Cost-effectiveness analysis of rivaroxaban for treatment and secondary prevention of venous thromboembolism in the Netherlands

Background: Until recently, standard treatment of venous thromboembolism (VTE) concerned a combination of short-term low-molecular-weight heparin (LMWH) and long-term vitamin-K antagonist (VKA). Risk of bleeding and the requirement for regular anticoagulation monitoring are, however, limiting their use. Rivaroxaban is a novel oral anticoagulant associated with a significantly lower risk of major bleeds (hazard ratio?=?0.54, 95% confidence interval?=?0.37–0.79) compared to LMWH/VKA therapy, and does not require regular anticoagulation monitoring.

Aims: To evaluate the health economic consequences of treating acute VTE patients with rivaroxaban compared to treatment with LMWH/VKA, viewed from the Dutch societal perspective.

Methods: A life-time Markov model was populated with the findings of the EINSTEIN phase III clinical trial to analyze cost-effectiveness of rivaroxaban therapy in treatment and prevention of VTE from a Dutch societal perspective. Primary model outcomes were total and incremental quality-adjusted life years (QALYs), as well as life expectancy and costs.

Results: Over a patient’s lifetime, rivaroxaban was shown to be dominant, with health gains of 0.047 QALYs and cost savings of €304 compared to LMWH/VKA therapy. Dominance was robustly present in all sensitivity analyses. Major drivers of the differences between the two treatment arms were related to anticoagulation monitoring (medical costs, travel costs, and loss of productivity) and the occurrence of major bleeds.

Conclusion: Rivaroxaban treatment of patients with venous thromboembolism results in health gains and cost savings compared to LMWH/VKA therapy. This conclusion holds for the Dutch setting, both for the societal perspective, as well as the healthcare perspective.     

From a System of National Accounts to a Process of National Wellbeing Accounting

There are repeated calls to go ‘Beyond GDP’, for measures of wellbeing and progress in addition to those that the System of National Accounts (SNA) is designed to provide. We identify key issues that can help build on the rigour of SNA whilst fitting the measurement of economic performance within a broader assessment of national wellbeing and progress. Such drivers are already leading to a proliferation of indicators and accounts, for example in the development of non‐monetary measures of natural resources, but there are significant measurement challenges, not least the question of whether a single, overall measure or index of wellbeing is valid. But the challenge of measurement, per se, is one thing: in our view, a more critical issue is whether the measures will actually be used. We propose a dynamic and multi‐staged approach for developing SNA, embracing the production and use of measures. This would start by identifying user requirements for wider measures, to provide the basis for national and cross‐national developments in well‐being accounting. We envisage greater branding and marketing of national well‐being concepts to promote measures and support their use. We call for outreach by producers, so that there is dialogue about the development and use of measures.     

International Capital Flows in the Model with Limited Commitment and Incomplete Markets

Recent literature has proposed two alternative types of financial frictions, i.e., limited commitment and incomplete markets, to explain the empirical patterns of international capital flows between developed and developing countries in the past two decades. This paper integrates these two frictions into a two-country overlapping-generations framework to facilitate a direct comparison of their respective effects. In our model, limited commitment distorts the investment made by agents with different productivity, which creates a wedge between the interest rates on equity capital vs. credit capital; while incomplete markets distort the investment among projects with different riskiness, which creates a wedge between the risk-free rate and the mean rate of return to risky capital. We show that the two approaches are observationally equivalent with respect to their implications for international capital flows, production efficiency, and aggregate output.     

Critical success factors for the sustainability of Kaizen event human resource outcomes: An empirical study

Kaizen events have been widely reported to produce positive change in business results and human resource outcomes. However, sustaining or improving upon the results of a Kaizen event over time can be difficult for many organizations and has received limited empirical research attention to date. This paper identifies the factors that most strongly influence the sustainability of work area employee attitudes and commitment to Kaizen events based on a field study of 65 events in eight manufacturing organizations. The findings also present guidelines for organizations and areas for future research.     

Political Leaders' Socioeconomic Background and Public Budget Deficits: Evidence from OECD Countries

This paper empirically analyzes the relationship between political leaders' socioeconomic backgrounds and public budget deficits utilizing panel data on 21 OECD countries from 1980 to 2008. Building on sociological, as well as economic research, we argue that the socioeconomic status of political decision‐makers, i.e., presidents or prime ministers, is an important determinant of fiscal budget decisions. Our theory‐consistent findings show that the tenures of lower‐class leaders – i.e., leaders of low socioeconomic status – are associated with a deficit‐to‐GDP ratio which is 1.6 percentage points higher than that during tenures of upper‐class leaders.     

WHICH AGGLOMERATION EXTERNALITIES MATTER MOST AND WHY?

This paper revisits the ongoing discussion on the importance of agglomeration externalities – specifically specialization, diversity and competition effects – that may contribute to innovation, productivity and urban employment growth. Previous meta‐analyses suggested that the evidence on agglomeration externalities is strongly context‐specific. Expanding an earlier analysis of 31 articles, we seek to draw in this paper more robust conclusions by means of the statistical evidence for agglomeration externalities presented in 73 scientific articles, all building on the seminal work of Glaeser et al. (1992). Our results confirm that the heterogeneity among studies is huge and can only be partially accounted for by means of an ordered probit analysis. Additionally, some evidence of publication bias is found. We conclude that the conventional lines of inquiry in this literature may now have reached strongly diminishing returns. New lines of inquiry, using rich micro‐level data on firms and workers, dynamic general equilibrium models at the macro level, more attention for spatial and temporal variation in the impacts of agglomeration, and further investigations into the spatial scope of externalities are promising avenues for further research that can enhance our understanding of how agglomeration externalities continue to fuel our increasingly urbanized world.     

Die Auswirkungen der Finanzkrise sowie von Solvency II auf <Emphasis Type="Italic">Insurance-linked Securities</Emphasis>

Der Beitrag stellt Insurance-linked Securities (“ILS”) als Instrument des alternativen Risikotransfers dar und grenzt ILS von anderen Instrumenten des alternativen Risikotransfers ab.     

Modern Slavery Disclosure Regulation and Global Supply Chains: Insights from Stakeholder Narratives on the UK Modern Slavery Act

Journal of Business Ethics - The purpose of this article is to problematise a particular social transparency and disclosure regulation in the UK, that transcend national boundaries in order to...