreaction model. We find that TS conditional momentum returns exceed conditional CS momentum returns because of its active position since TS takes a net long (short) position following UP (DN) markets while CS is a zero-cost strategy irrespective of the market state. Finally, we find no relation between idiosyncratic volatility (IV) and momentum returns which is not supportive of either the overconfidence or underreaction model but implies that IV is not a significant limit to arbitrage in Japan.     

Uncertainty,Control, and Karl Polanyi’s Protective Response

Post-Keynesian institutionalist economists like Wallace Peterson and John Kenneth Galbraith recognized that the impact of uncertainty on economic wellbeing depends in part on the degree of control people have over the sources and consequences of it. Given the inability of government and other large institutions to reduce uncertainty or to provide citizens with the ability to manage it, mediating structures are considered as an alternative means of promoting economic security. The article concludes by describing and evaluating several of these alternatives.     

Explaining differences in the productivity of investment across countries in the context of ‘new growth theory’

The purpose of this paper is to explain differences in the productivity of investment across 84 rich and poor countries over the period 1980–2011, and to test the orthodox neoclassical assumption of diminishing returns to capital. The productivity of investment is measured as the ratio of the long-run growth of GDP to a country’s gross investment ratio. Twenty potential determinants are considered using a general-to-specific model selection algorithm. Education, government consumption, geography, export growth, openness, political rights and macroeconomic instability are the most important variables. The data also suggest constant returns to capital, so investment and the determinants of productivity of investment differences matter for long-run growth.     

The reverse tragedy of the commons: an exploratory account of incentives for under-exploitation in an open innovation environment*

This paper presents an empirical account of a phenomenon that we refer to as the ‘reverse tragedy of the commons’ in open innovation. The name signifies the ‘under-exploitation’ of intellectual property (IP) under weak appropriability. The name is this graphic because the tragedy is costly, and can also render IP effectively worthless and block innovation in the short to medium term. We propose that the tragedy is borne out of the interaction between enterprise characteristics, a competitive setting and the framework that is set by the policy intervention. This finding is pertinent to policy-makers with regard to the design of research, development and innovation instruments, as well as managers who must determine how to implement open practices in innovation.     

Does a Clean Development Mechanism Facilitate International Environmental Agreements?

When politicians negotiate in international climate conventions they may suffer from incomplete information for each other’s preferences for reaching an agreement. As is known, this may cause failure to reach an efficient cooperative agreement. We study the role of cross border abatement provisions in the likelihood of such failure. For instance, the clean development mechanism was introduced in the context of the Kyoto Protocol to allow countries to make efficiency-enhancing use of cross-country low-cost mitigation opportunities. We use a simple bargaining framework to uncover why this mechanism may reduce the likelihood of reaching an efficient cooperative climate agreement.