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.     

Economic modeling to evaluate the impact of chronic myeloid leukemia therapy management on the oncology care model in the US

Abstract

Objective: To develop an economic model to evaluate changes in healthcare costs driven by restricting usage of branded tyrosine kinase inhibitors (TKIs) through substitution with generic imatinib among chronic myeloid leukemia (CML) patients in a typical Oncology Care Model (OCM) practice, and examine the impact on Performance-Based Payment (PBP) eligibility.

Methods: An Excel-based economic model of an OCM practice with 1,000 cancer patients during a 6-month episode of care was developed. Cancer types and proportions of patients treated in the practice were estimated from an OCM report. All-cause healthcare costs were obtained from published literature. It was assumed that if a practice restricts usage of branded TKIs for newly-diagnosed CML patients, 80% of the market share of branded imatinib and 50% of the market shares of 2^nd-gen TKIs would shift to generic imatinib. Among established TKI-treated patients, it was assumed that 80% of the market share of branded imatinib and no patients treated with 2^nd-gen TKIs would shift to the generic.

Results: Four CML patients were estimated for a 1,000-cancer patient OCM practice with a total baseline healthcare cost of $51,345,812 during a 6-month episode. If the practice restricts usage of branded TKIs, the shift from 2^nd-gen TKIs to generic imatinib would reduce costs by $12,970, while shifting from branded to generic imatinib lowers costs by $25,250 during a 6-month episode. Minimum reductions of $3,013,832 in a one-sided risk model and $2,372,010 in a two-sided risk model are required for PBP eligibility; the shift from 2^nd-gen TKIs to generic imatinib would account for 0.4% and 0.5% of the savings required for a PBP, respectively.

Conclusions: This analysis indicates that the potential cost reduction associated with restricting branded TKI usage among CML patients in an OCM setting will represent only a small proportion of the cost reduction needed for PBP eligibility.     

DISAGGREGATING FIRMS IN ANALYSING THE COSTS AND BENEFITS OF THE UNIVERSITY–INDUSTRY RELATIONSHIP: BASED ON AN ANALYTICAL AND EMPIRICAL STUDY FROM SCOTLAND

It has been acknowledged that universities are key institutions in national and regional systems of innovation. This recognition has led to a rich stream of literature analysing the university–industry relationship. However, relatively little attention has been devoted to disaggregating the ‘industry’ side of this relationship and examining the costs and benefits to the disaggregated parties involved. In the present article, which draws on an analytical and empirical study from Scotland, it is suggested that it makes sense to distinguish between three kinds of firms in analysing the university–industry relationship: large national and international R&D-intensive firms, university spin-out firms, and established small- and medium-sized enterprises (SMEs) that have had little interaction with universities. The different costs and benefits facing these firms in their interactions with universities are analysed. It is concluded that the established SMEs confront relatively high costs in relating to universities. Finally, the policy implications are explored.     

The impact of new goods and service products on firm growth: evidence from Austrian-linked firm-level data

Using a matched innovation survey and structural business statistics, we investigate the impact of the introduction of new service products and other types of technological innovations on firm growth measured as subsequent two-year employment growth. Results, based on median and robust regression methods for manufacturing firms, show that, on average, both the introduction of new goods and process innovations have a significant and positive impact on subsequent firm growth. In contrast, the introduction of new services does not, on average, have a significant impact on firm growth for both manufacturing and service firms. However, quantile regressions show that the introduction of new service products has a significant and positive impact on firm growth for high-growth service firms. Finally, in manufacturing, the introduction of product innovations has a positive impact on firm growth at both the lower and higher ends of distribution (i.e. for both high-growth and shrinking firms).     

Structural production layer decomposition: a new method to measure differences between MRIO databases for footprint assessments

Recent empirical assessments revealed that footprint indicators calculated with various multi-regional input–output (MRIO) databases deliver deviating results. In this paper, we propose a new method, called structural production layer decomposition (SPLD), which complements existing structural decomposition approaches. SPLD enables differentiating between effects stemming from specific parts in the technology matrix, e.g. trade blocks vs. domestic blocks, while still allowing to link the various effects to the total region footprint. Using the carbon footprint of the EU-28 in 2011 as an example, we analyse the differences between EXIOBASE, Eora, GTAP and WIOD. Identical environmental data are used across all MRIO databases. In all model comparisons, variations in domestic blocks have a more significant impact on the carbon footprint than variations in trade blocks. The results provide a wealth of information for MRIO developers and are relevant for policy makers designing climate policy measures targeted to specific stages along product supply chains.     

The influence of entrepreneurs’ social referents on start-up size

This paper uses social comparison theory to explore the effect that the average size of established businesses at the regional (provincial) level may have on start-up size. It is argued that established entrepreneurs at the regional level become referents of new entrepreneurs, influencing not only the decision to become entrepreneurs but also the characteristics of the new venture, such as its initial size. Specifically, the greater the average size of established businesses at the provincial level, the bigger the start-up size of new ventures. This paper further considers how this effect is moderated by two key individual level variables: knowing an entrepreneur personally (i.e., close social referent), and being the owner and manager of an existing business (i.e., past entrepreneurial and managerial experience). Predictions are tested using data that combine individual- and provincial-level information in Spain over the period 2008–2014. The results show the positive relationship of the average size of established businesses on new venture start-up size, and that this effect decreases when the entrepreneurs have previous entrepreneurial experience.     

The trade-off between innovation and defense industrial policy: A simulation model analysis of the Norwegian defense industry

The paper investigates the trade-off between innovation and defense industrial policy. It presents an agent-based simulation model calibrated for the Norwegian defense industry that compares different policy scenarios and examines the effects of a pending EU market liberalization process. The paper points to two main results. (1) It finds that a pure scenario where national authorities focus on, and provide support exclusively for, either a) international competitiveness or b) national defense and security objectives, is more Pareto efficient than a corresponding mixed strategy where policy makers simultaneously pursue both international competitiveness and defense and security objectives. (2) Under the conditions of the new EU liberalization regime, it finds that a stronger and more visible trade-off will emerge between international competitiveness and national defense and security objectives. Policy makers will have to choose which to prioritize, and set a clear agenda focusing on one of the two objectives.     

Analysing The Evolution Of Industry: The Relevance Of The Telecommunications Industry

This paper analyses the fundamental forces involved in the evolution of the telecommunications industry. It is suggested that there are five major forces that together drive the evolution of this industry: specialisation, competition, financial markets. endogenous consumer demand and permeable industry boundaries. An important research task is to further elaborate on the boundaries of not only the industry but of the industrial system taken as a whole.