Clinical and economic benefits of professional CGM among people with type 2 diabetes in the United States: analysis of claims and lab data

Background: It is estimated that one in 10 people in the US have a diagnosis of diabetes. Type 2 diabetes accounts for 95% of all cases in the US, with annual costs estimated to be $246 billion per year. This study investigated the impact of a glucose-measuring intervention to the burden of type 2 diabetes.

Objective: This analysis seeks to understand how professional continuous glucose monitoring (professional CGM) impacts clinical and economic outcomes when compared to patients who are not prescribed professional CGM.

Methods: This study utilized a large healthcare claims and lab dataset from the US, and identified a cohort of patients who were prescribed professional CGM as identified by CPT codes 95250 and 95251. It calculated economic and clinical outcomes 1 year before and 1 year after the use of professional CGM, using a generalized linear model.

Results: Patients who utilized professional CGM saw an improvement in hemoglobin A1C. The “difference-in-difference” calculation for A1C was shown to be –0.44%. There was no statistically significant difference in growth of total annual costs for people who used professional CGM compared to those who did not ($1,270, p?=?.08). Patients using professional CGM more than once per year had a –$3,376 difference in the growth of total costs (p?=?.05). Patients who used professional CGM while changing their diabetes treatment regimen also had a difference of –$3,327 in growth of total costs (p?=?.0023).

Conclusion: Significant clinical benefits were observed for patients who used professional CGM. Economic benefits were observed for patients who utilized professional CGM more than once within a 1-year period or who used it during a change of diabetes therapy. This suggests that professional CGM may help decrease rising trends in healthcare costs for people with type 2 diabetes, while also improving clinical outcomes.     

Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives

Abstract

Aims: To evaluate total costs and health consequences of a colorectal cancer (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of Integrated Delivery Networks (IDNs) and payers in the United States.

Materials and methods: We developed a budget impact and cost-consequence model that simulates CRC screening for eligible 50- to 75-year-old adults. A status quo scenario and an increased mt-sDNA scenario were modeled. The status quo includes the current screening mix of colonoscopy (83%), FIT (11%), and mt-sDNA (6%) modalities. The increased mt-sDNA scenario increases mt-sDNA utilization to 28% over 10 years. Costs for both the IDN and the payer perspectives incorporated diagnostic and surveillance colonoscopies, adverse events (AEs), and CRC treatment. The IDN perspective included screening program costs, composed of direct nonmedical (e.g. patient navigation) and indirect (e.g. administration) costs. It was assumed that IDNs do not incur the costs for stool-based screening tests or bowel preparation for colonoscopies.

Results: In a population of one million covered lives, the 10-year incremental cost savings incurred by increasing mt-sDNA utilization was $16.2 M for the IDN and $3.3 M for the payer. The incremental savings per-person-per-month were $0.14 and $0.03 for the IDN and payer, respectively. For both perspectives, increased diagnostic colonoscopy costs were offset by reductions in screening colonoscopies, surveillance colonoscopies, and AEs. Extending screening eligibility to 45- to 75-year-olds slightly decreased the overall cost savings.

Limitations: The natural history of CRC was not simulated; however, many of the utilized parameters were extracted from highly vetted natural history models or published literature. Direct nonmedical and indirect costs for CRC screening programs are applied on a per-person-per modality basis, whereas in reality some of these costs may be fixed.

Conclusions: Increased mt-sDNA utilization leads to fewer colonoscopies, less AEs, and lower overall costs for both IDNs and payers, reducing overall screening program costs and increasing the number of cancers detected while maintaining screening adherence rates over 10 years.     

Gender and Economics in Muslim Communities: A Critical Feminist and Postcolonial Analysis

ABSTRACT

This contribution seeks to delineate the broad contours of a transnational, anti-imperial feminist perspective on gender and economics in Muslim communities by bringing together feminist analyses of Orientalist tropes, development discourses and policies, and macro- and microeconomic trends. The goal is to facilitate conversations among scholars who have tended to work within their respective disciplinary and methodological silos despite shared interests. This approach pays special attention to intersectionality, historicity, and structural constraints by focusing on the diversity of the experiences of women and men by religion, location, citizenship, class, age, ethnicity, race, marital status, and other factors. It recognizes the complex relationships between the economic, political, cultural, and religious spheres and the role of local and transnational histories, economies, and politics in shaping people's lives. Finally, it emphasizes that openness to different methodological approaches can shed clearer light on the question of how various structural factors shape women's economic realities.     

