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Heathcote LE, Pollard DJ, Brennan A, Davies MJ, Eborall H, Edwardson CL, Gillett M, Gray LJ, Griffin SJ, Hardeman W, Henson J, Khunti K, Sharp S, Sutton S, Yates T. Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial. BMJ Open Diabetes Res Care 2024; 12:e003516. [PMID: 38471669 PMCID: PMC10936471 DOI: 10.1136/bmjdrc-2023-003516] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D. MATERIALS AND METHODS We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective. RESULTS Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years. CONCLUSIONS We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect. TRIAL REGISTRATION NUMBER ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.
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Affiliation(s)
| | - Daniel J Pollard
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Melanie J Davies
- Diabetes Research Department, University of Leicester, Leicester, UK
| | - Helen Eborall
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Michael Gillett
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | | | | | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Department, University of Leicester, Leicester, UK
| | | | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Pagán L, Yang W, Shao H, Wang Y, Zhang P. Medical expenditure trajectory and HbA1c progression prior to and after clinical diagnosis of type 2 diabetes in a commercially insured population in the USA. BMJ Open Diabetes Res Care 2023; 11:e003397. [PMID: 37914345 PMCID: PMC10626875 DOI: 10.1136/bmjdrc-2023-003397] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Medical expenditures of individuals with type 2 diabetes escalate before clinical diagnosis. How increases in medical expenditures are related to glucose levels remains unclear. We examined changes in HbA1c and medical expenditures in years prior to and shortly after type 2 diabetes diagnosis. RESEARCH DESIGN AND METHODS Using insurance claims and laboratory test results from a commercially insured population in the USA, we built three (2014, 2015, 2016) longitudinal cohorts with type 2 diabetes up to 10 years before and 2 years after the diagnosis (index year). We identified diabetes diagnosis using International Classification of Diseases, Ninth Revision and Tenth Revision codes and antidiabetic medication use. We ran two individual fixed regression models with annual total medical expenditures and average HbA1c values as dependent variables and number of years from diagnosis as the main independent variable and examined the risk-adjusted movement of the outcomes. RESULTS Our study included 9847 individuals (83 526 person-years). Medical expenditures and HbA1c levels increased before and peaked at the diagnosis year. Medical expenditures were $8644 lower 10 years and $5781 lower 1 year before diagnosis compared with the index year. HbA1c was 12.18 mmol/mol (1.11 percentage points) and 3.49 mmol/mol (0.32 percentage points) lower, respectively. Average annual increases in medical expenditures and HbA1c values over the prediagnosis period were $318 and 0.97 mmol/mol (0.09 percentage points), respectively. CONCLUSIONS Medical expenditures and HbA1c values followed similar trajectories before and after diabetes diagnosis. Our results can inform economic evaluations of programs and policies aimed at preventing type 2 diabetes.
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Affiliation(s)
| | - Wenya Yang
- The Lewin Group, Falls Church, Virginia, USA
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Eccher A, Dei Tos AP, Scarpa A, L'Imperio V, Munari E, Troncone G, Naccarato AG, Seminati D, Pagni F. Cost analysis of archives in the pathology laboratories: from safety to management. J Clin Pathol 2023; 76:659-663. [PMID: 37532289 PMCID: PMC10511949 DOI: 10.1136/jcp-2023-209035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
CONTEXT Despite the reluctance to invest and the challenging estimation of necessary supporting costs, optimising the archives seems to be one of the hottest topics in the future management of the pathology laboratories. Historically, archives were only partially designed to securely store and organise tissue specimens, and tracking systems were often flawed, posing significant risks to patients' health and legal ramifications for pathologists. OBJECTIVE The current review explores the available data from the literature on archives' management in pathology, including comprehensive business plans, structure setup, outfit, inventories, ongoing conservation and functional charges. DATA SOURCES Electronic searches in PubMed-MEDLINE and Embase were made to extract pertinent articles from the literature. Works about the archiving process and storage were included and analysed to extract information. Prepublication servers were ignored. Italian Institutional Regional databases for public competitive bidding processes were queried too. CONCLUSIONS A new emergent feeling in the pathology laboratory is growing for archives management; the digital pathology era is a great opportunity to apply innovation to tracking systems and samples preservation. The main aim is a critical evaluation of the return of investment in developing automatic and tracked archiving processes for improving not only quality, efficacy and efficiency of the labs but also patients' healthcare.
