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Desse EM, Mengesha WJ. Predicting construction cost under uncertainty using grey-fuzzy earned value analysis. Heliyon 2024; 10:e27662. [PMID: 38496852 PMCID: PMC10944266 DOI: 10.1016/j.heliyon.2024.e27662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Insufficient emphasis on planning and control is one of the major causes of several delayed and cost-overrun construction projects. To improve such performances, many studies have been conducted on project control techniques such as Earned Value Analysis (EVA) and its modifications: fuzzy EVA and grey EVA. Since there is no analytical model integrating fuzzy theory and grey theory simultaneously with EVA, this research aimed at predicting construction cost under uncertainty using grey-fuzzy EVA. Consequently, simple and valid project cost control grey-fuzzy EVA algorithms were developed to ensure continuous project cost performance improvement in the presence of imprecise data. In addition, an analysis result interpretation scheme was presented. Grey-fuzzy EVA was compared with fuzzy EVA and grey EVA to check its validity. Then, a case study of a road project in Addis Ababa, Ethiopia, was presented to demonstrate the application of grey-fuzzy EVA. This research contributes determinations of the lower limit, median, and upper limit of predicted costs and degree of greyness using grey-fuzzy EVA, which simplifies cost analysis, requires only a small number of data points (BAC, PV, AC, and Progress), needs no experts to create a membership function, and is comprehensible for practitioners as compared to fuzzy EVA and grey EVA used separately.
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Affiliation(s)
- Endale Mamuye Desse
- Department of Civil Engineering, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
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Sun L, Wang X, Hu Z, Liu W, Ning Z. Carbon reduction and cost control of container shipping in response to the European Union Emission Trading System. Environ Sci Pollut Res Int 2024; 31:21172-21188. [PMID: 38388976 DOI: 10.1007/s11356-024-32434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
In response to the EU ETS, we propose a cost model considering carbon emissions for container shipping, calculating fuel consumption, carbon emissions, EUA cost, and total cost of container shipping. We take a container ship operating on a route from the Far East to Northwest Europe as a case study. Environmental and economic impacts of including maritime transport activities in the EU ETS on container shipping are assessed. Results show that carbon emissions from the selected container ship using methanol are the smallest, and total cost of the selected container ship using methanol is the lowest. Among MGO, HFO, LNG, and methanol, methanol is the most environmentally and cost-effective option. Using LNG has greater environmental benefit, while using HFO has greater economic benefit. Compared to MGO, carbon reduction effects of LNG and methanol are 14.2% and 57.1%, and their cost control effects are 7.8% and 26.5%. Compared to HFO, carbon reduction effects of LNG and methanol are 11.7% and 55.8%, and the cost control effect of methanol is 9.3%. Speed reduction is effective in achieving carbon reduction and cost control of container shipping only when the sailing speed of the selected container ship is greater than 8.36 knots. Once the sailing speed is less than this threshold, speed reduction will increase carbon emissions and total cost of container shipping. This model can assess the environmental and economic impacts of including maritime transport activities in the EU ETS on container shipping and explore the measures to achieve carbon reduction and cost control of container shipping in response to the EU ETS.
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Affiliation(s)
- Ling Sun
- College of Transport & Communications, Shanghai Maritime University, Shanghai, China
- School of Management, Fudan University, Shanghai, China
| | - Xinghe Wang
- College of Transport & Communications, Shanghai Maritime University, Shanghai, China
| | - Zijiang Hu
- School of Management, Fudan University, Shanghai, China.
- School of Economics, Jiangsu University of Technology, Changzhou, China.
| | - Wei Liu
- College of Transport & Communications, Shanghai Maritime University, Shanghai, China
| | - Zhong Ning
- School of Management, Fudan University, Shanghai, China
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Yu F, Xiang Z, Wang X, Yang M, Kuang H. An innovative tool for cost control under fragmented scenarios: The container freight index microinsurance. Transp Res E Logist Transp Rev 2023; 169:102975. [PMID: 36506938 PMCID: PMC9722377 DOI: 10.1016/j.tre.2022.102975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
With the impact of the COVID-19 pandemic, global container freights have increased dramatically since the second half of 2020, which has significantly hampered the booking activities of fragmented transportation space for small and medium-sized import and export enterprises (SMIEEs). To provide SMIEEs with an effective tool for controlling shipping costs, we propose the design principles of index microinsurance under fragmented scenarios and design the container freight index microinsurance (CFIM) based on a comprehensive analysis of the term, compensation and share structures. We further establish the pricing model for the CFIM and selection procedure for product optimization, and illustrate the framework with a case study based on the data of the China Containerized Freight Index Europe Service, which demonstrates the good performance of the designed product even under extreme market conditions. The design principles proposed can shed light on the innovation of index microinsurance product that meets fragmented needs and the newly designed CFIM, along with the pricing and optimization procedure, provides practitioners with useful tools for cost control.
