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.     

Violations of Service Fairness and Legal Ramifications: The Case of the Managed Care Industry

Adapted from Chan's (2000) model depicting success of litigation, this paper argues that with the application of various legislation, health maintenance organizations' (HMOs') violations of service fairness to each group: enrollees, physicians, and hospitals give rise to each group's lawsuits against the HMOs. Various authors (Bowen et al., 1999; Seiders and Berry, 1998) indicate that justice concepts such as distributive, procedural, and interactional justice can be applied to the area of service fairness. The violation of these underlying justice principles with HMOs' service unfairness to enrollees, physicians, and hospitals is examined. A general synopsis of the ethical issues in the managed care industry is provided. The various lawsuits launched by each group: enrollees, physicians, and hospitals together with the key statutes used are discussed. This paper also highlights the provisions and ramifications of the 11 April 2000 landmark agreement that Aetna made with Texas Attorney General John Cornyn to settle the 1998 lawsuit brought against the company. Lastly, the current ethical issues in the managed care industry are further discussed. The value of this paper can be adapted to the study of organizations' service fairness violations in other industries or in the educational, governmental, and not-for-profit sectors both nationally and internationally.     

The Effects of Occupational Injuries After Returns to Work: Work Absences and Losses of On-the-Job Productivity

We extend the research on postinjury employment by estimating productivity losses for workers with permanent partial disabilities (PPDs) in the first three years after injury. Our method distinguishes between productivity losses attributed to spells of work absence versus reduced earnings during spells of employment. The method is applied to data for 800 Ontario workers with PPDs. The results document large productivity losses persisting at least three years after injury, with different loss patterns for workers returning to stable versus unstable employment. Human capital investments or job accommodations can reduce productivity losses, but the significant determinants of losses differ for the stable versus unstable employment groups.     

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.     

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.     

企业家不是天生的(2)——从梦想开始

200位老板的成功秘密除非先拥有一个梦想,否则将一事无成。——卡尔·桑德伯格翻开世界历史,最引人注目的事件都是由梦想引发的。希伯来的奴隶们之所以能够从埃及大批成功逃离是因为摩西《(圣经》故事中古犹太人的领袖)受到神灵的感召,梦想他的人民会获得自由。美国革命的发生,也正是由于人们梦想着自由、民主和正义。马丁·路德·金曾用他的演讲“我有一个梦想”来激励他的人民。     

Predicting corporate financial distress: Reflections on choice-based sample bias

Financial distress precedes bankruptcy. Most financial distress models actually rely on bankruptcy data, which is easier to obtain. We obtained a dataset of financially distressed but not yet bankrupt companies supplying a major auto manufacturer. An early warning model successfully discriminated between these distressed companies and a second group of similar but healthy companies. Previous researchers argue the matched-sample design, on which some earlier models were built, causes bias. To test for bias, the dataset was partitioned into smaller samples that approach equal groupings. We statistically confirm the presence of a bias and describe its impact on estimated classification rates.