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Affiliation(s)
- Albino Eccher
- Department of Diagnostics and Public Health, Università degli Studi di Verona, Verona, Italy
| | | | - Aldo Scarpa
- Department of Diagnostics and Public Health, Università degli Studi di Verona, Verona, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, Milano, Italy
| | - Enrico Munari
- Department of Pathology, University of Brescia, Brescia, Italy
| | - Giancarlo Troncone
- Public Health, University of Naples Federico II School of Medicine and Surgery, Napoli, Italy
| | | | - Davide Seminati
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, Milano, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, Milano, Italy
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Wechsler EV, Ahuja NK, Brenner D, Chan W, Chang L, Chey WD, Lembo AJ, Moshiree B, Nee J, Shah SC, Staller K, Shah ED. Up-Front Endoscopy Maximizes Cost-Effectiveness and Cost-Satisfaction in Uninvestigated Dyspepsia. Clin Gastroenterol Hepatol 2023; 21:2378-2388.e28. [PMID: 36646234 PMCID: PMC10542651 DOI: 10.1016/j.cgh.2023.01.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/01/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Practice guidelines promote a routine noninvasive, non-endoscopic initial approach to investigating dyspepsia without alarm features in young patients, yet many patients undergo prompt upper endoscopy. We aimed to assess tradeoffs among costs, patient satisfaction, and clinical outcomes to inform discrepancy between guidelines and practice. METHODS We constructed a decision-analytic model and performed cost-effectiveness/cost-satisfaction analysis over a 1-year time horizon on patients with uninvestigated dyspepsia without alarm features referred to gastroenterology. A RAND/UCLA expert panel informed model design. Four competing diagnostic/management strategies were evaluated: prompt endoscopy, testing for Helicobacter pylori and eradicating if present (test-and-treat), testing for H pylori and performing endoscopy if present (test-and-scope), and empiric acid suppression. Outcomes were derived from systematic reviews of clinical trials. Costs were informed by prospective observational cohort studies and national commercial/federal cost databases. Health gains were represented using quality-adjusted life years. RESULTS From the patient perspective, costs and outcomes were similar for all strategies (maximum out-of-pocket difference of $30 and <0.01 quality-adjusted life years gained/year regardless of strategy). Prompt endoscopy maximized cost-satisfaction and health system reimbursement. Test-and-scope maximized cost-effectiveness from insurer and patient perspectives. Results remained robust on multiple one-way sensitivity analyses on model inputs and across most willingness-to-pay thresholds. CONCLUSIONS Noninvasive management strategies appear to result in inferior cost-effectiveness and patient satisfaction outcomes compared with strategies promoting up-front endoscopy. Therefore, additional studies are needed to evaluate the drivers of patient satisfaction to facilitate inclusion in value-based healthcare transformation efforts.
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Affiliation(s)
- Emily V Wechsler
- Geisel School of Medicine, Hanover, New Hampshire; Section of Gastroenterology and Hepatology, Dartmouth Health, Lebanon, New Hampshire
| | - Nitin K Ahuja
- Division of Gastroenterology, Penn Medicine, Philadelphia, Pennsylvania
| | - Darren Brenner
- Division of Gastroenterology, Northwestern Medicine, Chicago, Illinois
| | - Walter Chan
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lin Chang
- Division of Gastroenterology, University of California Los Angeles, Los Angeles, California
| | - William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan
| | - Anthony J Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Baha Moshiree
- Division of Gastroenterology, Atrium Health, Charlotte, North Carolina
| | - Judy Nee
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Shailja C Shah
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric D Shah
- Geisel School of Medicine, Hanover, New Hampshire; Section of Gastroenterology and Hepatology, Dartmouth Health, Lebanon, New Hampshire; Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