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Affiliation(s)
- Fangping Yu
- Collaborative Innovation Center for Transport Studies, Dalian Maritime University, Dalian, Liaoning 116026, China
| | - Zhiyuan Xiang
- Collaborative Innovation Center for Transport Studies, Dalian Maritime University, Dalian, Liaoning 116026, China
| | - Xuanhe Wang
- School of Finance, Dongbei University of Finance and Economics, Dalian, Liaoning 116025, China
| | - Mo Yang
- School of Finance, Dongbei University of Finance and Economics, Dalian, Liaoning 116025, China
| | - Haibo Kuang
- Collaborative Innovation Center for Transport Studies, Dalian Maritime University, Dalian, Liaoning 116026, China
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Abstract
Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve "rough justice" and "supple solidarity." The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity.
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Affiliation(s)
- Leonard M Fleck
- Center for Bioethics and Social Justice, College of Human Medicine, Michigan State University, 965 Wilson Road C-208, East Lansing, MI, 48824, USA.
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Takala J, Moser A, Raj R, Pettilä V, Irincheeva I, Selander T, Kiiski O, Varpula T, Reinikainen M, Jakob SM. Variation in severity-adjusted resource use and outcome in intensive care units. Intensive Care Med 2022; 48:67-77. [PMID: 34661693 DOI: 10.1007/s00134-021-06546-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/25/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Intensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure. METHODS Data of 207,131 patients treated in 2008-2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015-2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015-2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models. RESULTS SMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5-5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR. CONCLUSION The wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.
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Cid C, Flores G, Del Riego A, Fitzgerald J. [Sustainable Development Goals: impact of lack of financial protection in health in Latin American and Caribbean countriesObjetivos de Desenvolvimento Sustentável: impacto da falta de proteção financeira em saúde nos países da América Latina e do Caribe]. Rev Panam Salud Publica 2021; 45:e95. [PMID: 34621301 PMCID: PMC8489847 DOI: 10.26633/rpsp.2021.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Determinar el impacto del gasto de bolsillo en salud en los hogares, los niveles de protección financiera y su desigualdad según variables relevantes en países de la Región. Se indaga su evolución y relación con el uso de servicios del sistema de salud. Métodos. Se recopila información descriptiva comparada acerca del gasto de bolsillo, su incidencia en la población, y su peso y composición en el consumo de los hogares. Se presentan indicadores de protección financiera en el nivel nacional y su distribución por quintiles de consumo total de hogares y por género. Se contrastan con un indicador de cobertura de servicios. Resultados. Los indicadores de gasto de bolsillo y protección financiera son deficientes pero diferenciados entre los países. Se identifica la composición del gasto en salud para un subgrupo de ellos y existen gradientes significativos cuando se estudian las desigualdades. Para algunos casos, se muestran cambios en el tiempo y posibles asociaciones con los niveles de cobertura de servicios. Discusión. La desprotección financiera afecta a una gran parte de la población, se configuran grupos de países con dificultades mayores que otros, con preponderancia de gasto en medicamentos y exposición mayor de grupos en situaciones de vulnerabilidad, como los más pobres y las mujeres, lo que denota una gran inequidad. Se identifican políticas de algunos países que pueden asociarse con la evolución de la protección financiera. Para reemplazar el gasto de bolsillo, barrera para el acceso, los países necesitan aumentar el gasto público mediante el financiamiento de los sistemas de salud en transformación hacia la salud universal.
