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.     

Psychometric validation of anti-clot treatment scale and treatment satisfaction questionnaire for medication version II in Japanese patients with atrial fibrillation

Aims: The Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM-II) are validated treatment satisfaction patient-reported outcome (PRO) instruments. The ACTS includes two domains: Burdens and Benefits; the TSQM-II includes four: Effectiveness, Side Effects, Convenience, and Global Satisfaction. Japanese-language versions of the ACTS and TSQM-II have been developed and linguistically validated. This study aimed to assess their psychometric properties in Japanese patients with atrial fibrillation (AF).

Materials and methods: ACTS and TSQM-II data from 534 patients with AF were collected in a Japanese post-marketing surveillance study of a direct oral-anticoagulant, rivaroxaban. Four key psychometric properties, in line with best practice guidelines from the US Food and Drug Administration, were examined using traditional psychometric methods: acceptability, scaling assumptions, reliability (i.e. internal consistency reliability, test-retest reliability), and construct validity (i.e. convergent validity and known groups).

Results: ACTS Burdens and Benefits and TSQM-II Effectiveness, Convenience, and Global Satisfaction scales were found to be acceptable (e.g. item-level missing data at baseline <4%), with all scales having good internal consistency (Cronbach’s alpha > 0.80). test-retest reproducibility intraclass correlation coefficients for the ACTS Burdens and Benefits were 0.59 and 0.65, respectively, and between 0.54–0.61 for the TSQM-II scales. Known-groups validity for the ACTS and TSQM-II was supported by differences in scale scores by positive and negative impact (p?<?0.05). Correlations between the ACTS and TSQM-II (convergent validity) were lower than expected (range r?=?0.09–0.48), but in line with the original ACTS development study.

Limitations: Evaluation of test-retest reproducibility was limited by assessment period, which was longer (3 months) than recommended guidelines (usually up to 2 weeks).

Conclusions: Overall, Japanese versions of ACTS and TSQM-II scales satisfied internal consistency reliability and traditional validity criteria. Our study supports the ACTS and TSQM-II as appropriate PRO instruments to measure satisfaction with anticoagulant treatment in Japanese patients with AF.

Trial registration: NCT01598051, clinicaltrials.gov; registered April 20, 2012.     

Intraday Returns and the Frequency of Trading at the Ask on the Sydney Futures Exchange: A Research Note

This article documents and provides explanations for intraday patterns in returns for the Share Price Index (SPI) futures contract traded on the Sydney Futures Exchange (SFE). Consistent with overseas futures markets research, a positive and significant overnight return is documented. Unlike overseas futures markets, we find little evidence of an end of day price rise. Our evidence suggests that overnight returns for the SPI contract are largely driven by the way returns are typically measured, which ignores the fact that there is a significantly greater frequency of sellers at the market close and buyers at the start of the day. These patterns are consistent with hedging behaviour by futures traders with long positions in the underlying stock.     

债务重组的会计问题研究

本文根据新会计制度的规定,就债务重组的基本原理五种债务重组方式的会计处理事项分别作了说明,并对中外关于债务重组的处理方法进行了比较,找出了其中的差异。为了寻找更为完善的对债务重组的会计处理方法,本文对新会计制度关于债务重组的某些不足之处进行了讨论,提出了相应的意见和建议。     

钢筋混凝土现浇楼板裂缝成因分析及防治措施

文章对某工业厂房现浇楼板产生裂缝进行调查,分析了裂缝的特征和产生的原因,介绍了防治裂缝的措施以及修补裂缝的方法。     

煤代油工程污水处理工艺的选择

文章通过分析巴陵分公司煤代油工程的污水排放特性及技术条件,探讨了污水处理工艺的选择。     

养老基金筹集模式的实证分析

当前的养老制度改革是关注的焦点。本文首先将从介绍现存的筹集模式入手,试图换个角度来思考在人口老龄化背景下的我国养老金基金制度,实证分析模式选择对于缴费率等的影响,并基于此,讨论未来改革的方向。     

Dominance Statistics: A Simulation Study on the d Statistic

Quality &; Quantity - Cliff (1993) has proposed the use of a measure of effect size alternative to traditionalmean differences: δ {? = Pr(xi1 &;gt; xj2) - Pr(xi1 &;lt; xj2)}which,...     

Optimising a Probabilistic Model of the Development of Play in Soccer

We present a probabilistic model based on the one developed by Hernández Mendo and Anguera (Revista de Psicologíca Social, 16(1), 71–93, 2001). Here we have tried to break down the interaction contexts that the opposing teams are able to generate and transform during the game. We are aware that a given player or team does not produce consistent behaviour in similar situations. However, a degree of uncertainty is assumed to exist regarding whether the results obtained are a specific function of the analysis used. In order to carry out this research a category system which optimized that used in the previous model was developed. This system should enable the interaction between teams to be observed within the actual play of a soccer game. A lag sequential analysis was performed on the basis of a coding of the behavioural flow. After describing the behavioural patterns obtained a probabilistic model of the development of play in soccer is proposed.     

Land use externalities, open space preservation, and urban sprawl

Parcel data on residential land conversion are used to investigate how land use externalities influence the rate of development and modify policies designed to manage urban growth and preserve open space. Several “smart growth” policies are found to significantly influence land conversion, including a development clustering policy that concentrates development and generates preserved open space. In addition to directly affecting a parcel's hazard rate of conversion, this policy is found to affect neighboring parcels' conversion by generating a positive open space externality that hastens their development. The implication that the clustering policy could generate a more sprawled pattern of development is explored using spatial simulation.