Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program

Objective:

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE.

Methods:

A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15?mg twice daily for 3 weeks followed by 20?mg once daily; n?=?405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended ‘bridging’ therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio?=?2.0–3.0; n?=?401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset.

Results:

Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median?=?1 day) compared with enoxaparin/VKA (mean?=?4.5 vs 6.1; median?=?3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients.

Conclusion:

In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.     

Mortality Among the Elderly in Sweden 1988–1997

By replacing the exponential growth in a Makeham function with a straight line at very high ages, graduated mortality rates gives an acceptable adherence to observed data.     

Mobility of public researchers, scientific knowledge transfer, and the firm's innovation process

The present study provides evidence on the mobility effects of researchers from the public R&D system with regard to firm's innovation process. This issue is particularly novel and important as these researchers contribute to the production and transfer of knowledge previously developed and accumulated in the public R&D system. The findings confirm that scientific knowledge which public researchers provide has a positive influence on both inputs and outputs of the firms' innovation process. The fact that firms have access to additional knowledge which is complementary to that they already hold represents a spur for exploiting and applying this new knowledge. The firms in this study continually increased their in-house R&D investments. As a result of these investments firms create new knowledge of a unique and valuable type. The study draws two important conclusions geared to providing a greater efficiency in human resource management and to improve the design of technology policies.     

Towards a Smart Tourism Business Ecosystem based on Industrial Heritage: research perspectives from the mining region of Rio Tinto,Spain

The implications of the study provide suggestions for future improvements relating to the development of industrial tourism destinations. The possibility of ‘re-using’ the old industrial and mining heritage could favour the development of an economic opportunity to the recession that affected most industrial regions after the 1960s. This paper is focused on the field of industrial heritage tourism management (IHTM) to deepen the knowledge about its business ecosystem. The IHTM is chosen because a number of evidences highlight the interconnections that exist between this field and the business ecosystem concept. To explore these interconnections, the purpose of this article is to define a frame of analysis based also on the emergent initiative of smart tourism and to set up a theoretical framework not only used to the case study of the region of Rio Tinto mine in Spain, but also used as a policy instrument to suggest propositions for recommending new paths for future studies.     

Non-cooperative bargaining in apex games and the kernel

This paper studies non-cooperative bargaining with random proposers in apex games. Two different protocols are considered: the egalitarian protocol, which selects each player to be the proposer with equal probability, and the proportional protocol, which selects each player with a probability proportional to his number of votes. Expected equilibrium payoffs coincide with the kernel for the grand coalition regardless of the protocol. The equilibrium is in mixed strategies and the indifference conditions can be reinterpreted in the language of the kernel.     

The Impact of Innovation on Employment in Services: Evidence from Italy

This article investigates the employment impact of innovation in services, using the data gathered through the 1993-95 Italian innovation survey. The empirical evidence shows that the impact of innovation on employment varies greatly across industries and according to the level of qualification of the labour force. Among small firms and in less than a half of the service sectors considered, the employment impact of innovation is positive, particularly in industries that have a strong scientific and technological base. A negative impact of innovation on employment is, on the contrary, found among large firms, capital-intensive industries and in all financial-related sectors (banking, insurance and other financial services). In these industries the labour-saving effect of innovation seems to be linked to the widespread use of Information and Communication Technologies (ICTs) which displace the least qualified employees. In the case of Italy, an overall negative impact of innovation on employment is found. It is argued that this result is affected by the Italian economy's specialisation in the most traditional service industries.     

Effective experimental controls for research in international accounting: Further thoughts

This paper responds to recent research by Ruland et al. [Ruland, W., Shon, J., Zhou, P., 2007. Effective controls for research in international accounting. Journal of Accounting and Public Policy, 26(1), 96–116.] that addresses the effectiveness of experimental controls for research in international accounting, with focus on Ndubizu and Sanchez [Ndubizu, G.A., Sanchez, M.H., 2006. The valuation properties of earnings and book value prepared under US GAAP in Chile and IAS in Peru. Journal of Accounting and Public Policy 25 (2)]. We attempt to remove some misconceptions about effective experimental controls that have surfaced in the debate. We argue that theory and refined proxies alleviate many of the control issues that have surfaced in the literature.