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Affiliation(s)
- Camilo Cid
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud. Washington D.C., Estados Unidos de América
| | - Gabriela Flores
- Organización Mundial de la Salud Ginebra Suiza Organización Mundial de la Salud, Ginebra, Suiza
| | - Amalia Del Riego
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud. Washington D.C., Estados Unidos de América
| | - James Fitzgerald
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud. Washington D.C., Estados Unidos de América
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Abstract
The severe situation caused by THE COVID-19 epidemic has not only hindered the steady development of social economy, but also had a great impact on the development of e-commerce logistics. For e-commerce enterprises, logistics cost is an important factor that affects the operation effect and consumer experience. Based on this, this study proposes cost control methods for e-commerce logistics in the prevention and control of COVID-19 environment. In this study, based on the actual environment of COVID-19 prevention and control, the logistics cost algorithm during the epidemic period is designed on the basis of the analysis of the influencing factors of e-commerce logistics cost, and the cross-border logistics strategy that conforms to the background of COVID-19 prevention and control and the demand of e-commerce logistics cost control is developed to better reduce the operating cost of logistics enterprises. The e-commerce logistics cost control method proposed in this article is effective in the prevention and control of new crown pneumonia, and the overall actual cost is within the budgeted cost range. The experimental results prove that the e-commerce logistics cost control method designed in this paper can help e-commerce companies achieve good economic benefits and proves that it has higher application advantages.
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Passi A, Plitt SS, Charlton CL. A low-cost initiative to reduce duplicate hepatitis B virus serological testing. Pract Lab Med 2021; 24:e00205. [PMID: 33553554 PMCID: PMC7848763 DOI: 10.1016/j.plabm.2021.e00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Currently, multiple clinical laboratories provide serological testing for hepatitis B virus (HBV) in Alberta, Canada. Concerns were raised regarding single serology specimens having duplicate testing performed during the specimen referral process from one laboratory to another. In an attempt to reduce duplicate testing for anti-HBs and HBsAg markers, we implemented a stamp on paper requisitions to identify if testing had already been performed on referred specimens. We aimed to determine the number of duplicate tests and cost of duplicate testing pre- and post-stamp implementation. Study design The requisition stamp was implemented between May and August 2016. HBV serology testing results from two clinical laboratories between January 01, 2015 and December 31, 2017 (n = 803,637) were examined. The number of tests performed on the same individual within a 3-day window was identified and the associated costs were determined. Results After stamp implementation, duplicated HBsAg and anti-HBs tests decreased from 20.8% (n = 28,545) and 18.4% (n = 20,151) to 3.7% (n = 4,604) and 2.5% (n = 2,593), respectively. This represented an estimated annual savings of $86,427 and $82,522 CAD in supply costs for HBsAg and anti-HBs tests, respectively. Conclusions The requisition stamp initiative was effective in reducing the number of duplicate tests performed between two laboratory sites. This low-cost intervention could be applied to other testing situations, including other highly duplicated serological markers, which may have broad reaching cost-saving effects for laboratory testing. We describe a low-cost, low-tech method to reduce duplicate serology testing. We decreased redundant testing from 20% to 3% among all HBsAg and anti-HBs testing. Applying this strategy to other high-volume tests could realize significant savings.
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Affiliation(s)
- Amrit Passi
- Public Health Laboratory (ProvLab), Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | | | - Carmen L Charlton
- Public Health Laboratory (ProvLab), Alberta Precision Laboratories, Edmonton, Alberta, Canada.,Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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Vogler S, Schneider P, Lepuschütz L. Impact of changes in the methodology of external price referencing on medicine prices: discrete-event simulation. Cost Eff Resour Alloc 2020; 18:51. [PMID: 33292293 PMCID: PMC7670789 DOI: 10.1186/s12962-020-00247-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several governments apply the policy of external price referencing (EPR), which considers the prices of a medicine in one or more other countries for the purpose of setting the price in the own country. Different methodological choices can be taken to design EPR. The study aimed to analyse whether, or not, and how changes in the methodology of EPR can impact medicine prices. METHODS The real-life EPR methodology as of Q1/2015 was surveyed in all European Union Member States (where applicable), Iceland, Norway and Switzerland through a questionnaire responded by national pricing authorities. Different scenarios were developed related to the parameters of the EPR methodology. Discrete-event simulations of fictitious prices in the 28 countries of the study that had EPR were run over 10 years. The continuation of the real-life EPR methodology in the countries as surveyed in 2015, without any change, served as base case. RESULTS In most scenarios, after 10 years, medicine prices in all or most surveyed countries were-sometimes considerably-lower than in the base case scenario. But in a few scenarios medicine prices increased in some countries. Consideration of discounts (an assumed 20% discount in five large economies and the mandatory discount in Germany, Greece and Ireland) and determining the reference price based on the lowest price in the country basket would result in higher price reductions (on average - 47.2% and - 34.2% compared to the base case). An adjustment of medicine price data of the reference countries by purchasing power parities would lead to higher prices in some more affluent countries (e.g. Switzerland, Norway) and lower prices in lower-income economies (Bulgaria, Romania, Hungary, Poland). Regular price revisions and changes in the basket of reference countries would also impact medicine prices, however to a lesser extent. CONCLUSIONS EPR has some potential for cost-containment. Medicine prices could be decreased if certain parameters of the EPR methodology were changed. If public payers aim to apply EPR to keep medicine prices at more affordable levels, they are encouraged to explore the cost-containment potential of this policy by taking appropriate methodological choices in the EPR design.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG, Austrian National Public Health Institute), Stubenring 6, A 1010, Vienna, Austria.
