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Li ZI, Hurley ET, Garra S, Blaeser AM, Markus DH, Shen M, Campbell KA, Strauss EJ, Jazrawi LM, Gyftopoulos S. Arthroscopic Bankart repair versus nonoperative management for first-time anterior shoulder instability: A cost-effectiveness analysis. Shoulder Elbow 2024; 16:59-67. [PMID: 38435039 PMCID: PMC10902416 DOI: 10.1177/17585732231187123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 03/05/2024]
Abstract
Purpose Arthroscopic Bankart repair (ABR) may be more effective than nonoperative management for patients with anterior shoulder instability following first-time dislocation. The purpose of the study was to determine the most cost-effective treatment strategy by evaluating the incremental cost-effectiveness ratio (ICER) for ABR versus nonoperative treatment. Methods This cost-effectiveness study utilized a Markov decision chain and Monte Carlo simulation. Probabilities, health utility values, and outcome data regarding ABR and nonoperative management of first-time shoulder instability derived from level I/II evidence. Costs were tabulated from Centers for Medicaid & Medicare Services. Probabilistic sensitivity analysis was performed using >100,000 repetitions of the Monte Carlo simulation. A willingness-to-pay (WTP) threshold was set at $50,000. Results The expected cost for operative management higher than nonoperative management ($32,765 vs $29,343). However, ABR (5.48 quality-adjusted life years (QALYs)) was the more effective treatment strategy compared to nonoperative management (4.61 QALYs). The ICER for ABR was $3943. Probabilistic sensitivity analysis showed that ABR was the most cost-effective strategy in 100% of simulations. Discussion ABR is more cost-effective than nonoperative management for first-time anterior shoulder dislocation. The threshold analysis demonstrated that when accounting for WTP, ABR was found to be the more cost-effective strategy.
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Affiliation(s)
- Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Anna M Blaeser
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Danielle H Markus
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Michelle Shen
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Pandey SK, Sharma V. Sudden and early death among medical professionals: How to reverse this trend? Indian J Ophthalmol 2023; 71:2286-2287. [PMID: 37202975 PMCID: PMC10391363 DOI: 10.4103/ijo.ijo_3229_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Suresh K Pandey
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
| | - Vidushi Sharma
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
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Tan CJ, Ng KYJ, Goh WL, Poon E, Chan RJ, Chew L, Farid M, Chan A. Work Outcomes and Medical Costs Among Singaporean Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2022. [PMID: 36169562 DOI: 10.1089/jayao.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To quantify and evaluate trends of work outcomes and medical costs among Singaporean adolescent and young adult (AYA) cancer survivors. Methods: This cross-sectional study was conducted at the National Cancer Centre Singapore between July 2016 and October 2018. Cancer patients who were diagnosed between the age of 15 and 39 years and had completed treatment were eligible. Siblings of cancer patients were recruited as controls. Work outcomes were collected using an investigator-designed questionnaire, while cost data were extracted from the hospital database. Descriptive statistics were used to quantify work and cost outcomes. Mixed-effects logistic regression was used to compare employment rates between survivors and controls. Generalized linear models were used to characterize trends between medical costs and symptom burden. Results: A total of 29 cancer survivors and 23 sibling controls were analyzed. Approximately 80% of survivors and controls were employed at the time of survey; however, more than half of the employed survivors reported impaired work outcomes due to effects from cancer and cancer treatment, including work reallocation, absenteeism, and decreased work ability. Median productivity loss due to absenteeism in the past 3 months was estimated to be U.S. dollar (USD) 110. Total medical cost incurred within the first year after treatment completion remained high at a median of USD6592, with out-of-pocket expenditure between 17.2% and 100.0%. Conclusion: Despite their young age and having completed cancer treatment, Singaporean AYA cancer survivors may continue to experience poor work outcomes even after resuming work. High medical costs may also persist.
