Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States–based retrospective claims database analysis

Abstract

Aims: The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.

Methods: This was a retrospective study conducted using the MarketScan Claims Database (2010–2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90 days following the index MDD date (profiling period) using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20?mg/day for nonelderly and ≥10?mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.

Results: Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per patient per year CVD-related hospitalization costs ($21,485 vs. $17,756), higher all-cause outpatient costs ($2,820 vs. $2,055), and higher CVD-related outpatient costs ($520 vs. $434) compared to patients receiving adequate MDD care.

Limitations: Clinical information such as depression severity and frailty, which are potential predictors of adverse CVD outcomes, could not be ascertained using administrative claims data.

Conclusions: Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.     

The demand for medical care services: evidence from Kuwait based on households’ out-of-pocket expenses

This article used a data set containing information on 1267 households from Kuwait to investigate the determinants of demand for medical care services by examining households’ out-of-pocket expenses. To deal with the problems associated with households’ health expenditure data, a two-part model (TPM) was estimated. Given Kuwait’s demographic composition, the model was estimated for full sample, nationals only and expatriates only. Prior to estimating the model, tests were conducted to select a transformation that reduces problems associated with heteroscedasticity and non-normality of the errors. In addition, tests were performed to determine if differences in the estimated coefficients across population groups were statistically significant.     

A production/remanufacture model with returns’ subassemblies managed differently

This paper considers a production-remanufacturing inventory model for a single product, where constant demand is satisfied from the inventory of newly produced and remanufactured items. Although the available models in the literature imply that collected used units (or returns) are disassembled for recovery purposes, these models really do not treat them as such. Contrary, the returns are assumed to be recovered as whole units, perhaps, for simplicity. This assumption may not capture the benefits reaped from product recovery programs. This paper addresses this limitation in the literature and assumes that each unit of a used product is collected and disassembled into components, where these components are sorted into subassemblies, which are fed back into the production-remanufacturing process. The returned subassemblies are remanufactured and reassembled to represent a second source of as-good-as-new units of the end-product. For this multi-component inventory problem, the question that needs to be answered is whether, or not, extreme strategies of either pure remanufacturing or pure production are more economical than a mixed strategy (one that combines both strategies). A mathematical model is developed that accounts for the inventories of subassemblies. The results suggested that not accounting for the disassembled components of a product leads to inappropriate inventory decisions that are not environmentally sound.     

Institutional Quality and Public Debt Accumulation: An Empirical Analysis

The question of public debt management for both developed and developing economies has generated an enormous amount of political as well as academic interest. This study examines how governance affects public debt accumulation in the MENA countries during the 1996–2015 period. The six Worldwide Governance indicators (voice and accountability, political stability and the absence of violence/terrorism, government effectiveness, regulatory quality, rule of law and control of corruption) were used to measure the quality of governance in these countries. The results show that only three governance indicators support well the hypothesis that poor governance leads to higher accumulation of MENA public debt. Moreover, the estimates suggest a significant indirect impact of bad governance operating via decreased GDP growth. These findings have important implications for policy makers of these countries, which are currently facing major fiscal and external imbalances due to the high cost of war and terrorist attacks, low oil prices and a decline in trade. Sound public debt management represents an urgent task especially that public debt management problems often find their origins in the lack of attention paid by policymakers to the costs of bad governance and weak macroeconomic management.     

A fuzzy goal programming approach to analyse sustainable development goals of India

Energy policy, environmental planning and economic development play a key role in sustainable development. Sustainable development requires suitable and strategic policies satisfying multiple and conflicting objectives. Fuzzy goal programming (FGP) is a well-known approach in multi-criteria decision-making for its practical application. In this article, a FGP approach is proposed to analyse environmental, energy and sustainability goals of India by the year 2030 with reference to the key economic sectors of India. The presented model analyses the improvement opportunities, requirement of efforts and implementation of the sustainable development plans. Numerical illustration is also provided for validation and application of the proposed model.     

Remittances and incumbency: Theory and evidence

By raising household income, remittances lower the marginal utility of targeted electoral transfers, thus weakening the efficacy of vote buying. Yet, remittances make individuals wealthier and believe the national economy is performing well, which is positively attributed to the incumbent. Building on these insights, I show that the confluence of these divergent channels generate a surprising result that at increasingly higher levels of dissatisfaction with the incumbent, a remittance recipient is more likely to vote for the incumbent than a non‐remittance recipient. These predictions and their underlying mechanisms are substantiated across 18 Latin American countries.     

Are Gay Men and Lesbians Discriminated against in the Hiring Process?

This article presents the first field experiment on sexual orientation discrimination in the hiring process in the Swedish labor market. Job applications were sent to about 4000 employers in 10 different occupations in Sweden. Gender and sexual orientation were randomly assigned to applications. The results show that sexual orientation discrimination exists in the Swedish labor market. The discrimination against the gay male applicant and the lesbian applicant varied across different occupations and appears to be concentrated in the private sector. The results also show that the gay male applicant was discriminated against in typical male‐dominated occupations, whereas the lesbian applicant was discriminated against in typical female‐dominated occupations. Theoretical implications are discussed.