The economic burden of psoriasis with high comorbidity among privately insured patients in the United States

Objective: To evaluate the impact of comorbidities on healthcare resource use (HRU), and direct and indirect work-loss-related costs in psoriasis patients.

Methods: Adults with psoriasis (≥2 diagnoses, the first designated as the index date) and non-psoriasis controls (no psoriasis diagnoses, randomly generated index date) were identified in a US healthcare claims database of privately-insured patients (data between January 2010 and March 2017 were used). Psoriasis patients were stratified based on the number of psoriasis-related comorbidities (0, 1–2, or ≥3) developed during the 12?months post-index. All outcomes were evaluated during the follow-up period, spanning the index date until the end of continuous health plan eligibility or data cut-off. HRU and costs per-patient-per-year (PPPY) were compared in psoriasis and non-psoriasis patients with ≥12?months of follow-up.

Results: A total of 9,078 psoriasis (mean age?=?44?years, 51% female) and 48,704 non-psoriasis (mean age?=?41?years, 50% female) patients were selected. During the 12?months post-index, among psoriasis vs non-psoriasis patients, 71.0% vs 83.0% developed no psoriasis-related comorbidities, 26.3% vs 16.0% developed 1–2, and 2.6% vs 1.0% developed ≥3 psoriasis-related comorbidities. Compared to non-psoriasis patients, psoriasis patients had more HRU including outpatient visits (incidence rate ratios [IRRs]?=?1.52, 2.03, and 2.66 for 0, 1–2, and ≥3 comorbidities, respectively [all p?p?p?p?Conclusions: HRU and cost burden of psoriasis are substantial, and increase with the development of psoriasis-related comorbidities.     

Quantifying public preferences for agri-environmental policy in Scotland: A comparison of methods

This paper compares two methods for determining policy priorities for reform of Scottish agricultural support. Multifunctional agriculture attempts to establish a new balance between traditional commodity support and payment for the production of non-market goods and services that are increasingly demanded by the public. Supplying non-market goods presents particular problems for optimal policy design, not least the elicitation of consumer demand for those goods. From public focus groups, a range of attributes was derived as central to the Scottish public’s preferences for future agri-environmental reform. This information was then combined in two separate survey methods using the Analytical Hierarchy Process (AHP) and choice experiments (CE). Both applications suggest that the public has defined preferences and a willingness to pay (using general income taxation) to affect changes beyond the status quo, and that policy payments should be targeted towards both environmental and social benefits. The divergent preference orderings derived from the alternative methods can be considered in the light of previous methodological debates on question framing, bounded rationality and respondent uncertainty. We speculate about the validity of alternative methodologies for informing particular policy questions.     

Price determinants of Aboriginal art, and its role as an alternative asset class

This paper analyzes auction results for over 4000 paintings by Australian Aboriginal artists to investigate determinants of prices in the Aboriginal art market. This is the first financial study of an indigenous art market, and hedonic, repeat sales and hybrid regression analyses find it shares price determinants with traditional art markets (with price premia attached to artist name, death, painting size, leading auction house, and winter sale). However, Aboriginal art’s unique features significantly affect prices, particularly works that use traditional Aboriginal media and those with reputation-affirming traits. An Aboriginal Art Index provides 6.6% annual return (standard deviation 17.9%), which is comparable to traditional asset classes and superior on a risk-adjusted basis. Returns to Aboriginal art are negatively correlated with returns from other assets, and so it adds value to a diversified investment portfolio.     

Demarketing places: Rationales and strategies

Abstract

The concept of demarketing, originally introduced by Kotler and Levy (1971 Kotler, P. and Levy, S.J. 1971. Demarketing, yes, demarketing. Harvard Business Review, 49: 74–80. [Web of Science ®] , [Google Scholar]), can be used in the context of places to describe specific activities aimed at deflecting interest, visitors, and/or investment to a particular place. This paper presents an exploratory investigation into the use of place demarketing in the UK. Thirteen in-depth interviews were conducted with place-marketing practitioners whose work was identified as incorporating elements of place-demarketing practice and activity. Four main rationales for demarketing places were identified: sustainability of the place product; market segmentation and targeting; reducing the effect of seasonality; and crisis prevention/management. The strategies identified in the place-demarketing process include: no marketing; redirection/marketing alternative places; informational place demarketing; restricting access; and pricing mechanisms. The paper concludes by drawing together some of the issues and implications that the demarketing of places raises.     

The Sunrise Economy: 24-hour Drinking Legislation in Leeds

ABSTRACT

As the growth of the public houses has become static within the UK the government has been looking at different ways in which they can strategically expand the market, of which one is the 24-hour drinking legislation.

