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.     

Discussion on the Benefits Distributing Structure in Village Land Deal

According to everyone average welfare value of land resources; this paper constitutes the base line of glebe usufruct deal value by analyzing the factors, which are affecting glebe usufruct deal value. Having adopted share＇s quotient of ownership and contracting power, the paper erects assigning mechanism to the income of glebe deal. Because of the share dynarnicity being adopted which shows the flexible strong points, the shares of ownership and contracting power avoid many unnecessary otiose disputes on income of glebe deal, adding the stability to the glebe usufruct deal. It is beneficial to the freedom flow and validity manufacture factor installment and also to the nonagricultural changing course.     

征地现状调查

２００３年７月以后，中央政府三令五申，不准滥征耕地，大肆圈地的势头得到遏制。但违规征地没有止息，耕地仍在减少，形势不容乐观，仍须从严控制。     

重庆市城市土地经济效益评价

从产出和投入两方面构建城市土地经济效益评价的指标体系,采用层次分析法对重庆城市土地的经济效益进行评价,可知:重庆城市土地的经济效益总体水平较低、波动较大,重庆城市近年来投入偏高影响了土地经济效益,而且重庆城市土地利用的集约化水平不高.     

Land Reform: Taking a Long(er) View

The paper proposes a broad argument that the end of state–led development from the 1970s coincided with (i) the final wave of major redistributive land reform, and its place within transitions to capitalism, that lasted from about 1910 to the 1970s, and (ii) the beginnings of contemporary 'globalization'. Self–styled 'new wave' agrarian reform in the age of neo–liberalism, centred on property rights, is unlikely to deliver much on its claims to both stimulate agricultural productivity and reduce rural poverty. The reasons are grounded in the basic relations and dynamics of capitalism, and how these are intensified and reshaped by and through globalization. Understanding these processes, with all their inevitable unevenness, requires (i) recognizing that the historical conditions of the 'classic' agrarian question no longer apply, and (ii) developing the means to investigate and understand better the changing realities facing different agrarian classes within a general tendency to the concentration of capital and fragmentation of labour, including how the latter may generate new agrarian questions of labour.     

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。     

Property Rights Reform in Rangeland China: Dilemmas On the Road to the Household Ranch

This paper contributes to the debate over land tenure in rural China by extending its spatial coverage to the country’s extensive rangeland regions. Key characteristics of pastoral tenure, identified from field appraisals in western China, include group tenure and fuzzy boundaries. Although these characteristics give rise to efficiency concerns, from a new institutional economics perspective they also facilitate the realization of certain benefits, benefits that could represent opportunity costs of further exclusiveness. The strengthening of rangeland co-management may constitute a more appropriate path to institutional improvement than the establishment of the household ranch, the current goal of national rangeland policy.     

城乡结合部用地矛盾成因分析--以北京市为例

特殊的土地利用和管理特点使得城乡结合部用地矛盾尤为凸现.人口、城市发展、集体经济发展是造成土地供求紧张的直接原因,但是管理制度的不健全则是导致和加剧矛盾激化的深层次原因.在对北京市城乡结合部土地利用与房地产市场调查的基础上,对北京市城乡结合部的用地矛盾进行分析,并从深层次揭示问题的根源和变化规律.