Predictors of glycemic control and diabetes-related costs among type 2 diabetes patients initiating therapy with liraglutide in the United States

Objective:

Liraglutide has been shown to significantly improve glycemic control and reduce body weight while minimizing the risk of hypoglycemia in adult patients with type 2 diabetes (T2D). This study aimed to identify characteristics that predict clinical and economic outcomes associated with liraglutide therapy in clinical practice in the US.

Methods:

Using the Truven Health MarketScan Laboratory Database, glycemic control (A1C <7%) and diabetes-related costs were evaluated in T2D patients initiating liraglutide between January 1, 2010 and June 30, 2012. Patients were required to have ≥1 post-index claim for liraglutide and A1C values at baseline and 6 months follow-up. All valid values of baseline A1C were included. Patients previously treated with GLP-1 receptor agonist(s) or insulin, or with evidence of type 1 diabetes, pregnancy, or gestational diabetes during the study period were excluded. Multivariable regression models were used to identify predictors of glycemic control and diabetes-related costs.

Results:

Of 417 patients newly treated with liraglutide, 54.0% achieved glycemic control (A1C <7%) during follow-up. Factors associated with increased odds of glycemic control during follow-up were: being female, POS/EPO health plan type, baseline A1C, early liraglutide initiation (0–1 prior oral anti diabetics [OADs] vs ≥2), adherence to liraglutide (defined as the proportion of days covered [PDC]), and diabetic retinopathy. Being female, earlier liraglutide initiation (0–1 prior OADs), and higher patient share of liraglutide costs were associated with significantly lower diabetes-related costs during follow-up. Factors associated with significantly higher post-index diabetes-related costs were: higher baseline A1C, baseline use of sulfonylureas, and diabetic retinopathy.

Conclusions:

Within this commercially-insured population of T2D patients treated with liraglutide, gender, baseline A1C, early liraglutide initiation (0–1 prior OADs), diabetic retinopathy, better adherence, and patient share of liraglutide costs were associated with increased odds of achieving glycemic control and the odds of having higher or lower diabetes-related costs.     

Seasonal employees' intention to return and do more than expected

Seasonal employment is important in the service industries. Having motivated and satisfied employees is fundamental when front-line employees play a key role for the customers' perceived service quality. Seasonal work differs from permanent employment in many aspects and if managed properly, this could be a competitive advantage and contribute to the success of an organization. This study focuses on seasonal employees' intention to return and to do more than expected at work as well as the relationships between certain motivational factors and job satisfaction. A survey was carried out at four ski resorts with 477 respondents. Correlation and regression analyses indicate that job satisfaction influences the intention to return but does not have a strong influence on organizational citizenship behaviour (i.e. doing more than expected at work). The results improve our understanding of seasonal workers' motivation and behaviour. The concluding part discusses managerial implications.     

Extracting Legitimacy: An Analysis of Corporate Responses to Accusations of Human Rights Abuses

Journal of Business Ethics - We ask what type of neutralization techniques corporations apply to allegations of human rights abuses. We proceed by undertaking a Qualitative Content Analysis (QCA)...     

Water accounting in Australia

This paper introduces water accounting as produced by the Australian Bureau of Statistics (ABS). It provides information about the ABS Water Accounts and highlights the many other organisations involved in the provision and use of water related data in Australia. The ABS Water Accounts have built upon previous reports on Australian water resources and the System of Environment and Economic Accounting [UN (United Nations) 2003. Draft Handbook Integrated Environmental and Economic Accounting. Studies in Methods, Series F, No. 61, Rev. 1. United Nations, European Commission, International Monetary Fund, Organisation for Economic Cooperation and Development, World Bank. New York.]. Information from the ABS Water Accounts is presented along with examples of their use in economic analyses designed to inform public debate and government decision-makers.A key feature of the Australian environment is that water is relatively scarce when compared with other inhabited continents. Rainfall displays a high level of spatial and temporal variability and droughts are common. In 2004 an Intergovernmental Agreement on a National Water Initiative (NWI) was reached by Australia's national and eight state and territory governments. The NWI aims to address environmental, economic and social concerns about the current and future state of Australia's water resources. The NWI specifically calls for the preparation of annual water accounts, which clearly indicates the expected usefulness of national and regional water accounts.     

Economies of scale and the optimality of rotational dynamics in forestry

Forest harvesting is traditionally analyzed in terms of the Faustmann rotation model. This paper considers the identification of optimal forest harvest regimes using jump controls. This approach enables the structural assumptions of clear-cut technology and identical cycles in perpetuity which are imposed in a Faustmann model to be relaxed. Jump control models permit investigation of the biological and economic conditions which favour continuous growth management regimes as opposed to clear-cut harvest regimes. A numerical solution approach to the jump control model is presented. The link between the harvest cost function and the optimal biomass path is analyzed. Economies of scale are shown to generate rotational harvest as optimal policies.      

