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.     

Untapped Knowledge about Water Reuse: the Roles of Direct and Indirect Educational Messaging

Water Resources Management - Public awareness of water quality concerns has increased since the Flint, MI crisis, but knowledge about water resources management remains low. Consequently,...     

Determinants of Fair Trade Product Purchase Intention of Dutch Consumers According to the Extended Theory of Planned Behaviour

The study reported in this paper investigated the determinants of fair trade (FT) product purchase intention among Dutch consumers according to the extended Theory of Planned Behaviour and determined whether the effects of those determinants differ between male and female consumers. To test the various research hypotheses, an online survey with 499 respondents from a Dutch research panel was employed. Results of the multi-group analysis using a structural equation modelling approach reveal that FT product purchase intention of both male and female consumers are predicated on moral obligation and self-identity. The impact of subjective norm on purchase intention is statistically significant for male consumers only. Analyses reveal that, indeed, the impact of subjective norm on FT product purchase intention is moderated by consumers’ gender.     

Revisiting the expatriate failure concept: A qualitative study of Scandinavian expatriates in Hong Kong

This article advances the understanding of expatriate failure, which remains a contested social phenomenon in international work life as well as scholarly research. The study challenges the definition of expatriate failure and its inherent biases, i.e., the epistemological primacy of the firm level and the failure/success binary. We argue that this qualitative study of 51 Scandinavian expatriates in Hong Kong can contribute to advancing theory on the expatriate failure concept by asking individual expatriates what constitutes failure to them. By applying social constructionist and social anthropological ideas to the expatriate failure concept debate, we develop the internationality thesis which demonstrates a discrepancy between the expatriates’ perceptions of successful international assignments and the actual nature of their lived lives; many expatriates desire to enrich their lives through experiencing an international/intercultural and adventurous lifestyle, but, in fact, living lives with limited intercultural exposure and interaction. We conclude by proposing a reconceptualisation of expatriate failure in terms of offering both a new definition and approach to researching expatriate failure in which time/duration, context, and geographical location need to be taken into account. We believe the new approach can overcome some of the empirical unsoundness of mainstream definitions.     

Reconciling Alternative Theories for the Safety of Owner–Operators

Motor carrier safety is an important concern of shippers, carriers, policy makers, consignees, insurance providers, and the motoring public. One aspect of carrier safety that has garnered substantial attention is whether carriers making greater use of owner–operators are more or less safe vis‐à‐vis carriers making greater use of employee drivers. Currently, conflicting theoretical predictions exist regarding the direction of this relationship. In this article, we offer a reconciliation of the alternative theoretical predictions by developing a coherent theory that merges sociological rational choice theory and theory regarding motor carrier safety. We subject our theory to empirical testing by fitting a series of seemingly unrelated regression models to a vector of safety measures tracked as part of the Federal Motor Carrier Safety Administration's Compliance, Safety, and Accountability program. Our results are consistent with our proposed theory of owner—operator safety and provide meaningful theoretical and managerial implications and directions for future research.     

Results of Studies on Strengthening Retaining Walls with Composite Materials

Power Technology and Engineering - The experimental results on retaining reinforced-concrete walls reinforced with anchor ties and carbon composite materials on the face side of hydraulic...