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. 相似文献
To date, the plausibility of theories of choice under risk hinges are mainly on experimental evidence. This paper devises and implements an approach amenable of assessing the performance of three families of models (expected utility, rank-dependent expected utility, and the cumulative prospect theory) using information from financial asset markets. Our findings unequivocally support reference-point dependence, diminishing marginal sensitivity, loss aversion, and nonlinear weighting of (gain and loss) physical probabilities. The empirical observations are found to be robust to, inter alia, the parameterization of the utility and probability weighting functions, “day-of-the-week effects”, the choice of a reference point, and the introduction of possible, low-probability market crashes (peso component). 相似文献
We show that incorporating distribution costs into a general equilibrium model of international portfolio choice helps to explain the home bias in international equity investment. Our model is able to replicate observed investment positions for a wide range of parameter values, even if agents have an incentive to hedge labor income risk by purchasing foreign equity. This is because the existence of a retail sector affects both the correlation of domestic returns with the domestic price level and the correlation between financial and non‐financial income. 相似文献
Aims: Data highlighting the cost drivers for non-valvular atrial fibrillation (NVAF) patients in terms of vitamin K antagonist (VKA) treatment and monitoring are lacking in France. This study aimed to evaluate the real-life daily cost of VKA treatment in 2013, in French patients suffering from NVAF.
Methods: This longitudinal observational study was performed using the EGB (Echantillon Généraliste des Bénéficiaires) database, a random sample of the French national insurance (NHI) database, which covers 80% of the population. All adult patients whose first NVAF anticoagulant treatment in 2013 was a VKA were analyzed. Costs were calculated for the duration of follow-up and then divided by the number of days of therapy. The analysis was performed both from the French NHI perspective (amount reimbursed by the NHI) and from a collective perspective.
Results: In this study, 3,254 NVAF patients treated with VKA in 2013 were included, and this sample comprised 52.6% males. The mean daily cost of VKA treatment was €1.13 (±1.18) according to the collective perspective (89.4% of this cost was associated to INR measurement) and €1.05 (±1.16) according to the NHI perspective.
Limitations: As diagnoses associated with procedures are not available in the EGB database, proxies were used, and an algorithm was created to define the AF population.
Conclusions: This analysis is the first to consider an exhaustive spectrum of the costs of VKA treatment in France using EGB data. VKA medication requires exhaustive follow-up, and, thus, associated costs are important. The results of the present study confirmed this close follow-up for VKA patients, making the cost of treatment by VKA nearly 10-times more expensive than the cost of medication itself. 相似文献
In recent decades, the media have covered many cases of corruption related to the celebration of mega-events around the globe. In most of these cases, politicians and other high officials are involved. This paper analyses the effect of hosting mega-events on the level of perceived corruption in 34 OECD countries, during 1996–2017. Summer and Winter Olympic Games, FIFA World Cups, and Universal Expositions are considered. Results show that, when we take the year of the celebration of the event as the turning point, there is no robust evidence in favour of a positive impact on perceived corruption. However, when we take the election date of the host country as the threshold, the magnitude of the effect is lasting, reaching its maximum value 1–2 years before the celebration itself, and increasing the perceived level of corruption by about 4%. 相似文献
As indicators of social welfare, the incidence of inequality and poverty is of ongoing concern to policy makers and researchers alike. Of particular interest are the changes in inequality and poverty over time, which are typically assessed through the estimation of income distributions. From this, income inequality and poverty measures, along with their differences and standard errors, can be derived and compared. With panel data becoming more frequently used to make such comparisons, traditional methods which treat income distributions from different years independently and estimate them on a univariate basis, fail to capture the dependence inherent in a sample taken from a panel study. Consequently, parameter estimates are likely to be less efficient, and the standard errors for between-year differences in various inequality and poverty measures will be incorrect. This paper addresses the issue of sample dependence by suggesting a number of bivariate distributions, with Singh–Maddala or Dagum marginals, for a partially dependent sample of household income for two years. Specifically, the distributions considered are the bivariate Singh–Maddala distribution, proposed by Takahasi (1965), and bivariate distributions belonging to the copula class of multivariate distributions, which are an increasingly popular approach to modelling joint distributions. Each bivariate income distribution is estimated via full information maximum likelihood using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey for 2001 and 2005. Parameter estimates for each bivariate income distribution are used to obtain values for mean income and modal income, the Gini inequality coefficient and the headcount ratio poverty measure, along with their differences, enabling the assessment of changes in such measures over time. In addition, the standard errors of each summary measure and their differences, which are of particular interest in this analysis, are calculated using the delta method. 相似文献
We investigate the firm-level investment response to unanticipated narrative shocks to average personal and corporate tax rates using a universal micro dataset of publicly-traded U.S. firms for the post-1976 period. Using local projections, we show that: (i) corporate tax shocks have significant effects on investment while personal tax shocks do not; (ii) corporate income tax responses are negative overall, and this result is driven by smaller firms who face larger borrowing constraints, especially when the accompanying monetary policy is contractionary or output gap is slack; (iii) there is some evidence of positive personal income tax responses during monetary contractions by dividend-paying firms, which is consistent with the recent literature. 相似文献
The data of the Russian Longitudinal Monitoring Survey (RLMS) – Higher School of Economics represents one of the few nationally representative sources of household and individual data for Russia. These data have been collected since 1992 and in recent years, thanks to more secure financial and logistical support, have become a resource increasingly drawn upon by scholars and students for national and cross-national studies. In this paper, we examine the extent of non-random attrition in the RLMS and discuss the circumstances under which this might give rise to biases in econometric analysis. We illustrate this with an example drawn from the health sphere. 相似文献
In this paper, we supplement the identification results for the mean treatment effect for the treated in the difference-in-differences framework studied by Abadie (2005) by establishing partial identification results for the distribution and quantile of the counterfactual outcome and of the treatment effect for the treated. Unlike the mean treatment effect which is identifiable from either the panel or the repeated cross sectional data, we show that the distribution/quantile of either the counterfactual outcome or of the treatment effect is only partially identified and in general the identified interval is tighter with panel than with the repeated cross sectional data. We further illustrate this gain from the panel via a numerical example. 相似文献
