Clinical and economic impact of rivaroxaban on the burden of atrial fibrillation: The case study of Japan

Objectives: Atrial fibrillation (AF) affects an estimated 1.5 million individuals in Japan, increasing their stroke risk and imposing considerable costs on the Japanese healthcare system. To reduce stroke incidence, guidelines recommend using anticoagulants in moderate-to-high risk non-valvular AF (NVAF) patients; however, many patients receive no treatment, aspirin only, or remain poorly-controlled on vitamin K antagonists (VKAs) due to high VKA discontinuation rates and non-adherence to guidelines. A prevalence-based Markov model was developed to estimate the clinical and budgetary impact of treating these patients with Xarelto^TM (rivaroxaban, Bayer AG) in Japan.

Methods: Population, baseline risk of events, and associated management costs were estimated using data from Japanese publications where available. Treatment efficacy and safety were derived from published data and the J-ROCKET AF trial. Drug and physician visit costs were based on data from the Ministry of Health, Labor, and Welfare, the J-ROCKET AF trial, and Japanese clinical guidelines.

Results: This model demonstrates that increased use of rivaroxaban in inadequately-managed NVAF patients could avoid 456 081 non-fatal ischemic strokes (IS) and 76 975 cardiovascular deaths over 10 years in Japan. This clinical benefit offsets the increased incidence of myocardial infarctions and anticoagulant-related bleeding. Decreased event costs could lead to a ¥188.4 billion decrease in net spending over the analysis time horizon.

Conclusions: Introducing rivaroxaban may decrease the burden of NVAF in Japanese society. From a clinical perspective, the reduction in IS and embolic events outweighs the increased risk of anticoagulant-related bleeding; from an economic perspective, reduced event costs offset drug and physician visit costs, resulting in cost savings.     

Analysis of Information Content in U.S. and Japanese Magazine Advertising

Abstract

The content of Japanese versus U.S. magazine advertisements is assessed to determine relative levels of information content based on the type of magazine, the kind of information, the product represented in the advertisement and the size of the advertisement. It was found that Japanese magazine advertisements were generally more informative than U.S. ads, although the emphasis on specific content varies cross-culturally.     

Welfare and market-access effects of piecemeal tariff reforms on environmentally preferable products

We examine how welfare and market access are affected by piecemeal tariff reforms on environmentally preferable products (EPP) in a small open economy. We define EPP as clean goods that, when consumed, have no impact on pollution. First, we show that a uniform reduction of all tariffs improves welfare if a country’s imports consist only of clean goods. If a clean good is a net substitute for all other goods in excess demand, then reducing the highest tariff on the clean good improves welfare. Second, we show that a proportional tariff reduction leading to a welfare improvement also increases the value of imports if all tariffs are set at the same ad valorem rates. If the clean good is a net substitute for all other goods in excess demand, then reducing the lowest tariff on the clean good increases the value of imports. Finally, we explore the link between the change in welfare and the change in the value of imports in response to the tariff reforms, and we show that unlike a proportional tariff reduction, a tariff reduction on the clean good does not necessarily lead to improvements in both welfare and market access.     

Electoral competition with environmental policy as a second best transfer

This paper explains why some governments fail to adopt policies that are sufficiently strong, while others adopt policies that are too stringent. Constructing a political economy model in which voters face uncertainty due to the types of politicians and the risk of environmental damage, we show that there is an equilibrium in which a politician uses a weaker environmental policy rather than efficient direct transfers for redistribution. We also show that there is an equilibrium in which a stricter environmental policy can be implemented by a politician who has no incentive to make transfers. Then, we discuss which equilibrium should be more plausible. We conclude that the latter equilibrium in which a too stringent environmental policy emerges can dominate the former unless the citizen’s estimate of environmental risk is sufficiently low.     

Endogenous Lobby Formation and Endogenous Environmental Protection with Unilateral Tariff Reduction

This paper studies how one country’s decision to liberalize trade affects the political economic structure that determines environmental policy in another country. By constructing a political economy model in which the formation of lobby groups and environmental policy are endogenously determined, we show that unilateral tariff reductions by a large country importing a polluting good will generate a lobby group with a relatively lower cost of organization in a small country exporting that good. A formulated lobby demands an inefficient environmental policy, and hence, the small country’s environmental regulations become less efficient. Then, we show that when a lobby already exists, unilateral tariff reductions result in the formation of a rival lobby and consequently make the small country’s environmental policy more efficient.     

Firm‐Driven Management of Longevity Risk: Analysis of Lump‐Sum Forward Payments in Japanese Nursing Homes

This study analyzes a unique economic circumstance of longevity risk management in the Japanese private nursing home market. This circumstance takes the form of a lump‐sum forward payment of lifetime rent by residents, which leaves most longevity risk to be covered by homes. To analyze this circumstance, I construct a structural econometric model of industrial organization for this market. For the underlying structure of longevity risk, I assume that both individual consumers and nursing homes utilize the subjective evaluation. My empirical analysis detects excess payments that can be compensated for only by an unrealistically long stay in nursing homes. This finding implies the existence of the exaggerated evaluation of longevity by economic agents. Thus, appropriate government intervention to help hedge longevity risk might improve social welfare.     

Scientific research,firm heterogeneity,and foreign R&D locations of multinational firms

We examine the influence of host countries’ scientific research strengths on global R&D location choices by multinational firms. In an analysis of 277 new R&D activities identified for 175 firms in 40 host countries and 30 technology fields, we find that the strength of relevant university research positively affects the likelihood that host countries attract foreign R&D. When allowing for firm heterogeneity, university scientific research appears only a significant factor for firms with a strong science orientation in their R&D activities. Host countries’ corporate scientific research has no systematic influence on R&D location choices. Empirical results are replicated in an analysis at the regional level covering regions in Europe, the United States, and Japan.     

Cost-effectiveness analysis of treatment regimens with obinutuzumab plus chemotherapy in Japan for untreated follicular lymphoma patients

Abstract

Aims

Obinutuzumab (GA101; G) is a new treatment for follicular lymphoma (FL) that is anticipated to have greater efficacy than the current treatment, rituximab (R). The aim of this study was to evaluate the cost-effectiveness of G plus chemotherapy (G?+?Chemo) against that of R plus chemotherapy (R?+?Chemo) for patients in Japan with previously untreated FL.