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.     

When open-mindedness lowers product evaluations: Influencers to consumers’ response to religious cues in advertising

Prior research has examined response to Christian religious cues used in secular marketing messages but has inadequately explored the underlying reasons for such response as well as why religious cues may negatively influence product evaluations. These limitations are addressed in this research work through three studies utilizing religious cues. In Studies 1a and 1b, ads with a Christian or Muslim religious cue (no religious cue) were found to produce lower (higher) product evaluations. Studies 2–3 then examined why religious cues in ads can produce lower product evaluations to show that open-mindedness moderated this effect (Study 2), and priming open-mindedness also influenced this effect (Study 3). Most interestingly, open-minded consumers were more negative toward religious cues in marketing communications than close-minded consumers, and priming open-mindedness magnified this effect. These novel effects are discussed in relation to the literature on open-mindedness and value-based consumption. Additionally, implications for research and practice are discussed.     

Incentives and teacher effort

Few would contest that teachers are a very important determinant of how much students learn in school, and how to improve teacher performance has been the focus of lively policy debate in both rich and poor countries. This paper examines how teacher incentives, both pecuniary and non‐pecuniary, correlate with teacher effort. Using school survey data from Lao PDR, we estimate measures of teacher effort, including the number of hours that teachers spend preparing for classes and teacher provision of private tutoring outside of class hours, which are not the typical measures used in previous research. Estimation results fit well under the standard labour supply framework and indicate that greater teacher effort is associated with non‐pecuniary incentives such as more teacher autonomy over teaching materials and monitoring as measured by the existence of an active parent – teacher association and the ability of school principals to dismiss teachers. Methodologically, this paper provides a detailed derivation of a simultaneous OLS‐probit model with school random effects that can jointly estimate teacher work hours and tutoring provision.     

How people pay: Evidence from grocery store data

Empirical evidence based on grocery store transaction data shows that consumer payment behavior at the point of sale is important for understanding models of money demand. There are statistically significant effects of transaction costs, opportunity costs, and product characteristics on the choice of payment instrument, which then, in turn, affect money demand. These results emphasize the overlap between the work of empirical researchers in payment choice and theoretical modelers of monetary economics and should inform both literatures.     

Implicit recourse and credit card securitizations: What do fraud losses reveal?

In this paper, we develop and test a model of implicit recourse in asset-backed securitizations. Fraud losses on securitized assets are generally incurred by the bank and do not affect the performance of securitization trusts, while credit losses do affect the trust’s performance and are potentially borne by the owner of the securitized assets. Thus, the classification of losses as either fraud or credit losses provides a potential avenue of implicit recourse to manipulate the performance of securitization trusts. Using annual data from 2001 to 2006, we find that the performance of the credit card securitization portfolio is negatively related to fraud losses reported by the bank. We examine these results in light of the proposed Basel II capital rules and argue that a bank’s incentive to provide implicit recourse will increase under the anticipated regime.     

Does a marching band impact college Football game attendance? A panel study of Division II

Marching bands are an integral part of the college football game-day experience by increasing both the quantity and quality of entertainment. Academic music programs could enhance a band’s entertainment value via better-trained members and recruitment of more highly skilled musicians. The impact of these influences on game-day attendance is explored using data from nine years of regular season games in Division II. The regression model controls for economic factors, home-team performance, demographic influences and game characteristics and employs boot-strap clustering methods for calculating standard errors of coefficients. Results suggest that a marching band, the existence of an academic music program and being a historically black college each exerts an independent positive impact on attendance after controlling for all other factors.     

The way forward: Leadership research in the hospitality industry

This paper constructs a framework for researching leadership in the hospitality industry and reviews previous approaches to hospitality leadership. Four paradigms were constructed from an analysis of the general field of leadership and are used to represent the underlying perspectives of researchers who operate within them. As a result of this analysis the paper seeks to demonstrate how each paradigm can contribute to the application of leadership theory to the hospitality industry and provides a number of new avenues for future research.