Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States–based retrospective claims database analysis

Abstract

Aims: The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.

Methods: This was a retrospective study conducted using the MarketScan Claims Database (2010–2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90 days following the index MDD date (profiling period) using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20?mg/day for nonelderly and ≥10?mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.

Results: Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per patient per year CVD-related hospitalization costs ($21,485 vs. $17,756), higher all-cause outpatient costs ($2,820 vs. $2,055), and higher CVD-related outpatient costs ($520 vs. $434) compared to patients receiving adequate MDD care.

Limitations: Clinical information such as depression severity and frailty, which are potential predictors of adverse CVD outcomes, could not be ascertained using administrative claims data.

Conclusions: Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.     

Setting operating policies for supply hubs

This paper deals with the joint management of operations at the supply hub for the customer and the upstream supplier. Different operating conditions are considered, namely, backordering, minimum and maximum specified inventory levels. Some analytical insights on better managing suppliers operating under a vendor managed inventory program are presented. Essentially, we show that the penalty cost imposed on over- and under-stocking, and the min–max policy for hub inventory reside in the power of the hub operator. The relationship between supply hub policy and performance measures is quite complex and non-linear in nature. We suggest a structured hierarchical approach which can help supply hub in achieving balance between various parties involved in chain. A numerical example and an algorithm are included to highlight this result.     

基于航空运输的应急物资配送网络优化研究

近年来突发事件的频发给我国带来了重大的生命财产损失,应急物资配送网络的合理构建是提高我国突发事件应急处置能力的重要途径之一.提出一个抗风险能力强、反应速度快、成本节约的基于航空系统的应急物资配送网络目标规划模型,优化应急物资配送中心布局以及应急配送网络的组织形式,并选取全国100个通用机场为例进行实证分析.研究结果表明,最佳的应急物资航空配送网络是以长春、乌鲁木齐、济南、成都、南昌为配送点的中心辐射式网络,且该网络布局形式的投入成本随应急反应时间的缩小而大幅上升.     

Why do firms delete brands? Insights from a qualitative study

Large consumer goods firms manage and market an assortment of brands and consistently deal with strategic challenges related to brand portfolio management, such as creating or acquiring brands, growing brand equity, managing brands in the portfolio and deleting brands. There is substantial research on several areas of brand portfolio management except in the area of brand deletion. This situation exists despite the fact that deleting weak brands has important implications for a firm and its brand portfolio. Therefore, it is critical to understand why firms delete brands from their portfolios. This research applies a qualitative approach using semi-structured interviews and thematic analysis in the context of firms that adopt a ‘house of brands’ brand architecture and presents findings guided by the strategic decision-making literature.