On the Contributions of Barbara Bergmann to Economics

Abstract

This paper examines the major economic contributions of Barbara R. Bergmann. After presenting her personal background information, it gives an overview of her theoretical framework. This is followed by her critique of economic methodology and an examination of her major contributions in micro-simulation, feminist analysis of labor markets and the family, and policy-oriented work focused on improving the lives of women and children. The essay concludes with a brief discussion of Bergmann's unique qualities as an activist economist in the pursuit of social change.     

Underperformance of Actively Managed Portfolios: Some Behavioral Insights

Abstract

Two glaring anomalies in investment management are apparent: (1) after fees, active portfolio managers do worse than market indices, and (2) clients continue to pay for services they don’t receive. The purpose of this paper is to offer explanations of these anomalies from a behavioral perspective. We explore some of the cognitive biases that perpetuate active management and subsequent underperformance, including herding, disposition, and endowment effects, as well as conservatism and status quo biases, overconfidence, and agency problems. Investors’ continued use of active managers despite persistent disappointing returns is attributed to being victims of framing effect, hot-hand fallacy, lack of knowledge as well as intimidation or insecurity, and status quo bias. We propose some ways that portfolio managers and investors could improve their decision making.     

Capabilities and Personal Identity: Using Sen to explain personal identity in Folbre's 'structures of constraint' analysis

Folbre's 'structures of constraint' analysis treats women as socially embedded in 'multiple, often contradictory positions, because they belong to multiple groups'. This paper addresses the problem of women's multiple collective identities by arguing that Sen's capability framework offers a means of explaining how women can maintain coherent personal identities. Using Sen's real opportunities sense of capabilities, the paper argues that women can acquire personal identities apart from their multiple collective identities if they acquire the specific capability of being able, freely and successfully, to negotiate their multiple group involvements. Folbre's list of policies for a more egalitarian family is reconsidered from this perspective.     

Burden of menstrual symptoms in Japanese women: results from a survey-based study

Abstract

Objective:

Menstrual symptoms are associated with various health problems in women and may also significantly impact their lives. This study aims to assess the current burden of menstrual symptoms in Japanese women.

Methods:

Two online surveys were conducted among women aged 15–49 years, where sampling was designed to approximate the age and geographic distribution in Japan. The first survey collected data on menstrual symptom severity based on a modified, 35-item, Japanese version of the Menstrual Distress Questionnaire (mMDQ), current treatments, and impact on work productivity. The second survey collected costs of outpatient treatment within the previous 3 months. Additional outcomes of the second survey will be presented in a separate paper.

Results:

In this study, 19,254 women had menses, with 74% suffering from menstrual symptoms. A total of 50% reported pain and 19% reported heavy bleeding. Increasing severity of menstrual symptoms and self-reported heavy bleeding were related to more outpatient visits and greater work productivity loss. Among subjects with heavy bleeding, increasing severity of symptoms was related to greater interference with daily life. The estimated annual economic burden extrapolated to the Japanese female population was 683 billion Japanese Yen (JPY) or ～8.6 billion United States Dollars (USD).

Limitations:

The study population may be biased due to the online survey method.

Conclusions:

To the authors’ knowledge, this is the first large-scale research assessing outcomes by severity categories for all menstrual symptoms and women’s perception of bleeding. A large proportion of women suffer from menstrual symptoms, and symptom severity impacts women’s lives. Menstrual symptoms lead to significant economic burden, mainly due to work productivity loss. However, the majority of women do not visit a gynecologist, even when their menstrual symptoms are severe. Thus, increasing public awareness on the recently available medical treatments has the potential to improve the overall burden of menstrual problems.     

Power,Intergroup Conflicts and Social Stratification in the United States: What has the Global Crisis Taught us?

