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.     

The equity impacts of bus rapid transit: A review of the evidence and implications for sustainable transport

The paper offers an analysis of empirical evidence on the equity impacts of operational Bus Rapid Transit (BRT) systems in the Global South. The focus is on vertical equity, i.e. whether BRT systems achieve progressive benefits for poorer segments of the population. Findings from Africa, Asia, and Latin America all suggest that BRT does offer significant benefits to low-income groups, in terms of travel time and cost savings, access enhancement, and safety and health benefits. However benefits are often skewed toward medium-income users and thus less progressive than they might be. Two primary reasons for this are insufficient spatial coverage and inappropriate fare policies. While many features of BRT potentially allow it to deliver pro-poor outcomes, such outcomes only materialize if BRT implementers pay specific and sustained attention to equity. The paper identifies key issues that need to be addressed to steer BRT implementation toward more socially sustainable outcomes—including better integration with other transit, paratransit, and nonmotorized transport services, and with the housing sector.     

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.     

Intermediate Inequality and Welfare: The Case of Spain, 1980–81 to 1990–91

The 1990–91 household expenditures distribution in Spain dominates, in the relative ("rightist") Lorenz sense, the 1980–81 distribution, but the latter dominates the former in the absolute ("leftist") Lorenz sense. This situation constitutes a textbook case for intermediate or "centrist" notions of inequality and social welfare. This paper presents the first empirical application of this sort, using the intermediate inequality concept introduced in Del Río and Ruiz-Castillo (2000). The data reveal that there is a decrease in household expenditures inequality for a relatively small set of centrist attitudes.     

The “swing of the pendulum” from public to market support for science and technology: Is the U.S. leading the way?

The structure and financing of science and technology activities are undergoing a slow, but profound, change. This change can be briefly characterized as a shift from relying and supporting public science to a stronger emphasis on “market-based” incentives for science and technology. In this paper we analyze this shift in a historical perspective, discussing both the theoretical explanations and the empirical trends of the ongoing change. While we do not claim to provide a comprehensive and exhaustive identification of the causes of this shift, we argue that it is largely driven by the perception of a shift of the U.S. policy towards market-based, rather than publicly supported, incentives for science and technology. This, in turn—given the strong economic performance of the United States over the 1990s—has influenced policies in most OECD countries, especially in Europe.We conclude by analyzing the evolution of research in U.S. higher education and find two major trends: an increasing diversity in the number of institutions of different types other than universities and a steady and continuous public funding of the leading U.S. universities. This has allowed the construction of an infrastructure now used largely by the private sector, but it also noted that the United States has not compromised public support for core areas or in those fields in which there is a clear perception that market incentives are not sufficient for meeting the strategic targets of the U.S. policy. The implication is that there is a considerable policy diversity in the U.S. practice and that all aspects of this diversity should be considered when using the United States as a reference.     

Alternative Forms of Mixing Banking with Commerce: Evidence from American History

Much of the discussion about banking and commerce in America has failed to make several crucial distinctions and has not accounted for many arrangements that have promoted the mixing of these activities. We investigate the history of banking and commerce in the United States, looking both at bank control of commercial firms and commercial firms' control of banks. We trace how these controls have changed with shifting definitions of "bank" and changing methods of "control." Despite the regulations prohibiting some arrangements that promote financial control, we find evidence of extensive linkages between banking and commerce in the United States. These linkages usually build on devices that are very close substitutes to the arrangements prohibited by law. Altogether, our findings question the often made claim that traditionally banking in the United States has been separated from commerce. Furthermore, given that research on Japan and Germany has shown that the mixing of banking and commerce matters for a variety of issues, our evidence also raises some questions on similar research in the United States which makes the simplifying assumption that these industries are separated.     

Analysing the factors influencing clean technology adoption: a study of the Spanish pulp and paper industry

Technological change has a relevant role to play in the transition towards a sustainable industry. However, slow diffusion of clean technologies can be observed in OECD countries. The analysis of the determinants and barriers to clean technology adoption should be a main goal of economists and social scientists. This paper shows that three sets of interrelated factors prevent but also stimulate the widespread adoption and diffusion of clean technology: these are factors external and internal to the firm, conditions of the potential adopters and characteristics of the environmental technology. These factors are included in the so‐called ‘triangular model’, which is further applied to the analysis of clean technology adoption in the pulp and paper industry in Spain. The empirical study shows that clean technology adoption decisions are the result of an interaction between these factors, often involving contradictory signals for the potential adopter. The paper closes with some public policy recommendations for the effective and efficient promotion of clean technology diffusion. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment.     

Is your vision consistent?: A method for checking, based on scenario concepts

Common sense tells us that the future is an essential element in any strategy. In addition, there is a good deal of literature on scenario planning, which is an important tool in considering the future in terms of strategy. However, in many organizations there is serious resistance to the development of scenarios, and they are not broadly implemented by companies. But even organizations that do not rely heavily on the development of scenarios do, in fact, construct visions to guide their strategies. But it might be asked, what happens when this vision is not consistent with the future? To address this problem, the present article proposes a method for checking the content and consistency of an organization's vision of the future, no matter how it was conceived. The proposed method is grounded on theoretical concepts from the field of future studies, which are described in this article. This study was motivated by the search for developing new ways of improving and using scenario techniques as a method for making strategic decisions. The method was then tested on a company in the field of information technology in order to check its operational feasibility. The test showed that the proposed method is, in fact, operationally feasible and was capable of analyzing the vision of the company being studied, indicating both its shortcomings and points of inconsistency.