Economic evaluation of dabigatran etexilate for the primary prevention of venous tromboembolic events following major orthopedic surgery in the Netherlands

Abstract

Objectives:

Dabigatran etexilate is a new oral direct thrombin inhibitor for prophylaxis of venous thromboembolism (VTE) in patients who have elective surgery for total hip replacement (THR) or total knee replacement (TKR). Among the advantages of dabigatran etexilate over subcutaneous prophylaxis with Low Molecular Weight Heparin (LMWH) are reduced resource uses for (i) teaching patients to self-inject; (ii) home-care visits for subcutaneous administration; and (iii) absence of heparin-induced thrombocytopenia (HIT). Based on the demonstrated non-inferiority, the aim of this study was to conduct a cost-minimization analysis of oral dabigatran etexilate vs subcutaneous low-molecular weight heparin (LMWH) and fondaparinux from the Dutch healthcare perspective.

Methods:

A retrospective cohort study was conducted to measure resource use associated with subcutaneous prophylaxis. Results of this study were used in the model to elucidate specific advantages of dabigatran etexilate, next to reduced needs for self-inject teaching and lack of Heparin-Induced Thrombocytopenia. Drug and other resource utilization data were combined with local unit costs. Probabilistic sensitivity analysis was performed to account for uncertainty around relevant parameters included.

Results:

Home-care visits for subcutaneous administration problems were needed in 9.9% (95% CI?=?6.4–13.4) and 9.6% (95% CI?=?5.8–13.4) of THR and TKR patients, respectively. Based on costs for 1000 patients treated with dabigatran etexilate vs LMWHs, per patient cost-savings with dabigatran etexilate were estimated at €30.68 (95% CI?=?2.01–65.52) and €23.19 (95% CI?=?0.69–48.48) for THR and TKR, respectively. The probability that dabigatran etexilate would be cost-saving was estimated at 98.3% and 97.9% for THR and TKR, respectively. These cost-savings were even higher when including fondaparinux in the analysis, with per patient cost-savings of €69.87 (43.42–106.10) and €18.33 (1.63–41.26) for THR and TKR, respectively. Separate calculations for dabigatran etexilate vs nadroparin and dalteparin in THR resulted in probabilities of achieving cost-savings with dabigatran etexilate of 36.2% and 100%, respectively. For TKR these probabilities were estimated at 54.3% and 100%, respectively.

Conclusions:

Thromboprophylaxis with dabigatran etexilate is cost-saving in patients undergoing THR and TKR from the Dutch healthcare perspective, compared to subcutaneous LMWHs.     

Cost-effectiveness of partially-hydrolyzed formula for prevention of atopic dermatitis in Australia

Abstract

Objective:

To perform an economic evaluation of a specific brand of partially hydrolyzed infant formula (PHF-W) in the prevention of atopic dermatitis (AD) among Australian infants.

Methods:

A cost-effectiveness analysis was undertaken from the perspectives of the Department of Health and Aging (DHA), of the family of the affected subject and of society as a whole in Australia, based on a decision-analytic model following a hypothetical representative cohort of Australian newborns who are not exclusively breastfed and who have a familial history of allergic disease (i.e., are deemed ‘at risk’). Costs, consequences, and incremental cost-effectiveness ratios (ICER) were calculated for PHF-W vs standard cow’s milk based infant formula (SF), and, in a secondary analysis, vs extensively hydrolyzed infant formula (EHF-Whey), when the latter was used for the prevention of AD.

Results:

From a representative starting cohort of 87,724 ‘at risk’ newborns in Australia in 2009, the expected ICERs for PHF-W vs SF were AU$496 from the perspective of the DHA and savings of AUD1739 and AU$1243 from the family and societal perspectives, respectively. When compared to EHF-Whey, PHF-W was associated with savings for the cohort of AU$5,183,474 and AU$6,736,513 from the DHA and societal perspectives.

Limitations:

The generalizability and transferability of results to other settings, populations, or brands of infant formula should be made with caution. Whenever possible, a conservative approach directing bias against PHF-W rather than its comparators was applied in the base case analysis. Assumptions were verified in one-way and probabilistic sensitivity analyses, which confirmed the robustness of the model.

Conclusions:

PHF-W appears to be cost-effective when compared to SF from the DHA perspective, dominant over SF from the other perspectives, and dominant over EHF-Whey from all perspectives, in the prevention of AD in ‘at risk’ infants not exclusively breastfed, in Australia.     

公共行政中的人性假设：事实与价值的论辩

“公共行政中的人是什么”是自公共行政创立以来所要回答的首要问题。在事实层面,行政人员有着个人的利益诉求,以“经济人”的方式生活,但在价值层面,公共行政组织的规范目的应当是追求和实现公共利益,行政人员必须坚持以“公共人”为价值取向,这也是现代社会公共行政的发展的必然要求。欲使行政人员成为真正的“公共人”,制度建设和道德建设都很重要,只有双管齐下,行政人员才有可能自觉接受公共精神准则的制约,切实维护公共利益。     

Has SOX Enhanced Non–Big 4 Auditors' Ability to Deal with Client Pressure?

