Cost-effectiveness analysis of rivaroxaban for treatment and secondary prevention of venous thromboembolism in the Netherlands

Background: Until recently, standard treatment of venous thromboembolism (VTE) concerned a combination of short-term low-molecular-weight heparin (LMWH) and long-term vitamin-K antagonist (VKA). Risk of bleeding and the requirement for regular anticoagulation monitoring are, however, limiting their use. Rivaroxaban is a novel oral anticoagulant associated with a significantly lower risk of major bleeds (hazard ratio?=?0.54, 95% confidence interval?=?0.37–0.79) compared to LMWH/VKA therapy, and does not require regular anticoagulation monitoring.

Aims: To evaluate the health economic consequences of treating acute VTE patients with rivaroxaban compared to treatment with LMWH/VKA, viewed from the Dutch societal perspective.

Methods: A life-time Markov model was populated with the findings of the EINSTEIN phase III clinical trial to analyze cost-effectiveness of rivaroxaban therapy in treatment and prevention of VTE from a Dutch societal perspective. Primary model outcomes were total and incremental quality-adjusted life years (QALYs), as well as life expectancy and costs.

Results: Over a patient’s lifetime, rivaroxaban was shown to be dominant, with health gains of 0.047 QALYs and cost savings of €304 compared to LMWH/VKA therapy. Dominance was robustly present in all sensitivity analyses. Major drivers of the differences between the two treatment arms were related to anticoagulation monitoring (medical costs, travel costs, and loss of productivity) and the occurrence of major bleeds.

Conclusion: Rivaroxaban treatment of patients with venous thromboembolism results in health gains and cost savings compared to LMWH/VKA therapy. This conclusion holds for the Dutch setting, both for the societal perspective, as well as the healthcare perspective.     

Environmental impacts of changes to healthier diets in Europe

Food consumption causes, together with mobility, shelter and the use of electrical products, most life cycle impacts of consumption. Meat and dairy are among the highest contributors to environmental impacts from food consumption. A healthier diet might have less environmental impacts. Using the E3IOT environmentally extended input output database developed in an EU study on Environmental Impacts of Products (EIPRO), this paper estimates the difference in impacts between the European status quo and three simulated diet baskets, i.e. a pattern according to universal dietary recommendations, the same pattern with reduced meat consumption, and a ‘Mediterranean’ pattern with reduced meat consumption. Production technologies, protein and energy intake were kept constant. Though this implies just moderate dietary shifts, impact reductions of up to 8% were possible in reduced meat scenarios. The slightly changed food costs do not lead to significant first order rebound effects. Second order rebounds were estimated by applying the CAPRI partial equilibrium model. This analysis showed that European meat production sector will most likely respond by higher exports to compensate for losses on the domestic meat market. Higher impact reductions probably would need more drastic diet changes.     

How a Firm's Domestic Footprint and Domestic Environmental Uncertainties Jointly Shape Added Cultural Distances: The Roles of Resource Dependence and Headquarters Attention

Even though many firms conduct most of their business domestically, international management research has remained remarkably silent on the role of a firm's domestic footprint in its internationalization strategy. We shed light on that role by exploring how the size of a firm's domestic footprint influences the cultural distance that the firm adds to its country portfolio when expanding internationally. Integrating resource dependence theory and the attention‐based view, we hypothesize that a firm's domestic footprint has a negative relationship with added cultural distance (ACD), and that domestic policy uncertainty strengthens this relationship whereas domestic demand uncertainty weakens it. We find robust support for our hypotheses in a sample of the world's largest retailers covering the period 2000–07, indicating that a firm's domestic footprint and domestic environmental uncertainties jointly shape cross‐cultural expansion strategies. Our findings suggest that ACDs reflect headquarters executives' desire to avoid ineffective foreign expansions, hinting at possible biases in studies of the performance effects of distance.     

Business incomes in rural Nicaragua: the role of household resources,location, experience and trust

This paper analyses the determinants of business income for rural households in Nicaragua. A sample of 1030 households was studied in order to assess the importance of material and behavioural factors that influence income from business activity. The households are involved in manufacturing, trade, services or have a mixture of businesses. They generally have a low income and asset value. Households supplement their income from wages and agricultural activities. To estimate non-farm business income per employed person we analyse the impact of resources, location, entrepreneurial experience and trust. Our results show that household resources and entrepreneurial experience are significant determinants for business income in all sectors. Trust is also important, particularly generalized trust. The contribution of other forms of trust, such as institutional trust, depends on the sector in which households participate.     

Measuring Motivations for Media Exposure: A Thesis

The present article discusses the problem of separating the motivation conceptempirically from other relevant concepts in research on mass media audiences.For about half a century, audience researchers use questionnaire items with adistinct format as measurements of motivations for media exposure. It isargued that these motivation items grammatically reflect the nature of themotivation concept as a theoretically intermediate variable between behaviourand its social or mental background, thus constituting the most plausibleindicators of the concept. However, it is also argued that these questionnaireitems are double-barrelled and that any measurement of motivations based onthe items can largely be considered an ambiguous mixture of behaviour and itssocial or mental origin. A study is presented that provides empirical support for this position.     

The role of home economics in agricultural extension

Home economics could play a vital, supportive and complementary role in agricultural extension. Home economics training is, however, in much need of reorientation if the profession is to play this much‐needed role. A comparison of the mission statements, foci and roles of these disciplines illustrates the value of including home economists in agricultural extension teams. The two professions have areas of similarity, but each also has specialist expertise vital to agricultural development. As a multidisciplinary, female‐dominated profession, home economics is able to assist agricultural extension officers in designing extension programmes which suit the needs of women farmers. The article outlines the areas of collaboration, specialist expertise and cooperation between the two professions while questioning the focus of traditional home economics training.     

How does earnings management influence investor’s perceptions of firm value? Survey evidence from financial analysts

Survey evidence shows CFOs to believe that earnings management can enhance investor valuation of their firms. This evidence raises the question of correspondence between the beliefs of CFOs and investors. Surveying financial analysts to gain insight into how earnings management influences investor perception of firm value, we find analysts’ and CFOs’ beliefs to be generally consistent. We find that analysts perceive meeting earnings benchmarks and smoothing earnings to enhance investor perception of firm value and all earnings management actions to reach a benchmark, save share repurchases, to be value destroying. CFOs, however, are reluctant to repurchase shares, preferring to use techniques viewed by analysts as value destroying (e.g., reductions in discretionary spending). Analysts’ inability to unravel such techniques perhaps explains CFOs’ preferences.     

Notes for Contributors

One aspect of globalisation is the convergence of income, media and technology, which in turn is expected to lead to homogeneous consumer behaviour. This convergence thesis is increasingly questioned. With converging national wealth there still is substantial variation of consumer behaviour across nations, which is not disappearing. Variation is found in all aspects of consumer behaviour: in consumption of packaged goods, in usage and ownership of durable goods, and in media behaviour. With disappearing differences of GNP per capita, culture is a powerful explaining variable. This paper provides evidence of divergence of consumer behaviour rather than convergence, it describes the influence of culture, how cultural variables can explain variance of consumption, and presents the consequences for international brand management and for global advertising.