39 research outputs found

    Long-term safety and efficacy of alogliptin, a DPP-4 inhibitor, in patients with type 2 diabetes: a 3-year prospective, controlled, observational study (J-BRAND Registry)

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    Introduction Given an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methods We registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.Results Of the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (>90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.Conclusions Alogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting

    Tax Law Asymmetries and Income Shifting: Evidence from Japanese Capital Keiretsu

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    While the asymmetric treatment of positive and negative income creates clear tax incentives to shift income among a group of closely related corporations, attempts to document the impact of such behavior on economic outcomes are relatively sparse. We aim to provide evidence on taxmotivated transfers from a large dataset of Japanese corporate groups. Using company level data on 33,340 subsidiary time pairs from 1988, 1990, and 1992, we consider testable implications of income shifting in a theoretical model tailored to the Japanese institution of the early 1990s and empirically examine the spread of the profitability distribution, the attrition rate of loss-making subsidiaries, and the propensity to report zero profit. The findings suggest that income shifting was pervasive when Japan had not adopted a formal allowance for group-level tax. The result underscores the importance of accounting for the inter-relatedness of companies, in designing a corporate income tax

    Bunching of Small Businesses at the Value-Added Tax Threshold in Japan: Lessons for the 2019 Tax Hike

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    本稿は帝国データバンクの大規模データを用い消費税の免税点の影響を検証する。集積動機を明らかにするため、2014年の消費税増税を準実験の機会と捉え、集積推計法を用い企業度数分布の歪みを増税前後で比較する。分布が益税の増加に反応していないことから、事務負担回避が集積の理由だと示唆される。また、歪みが発生させる経済的損失を考察するため、集積行動の形態も検討する。間接的エビデンスは租税回避を示唆している。推計では、免税点は約5万7千社の行動を歪ませ、それに伴い毎年170億円規模の益税が発生している。We examine the behavior of small firms near the exemption threshold under Japan's value-added tax (VAT). We employ Teikoku Data Bank's large-scale firm database and find visible bunching of firms just below the threshold of 10 million yen. To better understand the motive for bunching, we utilize the 2014 VAT hike as a quasi-experiment, since it increased the financial benefit of VAT exemption. Despite the increased financial incentive, the relative bunching mass remains unchanged, suggesting that the cost of complying with tax regulations motivates the bunching behavior. We also consider whether those bunching firms make real adjustments or conduct tax avoidance. We find indirect evidence favoring the tax-avoidance hypothesis. Our estimates suggest that the VAT threshold distorts the behavior of 57,000 firms, resulting in lost tax collection of 17 billion yen per annum. With Japan facing another round of VAT hike in October 2019, our research provides additional insights to inform the forthcoming policy change.(株)帝国データバンク本研究はJSPS科研費15KK0088、19K01695の助成を受けたものです。31

    The Response of Firms to Eligibility Thresholds: Evidence from the Japanese Value-Added Tax

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    It is common to define benefit eligibility for small business policies by restrictions on the firm size. This paper documents the effects of the value-added tax (VAT) threshold in Japan, focusing on the incentives for a large firm to "masquerade" as man

    Capital injection, restructuring targets and personnel management: The case of Japanese regional banks

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    A case study of the Japanese bank recapitalization by Hoshi and Kashyap (2005) identified a bank that overstated the progress of required personnel downsizing by shifting employees to subsidiaries. This paper asks if the recapitalization program had a design flaw. We focus on regional banks with a unique panel dataset of 81 banking groups that allows us to observe the employment levels of subsidiaries, in addition to those of parent banks, over fiscal 1994-2006. We estimate a labor-demand equation with sluggish adjustment to compare the employment patterns of public capital recipients and other banks. The result indicates that the shuffling of personnel to subsidiaries was a common response among banks that received large capital injections. Our finding highlights a tension between a reconstruction program and labor law when a country has a tight law on dismissal

    Procrastination, prompts, and preferences: Evidence from daily records of self-directed learning activities

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    This paper presents evidence showing that a libertarian paternalistic intervention having significant but uneven effects on the student procrastination of a coursework assignment. We observe the degree of procrastination in a language course at a Japanese university with individuals' electronic records of daily activities. With a quasi-experiment that generates variations in the frequency of interventions and the preference of students towards the course, we examine the effects of in-class verbal prompts by an instructor on the timing of task completion. We find that prompts affect behavior, especially when reinforced, but the responsiveness depends on the class preferences and the timing of interventions