Treatment discontinuation of long-acting injectables or oral atypical antipsychotics among Medicaid recipients with schizophrenia

Abstract

Aims: Among patients with schizophrenia, poor adherence and persistence with oral atypical antipsychotics (OAA) often results in relapse and hospitalization. Second-generation antipsychotic long-acting injectables (SGA LAI) have demonstrated higher adherence than first-generation antipsychotic LAI and OAA therapies. This study aimed to determine whether SGA LAIs are associated with better persistency compared to OAA among Medicaid recipients with schizophrenia.

Materials and methods: From the MarketScan Medicaid Database (January 1, 2010–June 30, 2016), patients aged ≥18?years with schizophrenia and ≥2 pharmacy claims more than 90?days apart for the same SGA LAI or OAA were selected. New users of the specific antipsychotic agent were classified, based on their index agent, as: OAA, paliperidone palmitate LAI (PPLAI), aripiprazole LAI (ALAI), and risperidone LAI (RLAI). Discontinuation during 1 year of follow-up was defined as a?≥?60-day gap in the index OAA or SGA LAI medication past the exhaustion of the previous claim’s supply. Inverse probability of treatment weights (IPTW) balanced the cohort characteristics, and weight outliers (<0.1 or >0.9) were excluded. IPTW-weighted Cox proportional hazards regression estimated hazard ratios for discontinuation.

Results: Cohorts included 7,029 OAA, 4,302 PPLAI, 586 ALAI, and 1,456 RLAI patients. Mean age was 38.0–41.0?years and 44.0–46.6% were female. Persistence was significantly longer in the SGA LAI cohorts than in the OAA cohort. Adjusted hazard ratios (95% confidence intervals) for discontinuation were 0.60 (0.56–0.64) for PPLAI, 0.69 (0.60–0.79) for ALAI, and 0.70 (0.64–0.77) for RLAI vs OAA.

Limitations: Results may not be generalizable to patients covered by commercial or Medicare insurance, and limitations inherent to any claims-based retrospective analysis apply.

Conclusions: SGA LAI may be a valuable option for treating schizophrenia given the improvement in persistence.     

From the ‘Hindu rate of growth’ to ‘unstoppable India’: has the services sector played a role?

India shifted from an import substitution growth strategy (ISS) to an export-led-growth strategy (ELGS) in July 1991. Consequently, liberalisation was promulgated not only in the industrial sector but in the services sector too in the post-1991 period. ‘services-led-growth strategy’ – a concomitant of ELGS – has led to an improvement in the revealed comparative advantage in the export of commercial services during the period 1990–2005. Furthermore, the openness of services and foreign direct investment in services have emerged as important determinants of gross domestic product growth during the period 1995–2005. The author therefore argues that if ISS led to the ‘Hindu rate of growth’ in the first three decades of planning, it is the services-led growth which has made ‘India unstoppable’ on the economic front.     

Diversification in Indian Agriculture toward High‐Value Crops: The Role of Small Farmers

Diversification by small farmers toward high‐value crops (fruits and vegetables [F & V]) that can raise farm incomes significantly has always been in question because of several reasons such as diseconomies of scale and lack of access to inputs such as capital and information. We present evidence that in India diversification toward high‐value crops exhibits a pro‐smallholder (rather than anti‐smallholder) bias. The smallholders however play a proportionally larger role in vegetables than in fruits cultivation. These patterns are consistent with simple comparative advantage‐based production choices. Even with small landholdings if labor endowments are high, such farmers diversify toward F & V. Though fruits cultivation is also labor intensive relative to cereals, it is less so relative to vegetables. Greater capital intensity implies a comparatively important role of credit in fruits. The results are robust to several tests on specification including those related to self‐selection. Chez les petits exploitants agricoles, la diversification en faveur de cultures à valeur élevée (fruits et légumes) permettant d’accroître considérablement le revenu agricole a toujours été remise en question pour diverses raisons, notamment les déséconomies d’échelle et le manque d’accès aux intrants comme le capital et l’information. Dans le présent article, nous montrons qu’en Inde, la diversification en faveur de cultures à valeur élevée semble plutôt favorable que défavorable aux petits exploitants agricoles. Toutefois, les petits exploitants sont proportionnellement plus présents dans la culture maraîchère que dans la culture fruitière. Ces observations concordent avec les choix d’une production fondée sur les avantages comparatifs. Même dans le cas des petites exploitations, lorsque les besoins de main‐d’?uvre sont élevés, elles se tournent vers les cultures fruitière et maraîchère. Bien que la culture fruitière soit une activitéà forte intensité de main‐d’?uvre comparativement à la culture céréalière, elle l’est moins que la culture maraîchère. L’intensité de capital élevée de la culture fruitière signifie que le crédit joue aussi un rôle important. Les résultats de plusieurs tests de spécification sont robustes, y compris ceux liés à l’auto‐sélection.     

Managerial incentives for undertaking exchange offers

This paper empirically examines management's motivation to convey information regarding firm value through exchange offers. We report a positive relation between stock price reactions to announcements of exchange offers and managerial stockholdings, and a weak negative relation with salary plus bonus. These findings are consistent with the incentives required for managers to signal firm value through exchange offer-induced leverage change.     

