Predictors for total hospital and cardiology cost claims among patients with atrial fibrillation initiating dabigatran or acenocoumarol in The Netherlands

Aims: The prevalence of atrial fibrillation (AF) has increased over the past years due to aging of the population, and healthcare costs associated with AF reflect a significant financial burden. The aim of this study was to explore predictors for the real-world AF-related in-hospital costs in patients that recently initiated anticoagulation with acenocoumarol or dabigatran.

Methods: Predictors for claimed total hospital care costs and cardiology costs in AF patients were explored by using hospital financial claims data from propensity score matched patient groups in a large Dutch community hospital. This study analyzed the total dataset (n?=?766) and carried out a secondary analysis for all matched pairs of anticoagulation naïve AF patients (n?=?590) by ordinal regression.

Results: Dabigatran was a predictor for significantly lower cardiology and total hospital care costs (Odds Ratio [OR]?=?0.43, 95% confidence interval (CI)?=?0.33–0.57; and OR?=?0.60, 95% CI?=?0.46–0.79, respectively). Female gender was a predictor for lower total hospital care costs. Predictors for an increase in total hospital care costs were the occurrence of stroke or systemic embolism, major bleeding, and minor bleeding. The costs predictors were comparable when limiting the analysis to patients that were anticoagulation naïve. Age and CHA₂DS₂-VASc were not predictors for either cardiology or total hospital care costs in both analyses.

Conclusion: Dabigatran treatment was as a predictor for lower cardiology costs and lower total hospital care costs in AF patients that initiated oral anticoagulation.     

EURANDOM: a decade of European stochastics

Conception, founding, start-up and development of EURANDOM are described by Willem van Zwet, Frank den Hollander (former scientific directors of EURANDOM) and Wim Senden (former managing director of EURANDOM).     

Back to the roots of the M/D/s queue and the works of Erlang, Crommelin and Pollaczek

A.K. Erlang introduced the M/D/ s queue in 1917, while F. Pollaczek and C.D. Crommelin formalized the theory using complex analysis and transforms. Let D ( s , λ ) denote the stationary probability of experiencing no waiting time in the M/D/ s queue with arrival rate λ and service requirement 1. We use D ( s , λ ) as a vehicle to give an overview of some of the results we obtained over the last years, including explicit characterizations of the roots, the derivation of infinite series from expressions in terms of roots using Fourier sampling and heavy-traffic limits obtained from square-root staffing. We propose to call D ( s , λ ) the Erlang D formula, for which several new results are presented and compared with the results of Pollaczek.     

Can Financial Incentives for Regional Education Authorities Reduce School Dropout?

This paper investigates the effect of a new type of financial incentive in education targeted at regional authorities. Previous studies have focused on financial incentives for students, teachers or schools. We identify the effect by exploiting the gradual introduction of a new policy aimed at reducing school dropout in the Netherlands. The introduction of the policy in 14 out of 39 regions and the use of a specific selection rule for the participating regions allow us to estimate local difference-in-differences models. Using administrative data for all Dutch students in the year before and the year after the introduction of the new policy we find no effect of the financial incentive scheme on school dropout. In addition, we find suggestive evidence for manipulation of outcomes in response to the program.     

Effects of Prominence,Involvement, and Persuasion Knowledge on Children's Cognitive and Affective Responses to Advergames

The integrated and highly involving nature of advergames has led to criticism and concern among academics and caretakers. It is assumed that children are highly susceptible to persuasion via advergames, but empirical evidence is scarce. Therefore, this study examined the effects of three factors typically associated with advergames: brand prominence, game involvement, and (limited) persuasion knowledge on cognitive and affective responses. An experiment among 7 to 12 year old children (N = 105) showed that brand prominence and game involvement influenced children's responses, while persuasion knowledge did not. Brand prominence led to increased brand recall and recognition, whereas game involvement led to more positive brand attitudes. The effect of game involvement was mediated by game attitude, indicating that children are susceptible to affective mechanisms induced by the game. Crucially, our results demonstrate that brand prominence evokes cognitive responses, while game involvement leads to affective responses. Finally, our study revealed that persuasion knowledge (i.e. knowledge of the commercial source of the game and its persuasive intent) did not influence cognitive or affective responses to the brand or game. This implies that even if children understand the game's commercial and persuasive nature, they do not use this knowledge as a defense against the advergame's effects. This study has important theoretical and practical implications regarding the influence of new marketing techniques on children.     

Agrobiodiversity,farm profits and land fragmentation: Evidence from Bulgaria

This paper presents an empirical analysis of the role of land fragmentation, crop biodiversity and their interplay with farm profitability. Original primary data are drawn from a survey conducted in the Plodiv region of Bulgaria. The econometric results stress the ambiguous role of land fragmentation on farm profitability. On one hand, land fragmentation reduces farm profitability. On the other hand, land fragmentation fosters crop diversification. We also find that crop biodiversity plays a beneficial role in farm profitability. Policies that aim to increase land consolidation and reduce fragmentation may overlook the positive link between diversity and plot heterogeneity. Policies that encourage land consolidation should, therefore, consider the crucial role that this has on other variables such as farm biodiversity.     

Contents of Volume 21

Volume Contents

Contents of Volume 21     

Targeting Revisited

Public spending programs aimed at alleviating poverty can eitherbe broadly targeted at categories ofspending or narrowly targetedat types of people. Each approach has benefits and costs tothe poor. It is often claimed that narrow targeting of the poorwill allow governments to reduce pQverty more effectively andat lower cost. But narrow targeting often has hidden costs,and once these costs are considered, the most finely targetedpolicy may not have any more effect on poverty than a broadlytargeted one. Both approaches also have hidden benefits, althoughless is known about their impact. Targeting can help, but itis not a cure-all. Reducing poverty calls for broadly targetedsocial sector spending combined with narrower targeting of cashand in-kind transfers to spec groups. It is also important forgovernments to experiment with schemes that offer better incentives,to carefully monitor the costs and outcomes, and to be flexibleand pragmatic in their policy responses.      

Strategy and the art of reinventing value

In "From Value Chain to Value Constellation: Designing Interactive Strategy" (July-August 1993), Richard Normann and Rafael Ramírez argue that successful companies increasingly do not just add value, they reinvent it. The key strategic task is to reconfigure roles and relationships among a constellation of actors--suppliers, business partners, customers--in order to mobilize the creation of value in new forms and by new players. What is so different about this new logic of value? It breaks down the distinction between products and services and combines them into activity-based "offerings" from which customers can create value for themselves. But as potential offerings become more complex, so do the relationships necessary to create them. As a result, a company's strategic task becomes the reconfiguration and integration of its compentencies and customers. Normann and Ramírez provide three illustrations of these new rules of strategy. IKEA has blossomed into the world's largest retailer of home furnishings by redefining the relationships and organizational pratices of the furniture business. Danish pharmacies and their national organization have used the opportunity of health care reform to reconfigure their relationships with customers, doctors, hospitals, drug manufacturers, and with Danish and international health organizations.(ABSTRACT TRUNCATED AT 250 WORDS)