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Affiliation(s)
- Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | | | - Wei Lin Goh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lita Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore.,Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
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Mann K, Waters AR, Park ER, Perez GK, Vaca Lopez PL, Kaddas HK, Warner EL, Ray N, Tsukamoto T, Allen K, Haaland B, Fair DB, Lewis MA, Kirchhoff AC. HIAYA CHAT study protocol: a randomized controlled trial of a health insurance education intervention for newly diagnosed adolescent and young adult cancer patients. Trials 2022; 23:682. [PMID: 35986416 PMCID: PMC9388989 DOI: 10.1186/s13063-022-06590-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND For adolescent and young adult (AYA) cancer patients aged 18 to 39 years, health insurance literacy is crucial for an effective use of the health care system. AYAs often face high out-of-pocket costs or have unmet health care needs due to costs. Improving health insurance literacy could help AYAs obtain appropriate and affordable health care. This protocol illustrates a randomized controlled trial testing a virtual health insurance education intervention among AYA patients. METHODS This is a two-arm multisite randomized controlled trial. A total of 80 AYAs diagnosed with cancer in the Mountain West region will be allocated to either usual navigation care or tailored health insurance education intervention with a patient navigator that includes usual care. All participants will complete a baseline and follow-up survey 5 months apart. The primary outcomes are feasibility (number enrolled and number of sessions completed) and acceptability (5-point scale on survey measuring satisfaction of the intervention). The secondary outcomes are preliminary efficacy measured by the Health Insurance Literacy Measure and the COmprehensive Score for financial Toxicity. DISCUSSION This trial makes a timely contribution to test the feasibility and acceptability of a virtual AYA-centered health insurance education program. TRIAL REGISTRATION ClinicalTrials.gov NCT04448678. Registered on June 26, 2020.
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Affiliation(s)
- Karely Mann
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Austin R. Waters
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC USA
| | - Elyse R. Park
- Health Promotion & Resiliency Intervention Research Program, Mongan Institute, Boston, MA USA
- Departments of Psychiatry & Medicine, Mass General Hospital/Harvard Medical School, Boston, MA USA
| | - Giselle K. Perez
- Health Promotion & Resiliency Intervention Research Program, Mongan Institute, Boston, MA USA
- Departments of Psychiatry & Medicine, Mass General Hospital/Harvard Medical School, Boston, MA USA
| | - Perla L. Vaca Lopez
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Heydon K. Kaddas
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Echo L. Warner
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- College of Nursing, University of Utah, Salt Lake City, UT USA
| | - Nicole Ray
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Tomoko Tsukamoto
- Adolescent and Young Adult Cancer Care Program, Intermountain Healthcare, Salt Lake City, UT USA
| | - Karlie Allen
- AYA Patient Navigation Program, Huntsman Cancer Hospital, Salt Lake City, UT USA
| | - Ben Haaland
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT USA
| | - Douglas B. Fair
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT USA
- Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT USA
| | - Mark A. Lewis
- Adolescent and Young Adult Cancer Care Program, Intermountain Healthcare, Salt Lake City, UT USA
| | - Anne C. Kirchhoff
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT USA
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Waters AR, Mann K, Warner EL, Vaca Lopez PL, Kaddas HK, Ray N, Tsukamoto T, Fair DB, Lewis MA, Perez GK, Park ER, Kirchhoff AC. "I thought there would be more I understood": health insurance literacy among adolescent and young adult cancer survivors. Support Care Cancer 2022; 30:4457-4464. [PMID: 35107600 PMCID: PMC10512194 DOI: 10.1007/s00520-022-06873-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health insurance literacy is crucial for navigating the US healthcare system. Low health insurance literacy may be especially concerning for adolescent and young adult (AYA) cancer survivors. To describe AYAs' health insurance literacy, we conducted semi-structured interviews with AYA survivors, on and off of treatment. METHODS We interviewed 24 AYA cancer survivors (aged 18-39 years) between November 2019 and March 2020. Interviews were recorded, transcribed, and quality-checked. Using two cycles of structured coding, we explored AYAs' health insurance literacy and examined thematic differences by policy holder status and age. RESULTS AYAs were 58.3% female, 79.2% non-Hispanic White, 91.7% heterosexual, and 62.5% receiving cancer treatment. Most participants had employer-sponsored health insurance (87.5%), and 41.7% were their own policy holder. Four themes emerged; in the first theme, most AYAs described beginning their cancer treatment with little to no understanding of their health insurance. This led to the three subsequent themes in which AYAs reported: unclear expectations of what their insurance would cover and their out-of-pocket costs; learning about insurance and costs by trial and error; and how their health insurance literacy negatively impacted their ability to navigate the healthcare system. CONCLUSIONS Our findings, while requiring confirmation in larger samples and in other health systems, suggest that the health insurance literacy needed to navigate insurance and cancer care is low among US AYA survivors and may have health and financial implications. As the burden of navigating insurance is often put on patients, health insurance education is an important supportive service for AYA survivors on and off of treatment.
