Comparative persistence and adherence with newer anti-hyperglycemic agents to treat patients with type 2 diabetes in the United States

Objectives: Non-adherence and non-persistence to anti-hyperglycemic agents are associated with worse clinical and economic outcomes in patients with type 2 diabetes. This study evaluated treatment persistence and adherence across newer anti-hyperglycemic agents (canagliflozin, dapagliflozin, sitagliptin, saxagliptin, linagliptin, liraglutide, or exenatide).

Methods: This retrospective cohort study of Truven Health Analytics Marketscan databases included adult patients with type 2 diabetes whose first pharmacy claim for a newer anti-hyperglycemic agent was between February 1, 2014 and July 31, 2014. Treatment persistence and adherence were assessed for 12 months after the first claim (post-index). Persistence was defined as no gap ≥90 days between the end of one pharmacy claim and the start of the next pharmacy claim post-index. Adherence used two definitions: proportion of days covered (PDC) and medication possession ratio (MPR). Multivariable analyses of non-persistence (hazard ratios) and adherence (odds ratios) were adjusted for baseline demographics, drug cost, clinical characteristics, and other anti-hyperglycemic agents.

Results: A total of 11,961 patients met all study selection criteria. Persistence rates at 12 months were significantly greater (p?p?=?0.83; PDC?=?0.79) and canagliflozin 300?mg (MPR?=?0.92; PDC?=?0.81) were greater than for the other index anti-hyperglycemic agents (MPR?=?0.33–0.75; PDC?=?0.33–0.72). Consistent results for treatment persistence and adherence were observed in multivariable analyses that were adjusted baseline characteristics.

Conclusions: Canagliflozin was associated with better treatment persistence and treatment adherence compared with other anti-hyperglycemic agents in real-world settings.     

The impact of a changing financial climate on a UK local charitable sector: voices from the front line

Forced to compete with private and public sector providers, charities experience tensions as the quest for a more commercially-oriented position may conflict with their social imperative. Little attention has been given to understanding the experiences of local charities as service providers. This paper captures the reactions of those working on the charity front line.     

Reorganizing School Lunch for a More Just and Sustainable Food System in the US

Public school lunch programs in the United States are contested political terrains shaped by government agencies, civil society activists, and agri-food companies. The particular organization of these programs has consequences for public health, social justice, and ecological sustainability. This contribution draws on political economy, critical food studies, and feminist economics to analyze the US National School Lunch Program, one of the world's oldest and largest government-sponsored school lunch programs. It makes visible the social and environmental costs of the “heat-and-serve” economy, where widely used metrics consider only the speed and volume of service as productive work. This study demonstrates that such a narrow understanding of the labor of lunch devalues care and undercuts the potential for school food provisioning to promote ecological and feminist goals. Further, it proposes a “high road” alternative and outlines an agenda for reorganizing school food provisioning to maximize care in all its dimensions.     

Does Accrual Management Impair the Performance of Earnings‐Based Valuation Models?

This study examines how accrual manipulations affect firm valuation in the years surrounding the passage of the Sarbanes‐Oxley Act (SOX). We compare the absolute percentage pricing errors of RIM and DCF valuation models for a group of US firms suspected to have engaged in accrual manipulations to avoid a small loss or a small earnings decline vs. ‘Normal’ firms matched on industry, year and size. We find that RIM can better estimate intrinsic value than DCF for the matched Normal firms in the pre‐SOX period, but not so for accrual manipulators, and that SOX mitigates the harmful effect of accrual manipulations, completely eliminating the difference in RIM's accuracy advantage over DCF between Normal firms and accrual manipulators. As a further analysis, we redefine Suspect firms as real‐activity manipulators and find a significant across‐group difference in accuracy wedge in both sample periods, implying that SOX has prompted firms to favor real‐activity manipulations over accrual manipulations.     

The Ethics of Meaningful Work: Types and Magnitude of Job-Related Harm and the Ethical Decision-Making Process

This research on the ethics of meaningful work examined how types of job-related harm (physical, economic, emotional, and cognitive) and their magnitude of consequences (MOC, low, high) influenced components of ethical decision-making (moral recognition, moral evaluations, and moral intentions). The research also investigated the moderating effects of individual differences (experience with carpal tunnel syndrome, experience with layoffs, ability to read others’ emotions, and intrinsic motivation orientation [IMO]) on the relation between the MOC and the ethical decision-making elements for each type of harm. Using a sample of 185 Chinese professionals, a between-subjects, fully crossed experimental scenario design revealed that physical and economic job-related harm were recognized as moral issues to a greater extent than cognitive or emotional harm. Second, physical job-related harm stimulated a higher level of moral evaluations than economic and cognitive harm. Third, individuals intended to act ethically when MOC was high versus low. Finally, experience with layoffs and IMO helped explain the relations between MOC and moral evaluations for economic and cognitive job-related harm, respectively. Implications for research and management are discussed.     