How long is a piece of elastic? The measurement of female activity rates in British censuses, 1951-1981

The available evidence concerning the growth of female labor force participation in the United Kingdom since World War II is reviewed. The authors first discuss changing concepts, methods, and results in British censuses from 1951 to 1981. They then reconstruct female labor force trends to take into account the biases identified. They propose a series of economic activity and employee rates for females aged 20-59 and for the proportion of part-time female employees.     

Women's employment transitions around child bearing

Women's increasing participation in the labor force since the 1950s demands that knowledge about their labor supply needs to keep pace with the changing world. One important change has occurred among mothers of small children, they are increasingly working for pay in successive generations, as the break in their employment has become increasingly shorter. Legislation was enacted in the UK to outlaw unequal pay and discrimination in employment on the basis of gender, while statutory maternity leave was introduced in 1976 and extended in 1986. The proportion of mothers taking maternity leave has since increased, as has full-time employment among mothers. The authors examine the transitions into and out of paid work which women make after childbirth, helping to determine whether recent generations of mothers have benefitted from the policy changes, whether all have benefitted equally, and whether any effects persist beyond the period around the first childbirth. Study data are drawn from the fifth sweep of the National Child Development Study (NCDS) 1958 birth cohort at age 33. The experiences of mothers in the 1958 generation suggests that women have begun to benefit from the equal opportunities provisions enacted in Britain during the 1970s. The age of the youngest child is the most important determinant of women's participation over the preschool years, and relatively better educated women have the highest degree of continuity in employment across childbirth.     

Perceptions of accounting professionals in the adoption and implementation of a single set of global accounting standards: Evidence from Bahrain

In the quest for a single set of global accounting standards, the International Accounting Standard Board (IASB) continues to work with regulators in other countries toward adoption of IFRS. This study reports on an exploratory study of Bahrain's accounting and auditing professionals' perceptions about important issues relevant to developing and implementing global accounting standards. Bahrain is a financial hub of the Middle East with distinct features that could provide some insights to harmonization issues. The respondents' views portray optimism by auditors and non-auditors that harmonization of accounting standards is a worthwhile objective that can be fairly, but gradually accomplished. However, the survey data indicate expected challenges in applying the IFRS principles-based accounting standards. The survey findings suggest that there will be a growing demand for detailed application guidance for IFRS. Also, it appears that nationalism may well continue to be a major impediment to global adoption of IFRS.     

Core business regulation and dual diversification patterns in the telecommunications industry

A firm is confronted with the separate decisions of product and international diversification. It is suggested that these postures are linked to external contingencies in firms who face core business regulation. A technique is developed to explain dual diversification patterns using evidence obtained from the new industry comprised of the Regional Bell Operating Companies (RBOCs).     

Health and hunger: nutrient response to income depending on caloric availability in Nepal

Using data from NLSS III, we estimate nutrient‐income elasticities for macronutrients, vitamins, and minerals. We further allow for differential nutrient demand response to income depending on where a household is in the caloric availability distribution. We find that some nutrients are income inelastic indicating that they are necessity goods while others are relatively income elastic. We further test and reject equivalent nutrient‐income elasticities across the caloric availability distribution. Households in the lowest calorie quintile have highly income elastic nutrient demand leaving them vulnerable to income fluctuations. Moreover, as households meet their first‐order caloric needs, they substitute away from cheap calorie‐dense staples toward more expensive nutrient‐dense foods. Finally, for most nutrients, households in the highest calorie quintile exhibit more elastic nutrient demand, similar to households in the lowest quintile. Our results suggest that policies aimed at improving income will likely also improve household nutrient availability, particularly for the most calorie poor households. They further suggest that policies aimed at protecting poor households from negative income shocks will also likely yield nutritional benefits.     

The contingent effect of specific asset investments on joint action in manufacturer-supplier relationships: An empirical test of the moderating role of reciprocal asset investments, uncertainty, and trust

Prior research provides evidence that manufacturer investment of specific assets dedicated to a particular supplier (manufacturer asset specificity) is an antecedent of joint action in manufacturer-supplier relationships. The authors build on prior research to identify several variables that moderate the effect of manufacturer asset specificity o on joint action. Drawing from transaction cost analysis and relational exchange theory, the authors propose a conceptual model that explicates the moderating role of three contextual variables: specific asset investments by the supplier (reciprocal asset investments), manufacturer decision-making uncertainty, and manufacturer trust in the supplier. Consistent with their hypotheses, results from a survey of firms in three SIC codes show that decision-making uncertainty and trust enhance the effect of manufacturer asset specificity on joint action. Contrary to expectation, however, the moderating effect of reciprocal asset investments was not significant. Theoretical and managerial implications of the results are discussed. Ashwin W. Joshi is an associate professor of marketing at the University of Calgary. He received his Ph.D. from Queen’s University (Canada). His research has been published inJournal of Business Research, Psychology and Marketing, Journal of Marketing Channels, Journal of Business-to-Business Marketing, as well as in many conference proceedings. Rodney L. Stump is an associate professor of marketing at Morgan State University. He received his Ph.D. from Case Western Reserve University. His research has appeared inJournal of Marketing Research, Journal of Business Research, Journal of Business-to-Business Marketing, Industrial Marketing Management, The International Executive, and other journals. He has also presented his research at numerous national and international conferences.