Healthcare resource use and costs of privately insured patients who switch,discontinue, or persist on anti-muscarinic therapy for overactive bladder

Objectives:

To compare the healthcare costs of patients with overactive bladder (OAB) who switch vs persist on anti-muscarinic agents (AMs), describe resource use and costs among OAB patients who discontinue AMs, and assess factors associated with persisting vs switching or discontinuing.

Methods:

OAB patients initiating an AM between January 1, 2007 and March 31, 2012 were identified from a claims database of US privately insured beneficiaries (n?≈?16 million) and required to have no AM claims in the 12 months before AM initiation (baseline period). Patients were classified as persisters, switchers, or discontinuers, and assigned a study index date based on their AM use in the 6 months following initiation. Baseline characteristics, resource use, and costs were compared between persisters and the other groups. Resource use and costs in the 1 month before and 6 months after the study index date (for switchers, the date of index AM switching; for persisters, a randomly assigned date to reflect the distribution of the time from AM initiation to switching among switchers) were also compared between persisters and switchers in unadjusted and adjusted analyses. Factors associated with persisting vs switching or discontinuing were assessed.

Results:

After controlling for baseline characteristics and costs, persisters vs switchers had significantly lower all-cause and OAB-related costs in both the month before (all-cause $1222 vs $1759, OAB-related $142 vs $170) and 6 months after the study index date (all-cause $7017 vs $8806, OAB-related $642 vs $797). Factors associated with switching or discontinuing vs persisting included index AM, younger age, and history of UTI.

Conclusion:

A large proportion of OAB patients discontinue or switch AMs shortly after initiation, and switching is associated with higher costs.     

THE DYNAMIC EFFECTS OF MULTILATERAL TRADE POLICY WITH EXPORT CHURNING

This article examines the relationship between export churning and the aggregate response to trade policy. I show that export churning—the share of bilateral exports by new or exiting exporters—varies systematically across export destinations and build a multicountry model with destination-specific investments in exporting capacity that is consistent with churning patterns. The model then predicts that trade liberalizations with minor export destinations deliver higher bilateral export growth than liberalizations with major export destinations, and the data support this prediction. Furthermore, the aggregate effects of trade policy depend critically on the pattern of export churning in the model.     

The impact of monitor choice on insurer loss reserves

This paper examines the association between monitoring and earnings management by property-casualty insurers. Prior literature has evaluated the impact of auditors and actuaries on insurer reserving. We extend this work by considering the nonrandom nature of monitor assignment. We model the insurer decisions regarding choice of auditor and actuary jointly using a Heckman selection model. Consistent with prior literature, we account for potential loss reserving incentives that may confound these decisions. We find that the use of internal actuaries is significantly related to higher reserve errors, but this is reduced, but not fully offset, when the internal actuary is an officer of the insurer. We find lower reserve error for auditors from a Big N firm. However, the use of an auditor and actuary from the same Big N firm is significantly related to higher reserve errors.     

Intergenerational influence on sustainable consumer attitudes and behaviors: Roles of family communication and peer influence in environmental consumer socialization

Intergenerational research on sustainable consumption remains scarce, particularly in relation to which factors may affect the level of intergenerational similarity and the direction of intergenerational transmission. The present study addresses these gaps and adds to the growing body of literature in environmental consumer socialization by examining intergenerational influence on sustainable consumer attitudes and behaviors in a sample of 146 dyads comprised of mothers and college-age daughters. In the domain of intergenerational influence, we study two potential moderating factors suggested in past consumer research: communication effectiveness and peer conformity. Using the co-orientational model and nominal dyad method, we reveal the existence of intergenerational similarity in dyads' sustainable consumer attitudes and behaviors—after accounting for nominal effects— and show that stronger parent–child communication between mother–daughter pairs leads to greater intergenerational similarity, whereas stronger peer influence on daughters reduces intergenerational agreement. Our analysis further suggests the presence of reverse environmental socialization, in which intergenerational influence predominantly occurs from daughter to mother. Dyads' subjective knowledge regarding sustainable consumption provides empirical insights for this co-orientational model finding on reverse intergenerational transfer. Overall, outcomes of this study encourage marketing managers to leverage young-adult offspring in the process of communicating sustainable marketing strategies.     

Integrating Africa by Competition and Market Policy

Review of Industrial Organization - Africa has the African Continental Free Trade Area (AfCFTA). The agreement will lower tariffs and facilitate internal market trade on the continent, and policy...