We investigate whether non–Big 4 auditors have enhanced their ability to resist client pressure over accrual reporting following the Sarbanes‐Oxley Act (SOX). Regressing abnormal accruals on proxies for economic bonding, we find that changes in the association, defined as (Post–Pre), are significantly negative, implying an improvement in auditor independence after SOX. Among non–Big 4 auditors, only Tier 3 auditors compromised reporting objectivity before SOX, but neither Tier 2 nor Tier 3 auditors yielded to client pressure after SOX. Evidence that these two groups of non–Big 4 auditors differ in the way they cope with client pressure in a loose regulatory regime highlights the importance of assessing the efficacy of SOX separately for subsets of auditors and contributes to an understanding of the underresearched, but inherently important, segment of the audit market served by non–Big 4 auditors. Further analysis indicates that the low pre‐SOX audit quality observed in the full sample is driven by non–PCAOB registrants.     

Disparities in the financial performance of agricultural entities according to the legal form: the case of Slovakia

Financial management in agricultural enterprises is affected by a range of factors that are not present in other sectors. One of the factors that affect the performance of enterprises is the legal or organizational form of the business. In Slovakia, the specific structure of farms is different from that of almost any other member state of the European Union. The aim of this paper is to evaluate the disparities in the financial performance of agricultural enterprises according to the legal form. We analysed and compared two groups of agricultural entities, agricultural cooperatives and business companies, for the period from 2005 to 2014. Based on an analysis of the differences using mathematical and statistical methods, we can conclude that the legal forms are distinguished in all monitored parameters and our hypothesis on the differences in economic performance of agricultural entities according to legal form was confirmed.     

From necessities to imaginary worlds: Structural change,product quality and economic development

In this paper we explore how innovation and structural change affected economic development in the long run, by which we mean a period such as the one between the industrial revolution and the present. We separate the period since the industrial revolution into two sub periods, which we call ‘necessities’ and ‘imaginary worlds’ and focus on three trajectories, increasing productive efficiency, increasing output variety, and increasing output quality and differentiation. In the paper we show how a combination of the three trajectories gave rise to the transition between ‘necessities’ and ‘imaginary worlds’ and propose a mechanism of economic development which could have given rise to the type of economic system which we can observe today. To create growing output quality and differentiation higher competencies were required. These higher competencies required higher levels of education and demanded higher wages, which contributed to raise consumers' purchasing power. These phenomena, combined with the income effect of the creation of new sectors, generated the disposable income with which consumers could purchase the new, higher quality, non necessities, goods and services generated by innovation. In the paper we study the impact of several model parameters on the stability of the virtuous circle previously described.     

Systemic technology policies: Issues and instruments

In this Introduction, we review the arguments that underpinned the workshop on which the special section is grounded and provide a structured sequence for the contents of the seven selected papers that comprise the section.     

Keynes and Sraffa's 'Difficulties with J. H. Hollander'

The paper reports on Jacob H. Hollander's cooperation with John Maynard Keynes and Piero Sraffa in the preparation of the latter's edition of The Works and Correspondence of David Ricardo. The report is based on archive material from various sources, including the unpublished papers of Edwin Cannan, Piero Sraffa, Jacob H. Hollander, John Maynard Keynes, and Jacob Viner, and the archive of the Royal Economic Society. The archive material consulted by us shows that, put mildly, Jacob H. Hollander did not promote Sraffa's editorial project: he held back material which he had received from Frank Ricardo and did not disclose to Sraffa that he owned several important letters which he had privately purchased. Moreover, Sraffa was refused access to Ricardiana even after he had traced them down in laborious detective work to be in Hollander's possession. Hollander's unwillingness to cooperate with Sraffa considerably delayed the publication of the Ricardo edition.     

Introduction to the Special Issue: Management in Africa in the Global Context 1

ABSTRACT

The primary focus of this introductory article is to provide a synoptic peek into the challenges and opportunities facing the countries of Africa in today's global economy and in their attempts to develop their national economies to achieve what is commonly termed the Millennium Development Goals. While foreign direct investment (FDI) is seen as a way to attain these goals, FDI flows to African countries remain extremely low. If Africa is to attract diversified FDI inflows, not just those focused on extractive/natural resources, African countries need to develop a system of management that is effective and efficient, internationally oriented and nationally focused, culturally inclusive and institutionally supportive and reliable, and one that promotes business growth and economic development with a sense of social responsibility.     

体面劳动问题研究的新进展与未来研究展望

全球化加剧了劳资关系的不平衡状态,强资本弱劳工的局面得以维护并日益加强,资方为追求利益最大化而忽视劳动者利益的事情屡屡发生。随着转型时期经济社会改革的深入推进,劳资关系问题也越来越引起人们的关注并成为社会的焦点问题之一,全面实现体面劳动成为各级政府的重要方针,企业、各类劳动组织以及劳动者都对实现体面劳动发出了强烈的呼声。金融危机后体面劳动研究有了新进展,未来体面劳动问题研究也大有可为。