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.     

天地一体化信息网络中天基卫星网络架构设计

为了充分利用各种空间设施资源，提升天基信息网络覆盖与传输能力，分别从天基信息网络体系架构和逻辑功能架构角度进行了系统性设计。与以往天基网络的设计不同，该设计更注重各类卫星网络的深度融合应用，为此将网络虚拟化技术引入天基卫星网络。同时，还提出了解决新架构下卫星组网难题的方法，将电磁涡旋、卫星灵活载荷和边缘计算技术设计到天基网络。仿真表明，所提出的架构能有效提升频谱利用率和减少卫星网络信令开销。     

用全覆盖的区域政策构建大协调的发展新格局

自促进中部地区崛起的战略提出以后，我国已形成了全面覆盖的区域政策体系。本文对我国4大区域战略进行了详细阐述，勾画了东西南北中大协调、共发展的崭新格局；并对各省级区域内部的协调发展进行了初步研究。     

基于RFID的零售企业信息追溯与补库策略

提出了基于无线射频技术（RFID）的零售企业生鲜食品的信息追溯技术和持续补库计划（CRP）策略,集成了整合发货和库存补货,并构建了用以计算最高库存量和配送周期的供应商管理库存模式下的补货数学模型,模型中充分考虑了生鲜食品的特性（腐坏）,确保零售企业销售生鲜食品的质量安全.在通过采用RFID技术实时监控销售和库存数据的基础上,供应商能够依据模型在发货周期内确定最佳的货物配送时间和配送数量,主动补货,在保证食品安全的同时实现总的长期平均成本最小化.     

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。     

建设项目全寿命期综合计划体系

建立了建设项目综合计划的工作过程和工作内容。与传统的狭义的项目计划不同，建设项目全寿命期综合计划必须以全寿命期项目目标为主导，以项目的功能建设和运行为核心．包括设计、组织策划、实施方案和实施过程计划、运行策划等，它们之间有复杂的内在联系，具有高度的系统性。     

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。     

基于混合激励机制的两层供应链产品开发合作博弈分析

针对供应商与制造商在产品开发合作中潜在的风险,建立了动态合作博弈模型,通过对正负激励策略的比较分析,得出两种激励策略按照一定结构混合运用能有效地发挥负激励降低合作风险、正激励增加合作收益的作用的结论。     

Generalized piecewise linear histograms

We extend the concept of piecewise linear histogram introduced recently by Beirlant, Berlinet and Györfi. The disadvantage of that histogram is that in many models it takes on negative values with probability close to 1. We show that for a wide set of models, the extended class of estimates contains a bona fide density with probability tending to 1 as the sample size n increases to infinity. The mean integrated absolute error in the extended class of estimators decreases with the same rate n^–2/5 as in the original narrower class.