Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism

Background:

Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), is commonly treated with a low-molecular-weight heparin such as enoxaparin plus a vitamin K antagonist (VKA) to prevent recurrence. Administration of enoxaparin?+?VKA is hampered by complexities of laboratory monitoring and frequent dose adjustments. Rivaroxaban, an orally administered anticoagulant, has been compared with enoxaparin?+?VKA in the EINSTEIN trials. The objective was to evaluate the cost-effectiveness of rivaroxaban compared with enoxaparin?+?VKA as anticoagulation treatment for acute, symptomatic, objectively-confirmed DVT or PE.

Methods:

A Markov model was built to evaluate the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios associated with rivaroxaban compared to enoxaparin?+?VKA in adult patients treated for acute DVT or PE. All patients entered the model in the ‘on-treatment’ state upon commencement of oral rivaroxaban or enoxaparin?+?VKA for 3, 6, or 12 months. Transition probabilities were obtained from the EINSTEIN trials during treatment and published literature after treatment. A 3-month cycle length, US payer perspective ($2012), 5-year time horizon and a 3% annual discount rate were used.

Results:

Treatment with rivaroxaban cost $2,448 per-patient less and was associated with 0.0058 more QALYs compared with enoxaparin?+?VKA, making it a dominant economic strategy. Upon one-way sensitivity analysis, the model’s results were sensitive to the reduction in index VTE hospitalization length-of-stay associated with rivaroxaban compared with enoxaparin?+?VKA. At a willingness-to-pay threshold of $50,000/QALY, probabilistic sensitivity analysis showed rivaroxaban to be cost-effective compared with enoxaparin?+?VKA approximately 76% of the time.

Limitations:

The model did not account for the benefits associated with an oral and minimally invasive administration of rivaroxaban. ‘Real-world’ applicability is limited because data from the EINSTEIN trials were used in the model. Also, resource utilization and costs were based on the US healthcare system.

Conclusion:

Rivaroxaban is a cost-effective option for anticoagulation treatment of acute VTE patients.     

An examination of the nature of the relationship between Leader-Member-Exchange (LMX) and turnover intent at different organizational levels

The present study investigates the nature of the relationship between Leader-Member-Exchange (LMX) quality and turnover intent in the South Korean hospitality industry. Self-administered survey questionnaires were collected from 232 frontline workers as well as 88 supervisors employed in hotel properties. Prior research has produced mixed results, finding linear relationships between LMX quality and turnover intent in some studies and non-linear relationships in others. Traditional hierarchical regression analyses were performed to test the nature of the relationship in these two samples. We found evidence for a U-shaped curvilinear relationship between LMX and turnover intent for non-supervisory employees, but only a linear relationship for supervisory employees. Conceptual and practical implications and recommendations for future research are provided.     

Does mandatory food safety training and certification for restaurant employees improve inspection outcomes?

The purpose of this study was to explore the relationship between mandatory food safety training and certification and inspection results of chain restaurants and independent restaurants, using current food safety inspection results of food service establishments in Central Florida. More specifically, this study examines whether there is any statistically significant difference in the violation frequency among chain and independent restaurants. Reducing the risk of any foodborne illness is a critical strategy that industry stakeholders should pursue in an area dominated by tourism such as Orlando, Florida. A one-way ANOVA was used to determine the differences between the two types of restaurants. Findings indicate that there is significant difference between chain and independent restaurants for critical violations. No difference was found when comparing chain verses independent restaurants for non-critical violations.     

Mobile Cultures? Hybridity,Tourism and Cultural Change

This paper addresses the problem of cultural change in relation to tourism. It will be argued that tourism research has tended to be theorised in terms of static models predicated on the assumptions of unilinear development, and cultural change being accounted for by a shift from one defined state into another. Beginning with a critique of the 'container model' of culture, this paper then draws on recent anthropological and sociological developments concerned with globalisation to critically examine the utility of the concept of hybridity. In conclusion, this paper will argue that what is required is a transformative and processual approach that is capable of accounting for the dynamic interplay of cultural change at both a micro and macro level.     

