Adherence to iron chelation therapy and associated healthcare resource utilization and costs in Medicaid patients with sickle cell disease and thalassemia

Background:

Sub-optimal patient adherence to iron chelation therapy (ICT) may impact patient outcomes and increase cost of care. This study evaluated the economic burden of ICT non-adherence in patients with sickle cell disease (SCD) or thalassemia.

Methods:

Patients with SCD or thalassemia were identified from six state Medicaid programs (1997–2013). Adherence was estimated using the medication possession ratio (MPR) of ≥0.80. All-cause and disease-specific resource utilization per-patient-per-month (PPPM) was assessed and compared between adherent and non-adherent patients using adjusted incidence rate ratios (aIRR). All-cause and disease-specific healthcare costs were computed using mean cost PPPM. Regression models adjusting for baseline characteristics were used to compare adherent and non-adherent patients.

Results:

A total of 728 eligible patients treated with ICT in the SCD cohort, 461 (63%) adherent, and 218 in the thalassemia cohort, 137 (63%) adherent, were included in this study. In SCD patients, the adjusted rate of all-cause outpatient visits PPPM was higher in adherent patients vs non-adherent patients (aIRR [95% CI]: 1.05 [1.01–1.08], p?<?0.0001). Conversely, adherent patients incurred fewer all-cause inpatients visits (0.87 [0.81–0.94], p?<?0.001) and ER visits (0.86 [0.78–0.93], p?<?0.001). Similar trends were observed in SCD-related resource utilization rates and in thalassemia patients. Total all-cause costs were similar between adherent and non-adherent patients, but inpatient costs (adjusted cost difference?=??$1530 PPPM, p?=?0.0360) were lower in adherent patients.

Conclusion:

Patients adherent to ICT had less acute care need and lower inpatient costs than non-adherent patients, although they had more outpatient visits. Improved adherence may be linked to better disease monitoring and has the potential to avoid important downstream costs associated with acute care visits and reduce the financial burden on health programs and managed care plans treating SCD and thalassemia patients.     

Insulin degludec versus insulin glargine U100 for patients with type 1 or type 2 diabetes in the US: a budget impact analysis with rebate tables

Background and aims: Drug rebates are almost universally negotiated privately between the manufacturer and the payer in the US. The aim of the present study was to illustrate the use of a “rebate table” to improve the transparency and utility of published budget impact analyses in the US by modeling ranges of hypothetical rebates for two comparators. Worked examples were conducted to illustrate the budgetary implications of using insulin degludec (IDeg) relative to insulin glargine (IGlar) U100 in patients with type 1 or 2 diabetes.

Methods: A short-term (1-year) budget impact model was developed to evaluate the costs of switching to IDeg from IGlar in patients with type 1 or 2 diabetes on basal-bolus and basal-only insulin, respectively. The analysis used insulin dose and hypoglycemia data from recent randomized trials, data on the prevalence of diabetes, and estimates of the proportion of patients using each insulin regimen. The model was configured to run multiple rebate scenarios to generate a rebate table in a hypothetical 1 million member commercial plan.

Results: Relative to IGlar, IDeg resulted in reductions in non-severe and severe hypoglycemia incidence and costs both in patients with type 1 and patients with type 2 diabetes. Insulin acquisition costs were higher, and respective rebates of 7.3% and 10.6% were required for IDeg to break-even with IGlar at the full list price. Incremental per member per month IDeg costs without a rebate were USD 0.04 in type 1 diabetes and USD 0.80 in type 2 diabetes.

Conclusions: Using IDeg instead of IGlar at list price could result in a modest increase in costs when considering insulin and hypoglycemia costs alone, but modest incremental rebates with IDeg would result in cost neutrality relative to IGlar. In addition, IDeg would result in reduced incidence of severe and non-severe hypoglycemia.     

The nature of the new employment relationship: A content analysis of the practitioner and academic literatures

At a general level, there appears to be almost universal agreement that the nature of the employment relationship is undergoing fundamental changes that have potentially enormous implications for how companies attract, motivate, and retain talent. This article is intended to assist HRM professionals in understanding, evaluating, and responding to those changes. The results of a study that evaluates current thinking regarding the nature of the new employment relationship by systematically analyzing the content of relevant articles are reported. Implications of the results for the management of employee relationships are discussed, and specific recommendations are provided. © 2000 John Wiley and Sons, Inc.     

