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 Engineer and The Plumber: Mediating Mumbai's Conflicting Infrastructural Imaginaries

Two decades ago, the rules governing the provision of piped municipal water supply in Mumbai became linked to the policy frameworks governing eligibility for a property titling scheme. This article outlines the ideological basis and practical implications of the shift, as well as the contradictions of the new regulatory regime. The article demonstrates how these contradictions have been mediated by the material and practical knowledge, embodied expertise, local authority and wide‐ranging socio‐political work of two sets of actors: municipal water engineers and a cast of characters known locally as ‘plumbers’. The social, political and hydraulic imaginaries animating the work of ‘plumbing’ are bound up with a temporal and spatial imaginary distinctly at odds with the network‐flow conception of hydraulic engineering within which the work of water supply planning and distribution in Mumbai is conceptualized, materialized and institutionalized. The hydraulic and legal contradictions of these clashing infrastructural idioms––of flow and event––have rendered the regulatory framework highly unstable. These contradictions eventually erupted in Mumbai's waterscape, leaving the city's water infrastructures suspended in a highly politicized state of limbo between dueling infrastructural imaginaries.     

How much are electric vehicles driven?

The prospect for electric vehicles as a climate change solution hinges on their ability to reduce gasoline consumption. But this depends on how many miles electric vehicles are driven and on how many miles would have otherwise been driven in gasoline-powered vehicles. Using newly-available U.S. nationally representative data, this paper finds that electric vehicles are driven considerably fewer miles per year on average than gasoline-powered vehicles. The difference is highly statistically significant and holds for both all-electric and plug-in hybrid vehicles, for both single- and multiple-vehicle households, and both inside and outside California. The paper discusses potential explanations and policy implications. Overall, the evidence suggests that today’s electric vehicles imply smaller environmental benefits than previously believed.     

Cross‐Functional Integration: Concept Clarification and Scale Development

The centrality of cross‐functional integration (CFI) to supply chain theory and practice has long been recognized. Yet researchers continue to struggle with consistently defining or measuring the CFI construct, thus limiting the utility of CFI research. This research develops (1) a comprehensive definition of CFI that synthesizes previous supply chain research and (2) a valid set of scale items that measure the conceptual domain outlined by this definition. The goal is to build a common foundation for extending knowledge on CFI's antecedents and consequences, and ultimately to improve scholars’ ability to guide a broader practitioner community still struggling to achieve integration in their organizations.     

Reconciling Alternative Theories for the Safety of Owner–Operators

Motor carrier safety is an important concern of shippers, carriers, policy makers, consignees, insurance providers, and the motoring public. One aspect of carrier safety that has garnered substantial attention is whether carriers making greater use of owner–operators are more or less safe vis‐à‐vis carriers making greater use of employee drivers. Currently, conflicting theoretical predictions exist regarding the direction of this relationship. In this article, we offer a reconciliation of the alternative theoretical predictions by developing a coherent theory that merges sociological rational choice theory and theory regarding motor carrier safety. We subject our theory to empirical testing by fitting a series of seemingly unrelated regression models to a vector of safety measures tracked as part of the Federal Motor Carrier Safety Administration's Compliance, Safety, and Accountability program. Our results are consistent with our proposed theory of owner—operator safety and provide meaningful theoretical and managerial implications and directions for future research.     

Moderation by goal commitment of the feedback–performance relationship: Theoretical explanation and preliminary study

This paper presents goal commitment as one stage of a multidimensional goal striving process that affects feedback acquisition, processing, and use during the achievement of performance goals. Specifically, this paper argues that higher goal commitment leads to more effective acquisition, processing, and use of feedback that in turn fosters higher performance than does lower goal commitment. To provide a preliminary test of this proposition, data from an earlier field study conducted by the author and colleagues [J. Occup. Organ. Psychol. 72 (1999) 107] were used to examine the moderating effects of goal commitment on the relationship between perceived task feedback amount and work performance of 196 rehabilitation counselors. Results were consistent with this proposed interaction, as perceived task feedback amount had a positive linear relationship with work performance for higher goal commitment rehabilitation counselors and a negative linear relationship with performance for lower goal commitment counselors. The discussion urges researchers to broaden their views of goal commitment beyond the goal difficulty–performance relationship and to devote more attention to moderators of the feedback–performance relationship. Directions for future research and practical implications are also discussed.     

Intraday Lead-Lag Relationships Between the Futures-, Options and Stock Market

In rational, efficiently functioning and complete markets, returns on derivative and underlying securities should be perfectly contemporaneously correlated. Due to market imperfections, one of these markets may reflect information faster. The use of high-frequency data and the choice for a small unit time interval to measure these lead-lag relations comes at the cost of some or many missing observations, causing traditional estimators to either under- or overestimate covariances and correlations. We use a new estimator to estimate lead-lag relationships between the cash AEX index, options and futures. We find that futures returns lead both options and cash index returns by approximately 10 minutes. The relationship between options and the cash market is not completely unidirectional.