Abstract

Drawing on early sociological analyses of how power and intergroup conflicts can affect the development of modern economies, this paper investigates how the recent Global Crisis (GC) has affected the stratification of the US society. The paper argues that the consumerist society has reinforced the historical stratification of social identities with white men in high-paid, high-social status managerial and financial occupations at the top, and black women in low-paid, low-status service occupations at the bottom. This paper calls for a deconstruction of the neoliberal individual into a unique combination of identities in a stratified capitalist society in order to reveal how social stratification has evolved during the GC. The paper finally concludes on the importance of heterogeneous identities in reflecting the diversity of societal and economic interests in order to address the issues of financial stability and sustainability at the corporate and societal levels.     

Women's Intrahousehold Decision-Making Power and Their Health Status: Evidence from Rural Ethiopia

ABSTRACT

This study examines how various determinants of women's decision-making power affect their health status in rural Ethiopia. It identifies the determinants of women's decision-making power using a qualitative survey conducted over 2008–9, and it investigates their effects on women's health status using the Ethiopian Rural Household Survey panel dataset for the period 1994–2004. The study finds that women's health status is positively associated with their education, the number of brothers they have, whether they live in their birthplace, and whether their age is close to that of their husband. In contrast, women's health is negatively associated with whether they are in a marriage of their choice compared to an arranged marriage. The study concludes that multiple factors originating from context-specific gender norms affect women's decision-making power and have differential effects on women's health outcomes.     

DETERMINANTS OF WOMEN'S MICROENTERPRISE SUCCESS IN AHMEDABAD,INDIA: EMPOWERMENT AND ECONOMICS

Abstract

Microenterprise success is often evaluated solely in terms of economic outcomes. These evaluations do not recognize how opportunities for success may differ across groups and contexts, and disregard the importance of power and control as factors in success. This article investigates the determinants of a two-dimensional concept of microenterprise success for women in Ahmedabad, India, by analyzing data from a 1998 study of home-based garment producers. Growing economic success for these garment producers decreased empowerment outcomes, which suggests that evaluating both economic and empowerment outcomes and their interactions is important to understanding the process of achieving success. Improving the economic outcomes of women's enterprises via better training and access to markets, credit, and capital equipment does not necessarily facilitate women's empowerment. Microenterprise scholars and practitioners must focus on improving women's status within their homes, so they may contribute to and benefit from the decisions made about how to use their resources.     

A review of biopsychosocial strategies to prevent and overcome early-recognized poor adherence in growth hormone therapy of children

Abstract

Background:

Adherence to growth hormone (GH) therapy among children is variable and remains a problem, possibly affecting growth outcomes and future health, and having economic consequences.

Objective:

To provide a review of the issues related to poor adherence to GH therapy in children and describe integrative strategies that may improve adherence.

Results:

Poor adherence may be caused by various factors, affecting both the children and their families. The key reasons for adherence difficulties are psychological/emotional problems, social/everyday problems and technical handling issues of the drug delivery device. Correspondingly a broad range of strategies to address adherence to GH therapy often revolve around counseling and education, not just for the patient but also for the family giving care.

Limitations:

This review is intended as a general survey of strategies which could help, in clinical practice, to overcome poor adherence to growth hormone therapy in children; it summarizes the representative literature but it does not aim to be a rigorous database literature search in every aspect.

Conclusions:

If poor adherence is recognized early on during treatment, appropriate steps may be taken to identify barriers that are amenable to change for encouraging the child to adhere to the treatment regimen. A preventative approach may also be considered; for example, doctors could address adherence issues early and train families of children treated with GH to recognize the resources as well as the barriers to adherence. The broad range of different causes for poor adherence demands a great variety of interventions, making it important to individualize optimal treatment behavior. Additionally, economic studies are required to quantify the cost of poor adherence to GH therapy and to show the financial benefits of good adherence.     