| | - Peter Schneider
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG, Austrian National Public Health Institute), Stubenring 6, A 1010, Vienna, Austria
| | - Lena Lepuschütz
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG, Austrian National Public Health Institute), Stubenring 6, A 1010, Vienna, Austria
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Malhotra NR, Smith JD, Jacobs AC, Johnson CE, Khan US, Ellison HB, Brintz BJ, Millar MM, Cloud WG, Nahmias J, Hendershot KM, Smith BK. High value care education in general surgery residency programs: A multi-institutional needs assessment. Am J Surg 2020; 221:291-297. [PMID: 33039148 DOI: 10.1016/j.amjsurg.2020.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ACGME mandates that residency programs provide training related to high value care (HVC). The purpose of this study was to explore HVC education in general surgery residency programs. METHODS An electronic survey was distributed to general surgery residents in geographically diverse programs. RESULTS The response rate was 29% (181/619). Residents reported various HVC components in their curricula. Less than half felt HVC is very important for their future practice (44%) and only 15% felt confident they could lead a QI initiative in practice. Only 20% of residents reported participating in a root cause analysis and less than one-third of residents (30%) were frequently exposed to cost considerations. CONCLUSION Few residents feel prepared to lead quality improvement initiatives, have participated in patient safety processes, or are aware of patients' costs of care. This underscores the need for improved scope and quality of HVC education and establishment of formal curricula.
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Affiliation(s)
- Neha R Malhotra
- University of Utah, Department of Surgery, Division of Urology, United States.
| | | | | | - Cali E Johnson
- University of Southern California, Department of Surgery, Division of Vascular Surgery, United States.
| | - Uzer S Khan
- West Virginia University, Department of Surgery, United States.
| | - Halle B Ellison
- Geisinger Health, Department of Surgery, Department of Palliative Care, United States.
| | - Benjamin J Brintz
- University of Utah, Department of Internal Medicine, Division of Epidemiology, United States.
| | - Morgan M Millar
- University of Utah, Department of Internal Medicine, Division of Epidemiology, United States.
| | - William G Cloud
- Baptist Memorial Memphis, Department of Surgery, Chief Quality & Safety Officer, United States.
| | - Jeffry Nahmias
- University of California - Irvine, Department of Surgery, United States.
| | | | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Vice-Chair of Education, United States.
