Rivaroxaban for non-valvular atrial fibrillation and venous thromboembolism in the Netherlands: a real-world data based cost-effectiveness analysis

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) have been included in international guidelines as important alternatives to vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE) and stroke prevention in non-valvular atrial fibrillation (NVAF). Meanwhile, in the Netherlands, NOACs are widely used next to VKAs. The objective of this study is to estimate the cost-effectiveness of treatment with rivaroxaban compared to VKAs in NVAF and VTE patients in the Netherlands, using data from international prospective observational phase IV studies.

Methods: Two models were developed to represent NVAF and VTE patients, populated with patients from the XANTUS (NCT01606995) and XALIA (NCT01619007) international prospective observational studies. The 1-year cost-effectiveness of rivaroxaban use, compared to VKAs, was explored in a population consisting of NVAF and VTE patients (base case) as well as for four scenarios with sub-populations: NVAF patients only, VTE patients only, NVAF patients with unstable international normalized ratio (INR), and NVAF patients using an INR self-measuring device.

Results: In the base case, rivaroxaban saved €72,350 and gained 21 quality-adjusted life-years (QALYs) in a simulation of 2,000 patients over the use of VKAs. Ergo, rivaroxaban was dominant over VKAs. The probabilistic sensitivity analysis showed a probability of 85% for rivaroxaban being dominant and 100% at a willingness-to-pay threshold of €20,000/QALY. Rivaroxaban appeared to be dominant in all scenarios as well, except for the NVAF-patients-only scenario where the incremental cost-effectiveness ratio (ICER) was €157/QALY.

Conclusions: In patients with NVAF or VTE, rivaroxaban treatment is likely to be cost-effective and a potentially cost-saving alternative to VKA in the Netherlands.     

Optimal monetary policy using an unrestricted VAR

This paper proposes a simple benchmark for monetary policy. Assuming the true model of the economy is unknown, it is based on an unrestricted vector autoregression (VAR). The key result is that instead of deriving optimal policy using the original VAR equations as the constraint, when no restriction is placed on the correlation structure of the VAR disturbances, the constraint should be formed from a transformation of the VAR. This method is applied to the USA, 1964–2009. Significant welfare gains are found compared with actual policy and using a Taylor rule. Incorporating a zero interest rate lower bound lowers output and inflation. Copyright © 2010 John Wiley & Sons, Ltd.     

Enlargement and the labour market: perception,theory and fact

Favourable labour market outcomes are essential for economic and social cohesion within the newly enlarged European Union. However, Eurobarometer evidence indicates that many in the 10 incoming countries are not convinced that membership will deliver such a result. Also, there is no unambiguous theoretical framework that suggests otherwise. A more optimistic scenario can be obtained by reference to the experiences of earlier low‐income Community entrants during their first years of membership, although long‐term convergence has remained elusive.     

Behind M&;As in China and the United States: Networks,learning, and institutions

Few scholars would dispute the argument that mergers and acquisitions (M&As) are different in China and the United States, but we know little about how they differ. This article reports one of the first studies that systematically compares and contrasts how M&As differ in these two countries. While prior research on M&As tends to emphasize economic and financial explanations while treating firms as atomistic actors severed from their institutional and network relations, we develop a new theoretical framework based on relational, behavioral, and institutional perspectives. We not only consider firms as learning actors embedded in network relations, but also compare and contrast their M&A patterns between China and the United States, two distinctive institutional contexts. We find that both a firm’s structural hole position and its learning orientation (exploration/exploitation) in alliances have direct and joint impacts on subsequent M&As. Further, such impacts differ across the two countries, due to their institutional disparities.     

Choice of Distribution System in the New Zealand Life Insurance Industry

Using 1988–93 panel data drawn from the New Zealand life insurance industry, this paper examines empirically the notion that the choice of distribution system is an efficient contracting solution to incentive conflicts between owners, managers and sales agents in life insurance firms. Consistent with what was hypothesised, the empirical results suggest that choice of distribution system is distinguished by organisational form, firm size, and sales commission. However, contrary to expectations, the variables representing product diversity and asset specificity were found not to be statistically significant. The empirical results thus lend mixed support for prior predictions.     