Reassessing welfare reform data: a response to cherry

Abstract

This is a response to Robert Cherry's comment on the article, “Welfare as We [Don't] Know It: A Review and Feminist Critique of Welfare Reform Research” that appeared in the 10(2) issue of Feminist Economics. This response argues that while some combination of welfare reform, the booming economy in the late 1990s, and changes in economic policy all worked together to decrease caseloads and increase employment rates among welfare leavers, these are incomplete measures of the impact of welfare reform on the lives of lone mothers. This paper also argues that the effects of welfare reform on lone mothers are more mixed than Cherry acknowledges. This paper concludes that when one holistically examines low-income lone mothers' lives, it is premature to declare welfare reform a success.     

Patriarchy and Property Rights among Yoruba Women in Nigeria

ABSTRACT

In most patriarchal societies, women's property rights are often achieved vicariously, usually through their husbands. By contrast, among the Yoruba of Nigeria, women have some levels of autonomy and independence such that they can accumulate property to which their husbands have no claim, yet they customarily do not have any inheritance right to their husbands’ property. This study examines how this gender-equitable property rights regime affects gender relations at the household and societal levels through in-depth interviews conducted in 2012 with fifty-six purposively selected women property owners who lived in urban Ibadan, Nigeria. Findings include that though economic power has improved the status of the women and contributes to development of their communities, it has not yet translated into equity in decision making. More than economic power is required to attain equality. The capability of defining goals and acting upon them is also critical.     

The Load Model: an alternative to QALY

Background: QALYs are widely used in health economic evaluation, but remain controversial, largely because they do not reflect how many people behave in practice. This paper presents a new conceptual model (Load Model) and illustrates it in comparison with the QALY model.

Methods: Load is the average annual weight attributed to morbidity and mortality over a defined period, using weightings based on preference judgements. Morbidity Load is attributed to states of illness, according to their perceived severity. When people are in full health, Load is zero (no morbidity). Death is treated as an event with negative consequences, incurred in the year following death. Deaths may be weighted equally, with a fixed negative weight such as ?100, or differ according to the context of death. After death, Load is zero. In a worked example, we use the standard gamble method to obtain a weighting for an illness state, for both Load and QALY models. A judge is indifferent between certainty of 1.5 years’ illness followed by death, or a 50/50 chance of 1.5 years’ full health or 1-year illness, each followed by death. The weightings calculated are applied to a hypothetical life, 72 years in full health followed by 3 years with illness then death, using both models. Three other hypothetical outcomes are also compared.

Results: For an example life, the relative size of the morbidity component compared with the mortality component is much higher in the Load model than in the QALY model. When comparing alternative outcomes, there are also substantial differences between the two models.

Conclusions: In the Load model the weight of morbidity, relative to mortality, is very different from that in the QALY model. Given the role of the QALYs in economic evaluation, the implications of an alternative, which generates very different results, warrant further exploration.     

INTELLECTUAL PROPERTY RIGHTS IN A KNOWLEDGE-BASED ECONOMY: A NEW FRAME-OF-ANALYSIS

The debate on software intellectual property rights (IPRs) has not only highlighted fundamental issues regarding the scheme of protection that software enjoys, it has also pointed out major gaps in the representation of computer programs as economic goods. In this respect, various interpretations of software propose a limited outlook by referring only to particular aspects of computer programs.

The paper discusses the economic nature of software and computational processes and how they should be properly represented as commodities by focusing on software IPR legislation in the US. It elaborates the similarities and differences between software applications and machines on the basis of historical evidence from the evolution of information technologies and computer science. Further, we discuss whether computer programs should enjoy IPR protection (like their physical equivalents) and which legal regime would induce the maximal degree of societal benefits, while satisfying private and public interests.

The paper also elaborates the essential issues of the distinction between ideas and expressions and the ways they are treated as intellectual property. It highlights major aspects in the debate over protection of software applications by both patents and copyrights and analyses the economic impact of the joint regime.

By highlighting the dissimilarities in the economic nature and market behaviour of ideas and expressions we point out the difficulties in drawing parallels between software and physical equivalents. Finally, we provide alternative ways to establish coherent juridical basis and legal policy of software IPRs that aim at stimulating innovation and developing the technological landscape in information technologies.     

