Healthcare costs of stroke and major bleeding in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants

Objective: To assess long-term healthcare costs related to ischemic stroke and systemic embolism (stroke/SE) and major bleeding (MB) events in patients with non-valvular atrial fibrillation (NVAF) treated with non-vitamin K antagonist oral anticoagulants (NOACs).

Materials and methods: Optum’s Clinformatics Data Mart database from 1/2009–12/2016 was analyzed. Adult patients with ≥1 stroke/SE hospitalization (index date) were matched 1:1 to patients without stroke/SE (random index date), based on propensity scores. Patients with an MB event were matched to patients without MB. All patients had an NOAC dispensing overlapping index date, ≥12?months of eligibility pre-index date, and ≥1 NVAF diagnosis. The observation period spanned from the index date until the earliest date of death, switch to warfarin, end of insurance coverage, or end of data availability. Mean costs were evaluated: (1) per-patient-per-year (PPPY) and (2) at 1, 2, 3, and 4?years using Lin's method.

Results: The cost differences were, respectively, $48,807 and $28,298 PPPY for NOAC users with stroke/SE (n?=?1,340) and those with MB (n?=?3,774) events compared to controls. Cost differences of patients with vs without stroke/SE were $49,876, $51,627, $57,822, and $60,691 at 1, 2, 3, and 4?years post-index, respectively (p?p?Limitations: Limitations include unobserved confounders, coding and/or billing inaccuracies, limited sample sizes over longer follow-up, and the under-reporting of mortality for deaths occurring after 2011.

Conclusions: The incremental healthcare costs incurred by patients with vs without stroke/SE was nearly twice as high as those of patients with vs without MB. Moreover, each additional year up to 4?years after the first event was associated with an incremental cost for patients with a stroke/SE or MB event compared to those without an event.     

Money,Prices and the Silver Industry during the Price Revolution

The discovery of American silver has been commonly viewed in the literature as the moving force behind the sustained rise of prices experienced by Western Europe from the early 16th to the mid-17th century. However, the mechanical connection between the money supply and the general price level implied by the Quantity Theory oversimplifies the analysis of a period characterized by different trends, some of which cannot be easily explained by the monetarist story: (i) Central Europe silver mining boomed between 1451 and 1540 following a phase of scarcity of money that was especially severe between the end of the 14th century and the beginning of the 15th century; (ii) European prices started to rise before American silver was significantly imported to the Continent; (iii) the rapid expansion of American mining coincided with the decline of the European silver industry (1540–1618); and finally (iv) Mexican and Peruvian bullion production evidenced a downward course during the period 1628–1697, but no alteration in the rising trend of European prices occurred in response. It is argued instead that the classical theory of value and distribution, emphasizing costs of production as determinants of the ‘natural’ value of commodities including precious metals, can accommodate the facts in a more consistent manner than the monetarist view.     

NOUVEL ESSOR DES FONDATIONS AU QUÉBEC ET AU CANADA: POUR UNE ANALYSE SOCIOPOLITIQUE FONDÉE SUR LE CONCEPT D'ÉCONOMIE PLURIELLE

Philanthropic foundations are the object of little research in Canada and Quebec. Our article recognizes the role of these organizations, as well as the presence of powerful new foundations, rich in assets and donations. This article consists of three parts. The first part presents a theoretical review of the American literature published from 2000 on. The second part examines data that we extracted from three main repertoires. Though informative, these repertoires tend to classify Canadian and Quebec foundations in categories that are mostly fiscal and legal and tend to break them down as public or private foundations. We therefore question the limits of studies based on such categories. In the third part of the article we propose a theoretical framework based on a sociopolitical point of view in an attempt to transcend the binary approach. Our approach borrows from the concepts of social and solidarity economy (SSE) and plural economy in order to better understand the new institutional arrangements in which foundations operate. This theoretical framework allows us to analyse foundations as actors of the SSE even though they might not reproduce automatically the principles and the values of the SSE in their behaviours. On the contrary, from the standpoint of a plural economy we may be in a better position to develop a sound sociopolitical analysis of diverse configurations and hybrid forms resulting from emulations or transactions between the principles of the social and solidarity economy (reciprocity), the private economy (competition) and the public economy (redistribution).     

Students' persistent preconceptions and learning economic principles

Economic views held by the general public tend to differ significantly from those of economic experts. Would these differences fade away if people were exposed to some economic instruction? In this article, the authors identify college students' preconceptions about economic issues at the beginning of the semester, verify their persistence throughout the semester, and test whether their beliefs are correlated to course performance. The authors conduct a survey at the beginning and end of the semester on a sample of first-year students taking an economic principles course. They find evidence of preconception persistence and reasoning inconsistencies, pointing to some cognitive biases as a plausible cause. Most students do not integrate the newly learned tools into their thinking process, even if they perform well in tests.     

