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.     

The ethos of business students

Business schools are the “nurseries” of the corporate world. This article offers an empirical analysis of the business student ethos on the basis of research conducted at three Dutch universities. A theoretical framework in the tradition of virtue ethics and dubbed “moral ethology” is used to identify the values business schools convey to their students. The central research question is: What types of ethos do Dutch business students have? Forty-three undergraduate students participated in Q-methodological research, a mixed qualitative–quantitative small-sample method. Five different types of ethos were generated: Do-Good Managers, Market Managers, Searching Managers, Balancing Managers, and Radical Market Managers. Some general characteristics that apply to all the types of ethos were identified, such as the search for efficiency. It is argued that business schools should pay much more attention to the values that are endorsed in both life and business and should help students to address situations in which values are neglected.     

Immigrants’ net direct fiscal contribution: How does it change over their lifetime?

Life-cycle direct public fiscal contributions and transfers are studied using longitudinal income tax data from 1982 to 2016 and administrative files for immigrants landed in Canada from 1980 to 2016. Relative to a comparison group comprising the Canadian-born and immigrants landed before 1980, immigrants since 1980 have a lower average net direct fiscal contribution (NDFC) during their working years due to their lower taxes and social security contributions but a higher average NDFC after 65 years of age because of reduced public pension eligibility and entitlement. Immigrants who landed at younger than 19 years old have much higher direct fiscal contributions than other age-at-arrival groups and reach their peak of contributions around 10 years earlier in life than other age-at-arrival groups. Immigrants whose age at arrival is above 65 have a less negative average NDFC than other age-at-arrival groups over the above-65 life cycle. These life-cycle age𠄁at-arrival trajectories are stable for immigrants in different landing cohorts. We apply the life-cycle estimates to project the present discounted value of lifetime NDFCs for immigrants who landed in 2016. For each landing age group, refugees and family class immigrants have negative or zero average present values of life-cycle NDFCs, much below that of economic immigrants.     

The Hassle Factor as a Psychological Barrier to a Green Home

Journal of Consumer Policy - In order to reach climate goals, policymakers stimulate homeowners to invest in sustainable measures in and around their house. Unfortunately, however, the number of...     

Vulnerability,due process,and reform in modern Mexico

Constitutional Political Economy - In this paper, we examine the relationship between socioeconomic vulnerabilities and due process violations in contemporary Mexico, using a novel survey of...     

A Walk in Customers' Shoes: How Attentional Bias Modification Affects Ownership of Integrity-violating Social Media Posts

The number of social media posts that expose company integrity violations has increased dramatically. In response, some companies empower employees to respond to customer blogs, which requires employees to recognize the customer's perspective. We show that attentional bias modification can be used to prime employees of two global Fortune 100 companies with a self-sufficiency or empathy bias. The results indicate that narrative transportation, or the extent to which employees mentally enter the world evoked by a customer's story, mediates the effect of attentional bias on two relevant psychological ownership dimensions: acknowledgment of responsibility and willingness to respond. Participants with a self-sufficiency bias neither acknowledge responsibility nor want to respond. However, participants primed with an empathy bias take responsibility for the customer's case and respond to the integrity violation. We find evidence for two boundary conditions of this effect: (1) it strengthens when the employee perceives the customer's financial vulnerability as high and (2) it weakens when the customer is impolite in the blog post.     

Wage and employment effects of a wage norm

Most transition countries used tax‐supported wage norms in the early 1990s, as a part of their market liberalization programmes. This article analyses how a firm‐level tax (or subsidy) on deviations from a pre‐set wage norm may promote employment by rotating the labour demand curve perceived by the workers’ union around the value of the norm. We derive the conditions under which it yields a positive employment effect. We test the effect of the norm on the wages on a sample of Polish firms in 1990 and 1991. The data support the role of the wage norm on the position of the perceived labour demand curve and the role of the tax rate on its slope.     

Capitalization of Flood Insurance and Risk Perceptions in Housing Prices: An Empirical Agent‐Based Model Approach

Federally regulated or insured lenders in the United States are mandated to require flood insurance on properties that are located in areas at high risk of flooding. Despite the existence of this mandatory flood insurance requirement, take‐up rates for flood insurance have been low, and the federal government's exposure to uninsured property losses from flooding remains substantial. Meanwhile, the value of capital at risk varies significantly with flood events and changing risk perceptions, which necessitates mechanisms that stabilize these dynamics. In this article we discuss how a scenario of complete insurance uptake, under various risk attitudes, affects the value of properties in the 100‐year and 500‐year flood zones. Our results indicate that an increase in flood insurance uptake may provide such a mechanism by lowering the value of capital at risk in the flood zone consistently, independent of homeowners' risk attitudes. We apply an empirical adaptive agent‐based model to examine the capitalization of insurance costs, risk premiums, and their interaction in housing prices. Our approach combines widely‐used empirical hedonic analysis with the computational economic framework. We highlight the usefulness of our method in capturing the marginal implicit price of homeowners' preferences that may change over time and separately assess the effect of various factors and policies on property values, illustrating the agent‐based modeling as a valuable complement to traditional hedonic analysis.     

Design principles of hybrid approaches in new product development: a systematic literature review

Setting the right approach for new product development (NPD) in the presence of uncertainty remains an ongoing debate in innovation management. Stage-gate systems (SGS) and agile methodology (AM) are the dominant approaches. Recently, hybrid approaches (combining SGS and AM) have been proposed. Although these hybrid approaches represent a significant development in NPD, combining them without considering their design principles might lead to contradictory and competing conceptual formulations, thus increasing the difficulty of comparison among studies. Moreover, scholars and practitioners may struggle to understand when, why and how a certain configuration of the NPD process provides the right response to different manifestations of uncertainty. The current literature faces problems regarding the clarity of design principles (e.g. flexibility and adaptability), and this has led to research gaps concerning the uncertainty contingency and outcomes of hybrid approaches. This study combines bibliometric and content analyses to identify four design parameters and principles of NPD hybrid approaches: flexibility, adaptability, velocity and integration. Our findings might help advance the development and comparison of different hybrid approaches.