A real-world analysis of healthcare costs and relative risk of hyperprolactinemia associated with antipsychotic treatments in the United States

Abstract

Aims: Antipsychotic medications are associated with an increased risk of hyperprolactinemia, but differ in their propensity to cause this complication. This study aimed to assess the economic burden of hyperprolactinemia, and to compare its risk among adult patients using atypical antipsychotics (AAs) with a mechanism of action associated with no/low vs high/moderate prolactin elevation.

Methods: This retrospective cohort study was based on US Commercial and Medicaid claims databases. Healthcare costs were compared between matched hyperprolactinemia and hyperprolactinemia-free cohorts using a two-part model. Risk of hyperprolactinemia was compared between patients receiving AAs with a mechanism of action associated with no/low (no/low prolactin elevation cohort) vs high/moderate prolactin elevation (high/moderate prolactin cohort) using logistic regression.

Results: In the commercially insured sample, compared to the hyperprolactinemia-free cohort (n?=?499), the hyperprolactinemia cohort (n?=?499) was associated with incremental total healthcare costs of $5,732 ($20,081 vs $14,349; p?=?.004), and incremental medical costs of $3,861 ($13,218 vs $9,357; p?=?.040), mainly driven by hyperprolactinemia-related costs. In the Medicaid-insured sample, compared to the hyperprolactinemia-free cohort, the hyperprolactinemia cohort was associated with incremental total healthcare costs of $10,773 ($30,763 vs $19,990; p?=?.004), and incremental medical costs of $9,246 ($20,859 vs $11,613; p?=?.004), mainly driven by hyperprolactinemia-related and mental health-related costs. The odds of hyperprolactinemia in the no/low prolactin elevation cohort were 4–5-times lower than that in the high/moderate prolactin elevation cohort (odds ratio =0.21; p?<?.001).

Limitations: Hyperprolactinemia may be under-reported in claims data.

Conclusions: Hyperprolactinemia is associated with substantial healthcare costs. AAs associated with no/low prolactin elevation reduce the risk of hyperprolactinemia by 4–5-times compared to AAs associated with moderate/high prolactin elevation. Treatment options with minimal impact on prolactin levels may contribute to reducing hyperprolactinemia burden in AA-treated patients.     

Risk and performance estimation in hedge funds revisited: Evidence from errors in variables

This paper revisits the performance of hedge funds in the presence of errors in variables. To reduce the bias induced by measurement error, we introduce an estimator based on cross sample moments of orders three and four. This Higher Moment Estimation (HME) technique has significant consequences on the measure of factor loadings and the estimation of abnormal performance. Large changes in alphas can be attributed to measurement errors at the level of explanatory variables, while we emphasize some shifts in the economic contents of the equity risk premiums by switching from OLS to HME.     

Restructuring the State-Owned Banking Sector: A Comparative Assessment of Approaches in Central Europe

MOCT-MOST: Economic Policy in Transitional Economies -     

Factors influencing purchase intent in virtual worlds: a review of the literature

Previous empirical studies have identified several factors that seem to play a role in determining purchase intent in virtual worlds; three-dimensional online environments in which users interact while represented by their avatars. So far however, a clear overview of these factors is lacking, and the question that remains is what factors affect purchase intent most. Therefore, this study aims to create an overview of factors that influence users’ purchase intent in virtual worlds, and to subsequently identify the most influential factors. To conduct this review, relevant literature was gathered using a variety of search engines and keywords. An article had to explicitly study factors influencing purchase intent in virtual worlds in order to be included in this review. This search method resulted in a selection of twelve relevant articles that were used for further analysis. Results show that perceived enjoyment, social influence, customization and ease of use are important factors that influence purchase intent in virtual worlds. Enjoyment of the virtual world, beliefs and attitudes of others, avatar customization, and easy-to-use virtual world applications can thus increase users’ willingness to purchase products in the virtual world. Practical implications as well as limitations and suggestions for future research are discussed.     

Phases of Globalization,Wages and Inequality

Open Economies Review - To analyse the globalization-wages-inequality relationship, we extend the North-South Heckscher-Ohlin-Samuelson (HOS) model by assuming (i) that the size of the South...     

