Effectiveness and safety of betrixaban extended prophylaxis for venous thromboembolism compared with standard-duration prophylaxis intervention in acute medically ill patients: a systematic literature review and network meta-analysis

Abstract

Aims: To determine the clinical effectiveness and safety of venous thromboembolism (VTE) prophylaxis using US- and Europe-approved anticoagulants relative to extended-duration VTE prophylaxis with betrixaban. Low molecular weight heparins (LMWHs), unfractionated heparin (UFH), fondaparinux sodium and placebo were each compared to betrixaban, as standard-duration VTE prophylaxis for hospitalized, non-surgical patients with acute medical illness at risk of VTE.

Materials and methods: A systematic literature review was conducted up to June 2019 to identify randomized controlled trials (RCTs) of VTE prophylaxis in hospitalized, non-surgical patients with acute medical illness at risk of VTE. Studies that reported the occurrence of VTE events (including death) and, where possible, major bleeding, from treatment initiation to 20–50?days thereafter were retrieved and extracted. A Bayesian fixed effect network meta-analysis was used to estimate efficacy and safety of betrixaban compared with standard-duration VTE prophylaxis.

Results: Seven RCTs were analyzed which compared betrixaban, LMWHs, UFH, fondaparinux sodium, or placebo. There were significantly higher odds (median odds [95% credible interval]) of VTE with LMWHs (1.38 [1.12–1.70]), UFH (1.60 [1.05–2.46]), and placebo (2.37 [1.55–3.66]) compared with betrixaban. There were significantly higher odds of VTE-related death with placebo (7.76 [2.14–34.40]) compared with betrixaban. No significant differences were observed for the odds of major bleeding with all comparators, VTE-related death with any active standard-duration VTE prophylaxis, or of VTE with fondaparinux sodium, compared with betrixaban.

Limitations and conclusions: In this indirect comparison, betrixaban was shown to be an effective regimen with relative benefits compared with LMWHs and UFH. This indicates that betrixaban could reduce the burden of VTE in at-risk hospitalized patients with acute medical illness who need extended prophylaxis, though without direct comparative evidence, stronger conclusions cannot be drawn.     

A sequential Monte Carlo approach to inference in multiple‐equation Markov‐switching models

Vector autoregressions with Markov‐switching parameters (MS‐VARs) offer substantial gains in data fit over VARs with constant parameters. However, Bayesian inference for MS‐VARs has remained challenging, impeding their uptake for empirical applications. We show that sequential Monte Carlo (SMC) estimators can accurately estimate MS‐VAR posteriors. Relative to multi‐step, model‐specific MCMC routines, SMC has the advantages of generality, parallelizability, and freedom from reliance on particular analytical relationships between prior and likelihood. We use SMC's flexibility to demonstrate that model selection among MS‐VARs can be highly sensitive to the choice of prior.     

Fluctuating levels of personal role engagement within the working day: A multilevel study

In this diary study, we examined a theoretical model in which the psychological conditions of meaningfulness, availability, and safety serve as mechanisms through which the work context during discrete situations within the workday influences “state” engagement. We further theorised that a person's “trait” level of engagement would exert cross‐level effects on the state level relationships. Multilevel analyses based on a sample of 124 individuals in six organisations and 1,446 situational observations revealed that meaningfulness and availability (but not safety) mediated the relationships between perceptions of the work context and state engagement. High levels of trait engagement strengthened the within‐person relation between availability and state engagement, yet weakened the within‐person relation between meaningfulness and state engagement, suggesting two different processes may be at play. Overall, the findings advance our understanding of engagement as a multilevel and temporally dynamic psychological phenomenon and promote a contextually based HRM approach to facilitating engagement.     

Obtaining collaboration benefits: the role of collaboration-specific investment and absorptive capacity in China

This study examines the role of collaboration-specific investment and absorptive capacity on the attainment of interorganizational collaboration benefits. Grounded in the extended resource-based view, and using survey data from Chinese executives, we study the driver for, and test the impacts of, collaboration-specific investment and organizational learning on collaboration performance. Our findings indicate that resource similarity between the collaborative partners affects the level of collaboration-specific investment and learning, and demonstrate an approach that firms can use to obtain both abnormal common and private benefits from participation in an interorganizational collaboration. Specifically, the findings suggest that collaboration-specific investment has a direct effect on the enhancement of absorptive capacity and attainment of common and private collaboration benefits. Furthermore, due to the direct effect of absorptive capacity on attainment of collaboration benefits, commitment of collaboration-specific investment has an indirect effect on the attainment of common and private collaboration benefits. This study is the first to apply both the competence-capability framework and extended resource-based view to study interorganizational collaboration. In fact, this study aims to determine mechanisms for a collaboration-participating firm to obtain more benefit, whether common or private. Our findings provide support for the importance of learning capability as a factor in the acquisition of collaboration benefits.     