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Hammami MB, Hussaini K, Chhaparia A, Khalid H, Chamberland R, Neuschwander-Tetri B. Inappropriate Testing for Acute Viral Hepatitis Is Common-Impact of an Intervention Using the Electronic Health Record in a Tertiary Teaching Hospital in the United States. Ochsner J 2020; 20:293-8. [PMID: 33071662 DOI: 10.31486/toj.19.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Unnecessary laboratory tests contribute to the financial burden placed on hospitals, patients, insurers, and taxpayers. In our institution, we noted acute viral hepatitis serologic testing in patients with chronic liver disease, sometimes done repetitively, in the absence of substantially elevated aminotransferase levels. The goal of this study was to determine the frequency of unnecessary testing for acute hepatitis A and B infections and then reduce testing rates by implementing an intervention in the electronic health record. Methods: In a 2-year period, 2 successive interventions questioning the appropriateness of ordering viral hepatitis serology based on transaminase elevation and prior serology results were implemented in the electronic health record system at Saint Louis University Hospital. The first intervention allowed providers to override the warning without providing a reason; the second intervention required justification to proceed with the order. Preintervention and postintervention appropriate and inappropriate testing proportions were compared using Fisher exact test. Results: The electronic reminders resulted in a statistically significant reduction of inappropriate testing rates; however, testing rates remained high whether the provider had to justify overriding the automatic alert or not. Conclusion: Our research demonstrated that the rates of inappropriate testing for acute viral hepatitis at our institution were unnecessarily high and showed that a simple intervention in the medical record system may be useful in reducing inappropriate testing. Our interventions were feasible and implemented at minimal cost. Similar interventions could be used to target other unnecessary tests, but education and additional interventions will likely be required to reduce unnecessary testing further.
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Neyt M, Gerkens S, San Miguel L, Vinck I, Thiry N, Cleemput I. An evaluation of managed entry agreements in Belgium: A system with threats and (high) potential if properly applied. Health Policy 2020; 124:959-964. [PMID: 32616313 DOI: 10.1016/j.healthpol.2020.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the strengths and weaknesses of managed entry agreements (MEAs) in Belgium. METHODS All Belgian MEAs signed between 2010 and 2015 (n = 71) were studied, including the re-evaluations of 16 reimbursement requests for which the initial MEA had ended. The analysis was supported by the findings from a systematic literature review and structured interviews with Belgian stakeholders. RESULTS The current application of MEAs provides the short-term advantage of getting a positive reimbursement decision with lower confidential prices. However, it is not clear whether the negotiated prices are in line with the added value of the interventions. Furthermore, the contracts do not provide incentives for manufacturers to gather evidence or to set public prices at an acceptable level. CONCLUSIONS Based on our analysis of the Belgian MEAs and discussions with Belgian stakeholders, an overview of various issues and pitfalls related to the current application of the system is given. Recommendations are made related to providing correct incentives to deliver good evidence, establishing a correct link between identified uncertainties/problems and the type and content of the MEA, reducing the risk of making the system non-transparent, the importance of international collaboration, etc. in order to optimize the potential of this system. These recommendations are addressed to both the Belgian policymakers and stakeholders in other countries making use of MEAs.
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Affiliation(s)
- Mattias Neyt
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
| | - Sophie Gerkens
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Irm Vinck
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Nancy Thiry
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
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Karim HMR. Healthcare delivery cost and anesthesiologists: Time to have a greater role and responsibility. World J Anesthesiol 2019; 8:19-24. [DOI: 10.5313/wja.v8.i3.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/06/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
With the advancement of technology and health sciences, health care delivery costs are steadily increasing. This affects both households and governments. Unfortunately, the present truth is that health has become an essential but unaffordable commodity. This is very concerning. Quality, up-to-date, cost-effective health care delivery is one of the prime objectives, and focuses on administration and health care authority. As the per capita spent on health from public/government funds is very poor in developing countries, the responsibility of cost-effective health care delivery falls primarily on the shoulder of the treating physicians. Anesthesiologists are becoming an indispensable part of health care delivery, having a diverse role in the emergency, critical care, pain, and perioperative care of patients. As the population ages, the need for surgical care is also increasing. Therefore, the anesthesiologist can also play a more significant role in delivering cost-effective health care, and minimize the cost without affecting the quality. This brief narrative review analyzes the current practice of anesthesiologists in two prime areas in the context of cost-savings: Preoperative investigation and low/minimal flow anesthesia.
