Rivaroxaban for non-valvular atrial fibrillation and venous thromboembolism in the Netherlands: a real-world data based cost-effectiveness analysis

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) have been included in international guidelines as important alternatives to vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE) and stroke prevention in non-valvular atrial fibrillation (NVAF). Meanwhile, in the Netherlands, NOACs are widely used next to VKAs. The objective of this study is to estimate the cost-effectiveness of treatment with rivaroxaban compared to VKAs in NVAF and VTE patients in the Netherlands, using data from international prospective observational phase IV studies.

Methods: Two models were developed to represent NVAF and VTE patients, populated with patients from the XANTUS (NCT01606995) and XALIA (NCT01619007) international prospective observational studies. The 1-year cost-effectiveness of rivaroxaban use, compared to VKAs, was explored in a population consisting of NVAF and VTE patients (base case) as well as for four scenarios with sub-populations: NVAF patients only, VTE patients only, NVAF patients with unstable international normalized ratio (INR), and NVAF patients using an INR self-measuring device.

Results: In the base case, rivaroxaban saved €72,350 and gained 21 quality-adjusted life-years (QALYs) in a simulation of 2,000 patients over the use of VKAs. Ergo, rivaroxaban was dominant over VKAs. The probabilistic sensitivity analysis showed a probability of 85% for rivaroxaban being dominant and 100% at a willingness-to-pay threshold of €20,000/QALY. Rivaroxaban appeared to be dominant in all scenarios as well, except for the NVAF-patients-only scenario where the incremental cost-effectiveness ratio (ICER) was €157/QALY.

Conclusions: In patients with NVAF or VTE, rivaroxaban treatment is likely to be cost-effective and a potentially cost-saving alternative to VKA in the Netherlands.     

HR managers’ talent philosophies: prevalence and relationships with perceived talent management practices

Abstract

HR managers have different beliefs about the nature, value, and instrumentality of talent—referred to as ‘talent philosophies’. In line with cognitive psychology, we reason that talent philosophies are similar to mental models that influence how HR managers interpret and use talent management (TM) practices within their organizations. In this article, we explore the prevalence of four different talent philosophies (exclusive/stable; exclusive/developable; inclusive/stable; inclusive/developable) in a sample of 321?HR managers. We then explore how talent philosophies relate to organizational context (i.e. size, ownership form, multinational orientation) as well as to HR managers’ perceptions of their organization’s TM practices. Cluster analysis corroborated the presence of the four talent philosophies in our dataset. All four talent philosophies were represented almost equally often in the overall dataset. Organizational size was found to be related to talent philosophies, such that HR managers who worked in smaller organizations were more likely to hold an inclusive talent philosophy. We also found support for the relationship between talent philosophies and perceptions of the exclusiveness or inclusiveness of the organization’s definition of talent, and its degree of workforce differentiation. Contrary to expectations, results did not support a link between talent philosophies and perceived talent identification criteria.     

International deflation risks under alternative macroeconomic policies

We use a version of the Global Projection Model covering the United States, Euro area and Japan to assess options for dealing with the looming risk of international deflation. The zero floor to interest rates constrains monetary policy. Confidence intervals, derived from stochastic simulations, indicate ranges of uncertainty. The results suggest a high probability of a declining price level for a couple of quarters in 2009. Suitable policy adaptations reduce the risk that this might turn into a prolonged, global deflation. These include: a price level path target for monetary policy, which would respond to previous, as well as expected, shortfalls from the desired inflation rate; a more stimulative fiscal policy; and an increase in the long-run target for inflation.     

The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia

The article compares the incidence of public healthcare across11 Asian countries and provinces, testing the dominance of healthcareconcentration curves against an equal distribution and Lorenzcurves and across countries. The analysis reveals that the distributionof public healthcare is prorich in most developing countries.That distribution is avoidable, but a propoor incidence is easierto realize at higher national incomes. The experiences of Malaysia,Sri Lanka, and Thailand suggest that increasing the incidenceof propoor healthcare requires limiting the use of user fees,or protecting the poor effectively from them, and building awide network of health facilities. Economic growth may not onlyrelax the government budget constraint on propoor policies butalso increase propoor incidence indirectly by raising richerindividuals' demand for private sector alternatives.     

