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.     

Foreign banks in Japan: A study of a Japanese deregulation process

The deregulation of foreign banks in Japan, although corresponding in broad outline to world-wide trends, has diverged substantially in many particulars from patterns seen elsewhere. It has tended to be excruciatingly slow and piecemeal and to have been of minimal benefit to foreign banks. A review of this process leads to the conclusion that these characteristics result from organisational and political-bureaucratic factors inherent to the Japanese style of government which is, in turn, partially a reflection of Japanese culture. Although these non-economic factors have influenced the specific pattern of change, its overall direction appears to have been consistent with the broader national interest.The authors wish to acknowledge financial support from the Social Science and Humanities Research Council of Canada, the Florsheimer Center for Policy Studies, and the Krueger Center for Financial Research.     

Tourism as an alternative source of regional growth in Portugal: a panel data analysis at NUTS II and III levels

The role of tourism is of vital economic importance, particularly for small countries with a privileged geographical location and favourable weather conditions. This paper examines the importance of tourism as a conditioning factor for higher regional growth in Portugal by employing the conditional convergence hypothesis of Barro and Sala-i-Martin, associated with the endogenous growth theory. The panel data estimation approach provides evidence of the positive impact of tourism (through the accommodation capacity) on the growth in per-capita income among the Portuguese regions, increasing the rate of convergence. Therefore, tourism can be considered as an alternative source for stimulating higher regional growth in Portugal, if the supply characteristics of this sector are improved.     

Capacity Commitment versus Flexibility

We show how technological flexibility choices and equilibrium configurations (both simultaneous and sequential duopoly) depend on six industry characteristics. Low market volatility combined with intermediate market size favors inflexible technologies; large values of either volatility or size favor flexible technologies; low or intermediate values of both favor the coexistence of flexible and inflexible technologies. The possibility of a flexibility trap exists in industries of low volatility and intermediate size. Entry prevention can sometimes be achieved by inflexible technologies or flexible technologies, depending on the industry characteristics.     

The Flemish customer contact centre for public information from a marketing and management perspective

This paper describes the Flemish customer contact centre for government information (‘the Flemish Infoline’) as an example of marketing in the public sector. First it defines the term ‘customer contact centre’ and describes the objectives and main characteristics of the Flemish Infoline. It then identifies the three reasons for setting up the Flemish Infoline in 1999: the complicated Belgian institutional landscape; the unprofessional telephone traffic handling and service; and the lack of knowledge about citizens' information needs. Finally, the paper applies Kotler's 4 Ps concept to the case, and puts the relevant stages from Lees‐Marsh‐ment's political marketing orientations into one integrated scheme in order to understand the functioning of the Flemish Infoline. Based on the literature and on an in‐depth interview with the project head of the Flemish Infoline, the authors demonstrate that marketing techniques can be used in contact centres for public information, but they also illustrate some important differences from those in the forprofit sector, such as the available amount of customers' personal data, the level of call operators' skills and the degree of heterogeneity of the questions. Further research on information needs and contact centres, and providing one ‘umbrella’ contact centre for government information in Belgium are recommended. Copyright © 2003 Henry Stewart Publications     

一种双机热备份计算机系统

本文探讨了计算机系统冗余备份的工作原理和实现方法，介绍了一种实用的双机热备份切换、控制系统和其切换、控制单元的组成和工作原理。     

Predictive validity of ethnic identification measures: An illustration of the English/French classification dilemma in Canada

To establish the predictive validity of ethnic identification measures, respondents in the Montreal Urban Community were surveyed and measured on a variety of ethnic dimensions. The data was then fed to a clustering algorithm. Two-group clustering assignments were then compared to traditional taxonomic measures. It is shown that some measures do an excellent job in classifying respondents, while others, which are commonly used in practice, do not fare as well.     

The Impact of the 9/11 Events on the American and French Stock Markets

Markets reacted strongly to the World Trade Center attacks both in Europe and in the United States. The extent of this crisis was difficult to assess at the time, underlining the need for a specific tool to measure the magnitude of financial crises. A first measure was recently proposed and applied to the foreign exchange market by Zumbach et al. (2000a,b ). Their measure relies on an analogy with geophysics; the related index of market shocks (IMS) that we propose here is also the counterpart of the Richter scale used for earthquakes. We apply this measure on the French and the American stock markets to put large market events into perspective. The crisis triggered by the September attacks was actually the worst since 1987, and the ninth worst when compared to major historical ones.     

Prudence, Demand Uncertainty, Background Risk, and the Law of Supply: A Nonexpected Utility Approach to the Firm

We identify two motives, prudence and risk aversion, which give rise to precautionary behavior for a quantity- or price-setting monopolist facing demand uncertainty who has dual theoretic preferences. We also analyze a piecewise linear profit function due to a tax on profits that varies with the profit level. We show that the comparative statics of greater risk (mean-preserving spread and mean-utility preserving spread) can be totally or partially determined by the Diamond-Stiglitz and Kihlstrom-Mirman single-crossing property. For example, for a prudent risk-averse quantity-setting dual theoretic monopolist, a mean-preserving spread will have the same impact on output under uncertainty as a fall in the state of demand under certainty. Finally, we find that, in contrast to expected utility, a stochastically larger state of demand (first-order stochastic dominance) will raise output even if background risk is present.