The mediating effect of work–family conflict in the relationship between job stress and intent to stay: The case of tourism and hospitality workers in Macau

ABSTRACT

This study explores the mediating effect of work–family conflict in the relationship between job stress and intent to stay. The study revealed that once the intervention took place, employees' job stress has ceased to exert direct influence on their turnover intention. This signifies that work–family conflict is the underlying cause which discourages stressful employees to remain with their employer. The study was conducted in Macau to a group of tourism workers by means of street intercept survey.     

Executive compensation,earnings management and shareholder litigation

This paper examines the effects of executive compensation and potential for earnings management on the incidence of shareholder class action lawsuits and their outcomes. Although damage measurement factors, managerial option intensity, and earnings management all significantly affect the probability of lawsuits, they differ in their influence on the likelihood of positive settlement and on settlement amount: Damage factors do not affect the likelihood of settlement versus dismissal. High option intensity raises the probability of positive settlement, but does not affect its amount. High earnings management, on the other hand, does not affect the likelihood of settlement, but does increase settlement amount. These findings suggest that factors typically used to explain shareholder lawsuits should be interpreted with care.     

Diagnosis of Dry Bulk Shipping Market

A sudden severe winter for dry bulk shipping market Since the second half of last year, dry bulk shipping market experienced a sudden and dramatical change which caught ev- eryone off guard in just a few months＇ time. As the wind vane of dry bulk shipping market, BDI index （Baltic index） has been climbing higher and higher from the middle of 2005. It began to nearly shoot up into the 2007. From the middle of 2007 to the early 2008, BDI index increased by about 6,000 points within a short time of half a year and reached topped aroundl 1,000 points. However, after it peaked at the historical 11,793 points in the middle of 2008, the index took a scary nosedive and plunged to 1,100 points in November, 2008, evaporated over 90%.     

The relationship between learner utility reactions and predicted learning transfer among trainees

Although learner reaction measures are increasingly shown to be insufficient indicators of training effectiveness and impact, they are still highly over–used in practice. New research on transfer of learning is contributing to a better understanding of how reaction measures may relate to important HRD outcomes. This study explored the relationship between learner utility reactions and predictors of learning transfer as operationalised in the Learning Transfer System Inventory. A limited correlation between participant reaction measures and predictors of learning transfer was found. However, the results of this study continue to raise questions about the role and value of reaction measures.     

Offshore outsourcing of services: An evolutionary perspective

Offshore outsourcing is gaining increasing importance and attention in both theory and practice. The purpose of this research is to use nine in-depth case studies to analyze the evolution of offshore services outsourcing with regard to how expectations and governance structures change over time. Five testable propositions are presented, building on institutional theory, transaction cost, and resource-based perspectives. The cases demonstrate that offshore outsourcing is initiated because of increasing internal and external pressure to conform and reduce costs. Moreover, companies “chase” efficiency improvements in other geographic locations. But after reducing costs, companies discover more strategic benefits such as the potential to increase quality and market share. Importantly, as buyer–supplier relationships move from tactical to more strategic, expectations and governance structures change.     

If you build it,will they come? Student preferences for Makerspace environments in higher education

The Maker Movement inspires people to express their creativity by making things in a self-directed and, often, collaborative learning endeavor. The excitement of the movement has spurred the development of various types of Makerspaces across the United States and the World to further enable people to make and innovate. The education community has recognized the potential for Makerspaces as learning environments that can foster interdisciplinary collaboration and self-directed learning. As such, there is much excitement to create Makerspaces within K-12 schools, libraries, colleges and universities. However, contrary to the formal design process used to build many school facilities, successful grass-roots makerspaces are most often created when those with like-minded interests come together and adapt the building around them to fit their needs. The research in this paper focuses on the design of such spaces by applying the environmental preferences predictors psychology construct. The study surveyed 276 students from art and design, engineering, and liberal arts majors to better understand their preferences as related to images of eight different Makerspaces. The results are broken down by the four predictors of preference, major, and gender. The results highlight differences among the images along with design considerations for creating spaces that welcome a broader audience.