Corporate social responsibility communication: stakeholder information, response and involvement strategies

While it is generally agreed that companies need to manage their relationships with their stakeholders, the way in which they choose to do so varies considerably. In this paper, it is argued that when companies want to communicate with stakeholders about their CSR initiatives, they need to involve those stakeholders in a two-way communication process, defined as an ongoing iterative sense-giving and sense-making process. The paper also argues that companies need to communicate through carefully crafted and increasingly sophisticated processes. Three CSR communication strategies are developed. Based on empirical illustrations and prior research, the authors argue that managers need to move from 'informing' and 'responding' to 'involving' stakeholders in CSR communication itself. They conclude that managers need to expand the role of stakeholders in corporate CSR communication processes if they want to improve their efforts to build legitimacy, a positive reputation and lasting stakeholder relationships.     

Using DEA and Worst Practice DEA in Credit Risk Evaluation

The purpose of this paper is to introduce the concept of worst practice DEA, which aims at identifying worst performers by placing them on the frontier. This is particularly relevant for our application to credit risk evaluation, but this also has general relevance since the worst performers are where the largest improvement potential can be found. The paper also proposes to use a layering technique instead of the traditional cut-off point approach, since this enables incorporation of risk attitudes and risk-based pricing. Finally, it is shown how the use of a combination of normal and worst practice DEA models enable detection of self-identifiers. The results of the empirical application on credit risk evaluation validate the method. The best combination of layered normal and worst practice DEA models yields an impressive 100% bankruptcy and 78% non-bankruptcy prediction accuracy in the calibration data set, and equally convincing 100% and 67% out-of-sample classification accuracies.     

On the measurement of risk aversion from experimental data

Attitudes towards risk are measured for households in Northern Zambia using an experimental gambling approach with real payoffs that at maximum were equal to 30% of average total annual income per capita. The results of the experiment show decreasing absolute risk aversion and increasing partial risk aversion. Determinants of risk aversion are investigated using random effects interval regression model exploiting the panel data structure of the repeated experiments. Wealth indicator variables are found to be significant, and partial relative risk aversion decreases as wealth increases. Females are found to be more risk averse than males.     

Valuing Climate Change Effects Upon UK Agricultural GHG Emissions: Spatial Analysis of a Regulating Ecosystem Service

This article provides estimates of the physical and economic value of changes in greenhouse gas (GHG) emissions projected to arise from climate change induced shifts in UK agricultural land use during the period 2004–2060. In physical terms, significant regional differences are predicted with the intensity of agricultural GHG emissions increasing in the upland north and western parts of the UK and decreasing in the lowland south and east of the country. Overall these imply relative modest increases in the physical quantity of emissions. However, rapid rises in the expected marginal value of such emissions translate these trends into major increases in their economic costs over the period considered.     

The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey

Aims: Intermittent catheterization (IC) is the gold standard for bladder management in patients with chronic urinary retention. Despite its medical benefits, IC users experience a negative impact on their quality of life (QoL). For health economics based decision making, this impact is normally measured using generic QoL measures (such as EQ-5D) that estimate a single utility score which can be used to calculate quality-adjusted life years (QALYs). But these generic measures may not be sensitive to all relevant aspects of QoL affected by intermittent catheters. This study used alternative methods to estimate the health state utilities associated with different scenarios: using a multiple-use catheter, one-time-use catheter, pre-lubricated one-time-use catheter and pre-lubricated one-time-use catheter with one less urinary tract infection (UTI) per year.

Methods: Health state utilities were elicited through an internet-based time trade-off (TTO) survey in adult volunteers representing the general population in Canada and the UK. Health states were developed to represent the catheters based on the following four attributes: steps and time needed for IC process, pain and the frequency of UTIs.

Results: The survey was completed by 956 respondents. One-time-use catheters, pre-lubricated one-time-use catheters and ready-to-use catheters were preferred to multiple-use catheters. The utility gains were associated with the following features: one time use (Canada: +0.013, UK: +0.021), ready to use (all: +0.017) and one less UTI/year (all: +0.011).

Limitations: Internet-based survey responders may have valued health states differently from the rest of the population: this might be a source of bias.

Conclusion: Steps and time needed for the IC process, pain related to IC and the frequency of UTIs have a significant impact on IC related utilities. These values could be incorporated into a cost utility analysis.