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.     

Hedonic pricing and the role of stud fees in the market for thoroughbred yearlings in Australia

Using data from one of Australia's largest thoroughbred auction houses, we investigate the price determinants of thoroughbred yearlings sold at auction. We include novel key variables to construct hedonic pricing models and examine the relative role of stud fees compared to the wide range of attributes in the pricing of yearlings. We find that the price effect of stud fees is influenced by the value buyers place on both the characteristics of sires and the characteristics of sire side siblings. The findings imply that the quality of dams a sire has been matched within the breeding market has consequential effects on yearling prices through the sire's stud fee and progeny.     

'High-performance' Management Practices, Working Hours and Work–Life Balance

The effects of selected high‐performance practices and working hours on work–life balance are analysed with data from national surveys of British employees in 1992 and 2000. Alongside long hours, which are a constant source of negative job‐to‐home spillover, certain ‘high‐performance’ practices have become more strongly related to negative spillover during this period. Surprisingly, dual‐earner couples are not especially liable to spillover — if anything, less so than single‐earner couples. Additionally, the presence of young children has become less important over time. Overall, the results suggest a conflict between high‐performance practices and work‐life balance policies.     

Facilitating Global Organizational Learning in Product Development at Whirlpool Corporation

The challenges of leveraging learning about product development in a global company are complex. Whirlpool Corporation is addressing these challenges, using a multidimensional strategy that couples work in advanced products and product development with organization development and training. Deborah Durate and Nancy Snyder describe how Whirlpool has implemented training, best practices conferences, and programs focused on enhancing the performance of product development teams to facilitate learning after product development efforts and to leverage that learning on a global basis. Programs and processes are described, and lessons learned as well as guidelines for development are offered.     

UK Asian communities: A profitable market for nonprofits?

The ethnic minority communities in the UK are an increasingly powerful force. But UK charities have not had a great deal of experience in approaching this market, despite a readily acknowledged desire to increase their own levels of cultural diversity. How many want a better ethnic representation among their donor base? How many want greater cultural diversity among volunteers, let alone staff? This paper examines the Asian communities within the UK, and suggests that these are groupings with which UK charities should be engaging. The communities are identifiable, with strong philanthropic traditions, they have increasing economic power and they are accessible. The paper also looks briejly at a positive response generated by one organisation-the Aga Khan Foundation (UK) — to a non-denominational, intercommunal appeal for funds from the Asian Communities in the UK.     

There's something about saving …

The paper considers how people should plan their saving, given certain assumptions about inheritance and changes in household circumstances. The results are produced by a model that takes into account tax and state benefits as well as various private savings vehicles. It concludes that, for many households, saving for retirement through a ‘pension’ might not be optimum and that the best strategy is to vary the incidence and allocation of saving in response to changes in household circumstances.     

Retesting Fair's (1978) model on infidelity

Modern econometrics stresses the diagnostic testing of estimated models as an important part of the model‐building process. In a survey article published in this journal (Pagan and Vella 1989 ), methods for testing the validity of the assumptions underlying the censored regression of the Tobit model were presented. This paper questions the numerical results presented there. Indeed, my results concerning the tests when applied to Fair's well‐known model for infidelity (1978) are the opposite of those presented in this journal. Copyright © 2003 John Wiley & Sons, Ltd.     

When promises become contracts: Implied contracts and handbook provisions on job security

In this article, policy capturing was used to examine how lawyers, as experts, understand the wording in employee handbook passages that promise procedural protections for employees. Specifically, how the wording of employee handbook passages can create both legal and nonlegal obligations was examined. Forty-six lawyers were asked to make the following judgments: whether the handbook passage constituted a legal or moral obligation and the chances of the employer winning or being granted a summary judgment in a wrongful discharge suit. Five aspects of the handbook passages were examined: verb strength, specificity, contract disclaimers, legalistic jargon, and the employee's signature.