The multivariate Variance Gamma model: basket option pricing and calibration

In this paper, we propose a methodology for pricing basket options in the multivariate Variance Gamma model introduced in Luciano and Schoutens [Quant. Finance 6(5), 385–402]. The stock prices composing the basket are modelled by time-changed geometric Brownian motions with a common Gamma subordinator. Using the additivity property of comonotonic stop-loss premiums together with Gauss-Laguerre polynomials, we express the basket option price as a linear combination of Black & Scholes prices. Furthermore, our new basket option pricing formula enables us to calibrate the multivariate VG model in a fast way. As an illustration, we show that even in the constrained situation where the pairwise correlations between the Brownian motions are assumed to be equal, the multivariate VG model can closely match the observed Dow Jones index options.     

Communicating Sensory Attributes and Innovation Through Food Product Labeling

This article explores the influence of food product packaging on consumers’ sensory expectations and perceived newness of the product. Two experiments examine to what extent consumers use product typicality, graphical representations, and package typicality in evaluating new food products. Study 1 finds that (1) a typical flavor induces more positive expectations of pleasantness, taste, color, and smell, and (2) the presence of graphic representation on product labels increases perceived pleasantness but does not affect sensory expectations. Study 2 indicates that the product seems newer in the absence of a package (label-only condition), but when the product packaging is presented, an atypical package conveys more newness than a typical package. These results provide practical guidelines for the design and introduction of innovative food products.     

Intraday hedging with financial options: the case of electricity

As market intermediaries, electricity suppliers purchase electricity from the wholesale market or self-generate to deliver their customers. However, electricity suppliers are uncertain about how much electricity their residential customers will use at any hour of the day until they actually turn switches on. While demand uncertainty is a common feature of all commodity markets, suppliers generally rely on storage to manage it. Singularly, electricity suppliers are exposed to joint volumetric and price risk on an hourly basis given the physical attributes of electricity. In the literature on electricity markets, few articles compare the efficiency of forward contracts, options and physical assets (i.e. power plants) within intraday hourly hedging portfolios, whereas electricity markets are precisely hourly markets. We analyse portfolios made of forwards, options and/or power plants for specific hourly clusters (9 am, 12 pm, 18 pm, 9 pm) based on electricity market data from 2013 to 2015 from the integrated German–Austrian spot market. Through a VaR model, we prove that intraday hedging with forwards is structurally inefficient compared to financial options and physical assets, no matter the cluster hour. Moreover, our results demonstrate the contribution of ‘out of the money’ options for all hours within volatile spot markets.     

Real-life cost of vitamin K antagonist treatment in patients with non-valvular atrial fibrillation in France in 2013

Aims: Data highlighting the cost drivers for non-valvular atrial fibrillation (NVAF) patients in terms of vitamin K antagonist (VKA) treatment and monitoring are lacking in France. This study aimed to evaluate the real-life daily cost of VKA treatment in 2013, in French patients suffering from NVAF.

Methods: This longitudinal observational study was performed using the EGB (Echantillon Généraliste des Bénéficiaires) database, a random sample of the French national insurance (NHI) database, which covers 80% of the population. All adult patients whose first NVAF anticoagulant treatment in 2013 was a VKA were analyzed. Costs were calculated for the duration of follow-up and then divided by the number of days of therapy. The analysis was performed both from the French NHI perspective (amount reimbursed by the NHI) and from a collective perspective.

Results: In this study, 3,254 NVAF patients treated with VKA in 2013 were included, and this sample comprised 52.6% males. The mean daily cost of VKA treatment was €1.13 (±1.18) according to the collective perspective (89.4% of this cost was associated to INR measurement) and €1.05 (±1.16) according to the NHI perspective.

Limitations: As diagnoses associated with procedures are not available in the EGB database, proxies were used, and an algorithm was created to define the AF population.

Conclusions: This analysis is the first to consider an exhaustive spectrum of the costs of VKA treatment in France using EGB data. VKA medication requires exhaustive follow-up, and, thus, associated costs are important. The results of the present study confirmed this close follow-up for VKA patients, making the cost of treatment by VKA nearly 10-times more expensive than the cost of medication itself.