Building the Planning Consensus: The Plan of Chicago,Civic Boosterism,and Urban Reform in Chicago, 1893 to 1915

Since its publication in 1909, Daniel Burnham's Plan of Chicago has been criticized for its lack of attention to social issues and for the failure of subsequent reconstruction projects to live up to the ambition of the plan. These criticisms assume that the Plan of Chicago was insufficiently progressive, or they evaluate the Plan by reference to the successes and failures of subsequent decades of urban reconstruction in Chicago. This article argues that the key to understanding the Plan of Chicago is to place it in its historical context. Burnham's Plan of Chicago was an expression of the tradition of Chicago civic boosterism and earlier city‐building practices as much as it was of the nascent profession of city planning. Finally, while the Plan did neglect housing, poverty, and other social questions, it did possess a social vision based on civic inclusivity, rather than economic inclusivity. The Plan can be read as a reform document based on the assumption that physical environment shapes individual character and social relationships. It assumed the creation of a unified and harmonious physical city would produce a contented and productive citizenry. In short, the Plan of Chicago deployed a transformative vision in the service of conservative goals.     

When do unethical brand perceptions spill over to competitors?

We examine whether the unethical actions of marketplace brands (e.g., the Volkswagen emissions scandal) hurt the ethical perceptions of competing brands (e.g., Ford, BMW). Across two studies, we find evidence for this unethical spillover effect and show that it can negatively affect consumers’ liking and purchase intentions for a competing brand. The results show that the spillover effect (1) only occurs for similar competitors and (2) is moderated by construal level (CL). Specifically, the spillover effect is more likely to occur when consumers focus on the finer details of the unethical brand’s transgression (i.e., low CL) but not when they focus on the bigger picture of the transgression (i.e., high CL). Thus, while it is intuitively appealing to assume that brands may benefit from a competitor’s foible, this research indicates that competitors may be hurt by a similar brand’s wrongdoing.     

CORPORATE HEDGING AND SHAREHOLDER VALUE

Although theory suggests that corporate hedging can increase shareholder value in the presence of capital market imperfections, empirical studies show overall mixed support for rationales of hedging with derivatives. Although various empirical challenges and limitations advise some caution with regard to the interpretation of the existing evidence, the results are consistent with derivatives use being just one part of a broader financial strategy that considers the type and level of financial risks, the availability of risk management tools, and the operating environment of the firm. Moreover, corporations rely heavily on pass‐through, operational hedging, and foreign currency debt to manage financial risk.     

Exchange traded contracts for difference: Design,pricing, and effects

Contracts for Difference (CFDs) are a significant financial innovation in the design of futures contracts. Over‐the‐counter trading in the UK is significant and has created controversy, but there is no published academic research into the design, pricing, and effects of CFDs. This study analyzes CFD contract design and pricing. It uses a unique database of trades and quotes on exchange traded equity CFDs introduced by the Australian Securities Exchange to test theoretical pricing relationships, and draws out implications for successful design and trading arrangements for the introduction of new derivative contracts. © 2010 Wiley Periodicals, Inc. Jrl Fut Mark     

The Volatility of European Banking Systems: A Two-Decade Study

This paper examines the trends and composition of volatility across European banking systems from January 1988 to December 2010. While there is no evidence of a long-term trend in the average level of banking system volatility, there is a change in its composition resulting from the growing importance of International and European nonfinancial components, especially in the largest banking systems. We argue that the changing composition of banking system volatility is the effect of a long-term integration process (with a growing importance of cross-border activities) that has not been influenced by the introduction of the Euro. Our results highlight the increasing vulnerability of the European banking systems to International and European shocks and an increasing likelihood of cross-border banking crises, and the need for regulatory reforms that focus on effective cross-border crisis management and resolution so as to safeguard the systemic stability of European banking in the near future.     

Supply Chain Management Competency and Firm Financial Success

Supply chain management (SCM) plays a major role in creating (or destroying) shareholder value by influencing the three major drivers of firm financial performance: revenue, operating costs, and working capital. Yet, the relationship between SCM competency and firm financial performance is not well‐established. Drawing on the resource‐based view of the firm, this study assesses this relationship using Delphi‐style opinion data from AMR Research’s Supply Chain Top 25 rankings to assess SCM competency and Altman’s (1968) Z‐score statistic as the measure of financial success. The study findings show that firms recognized by industry experts for SCM competency have significantly higher Z‐scores than their close competitors and industry averages.