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Affiliation(s)
- Habib Md Reazaul Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur 492099, India
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Rahmany K, Barati M, Ferdosi M, Rakhshan A, Nemati A. Strategies for reducing expenditures in Iran's health transformation plan: A qualitative study. Med J Islam Repub Iran 2018; 32:102. [PMID: 30854346 PMCID: PMC6401558 DOI: 10.14196/mjiri.32.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 12/05/2022] Open
Abstract
Background: Iranian health system underwent a series of reforms entitled Health Transformation Plan (HTP) in 2014. The plan started with packages that have imposed financial burden and increased expenditure in the health system. This study aimed to identify strategies and solutions to reduce expenditures in HTP in Iran. Methods: To conduct this qualitative study, the researchers held 15 semi-structured interviews with prominent experts in the research arena in 2018. Content analysis was used to analyze the data using MAXQDA 10 software. Results: Data collection yielded 9 main topics, including purchase and provision medicine, prescription, purchase and use of equipment, diagnostic medical services, referral system, human resources, physical space, payment system, and modifying and increasing base salaries. Conclusion: In Iran's health system, some aspects of HTP wasted resources, eg, the waste of resources in the service delivery system; thus, policymakers should consider proper strategies to control the costs based on the nature of their implementation.
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Affiliation(s)
- Keivan Rahmany
- Health Management and Economics Research center (HMERC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Barati
- Student Research Committee, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Ferdosi
- Health Management and Economics Research center (HMERC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Rakhshan
- Department of Foreign Languages, Tehran University of Medical Sciences, Tehran, Ira
| | - Ali Nemati
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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15
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Chan MK, Zeng G. Unintended consequences of supply-side cost control? Evidence from China's new cooperative medical scheme. J Health Econ 2018; 61:27-46. [PMID: 30053710 DOI: 10.1016/j.jhealeco.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 03/31/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
We examine the effects of a "per-episode fee limit" that was recently implemented as a cost-control policy in China's health care system. Using hospital administrative data on a rural public health insurance program in China, we find that hospital departments dynamically adjust episode fees in response to the level of stress under fee limits. We also document anomalous cycles in the fees and length of stay of discharged episodes, which are consistent with the dynamically optimizing behavior to comply with the fee limit. We find qualitatively similar results in administrative data from an urban public health insurance program.
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Affiliation(s)
- Marc K Chan
- Faculty of Business and Economics, University of Melbourne, Parkville, VIC 3010, Australia.
| | - Guohua Zeng
- School of Economics and Management, Jiangxi University of Science and Technology, China.
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16
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Liu S, Wang J, Zhang L, Zhang X. Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China. BMC Pregnancy Childbirth 2018; 18:66. [PMID: 29523121 PMCID: PMC5845290 DOI: 10.1186/s12884-018-1698-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County. METHODS Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables. RESULTS The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples. CONCLUSION The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers' motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.
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Affiliation(s)
- Shuang Liu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Liang Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Xiang Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
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17
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García-Cornejo B, Pérez-Méndez JA. Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level. Health Policy 2018; 122:396-403. [PMID: 29398159 DOI: 10.1016/j.healthpol.2018.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 09/27/2017] [Accepted: 01/18/2018] [Indexed: 11/30/2022]
Abstract
Promoting the improvement of standardized cost systems (CS) is one of the measures available to health policy makers for the purpose of improving efficiency in hospitals over the long-term. Nevertheless, very few studies evaluate the relationship between alternative CS and the costs really incurred. We use data from 242 hospitals of the Spanish National Health Service (NHS) between 2010 and 2013 in order to explore the determinants of the cost per adjusted patient day, using a difference-in-differences approach where the treatment is the implementation of an advanced CS. We also investigate if the association between advanced CS and unit cost is different depending upon the technological level of the hospital. Results show that hospitals with more advanced CS contained their costs better. However, the latter effect of advanced CS is lower in hospitals with a greater endowment of high technology. Results suggest that health authorities should support the development of CS, particularly in high-tech hospitals, which are usually larger and more complex hospitals that tend to accumulate a greater portion of NHS hospital sector expenditure.
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Affiliation(s)
- Beatriz García-Cornejo
- Department of Accounting, Faculty of Economics and Business, University of Oviedo, Spain.
| | - José A Pérez-Méndez
- Department of Accounting, Faculty of Economics and Business, University of Oviedo, Spain
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18
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Joannidis M, Klein SJ, Metnitz P, Valentin A. [Reimbursement of intensive care services in Austria : Use of the LKF system]. Med Klin Intensivmed Notfmed 2018; 113:28-32. [PMID: 29318326 DOI: 10.1007/s00063-017-0391-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Abstract
In Austria, the reimbursement of intensive care services is based on a Diagnosis-Related Groups (DRG) system which has been adapted to the Austrian framework conditions. Compared to Germany where economic considerations had led to personnel cuts, mandatory targets outlined in both the LKF ("Leistungsorientierte Krankenanstaltenfinanzierung", Performance-oriented Hospital Financing) and ÖSG ("Österreichischer Strukturplan Gesundheit", Austrian Health Care Structure Plan) plans ensure a high level of medical and intensive care. A clearly defined minimal nurse-to-bed ratio should ensure adequate care of critically ill patients. However, such a staffing ratio is still lacking for intensive care unit physicians. The following article is meant to outline the fundamental structures of the Austrian intensive care units and provide consideration about further optimization of intensive care medicine provided in Austria to ensure the high level of care in the future.