Pharmacoeconomic aspects of poor adherence: can better adherence reduce healthcare costs?

Abstract

Background:

Poor adherence to medical treatment is one of the main reasons why patients do not achieve the full benefits of their therapy. It also has a substantial financial weight in terms of money wasted for unused medication and increased healthcare costs including hospitalization due to clinical complications.

Objective:

To provide an overview and examples of the financial and economic consequences of poor adherence to treatment, techniques and devices for monitoring adherence and interventions for improvement of treatment adherence.

Results:

New electronic devices with monitoring features may help to objectively monitor patients’ adherence to a treatment regimen that can help a healthcare professional determine how to intervene to improve adherence and subsequent clinical outcome. Interventions that aim to enhance adherence may confer cost-effectiveness benefits in some indications and settings. The nature of the intervention(s) used depends on a range of factors, including patient preference, therapy area and cost of the intervention. However, there is a pressing need for rigorous trials, as current studies often have major flaws in the economic methodology, especially in terms of incremental analysis and sensitivity analysis.

Limitations:

This review has focused on a limited number of therapeutic areas as coverage of a more extensive range of diseases may be beyond the scope of such a summary. Nevertheless, the examples are representative of the challenges encountered in many other diseases.

Conclusions:

The clinical and economic consequences of non-adherence and interventions to improve compliance reflect the nature and severity of non-adherence, as well as the pathophysiology and severity of the disease. Interventions that aim to enhance adherence may confer cost-effectiveness benefits in some indications and settings, and good adherence can help payers and providers contain costs by extracting maximum value from their investment in therapies.     

State-firm Coordination and Upgrading in Spain's and Korea's ICT Industries

ABSTRACT

Generating sustainable growth and reaching advanced economy status depend on the ability of countries to host local, globally competitive firms in skill-, capital-, and knowledge-intensive industries. However, few countries succeed. This paper asks whether state activism is necessary to foster economic transformation at high levels of complexity in the globalisation era, and if so, what strategies are effective. Using evidence from Spain's and Korea's ICT industries since the 1980s, the paper argues that state-firm coordination remains necessary to reach the efficiency frontier in complex industries. However, coordination has shifted from hierarchical structures to nonhierarchical models in which states and firms develop mutually agreed-upon working rules to reach beneficial outcomes. Nonhierarchical coordination may involve adopting different institutional configurations, depending on the identities and capabilities of firms and national governments and on the nature of linkages with other nations. These linkages may lead to alternative pathways to upgrading and diverse productive specialisations.     

The Rejection of Qualitative Research Methods in Economics

Abstract:

The article analyzes the status quo of qualitative methods in economics. While a majority of economists consider knowledge of empirical research methods to be of considerable importance, it must be noted that qualitative research methods are scarcely implemented in economic publications. Given all the advantages of qualitative research methods, the reasons and processes responsible for the rejection of qualitative research methods in economics must be empirically identified and further discussed. To gain insights into the perception and application of qualitative research methods in economics revealing the status and representational patterns in qualitative social research. I addressed professors, editors of economic journals, and postdocs from Germany to access economists’ functional orientations and interpretative patterns, in order to establish preliminary indicators with regard to the subject-specific perspectives and the underlying scientific conceptions of economists. My findings reveal a fundamental rejection of qualitative research methods in economics due to methodological critique, a nomothetic world view and missing career opportunities. The article intends to initiate a discussion about the missing opportunities of the methodological contraction in the economic profession.     

Sustainable Economics: Understanding Market and Government Roles

Abstract

There has always been a debate on the roles of government and market for economic growth and development. Economic development encompasses more than just growth; it seeks the betterment of the standard of living and higher Human Development Index. There is no single strategy that would be considered the best solution for economic development. Market role and government intervention are both necessary for economic development. Since the economy is dynamic, then the policies adopted need to change according to the circumstances. It is argued that government intervention is sometimes necessary to ensure basic economic development, even if it essentially fails in economic growth in the short-term. Nonetheless, a good solution between the roles of market and government is through finding a dynamic equilibrium point between them. Therefore, the best policy is a policy that is resilient to change.