Contradictions of the Climate-Friendly City: New Perspectives on Eco-Gentrification and Housing Justice

As local governments and corporations promote ‘climate friendliness’, and a low-carbon lifestyle becomes increasingly desirable, more middle- and upper-income urban residents are choosing to live near public transit, on bike- and pedestrian-friendly streets, and in higher-density mixed-use areas. This rejection of classical forms of suburbanization has, in part, increased property values in neighborhoods offering these amenities, displacing lower-income, often non-white, residents. Increased prevalence of creative and technology workers appears to accelerate this trend. We argue that a significant and understudied socio-environmental contradiction also occurs where the actual environmental outcomes of neighborhood transformation may not be what we expect. New research on greenhouse gas emissions shows that more affluent residents have much larger carbon footprints because of their consumption, even when reductions in transportation or building energy emissions are included. We describe an area in Seattle, Washington, the location of Amazon's headquarters, experiencing this contradiction and show a distinct convergence of city investments in low-carbon infrastructure, significant rises in housing prices and decreases in lower-income and non-white residents. We conclude with a discussion of a range of issues that require more attention by scholars interested in housing justice and/or urban sustainability.     

Economic modelling of costs associated with outcomes reported for type 2 diabetes mellitus (T2DM) patients in the CANVAS and EMPA-REG cardiovascular outcomes trials

Aims: To model direct medical costs associated with reductions in cardiovascular disease (CVD) events in T2DM patients reported in the CANVAS and EMPA-REG trials, which assessed the cardiovascular safety of canagliflozin and empagliflozin, respectively.

Materials and methods: Costs were modeled from a US managed care organization (MCO) perspective for the CVD outcomes included in both trials: three-point major adverse cardiovascular event (MACE) and its components (cardiovascular-related death, nonfatal myocardial infarction, nonfatal stroke), as well as heart failure requiring hospitalization. The rate of CVD events averted (difference between study drug and placebo) was projected to the portion of an MCO T2DM population matching the respective trial’s inclusion criteria. A targeted literature search for paid amounts directly associated with each CVD event provided the unit costs, which were applied to the projected number of events averted, to calculate costs avoided per member per year (PMPY). One-way sensitivity analyses were performed on events averted, unit costs, and percentages of trial-applicable patients.

Results: Based on three-point MACE events averted, costs avoided PMPY of $6.17 (range: $1.27–$10.94) for CANVAS and $2.75 ($0.19–$4.83) for EMPA-REG were estimated. Costs avoided for individual components of MACE ranged from $0.77 to $3.84 PMPY for CANVAS and from -$0.97 (additional costs) to $1.54 for EMPA-REG. PMPY costs avoided for heart failure were $2.72 for CANVAS and $1.32 for EMPA-REG.

Limitations and conclusions: Models assumed independent, non-recurrent outcomes and were restricted to medical costs directly associated with the trial-reported events. The reductions in CVD events in T2DM patients reported for both CANVAS and EMPA-REG project to a positive cost avoidance for these events in an MCO population. The analysis did not include an assessment of the impact on total cost, as the costs associated with adverse events, drug utilization or other clinical outcomes were not examined.     

Attitudes about EU expansion and zero‐sum thinking

EU expansion can be seen as a positive‐sum process benefiting all countries by creating larger markets that stimulate more productive economies through increased specialization and economies of scale, implying that the general public in all countries should favour expansion. Contrarily, expansion can be perceived as zero‐sum. Capital and production relocate from higher to lower wage regions while labour does the opposite, possibly raising unemployment and reducing wages in the higher wage regions. The general public in these countries may come to oppose EU expansion attributing any deterioration in their work situation to the gains of new citizens of the European Union. Analysis of changes in Irish attitudes towards EU expansion in 2002, 2007 and 2009 finds no evidence of a link from lowered economic conditions to increased opposition to EU expansion. The only evidence for zero‐sum thinking is that diminished economic circumstances are associated with increased opposition to immigration, but this is not associated with increased opposition to further EU expansion.