Risk,commitment, and project abandonment

This article deals briefly with the most loathsome of business topics — the admission of failure. Rather than actively encouraging project Anti-champions, many organizations experiencing financial duress inadverdently stifle opposing opinion. In some cases recognition is delayed until it is too late. This is unfortunate since failure can be managed like any other business situation. Companies with CEOs that foster open communications between finance and operations are more likely to avoid escalating commitment to failed projects.Prudence is a rich, ugly old maid courted by incapacity. William Blake Mike Devaney is Associate Professor of Finance at South-East Missouri State University. His primary research interest is real estate finance. He has published in the Journal of the American Real Estate and Urban Economics Association, Journal of Real Estate Research, and The Appraisal Journal to name a few. He also enjoys writing on popular business myth and has published on this subject in Business and Society Review as well as others.     

Governance, organizational capabilities, and restructuring in transition economies

This paper focuses on the links between governance, firm capabilities and restructuring following the large-scale privatization process in Central and Eastern European transition economies using an integrative approach. Restructuring in these countries has been motivated by political and institutional changes and less so by market forces. Accordingly, political processes have produced political solutions such as “give-away” privatizations to insiders. These privatizations, in contrast to divestitures to outside owners, have realized less substantive restructuring because non-market incentives, such as too much managerial equity ownership, have created managerial entrenchment. In addition, we propose a connection between governance and organizational learning suggesting that learning is inhibited by excessive managerial ownership and lack of board knowledge regarding its oversight function. Furthermore, this entrenchment and poor board functioning may be perpetuated in financial-industrial groups, which have emerged as substitutes for market intermediaries in emerging economies. Thus, we propose that outside ownership involvement and the development of organizational capabilities may facilitate restructuring in the Central and Eastern European context. Our theoretical arguments are supported by case study evidence from transition economies.     

Can integrated infrastructure investment plans contribute to more effective public spending? The case of Mozambique

All countries, especially developing countries with limited financial resources, face difficult decisions in prioritising public funds for investment projects in the face of multiple demands in order to achieve strategic public goals. Effective investment often requires coordination between different institutions and the management of political pressure to divert investment in support of private interests. It also requires the identification of appropriate sources of funds for different purposes. The preparation of an integrated infrastructure investment plan (IIIP) that uses structured approaches to review investment proposals has been suggested, and adopted in some cases, as an instrument to address these challenges and bridge the gap between national planning and sectoral budgeting. This article considers the experience of Mozambique in deploying an IIIP as well as some recent events and concludes that the instrument may be helpful as part of a system of investment planning and allocation but that it has significant limitations.     

BAYESIAN PERSUASION WITH PRIVATE EXPERIMENTATION

This article studies a situation in which a sender tries to persuade a receiver by providing hard evidence that is generated by sequential private experimentation where the sender can design the properties of each experiment contingent on the experimentation history. The sender can selectively reveal as many outcomes as desired. We determine the set of equilibria that are not Pareto‐dominated. In each of these equilibria under private experimentation, the persuasion probability is lower and the receiver obtains access to higher quality information than under public experimentation. The decision quality improves in the sender's stakes.     

Venture Capitalists, Business Angels, and Performance of Entrepreneurial IPOs in the UK and France

Abstract:  Using a unique sample of 444 entrepreneurial IPOs in the UK and France, this paper analyses the investment patterns and the stock-market performance effects of two types of early stage investors: venture capitalists (VCs) and business angels (BAs). Extending existing research, we identify important endogeneity and institutional effects. Our findings indicate that UK IPOs have a higher retained ownership and lower participation ratio by BAs, but a lower retained ownership and participation ratio by VCs than in France. BA and VC investments are substitutes, and they are endogenously determined by a number of firm- and founder-related factors, such as founder ownership and external board 'interlocks', and underwriter reputation. UK VCs are effective third-party certifying agents who reduce underpricing in UK IPOs, whereas in French IPOs they increase it by appearing to engage in grandstanding. This certification effect is more significant in UK IPOs involving both high VC and BA ownership. Finally, underpricing increases with VC participation ratio, where the higher exit of VCs seems to increase the risk premium required by outside investors, in particular in the UK.