Making Chile Visible: Purposes,Operationalisation and Audiences from the Perspective of Nation Branding Practitioners

Chile has become the paradigm of nation branding in Latin America, employing branding initiatives to try to shake off the uncomfortable past of Augusto Pinochet’s dictatorship, as well as to create a ‘new’ image that fits into a globalised and neoliberal world. Whilst there has previously been some analysis of Chile’s branding efforts, the viewpoints of the local actors involved in these initiatives have largely been ignored. This article addresses this issue, examining the tensions faced by different individuals who have taken part in nation branding in the country. Drawing on interviews with some of these individuals, this article examines three areas of tension: (1) the conflicting purposes guiding the practice of nation branding, (2) the difficulties around the operationalisation of nation branding and (3) the controversies regarding the intended audiences for their efforts.     

Country Differences in Material Deprivation in Europe

This paper assesses to what extent differences in the characteristics of individuals (micro‐level perspective) and country‐specific factors (macro‐level perspective) can explain country differences with respect to material deprivation levels. Thus, our work aims to simultaneously consider the macro dimension and the predominantly individually‐oriented study field of material deprivation using multilevel techniques. We make use of the European Union Statistics on Income and Living Conditions. Our results show that country‐specific factors seem to be much more relevant than individual effects in explaining country differences in material deprivation. We estimate that the introduction of country‐specific factors reduces the proportion of total variance due to between‐country differences in deprivation by 72.7 percent, while individual‐level variables reduce this proportion by only 9.4 percent. We also show, through interaction variables, that the effect of sociodemographic characteristics can be shaped by institutional and structural factors, especially by the level of GDP.     

Does personal background influence a finance minister to cook the books? An investigation of creative accounting in Swiss cantons

This article aims to identify the factors influencing the use of creative accounting in the public sector. Its distinctive feature is that it sheds light on creative accounting when used, not to hide public deficits, but to conceal surpluses. It especially explores the impact of the finance minister’s (FM)’s background on the phenomenon. We take advantage of the quasi-experimental settings of the Swiss cantons in which the financial management act sets out the possibility of implementing certain accounting gimmicks, including mainly additional ‘depreciation’ charges. These charges, which are depreciations in name only, enable the FM to artificially inflate expenses, thus increasing the deficit or reducing the surplus. Our panel data set of the 26 cantons over the period 1980–2012 includes a new data set of creative accounting and of 116 cantonal FMs. Our results indicate that the FMs cook the books irrespective of their personal or ideological background with the exception that trained economists tend to apply creative accounting more. Additionally, stringent fiscal rules urge FMs towards more surplus-hiding accounting.     

Economic modelling of costs associated with outcomes reported for type 2 diabetes mellitus (T2DM) patients in the CANVAS and EMPA-REG cardiovascular outcomes trials

Aims: To model direct medical costs associated with reductions in cardiovascular disease (CVD) events in T2DM patients reported in the CANVAS and EMPA-REG trials, which assessed the cardiovascular safety of canagliflozin and empagliflozin, respectively.

Materials and methods: Costs were modeled from a US managed care organization (MCO) perspective for the CVD outcomes included in both trials: three-point major adverse cardiovascular event (MACE) and its components (cardiovascular-related death, nonfatal myocardial infarction, nonfatal stroke), as well as heart failure requiring hospitalization. The rate of CVD events averted (difference between study drug and placebo) was projected to the portion of an MCO T2DM population matching the respective trial’s inclusion criteria. A targeted literature search for paid amounts directly associated with each CVD event provided the unit costs, which were applied to the projected number of events averted, to calculate costs avoided per member per year (PMPY). One-way sensitivity analyses were performed on events averted, unit costs, and percentages of trial-applicable patients.

Results: Based on three-point MACE events averted, costs avoided PMPY of $6.17 (range: $1.27–$10.94) for CANVAS and $2.75 ($0.19–$4.83) for EMPA-REG were estimated. Costs avoided for individual components of MACE ranged from $0.77 to $3.84 PMPY for CANVAS and from -$0.97 (additional costs) to $1.54 for EMPA-REG. PMPY costs avoided for heart failure were $2.72 for CANVAS and $1.32 for EMPA-REG.

Limitations and conclusions: Models assumed independent, non-recurrent outcomes and were restricted to medical costs directly associated with the trial-reported events. The reductions in CVD events in T2DM patients reported for both CANVAS and EMPA-REG project to a positive cost avoidance for these events in an MCO population. The analysis did not include an assessment of the impact on total cost, as the costs associated with adverse events, drug utilization or other clinical outcomes were not examined.