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Affiliation(s)
- M Joannidis
- Gemeinsame Einrichtung internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - S J Klein
- Gemeinsame Einrichtung internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - P Metnitz
- Klinische Abteilung für allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Graz, Österreich
| | - A Valentin
- Abteilung für Innere Medizin, Kardinal Schwarzenberg Klinikum, Schwarzach i. Pongau, Österreich
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Trumbic B, Zéphir H, Ouallet JC, Le Page E, Laplaud D, Bensa C, de Sèze J. Is the Choosing Wisely ® campaign model applicable to the management of multiple sclerosis in France? A GRESEP pilot study. Rev Neurol (Paris) 2017; 174:28-35. [PMID: 29128151 DOI: 10.1016/j.neurol.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/11/2017] [Accepted: 06/15/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Launched in the US in 2012, Choosing Wisely® is a campaign promoted by the American Board of Internal Medicine (ABIM) Foundation with the goal of improving healthcare effectiveness by avoiding wasteful or unnecessary medical tests, treatments and procedures. It uses concise recommendations produced by national medical societies to start discussions between physicians and patients on the relevance of these services as part of a shared decision-making process. The Multiple Sclerosis Focus Group (Groupe de Reflexion Autour de la Sclérose en Plaques; GRESEP) undertook a pilot study to assess the relevance and feasibility of this approach in the management of multiple sclerosis (MS) in France. METHODS Recommendations were developed using the formal consensus method from the guidelines of the French National Health Authority (HAS). A steering committee selected the themes and drafted concise evidence reviews. An independent rating group then assessed these recommendations for clarity, relevance and feasibility. RESULTS Seven recommendations were accepted: (1) avoid systematic ordering of multimodal evoked potential studies for diagnosing MS; (2) do not treat MS relapses with low-dose oral corticosteroids; (3) when treating MS relapse with high-dose corticosteroids, the systematic use of the intravenous route is unnecessary if the oral route can be used; (4) systematic hospitalization is not necessary for treating MS relapse with high-dose corticosteroid therapy, particularly if the oral route is used, except for the first treated relapse and the presence of exclusion or non-eligibility criteria; (5) in the absence of clinical signs or symptoms of urinary infection, avoid systematic screening with urine microscopy and culture before the administration of corticosteroid therapy for MS relapse in patients using intermittent self-catheterization; (6) avoid antibiotic treatment of clinically asymptomatic MS patients using intermittent self-catheterization, even if urine microscopy and culture reveal the presence of microorganisms; and (7) avoid introducing symptomatic drug treatment for MS-related fatigue. CONCLUSION This pilot study, the first of its kind in France, has demonstrated the relevance and feasibility of adapting the Choosing Wisely® model to MS by practitioners specializing in the disorder. However, the acceptability of these recommendations by other practitioners in other specialist fields as well as their impact on everyday clinical practices now need to be studied.
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Affiliation(s)
- B Trumbic
- Affinités Santé, 59 Rue du Faubourg Saint-Antoine, 75011 Paris, France; Cap Evidence, 105, rue des Moines, 75017 Paris, France.
