Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results

Aims: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6–12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates.

Methods: Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA).

Results: Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (–$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI]?=?–$1,454 [–$2,396, $1,231]).

Limitations: This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited “real-world” applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems.

Conclusions: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6–12 months of VTE treatment.     

Transmission of information within transnational social networks: a field experiment

Several studies have shown a relationship between the stocks of migrants and country-level investment in the home country; however the mechanism through which this relationship operates is still unexplored. We use a field experiment in which participants who are recent immigrants send information about risky decisions to others in their social network in their home country. The results demonstrate how this information influences decisions in the home country. We find that the advice given by family members and decisions made by friends significantly affects an individual’s risky decision-making.     

Dreissenid veliger dynamics along a nearshore to offshore transect in Lake Michigan

Dreissenid mussel veligers compose a substantial component of pelagic biomass in the Great Lakes, yet their dynamics are poorly understood. To evaluate seasonal, spatial, and inter-annual variation in veliger density, we used a 64-μm mesh plankton net (2008, 2013–2016) and a 153-μm mesh plankton net (2007–2016) to collect dreissenid veligers at nearshore (15–25?m depth), transitional (45?m) and offshore (93–110?m) sites in southeast Lake Michigan during March–December. We also evaluated trends in density of recently settled mussels relative to veliger abundance and the density of the standing stock of adult mussels. Veliger density peaked during both summer and fall at all sites, but peak densities in summer were generally higher nearshore, whereas peak densities in the fall were generally higher offshore. The density of veligers in the 153-μm net was overall 28% of that in the 64-μm net, but there was high variability in this comparison among months. Smaller veligers were much more abundant in the 64-μm net, but there was little difference in the size distribution and abundance between nets for the 210–300?μm size classes. Thus, the 153-μm net could still be a useful tool for assessing density trends of larger veligers just prior to their settlement. Newly settled mussels (≤2?mm) were most abundant in summer or fall at the nearshore and offshore sites but were nearly absent at the transitional site despite the high density of veligers there. Factors other than veliger density must play an important role in mussel recruitment.     

Influence of episodic wind events on thermal stratification and bottom water hypoxia in a Great Lakes estuary

Hypoxia formation and breakdown were tracked during 2015 in Muskegon Lake estuary at multiple locations, and five years (2011–2015) of time-series buoy observatory data were evaluated for the effect of episodic wind-events on lake mixing. Bi-weekly water temperature and dissolved oxygen (DO) profiles at four locations revealed that hypoxia occurred at all sites and persisted for 2–3 months during summer 2015. On one date in late-summer, up to 24% of the lake’s volume was estimated to be mildly hypoxic (DO < 4 mg L^?1) as defined by lake sturgeon requirements. Patterns of wind speed and water column stability in late spring indicated that high winds and low stability delayed the onset of hypoxia while in late summer low winds and high stability delayed degradation of hypoxia. Wind speeds appear to play a great role in the interannual variability of stratification and subsequent hypoxia. Water temperature and DO profiles taken before and after one mid-summer mixing event (wind speed >7.7 m s^?1 for 10 h), indicated that while the wind was unable to completely mix the entire water column, it deepened the epilimnion by ～1.5 m and sheared a thin layer from the upper hypolimnion. By entraining internally loaded nutrients, such episodic wind-events may initiate and sustain algal blooms in nutrient limited surface waters. Quantifying the variable role of wind and mixing events will be key to integrating limnological processes into climate models of the future.     

The Effect of Media Coverage on the Pricing of Seasoned Equity Offerings

This paper examines the role of media coverage and investor attention on the outcomes of seasoned equity offerings (SEOs). I use an archive of Thomson Reuters news articles to proxy for firm visibility and investor attention. I find that the volumes of news articles prior to the offerings are positively associated with the offer price discounts of SEOs. Furthermore, the volumes of news articles are negatively associated with the cumulative abnormal returns three days around the SEOs. I conclude that the costs of equity increase with media coverage prior to SEOs. Overall, the evidence is consistent with the hypothesis that media coverage affects investors' information processing in SEOs. Copyright © 2018 ASAC. Published by John Wiley & Sons, Ltd.     

Flood Risk and Salience: New Evidence from the Sunshine State

A growing literature finds evidence that flood risk salience varies over time, spiking directly following a flood and then falling off individuals' cognitive radar in the following years. In this article, we provide new evidence of salience exploiting a hurricane cluster impacting Florida that was preceded and followed by periods of unusual calm. Utilizing residential property sales across the state from 2002 through 2012, our main estimate finds a salience impact of ?8%, on average. The salience effect persists when we base estimation only on spatial variation in prices to limit confounding from other simultaneous changes due to shifting hedonic equilibria over time. These effects range from housing prices decreases of 5.4–12.3% depending on the year of sale. Understanding flood risk salience has important implications for flood insurance and disaster policy, the benefits transfer literature, and, more broadly, our understanding of natural disaster resilience. JEL Classification: Q51, Q54, R21     

Comparison of Sharp Interface to Variable Density Models in Pumping Optimisation of Coastal Aquifers

Water Resources Management - A number of models have been developed to simulate seawater intrusion in coastal aquifers, which differ in the accuracy level and computational demands, based on the...