Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results

Aims: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6–12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates.

Methods: Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA).

Results: Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (–$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI]?=?–$1,454 [–$2,396, $1,231]).

Limitations: This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited “real-world” applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems.

Conclusions: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6–12 months of VTE treatment.     

Transmission of information within transnational social networks: a field experiment

Several studies have shown a relationship between the stocks of migrants and country-level investment in the home country; however the mechanism through which this relationship operates is still unexplored. We use a field experiment in which participants who are recent immigrants send information about risky decisions to others in their social network in their home country. The results demonstrate how this information influences decisions in the home country. We find that the advice given by family members and decisions made by friends significantly affects an individual’s risky decision-making.     

Climate for conflict management,exposure to workplace bullying and work engagement: a moderated mediation analysis

The present study investigates a potential preventive factor in relation to workplace bullying. Specifically, we examine how climate for conflict management (CCM) may be related to less bullying, increased work engagement, as well as whether CCM is a moderator in the bullying engagement relationship. The study was based on a cross-sectional survey among employees in a transport company (N = 312). Hypotheses were tested simultaneously in a moderated mediation analysis which showed that bullying and job engagement were related (H1), CCM was related to less reports of bullying (H2), CCM was related to work engagement (H3) and that CCM was indirectly related to job engagement through bullying (H4), but only when CCM was weak (H5). That is, CCM moderated the relationship between bullying and work engagement in that this relationship only existed when CCM was low. The present study contributes to theory within this research field by showing that organizational measures may not only prevent bullying, but may also affect how employees react when subjected to bullying. Furthermore, the effect of climate in relation to bullying may be down to the narrow bandwidth facet of CCM. The study informs employers how they may act to prevent bullying while also reducing the potential negative outcomes of those cases of bullying that inevitably will show up from time to time.     

Financial Instruments and Promotional Banking in the EU are Growing — But is this Justified?

Institutions and the European Investment Bank are at the forefront of EU investment policy. Their role is expanding and it is now a widely-held position that an improvement in the economy will not eliminate the need for their intervention. The proposals for the 2021–2027 MFF launch more financial instruments and present ‘InvestEU’ as a larger more powerful version of the European Fund for Strategic Investments (EFSI). However, promotional banking is often misunderstood and so is the actual size of promotional banking in Europe in which InvestEU will operate.     

In the city: The John Lewis partnership and planned shopping centres

A defining feature of large-scale retailing during the period 1950–1980 was the emergence and evolution of planned shopping centres. During the 1950s, department stores in the United States were in the vanguard of this phenomenon. In contrast, British department stores continued operating from traditional high street sites, and had limited opportunities for expansion within planned shopping centres until the 1970s. This paper addresses the connection between department store retailing and the development of the planned shopping centre in Britain from the perspective of one enterprise: the John Lewis Partnership. The article demonstrates that the Partnership was willing to operate department stores within centrally located shopping centres, but was circumspect about operating stores in non-centrally located shopping centres.     

Characterization of the Row Geometric Mean Ranking with a Group Consensus Axiom

An axiomatic approach is applied to the problem of extracting a ranking of the alternatives from a pairwise comparison ratio matrix. The ordering induced by row geometric mean method is proved to be uniquely determined by three independent axioms, anonymity (independence of the labelling of alternatives), responsiveness (a kind of monotonicity property) and aggregation invariance, which requires the preservation of group consensus, that is, the pairwise ranking between two alternatives should remain unchanged if unanimous individual preferences are combined by geometric mean.     

Fixed-Term Contracts and Labor Market Duality in France

The French labor market is segmented between permanent and temporary workers. The second category has difficulty in getting an open-ended contract. This paper aims at depicting workers on short-term contracts and shows the consequences on their professional career are negative and significant. A large part of the wage gap between permanent and temporary workers remains unexplained by observable characteristics. They receive less on-the-job training and their likelihood of obtaining a stable job is lower than 30% after 1 year and a half. They have also a higher probability of being the adjustment variable in case of an economic negative shock. These different findings show the importance of using public policies to encourage transitions from fixed-term to permanent employment and reducing labor-market duality.     

Settlement procedures and stock market efficiency

This study examines why most derivatives markets that settle on the day following expiration choose the opening rather than the closing price as the final settlement price (FSP), whereas most markets that settle on the expiration day select an average rather than a single price as the FSP. Four exogenous changes in the Taiwan Futures Exchange settlement procedures provide an experimental basis for studying the settlement procedures’ impact on underlying assets. Greatest market efficiency is observed when the FSP is determined by a single rather than an average price and hypothesize that manipulation is prevented at the expense of market quality.     

A New Regulatory Paradigm for the Digital Sector in Europe

The new regulatory framework in the digital sector in Europe is likely to fall short of expectations. A fragmented digital market with insuffi cient incentives for investment is the probable outcome. European regulators should abandon their approach in favour of a new and more flexible set of ideas discussed in this paper.     

Integrated bio-economic models as tools to support land-use decision making: a review of potential and limitations

Bio-economic modelling has become a useful tool for anticipating the outcomes of policies and technologies before their implementation. Advances in mathematical programming have made it possible to build more comprehensive models. In an overview of recent studies about bio-economic models applied to land-use problems in agriculture and forestry, we evaluated how aspects such as uncertainty, multiple objective functions, system dynamics and time have been incorporated into models. We found that single objective models were more frequently applied at the farm level, while multiple objective modelling has been applied to meet concerns at the landscape level. Among the objectives, social aspects are seldom represented in all models, when being compared to economic and environmental aspects. The integration of uncertainty is occasionally a topic, while stochastic approaches are more frequently applied than non-stochastic robust methods. Most multiple-objective models do not integrate uncertainty or sequential decision making. Static approaches continue to be more recurrent than truly dynamic models. Even though integrating multiple aspects may enhance our understanding of a system; it involves a tradeoff between complexity and robustness of the results obtained. Land-use models have to address this balance between complexity and robustness in order to evolve towards robust multiple-objective spatial optimization as a prerequisite to achieve sustainability goals.