| | - H Zéphir
- Pôle de Neurologie, Hôpital Roger-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - J-C Ouallet
- Pôle des Neurosciences Cliniques, Service de Neurologie, CHU de Bordeaux Pellegrin Tripode, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Le Page
- Service de Neurologie, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - D Laplaud
- Service de Neurologie, CHU de Nantes, 44093 Nantes cedex, France; Inserm UMR1064, Pavillon Jean-Monnet - Hôtel-Dieu, 30, boulevard Jean-Monnet, 44093 Nantes 01, France
| | - C Bensa
- Service de Neurologie, Fondation Rothschild, 25, rue Manin, 75019 Paris, France
| | - J de Sèze
- Service de neurologie, CHU de Strasbourg, Inserm UMR 1119, CIC de Strasbourg Inserm 1434, Fédération de Médecine translationnelle de Strasbourg (FMTS), 11, rue Humann, 67000 Strasbourg, France
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20
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Arliani GG, Sabongi RG, Batista AF, Astur DC, Falotico GG, Cohen M. EVALUATION OF THE KNOWLEDGE ON COST OF ORTHOPEDIC IMPLANTS AMONG ORTHOPEDIC SURGEONS. Acta Ortop Bras 2016; 24:217-221. [PMID: 28243178 PMCID: PMC5035696 DOI: 10.1590/1413-785220162404153822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To determine the knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic surgical devices used in surgical implants. Methods: A questionnaire was applied to Brazilian Orthopedic Surgeons during the 46th Brazilian Congress on Orthopedics and Traumatology. Results: Two hundred and one Orthopedic Surgeons completely filled out the questionnaire. The difference between the average prices estimated by the surgeons and the average prices provided by the supplier companies was 47.1%. No differences were found between the orthopedic specialists and other subspecialties on the prices indicated for specific orthopedic implants. However, differences were found among orthopedic surgeons who received visits from representatives of implant companies and those who did not receive those visits on prices indicated for shaver and radiofrequency device. Correlation was found between length of orthopedic experience and prices indicated for shaver and interference screw, and higher the experience time the lower the price indicated by Surgeons for these materials. Conclusion: The knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic implants is precarious. Reduction of cost of orthopedics materials depends on a more effective communication and interaction between doctors, hospitals and supplier companies with solid orientation programs and awareness for physicians about their importance in this scenario.Level of Evidence III, Cross-Sectional Study.
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21
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Ferrario MG, Lizán L, Montagnoli R, Ramírez de Arellano A. Liraglutide vs. sitagliptin add-on to metformin treatment for type 2 diabetes mellitus: Short-term cost-per-controlled patient in Italy. Prim Care Diabetes 2016; 10:220-226. [PMID: 26546244 DOI: 10.1016/j.pcd.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/30/2015] [Accepted: 10/03/2015] [Indexed: 12/15/2022]
Abstract
AIM To estimate the short-term cost-per-controlled-patient with type 2 diabetes mellitus with liraglutide 1.2mg/day vs. sitagliptin 100mg/day as add-on treatment to metformin in Italy. METHODS The percentage of controlled patients, i.e. with "HbA1c<7% without hypoglycemia and weight gain", at 26 and 52 weeks with liraglutide and sitagliptin, as well as at 78 weeks for patients switching at 52 weeks from sitagliptin to liraglutide or hypothetically continuing on sitagliptin were obtained from randomized clinical trials (RCT) and a meta-analysis. The treatment cost-per-controlled-patient was calculated from the perspective of the National Health System over a 26, 52- and 78-week time horizon. RESULTS Despite the higher acquisition cost of liraglutide vs. sitagliptin, at 26 weeks liraglutide resulted in a lower cost-per-controlled-patient (€1460 vs. €1820 - with efficacy from RCT - and €1593 vs. €2234 - with efficacy from a meta-analysis), as well as at 52 weeks (€2627 vs. €2649). At 78 weeks, in patients who have switched from sitagliptin to liraglutide at 52 weeks, the cost-per-controlled-patient is also lower than that of patients continuing sitagliptin for 78 weeks (€2889 vs. €3970). CONCLUSIONS Due to higher efficacy, liraglutide is associated with better cost-benefit than sitagliptin at 26, 52 and 78 weeks.
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Affiliation(s)
| | - Luis Lizán
- Outcomes'10, Universidad Jaume I, Castellón, Spain
| | | | - Antonio Ramírez de Arellano
- EU-HEOR Novo Nordisk, Madrid, Via de los Poblados, 3, Parque Empresarial Cristalia, Edificio 6-4ª Planta, Spain.
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22
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Bogaev RC. Cost considerations in the treatment of heart failure. Tex Heart Inst J 2010; 37:557-558. [PMID: 20978567 PMCID: PMC2953230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Roberta C Bogaev
- Heart Failure & Cardiac Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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