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Affiliation(s)
- Austin R Waters
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Karely Mann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- University of Arizona Cancer Center, Tucson, AZ, USA
- University of Arizona College of Nursing, Tucson, AZ, USA
| | | | - Heydon K Kaddas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Nicole Ray
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Douglas B Fair
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mark A Lewis
- Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Derlet RW, McNamara RM, Tomaszewski C. Corporate Control of Emergency Departments: Dangers from the Growing Monster. J Emerg Med 2022; 62:675-684. [PMID: 35400510 DOI: 10.1016/j.jemermed.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Corporate control in emergency departments (EDs) has increased during the past 20 years through hospital consolidation and the growth of ED contract management groups. OBJECTIVES To describe the growing corporate influence in the practice of emergency medicine and associated dangers to the public's safety and well-being. DISCUSSION Hospital systems through mergers and acquisitions have created regional monopolies providing them the power to charge high fees, which can lead to economic hardship for patients. Hospitals have also increasingly employed physicians and can exert influence over their practice to further increase profits. ED contract management groups (CMGs) obtain the exclusive contract for emergency services and gain control over the livelihood of emergency physicians, decreasing their autonomy and inserting the business interest into the physician-patient relationship, and this may result in harm to patients. Safety issues identified by emergency physicians may not be articulated for fear of being fired, and protocols may direct physicians to order unneeded testing and encourage unnecessary hospital admissions to make higher profits. Of additional concern, some CMGs are involved in graduate emergency medicine education, exposing physicians in training to corporate influence during their formative years. CONCLUSIONS Given the potential harm to patients due to corporate influence, there must be serious consideration for legislative or regulatory solutions regarding the increasing corporate control of emergency medicine in the United States.
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Affiliation(s)
- Robert W Derlet
- Department of Emergency Medicine, University of California, Davis, Sacramento, California.
| | - Robert M McNamara
- Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania
| | - Christian Tomaszewski
- Department of Emergency Medicine, University of California San Diego, San Diego, California
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Havlik JL, Mercurio MR, Hull SC. The Case for Ethical Efficiency: A System That Has Run Out of Time. Hastings Cent Rep 2022; 52:14-20. [PMID: 35476354 DOI: 10.1002/hast.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The American health care system increasingly conflates physician "productivity" with true clinical efficiency. In reality, inordinate time pressure on physicians compromises quality of care, decreases patient satisfaction, increases clinician burnout, and costs the health care system a great deal in the long term even if it is financially expedient in the short term. Inadequate time to deliver care thereby conflicts with the core principles of biomedical ethics, including autonomy, beneficence, nonmaleficence, and justice. We propose that the health care system adjust its focus to recognize the nonmonetary value of physician time while still realizing the need to deploy resources as effectively as possible, a concept we describe as "ethical efficiency."
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Kang G. Two Months, Eight Chinese Physicians Suffered Sudden Death. Am J Med 2021; 134:e398-e399. [PMID: 34049634 DOI: 10.1016/j.amjmed.2019.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/18/2019] [Indexed: 11/24/2022]
Affiliation(s)
- GuanYang Kang
- Department of Cardiology The Fifth People's Hospital of Dongguan The Dongguan Affiliated Hospital of Medical College of Jinan University (also called Taiping People's Hospital of Dongguan) Dongguan, Guangdong China
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The Reply. Am J Med 2021; 134:e400. [PMID: 34049635 DOI: 10.1016/j.amjmed.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022]
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Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2960. [PMID: 32802654 PMCID: PMC7413786 DOI: 10.1097/gox.0000000000002960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022]
Abstract
Mastectomy and implant-based reconstruction is typically performed in a hospital setting (HS) with overnight admission. The aim of this study was to evaluate postoperative complications and outcomes with same-day discharge from an ambulatory surgery center (ASC) compared with the same surgery performed in the HS.
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