Relationships among healthy lifestyle beliefs and body mass index in urban China

Consumption is a major driving force in China's economy. The consumer society is particularly emerging in the more urbanized and affluent regions in China. Given the rise of consumerism on the one hand, and the rise of overweight and obesity on the other, this study explored whether the proliferating consumer culture is a threat to the traditional health culture in China. The lifestyle‐oriented approach used in this study does not confirm a straightforward relationship between an upward trend in Chinese with (economic) assets to join the consumer society and a downward trend in health interest among urban Chinese. The result that the rise of the consumer society is not directly accompanied by a devaluation of health issues does not imply that lifestyle research is of no use. On the contrary, this paper successfully identified four dimensions of health‐related lifestyle for urban China, namely Food‐health Belief, Perceived Knowledge, Health Careless and Group Conformity. This result is informative with respect to the complexity of sociocultural factors influencing the increasing prevalence of overweight and obesity.     

The trend in female labour force participation: what can be expected for the future?

This study investigates the increase in the labour force participation rate of women. We estimate a binary age–period–cohort model for a sample of Dutch women born between 1925 and 1986. The results indicate that the increasing level of education and the diminishing negative effect of children have played an important role. Moreover, we find important unobserved cohort effects for pre-1955 generations, which is in line with results of studies on social norms. It is shown that the growth in female participation is likely to slow down in the near future, as such cohort effects are not relevant for younger generations.     

Turning the page? EU fiscal consolidation in the wake of the crisis

The fiscal cost of the financial and economic crisis in Europe is huge. The paper provides provisional estimates of this cost and looks at its implications for the sustainability of public finances, taking into account also the impact of aging populations. The historical experience suggests that economic growth is persistently lowered in the aftermath of financial crisis, making fiscal consolidation more difficult yet all the more essential. Meanwhile the timing of the exit from fiscal stimulus and subsequent fiscal consolidation must reconcile sustainability and stabilisation goals—a delicate balancing act. The paper will argue in favour of structural reform to boost the economic growth potential alongside fiscal consolidation. The fiscal coordination framework in the EU, together with the Europe 2020 strategy, is seen to underpin this approach.     

Environment versus growth — A criticism of “degrowth” and a plea for “a-growth”

In recent debates on environmental problems and policies, the strategy of “degrowth” has appeared as an alternative to the paradigm of economic growth. This new notion is critically evaluated by considering five common interpretations of it. One conclusion is that these multiple interpretations make it an ambiguous and rather confusing concept. Another is that degrowth may not be an effective, let alone an efficient strategy to reduce environmental pressure. It is subsequently argued that “a-growth,” i.e. being indifferent about growth, is a more logical social aim to substitute for the current goal of economic growth, given that GDP (per capita) is a very imperfect indicator of social welfare. In addition, focusing ex ante on public policy is considered to be a strategy which ultimately is more likely to obtain the necessary democratic-political support than an ex ante, explicit degrowth strategy. In line with this, a policy package is proposed which consists of six elements, some of which relate to concerns raised by degrowth supporters.     

Optimal Conservation Programs, Asymmetric Information and the Role of Fixed Costs

An increasing number of environmental protection programs offers financial compensation to farmers in exchange for conservation services. Incentive-compatible contracts can be designed to mitigate excess compensation, but the extant literature suggests that outcomes are always second-best so that other instruments (such as conservation auctions) may be preferred. We argue that the claim regarding the first-best solution never being incentive-compatible is correct if all conservation costs are variable in nature; if there are fixed costs too, the first-best compensation scheme may be incentive-compatible after all. Given the relevance of fixed costs in conservation issues, we conclude that incentive-compatible contracts should be given a second chance as a policy measure to induce conservation.