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’.     

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.     

Characterization of the Row Geometric Mean Ranking with a Group Consensus Axiom

An axiomatic approach is applied to the problem of extracting a ranking of the alternatives from a pairwise comparison ratio matrix. The ordering induced by row geometric mean method is proved to be uniquely determined by three independent axioms, anonymity (independence of the labelling of alternatives), responsiveness (a kind of monotonicity property) and aggregation invariance, which requires the preservation of group consensus, that is, the pairwise ranking between two alternatives should remain unchanged if unanimous individual preferences are combined by geometric mean.     

Perceptions of the benefits of the A3 planner in facilitating project-based learning in accounting education

This paper evaluates ways of instilling project management skills into accounting-based learning by the use of an iterative A3 planner to plan, monitor and review assignment progress. The application of an A3 planner to facilitate a project-based learning (PBL) group assignment in undergraduate accounting education has been critically evaluated in terms of both the student and tutor experience. The study uses a mix of qualitative and quantitative data. Quantitative data assisting exploration of perceptions were collected through 100 undergraduate students. A series of focus group discussions were carried out to investigate students’ engagement and tutors’ teaching experiences regarding the adoption of the A3 planner. The results suggest that the A3 planner promotes active planning and effective management of a PBL group assignment. It makes students’ thought processes more visible thereby facilitating and enhancing the tutoring/mentoring process. Moreover a more interactive and transparent approach by doing assignment via the use of an iterative A3 planner has ensured more feedback points and action based efficiency in the doing approach for learners.     

Advertising to the masses: the effects of crowding on the attention to place-based advertising

Advertising situated in environments where people congregate or pass through on their way to somewhere else benefit from being placed in such high traffic areas. However, these strategically placed ads also suffer from conditions of human crowding that prevents them from being noticed and processed. We undertake a study of place-based advertising in a shopping mall using facial recognition software to determine the effect of human density on the attention directed to advertising. We find that as human density increases, attention to advertising decreases, but only to a point where it begins to increase again. Our research also finds that human density plays a moderating role on the motivation to process advertising.