The 24-hour drinking legislation has been operative in the United Kingdom for just over one year now and this article looks at how a chain of public houses has adopted this legislation into their day-to-day running of the business. The paper also discusses the types of consumer's who frequent the public houses at the new trading times and in particular, with the aid of consumer behaviour theory and in particular the PIECE model, discusses the process in which these consumer's go through.

The main conclusions denote that shift workers, the unemployed, and blue collar workers all use these premises at the new trading times.     

Seeds of distrust: conflict in Uganda

We study the effect of civil conflict on social capital, focusing on Uganda’s experience during the last decade. Using individual and county-level data, we document large causal effects on trust and ethnic identity of an exogenous outburst of ethnic conflicts in 2002–2005. We exploit two waves of survey data from Afrobarometer (Round 4 Afrobarometer Survey in Uganda, 2000, 2008), including information on socioeconomic characteristics at the individual level, and geo-referenced measures of fighting events from ACLED. Our identification strategy exploits variations in the both the spatial and ethnic intensity of fighting. We find that more intense fighting decreases generalized trust and increases ethnic identity. The effects are quantitatively large and robust to a number of control variables, alternative measures of violence, and different statistical techniques involving ethnic and spatial fixed effects and instrumental variables. Controlling for the intensity of violence during the conflict, we also document that post-conflict economic recovery is slower in ethnically fractionalized counties. Our findings are consistent with the existence of a self-reinforcing process between conflicts and ethnic cleavages.     

Hierarchy and conservatism in the contributions of resources to entrepreneurial activity

This study addresses the relationship between the munificence offered by a country’s proximate institutions in terms of a critical financial resource (informal investments) and human resource (entrepreneurship education) and its early-stage entrepreneurial activity. We also examine how this relationship might be moderated by underlying cultural values. Our main thesis is that the positive effects of resource munificence of proximate institutions on early-stage entrepreneurial activity should be attenuated in countries with a more hierarchical and conservative culture. We test our hypotheses using a multi-source dataset that spans 42 countries.     

Australia's approach to airport charges: The Sydney Airport experience

Australia has been progressive by world standards in its programme of airport privatisation and the adoption of a ‘light-handed’ regime of airport regulation. This paper discusses Sydney Airport's experience in negotiating commercial pricing agreements with airlines in the context of the light-handed regime and the Australian infrastructure access arrangements. It concludes that contractual relationships in an environment of informal regulation are able to provide sound, and arguably superior, outcomes to formal price regulation.     

Adherence,persistence, and inpatient utilization among adult schizophrenia patients using once-monthly versus twice-monthly long-acting atypical antipsychotics

Aims: This study compared healthcare resource utilization (HRU), healthcare costs, adherence, and persistence among adult patients with schizophrenia using once-monthly (OM) vs twice-monthly (TM) atypical long-acting injectable (LAI) antipsychotic (AP) therapy.

Materials and methods: A longitudinal retrospective cohort study was conducted using Medicaid claims data from six states. Patients initiated on aripiprazole or paliperidone palmitate were assigned to the OM cohort; risperidone-treated patients were assigned to the TM cohort. HRU and healthcare costs were assessed during the first 12 months following stabilization on the medication. Adherence was measured using the proportion of days covered (PDC) during the first year of follow-up. Persistence to the index medication was measured during the first 2 years following the index date. Comparison between the cohorts was achieved using multivariable generalized linear models, adjusting for demographic and clinical characteristics.

Results: Patients in the OM LAI cohort had lower inpatient HRU and medical costs when compared with patients in the TM cohort. Higher medical costs in the TM LAI cohort offset the higher pharmacy costs in the OM LAI cohort. Mean PDC during the first 12 months of follow-up was higher in the OM cohort than in the TM cohort (0.56 vs 0.50, p?<?.01). Median persistence was longer in the OM cohort than in the TM cohort (7.5 months vs 5.5 months), as was the hazard of discontinuing the index medication (hazard ratio?=?0.83, p?=?.01). Kaplan-Meier rates of persistence at 1 year were higher for OM patients than for TM patients (37.6% vs 29.6%, p?<?.01).

Limitations: This was a Medicaid sample with few aripiprazole LAI patients (5.4% of OM cohort). Medication use was inferred from pharmacy claims.

Conclusions: Among Medicaid patients in these six states, OM AP treatment was associated with lower HRU, better adherence and persistence, and similar total costs compared to patients on TM treatment.     

The effect of international tourism on economic development: An empirical analysis

The expansion of international tourism in developing countries is generally considered to promote their economic development. In this paper, the impact of international tourism on economic development is modelled using an aggregate production function framework. It specifically investigates intersectoral externalities and marginal factor productivity differences between the international tourism sector and the rest of the economy. The net effect of international tourism on GDP per capita is examined via an empirical analysis of 37 developing economies. The results indicate that international tourism may positively affect economic development in these countries.