Green marketing strategies: an examination of stakeholders and the opportunities they present

As green marketing strategies become increasingly more important to firms adhering to a triple-bottom line performance evaluation, the present research seeks to better understand the role of “green” as a marketing strategy. Through an integration of the marketing, management, and operations literatures, an investigative framework is generated that identifies the various stakeholders potentially impacted through the environmentally friendly efforts of a firm. Specifically, the inter-connected nature of the core business disciplines of marketing, management (both strategy and human resources), and operations are examined as controllable functions within an organization from which strategies can be enacted to affect a firm’s stakeholders. The prior research in these areas is examined to identify potential research opportunities in marketing while also offering a series of representative research questions that can help guide future research in marketing.     

Voting on meritocracy

This paper considers a setting where a resource such as education budget is to be distributed among agents. The latter differ in their ability to make use of the resource, and the issue is that of determining the allocation rule whereby the individual shares of the resource (may) depend on their relative efforts of obtaining it. The paper's focus is on endogenous determination, through voting, of the degree of meritocracy in the resource allocation system, which determines the marginal productivity of one's effort. It is found that a meritocratic system is expected to be supported by highly productive individuals and opposed by those with low productivity. When the decision making becomes less elitist and involves broader participation of population groups the support for meritocracy decreases.     

Economic Analysis for the UK National Ecosystem Assessment: Synthesis and Scenario Valuation of Changes in Ecosystem Services

We combine natural science modelling and valuation techniques to present economic analyses of a variety of land use change scenarios generated for the UK National Ecosystem Assessment. Specifically, the agricultural, greenhouse gas, recreational and urban greenspace impacts of the envisioned land use changes are valued. Particular attention is given to the incorporation of spatial variation in the natural environment and to addressing issues such as biodiversity impacts where reliable values are not available. Results show that the incorporation of ecosystem services and their values within analyses can substantially change decisions.     

Dynamic Seemingly Unrelated Cointegrating Regressions

We propose the parametric Dynamic Seemingly Unrelated Regression (DSUR) estimator for simultaneous estimation of multiple cointegrating regressions. DSUR is efficient when the equilibrium errors are correlated across equations and is applicable for panel cointegration estimation in environments where the cross section is small relative to the available time series. We study the asymptotic and small sample properties of the DSUR estimator for both heterogeneous and homogeneous cointegrating vectors. We then apply the method to analyse two long-standing problems in international economics. Our first application revisits the estimation of long-run correlations between national investment and national saving. Our second application revisits the question of whether the forward exchange rate is an unbiased predictor of the future spot rate.     

Rational expectations for large CGE models: A practical algorithm and a policy application

We describe a simple iterative method for solving large dynamic CGE models under rational expectations. Details are given for Australia's MONASH model but the approach applies to a wide range of CGE models. The method is automated in the RunMONASH Windows software, putting CGE modelling under rational expectations within the reach of non-specialist modellers. We provide an illustrative application in which MONASH results under rational expectations are compared with results under static expectations. The application and supporting software can be downloaded. Results from the application are interpreted in terms of elementary economic mechanisms.     

The contracting value of tainted reports in cost reduction settings

While cost accounting is a well-developed discipline with a rich institutional past, it is criticized for being manipulable. This criticism is due, in part, to the existence of multiple, yet equally accepted cost allocation procedures or cost estimation techniques. Employing a principal-agent model, cost accounting is modeled as a menu of alternative methods which, conditional on agent effort, produce noisy, unbiased and independently distributed (i.e., equally defensible) measures from which a single realization is selected ex post as the report used to contract with the agent. Assuming that the report does not indicate which method produced it, the report modeled is “tainted” in that the lowest (most favorable to the agent) outcome is reported, where the “amount” of tainting corresponds to the menu's size. The paper identifies bright-line conditions where the principal's expected net payoff is independent of the amount of tainting, demonstrating that tainting does not necessarily affect the report's incentive value.