The goal of this study is to determine the cost-effectiveness of MIRISK VP, a next generation coronary heart disease risk assessment score, in correctly reclassifying and appropriately treating asymptomatic, intermediate risk patients.
Study design:
A Markov model was employed with simulated subjects based on the Multi-Ethnic Study of Atherosclerosis (MESA). This study evaluated three treatment strategies: (i) practice at MESA enrollment, (ii) current guidelines, and (iii) MIRISK VP in MESA.
Methods:
The model assessed patient healthcare costs and outcomes, expressed in terms of life years and quality-adjusted life years (QALYs), over the lifetime of the cohort from the provider and payer perspective. A total of 50,000 hypothetical individuals were used in the model. A sensitivity analysis was conducted (based on the various input parameters) for the entire cohort and also for individuals aged 65 and older.
Results:
Guiding treatment with MIRISK VP leads to the highest net monetary benefits when compared to the ‘Practice at MESA Enrollment’ or to the ‘Current Guidelines’ strategies. MIRISK VP resulted in a lower mortality rate from any CHD event and a modest increase in QALY of 0.12–0.17 years compared to the other two approaches.
Limitations:
This study has limitations of not comparing performance against strategies other than the FRS, the results are simulated as with all models, the model does not incorporate indirect healthcare costs, and the impact of patient or physician behaviors on outcomes were not taken into account.
Conclusions:
MIRISK VP has the potential to improve patient outcomes compared to the alternative strategies. It is marginally more costly than both the ‘Practice at MESA Enrollment’ and the ‘Current Guidelines’ strategies, but it provides increased effectiveness, which leads to positive net monetary benefits over either strategy. 相似文献
A stock listing usually reflects easy access to external equity financing. Although scant empirical evidence exists on the matter, the literature suggests that the enhanced standing towards creditors - which would result in easier access to debt financing - is an extra advantage of being publicly quoted. This paper tests whether a stock listing leads to more flexibility of debt financing, using a data set of listed and comparably large unlisted companies. The data reveals that listing mainly increases the flexible use of debt financing. The difference between listed and unlisted firms is most apparent when investment opportunities tend to arrive in low-cash-flow states. Furthermore, as the unlisted firms in the dataset are all large consolidating business groups, the results indicate that a group structure does not substitute for listing. The results are robust to different estimation methods. 相似文献
Executive compensation, especially cash bonus compensation, has come under fire by the Securities and Exchange Commission (SEC), the US Federal government, and the media for its role in the current economic crisis. Specifically, the SEC has argued that some compensation packages provide incentives for risk-taking that may undermine shareholder value over the long-term. Short-term incentive payments to executives in the form of cash bonuses are mostly contingent on reaching targets of accounting-related measures or financial performance measures (FPMs). However, the incentives from these payments may lead to accrual manipulation and earnings management (EM). Alternative measures are non-financial performance measures (NFPMs). We expect that firms that employ NFPMs in bonus contracts will have a lower prevalence of EM, since these measures tend to focus executives on the long-term. In this paper, we examine the type of performance measures used by firms in the S&;P 500 index in their cash bonus compensation. We find that firms that use both FPMs and NFPMs have lower discretionary accruals compared to firms that use only FPMs, consistent with lower income-increasing EM. However, we do not find evidence of a reduction in EM behavior using the incidence of meeting or just beating analyst earnings benchmarks, another common EM proxy. In additional tests on a subset of firms with equity offerings, in which incentives for income-increasing manipulation are likely high, we find that firms with NFPMs have lower discretionary accruals. The implication is that NFPMs can be used in compensation contracts to reduce EM behavior and mitigate erroneous executive compensation. This is important to investors as well as regulators, especially in light of the recent debate on compensation reform. 相似文献
Sustainable development and marketing are applied across the tourism spectrum, yet a need exists to make them relevant to specific forms of tourism, such as wine tourism. In this consumer-driven economy, tourism marketers often seek effective ways to market destinations. This study attempts to identify the environmental wine tourist by examining environmental personality characteristics and certain demographics on purchase intention, thus making it possible to better understand their concerns and motivations, which should aid marketing and advertising efforts. The results suggest wine tourists may be willing to pay for environmentally friendly wines with females possessing stronger environmental attitudes about protecting wine region destinations, thus influencing stronger behaviors toward purchase intention. 相似文献
Here the author considers the reasons for the current disillusionment of many concerned with ‘equal opportunities’ policies in employment and reviews the potential of an EO orientation for progressive change within organisations and draws on her current research on responses to EO, citing a company in the retail sector. 相似文献
Consumers may have learned to generalize from usage experiences that nationally advertised, name-brand items tend to be higher
in quality than unadvertised brands. Such generalization may have prompted the substitution of brand-name evaluations for
search in quality assessments of nondurable experience goods. This paper offers theoretical arguments which suggest that if
some consumers do not search, all firms in nondurable, experience goods markets can increase their profits if some substitute
dissipative advertising (i.e., advertising which ignores information about product performance characteristics) of brand names
for product quality enhancements. Undersearching by consumers invites firms to downgrade value in nondurable, experience goods
markets. In support of the hypothesized substitution by consumers of brand-name evaluations for search in nondurable, experience
goods markets, this paper reports results of a field experiment in which the influences on quality assessments of brand name
and product composition were studied in two categories where dissipative advertising is heavily relied upon. Results suggest
that branding is relied upon more heavily than search to assess quality, even when brand cues are inconsistent with actual
quality levels and search is costless, suggesting that dissipative advertising can be extremely effective. 相似文献
ABSTRACT We revisit Karen Legge's (2001 ) critique of HRM in which she argues that the attempt of modernist/positivist HRM research to show that HRM improves organizational performance is a 'spent round'. We note that despite spirited challenges by Legge and others, the discourse of HRM is becoming increasingly dominant. Accordingly, we use discourse analysis to examine why this might be the case. Specifically, we analyse the texts produced in the engagement between Karen Legge and David Guest to show how modernist/positivist texts like those of Guest have been successful in constructing an identity for HRM and embedding it in the broader academic discourse concerning the employment relationship, while critical researchers like Legge face a number of difficulties in producing 'counter-texts'. 相似文献
This paper provides additional evidence on the usefulness of duration as a strategy tool by developing a two-factor duration model and by using a reasonably reliable database to compare empirically the relative performance of maturity, one-factor duration, and two-factor duration matching strategies in immunizing portfolios of default-free and option-free bonds against interest rate risk. The results suggest that, on average, duration models, even for arbitrarily assumed simple stochastic processes, are more accurate than maturity models and that increased accuracy may be achieved by increasing the length of the planning period and the number of factors in the model. 相似文献
The suggestion by Mr. Bumb that several of our factor analyses are spurious is questioned on both technical and empirical grounds. Evidence of exceeding robustness of our factor-analytic results is presented. 相似文献