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.     

A rational rank four demand system

Past parametric tests of demand system rank employed polynomial Engel curve systems. However, by Gorman's ( 1981 ) theorem, the maximum possible rank of a utility‐derived polynomial demand system is three. The present paper proposes a class of demand systems that are utility derived, are close to polynomial, and have rank four. These systems nest rational polynomial demands, and so can be used to test ranks up to four. These systems are suitable for applications where high rank is likely, such as demand systems involving a large number of goods. A test of rank using this new class of systems is applied to UK consumer demand data. Copyright © 2002 John Wiley & Sons, Ltd.     

Saving Accounts versus Stocks and Bonds in Household Portfolio Allocation

We study the structure of household portfolios of financial wealth by analyzing both the determinants of total financial wealth and the choice between risky (stocks and bonds) and riskfree assets (saving accounts). The econometric specification is a generalized trivariate Tobit model, estimated on a cross section of 3,077 households in the Netherlands in 1988. We account for endogeneity of financial wealth and for selectivity due to nonreporting. Results show that the level of financial wealth and the marginal tax rate are major determinants of the allocation between riskfree and risky assets.     

Procedures for revising management judgments forecasts

Forecast improvement is often approached by attempting to find the “best” model for a given situation. Less attention has been paid to the possibility of examining past prediction errors for patterns that may suggest forecast adjustments for the future. This empirical study involves one firm’s management judgment forecasts for product sales and the attempts made to improve their accuracy by removing certain types of bias. In three of the five series examined, error reduction averaging close to thirty percent occurs as a result of the adjustment procedure. The other two series proved to be relatively free from bias and were therefore not in need of the correction method described.     

The Falsification of Four Popular Hypotheses About the Asian Crisis

Various claims have been made about the causes of the Asian crisis and its spread. Here, we use data on the behaviour of capital flows during the crisis to test the strong forms of four such hypotheses, that portfolio investors and hedge funds played a dominant role in initiating and/or spreading the crisis; that moral hazard kept efficient markets from predicting the crisis; and, finally, the common lender hypothesis of Kaminsky and Reinhart. In the process we also test implications of the Calvo-Mendoza model of rational investor ignorance. All are falsified as monocausal explanations. For example, portfolio investments that could not have been subject to substantial moral hazard continued to flow into Asia until very shortly before the crisis. Likewise, banks were a much larger source of capital outflows during the crisis than were portfolio investors. While falsified in their strongest forms, several of these hypotheses in less strong forms should play a role in a more nuanced analysis. It is necessary to move past simple single-factor approaches in order to produce a more complete, synthetic explanation of this episode.     

Measuring Market Orientation: Exploring a Market Oriented Approach

This paper demonstrates that applications of existing approaches to measuring market orientation are myopic, non-comparative and over-reliant on the views of single respondents. Consequently, a multi-perspective, multi-informant approach for measuring market orientation is generated which focuses on gauging customers', competitors' and intra-organizational members' perceptions of the market orientation of an organization. To evaluate the psychometric properties of this approach an application of this design in a survey of manufacturing industry is subjected to tests for inter-rater reliability, scale reliability, content validity, criterion-related validity and construct validity. The conclusion of this evaluation is that the developed measure is both a reliable and valid means of gauging market orientation. The paper concludes with a series of implications for both theorists and practitioners.     

Background Risk and the Performance of Insurance Markets under Adverse Selection

Background risk can influence the performance of insurance markets that must deal with adverse selection when applicants are risk vulnerable, since they are more averse to bearing the insurable risk as a result of their exposures to background risk. We show that background risk always results in a lower deductible for the incentive constrained contract, and that a broader range of markets attains the stable sequential equilibrium cross-subsidized pair of separating contracts. We conclude that background risk always improves the performance of markets for coverage against (insurable) foreground risks that must deal with adverse selection. We also find, however, that these improvements are never sufficient to offset the cost to insureds of bearing the background risk.     

Myopic loss aversion and the equity premium puzzle reconsidered

Benartzi and Thaler [The Quarterly Journal of Economics 110 (1995) 73–92] offer a quasi-rational explanation for the equity premium puzzle. We reconsider their methodology and, making a simple modification to it, find that their analysis is not robust.     

Furthering the integration of marketing and logistics through customer service in the channel

Recent emphasis on customer service in both the academic and trade literature reveals a growing but confusing body of knowledge. Both the marketing and logistics disciplines have offered varying definitions of customer service, but have failed to offer a comprehensive framework which represents customer service and its related marketing and logistics issues. This article offers the viewpoint that customer service is a conceptual unifying factor for integrating marketing and logistics. The channel system is introduced as the vehicle by which buyer/seller relationships must be analyzed to understand formation of buyer expectations, interaction of marketing and logistics activities, and subsequent customer service performance. The institutional, behavioral, and physical dimensions of channel activity influence many of the marketing and logistics decisions made by management. The framework offered in this article differs from previous efforts in that customer service is the output of the unified activities of marketing and logistics. It considers marketing and logistics decisions jointly, re-evaluates and expands the production function in logistics, and ties customer service to customer satisfaction or dissatisfaction.     

The evolution of rationality and the Red Queen

Strategic rationality is subjected here to natural selection. In a zero-sum repeated game of incomplete information, one long-run individual is informed of the state of the world, and plays against a sequence of short-run opponents who are not. Strategies are noisy and have bounded recall. An equilibrium in these is shown to exist. Relative to any such equilibrium, sufficiently greater recall enjoys an advantage that is not decreasing in the original level of recall, thus capturing the Red Queen effect. The selection pressure to reduce a small amount of noise is less than that to increase recall.