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Dismuke-Greer CE, Almeida EJ, Silva MA, Dams-O'Connor K, Rocek G, Phillips LM, Negro AD, Walker WC, Nakase-Richardson R. Impact of Posttraumatic Amnesia Duration on Traumatic Brain Injury (TBI) First Year Hospital Costs: A Veterans Affairs TBI Model Systems Study. Arch Phys Med Rehabil 2023:S0003-9993(23)00222-8. [PMID: 37084937 DOI: 10.1016/j.apmr.2023.03.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To examine the association between severity of traumatic brain injury (TBI) as measured by duration of post-traumatic amnesia (PTA) and first year hospitalization costs for service members and veterans (SMVs) treated for TBI at Polytrauma Rehabilitation Centers (PRCs) within the Veterans Health Administration (VHA). DESIGN Multivariable models of merged datasets from the VA TBI Model Systems (VA-TBIMS) national database containing TBI clinical characterization including PTA with VHA hospital cost data. SETTING Five VA PRCs. PARTICIPANTS VA-TBIMS participants with known PTA who received inpatient rehabilitation within 1 year of their TBI at any of 5 PRCs between 2010-2020. INTERVENTIONS N/A MAIN OUTCOME MEASURES: Total, acute care, rehabilitation, intensive care unit (ICU), and surgery costs across all VA hospitals. RESULTS A total of 717 SMVs (mean age 36.9 years, 94.1% male, 76.8% non-Hispanic White, 7.8% active duty) met inclusion criteria for the unadjusted analyses. Unadjusted mean total hospital costs in the first-year post TBI were approximately $201,214 higher for those with PTA duration ≥24 hours ($351,157) than PTA <24 hours ($149,943). In adjusted models (n=583), each additional day of PTA duration incrementally increased total ($1453), rehabilitation ($1324), ICU ($78) and surgery ($39) costs. Other significant covariates included age, acute care length of stay, Disability Rating Scale on rehabilitation admission, penetrating violent cause of injury, and drug abuse. CONCLUSIONS This study demonstrates that PTA as a quantitative measure of TBI severity significantly impacts first-year hospitalization costs of SMVs treated at PRCs. Each additional day of PTA was associated with higher total, rehabilitation, ICU, and surgery costs. Mean first year hospital costs were also found to exceed the highest budget allocation to VHA facilities for a veteran treated at a PRC. These findings have possible implications for hospital care provision for those receiving inpatient rehabilitation in VHA settings.
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Affiliation(s)
| | | | - Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Internal Medicine Sleep & Pulmonary Division, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine, New York, NY; Department of Neurology, Icahn School of Medicine, New York, NY
| | - George Rocek
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL
| | - Leah M Phillips
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL
| | - Ariana Del Negro
- Tampa VA Research and Education Foundation, Inc, Temple Terrace, FL
| | - William C Walker
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Department of Internal Medicine Sleep & Pulmonary Division, Morsani College of Medicine, University of South Florida, Tampa, FL; DHA Traumatic Brain Injury Center of Excellence, Tampa, FL
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Romandini M, Ruales-Carrera E, Sadilina S, Hämmerle CHF, Sanz M. Minimal invasiveness at dental implant placement: A systematic review with meta-analyses on flapless fully guided surgery. Periodontol 2000 2023; 91:89-112. [PMID: 35906928 DOI: 10.1111/prd.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Indexed: 12/31/2022]
Abstract
Flapless and fully guided implant placement has the potential to maximize efficacy outcomes and at the same time to minimize surgical invasiveness. The aim of the current systematic review was to answer the following PICO question: "In adult human subjects undergoing dental implant placement (P), is minimally invasive flapless computer-aided fully guided (either dynamic or static computer-aided implant placement (sCAIP)) (I) superior to flapped conventional (free-handed implant placement (FHIP) or cast-based/drill partially guided implant placement (dPGIP)) surgery (C), in terms of efficacy, patient morbidity, long-term prognosis, and costs (O)?" Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the PICO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, performed full-text analysis, extracted the data from the published reports, and performed the risk of bias assessment. In cases of disagreement, a third review author took the final decision during ad hoc consensus meetings. The study results were summarized using random effects meta-analyses, which were based (wherever possible) on individual patient data (IPD). A total of 10 manuscripts reporting on five RCTs, involving a total of 124 participants and 449 implants, and comparing flapless sCAIP with flapped FHIP/cast-based partially guided implant placement (cPGIP), were included. There was no RCT analyzing flapless dynamic computer-aided implant placement (dCAIP) or flapped dPGIP. Intergroup meta-analyses indicated less depth deviation (difference in means (MD) = -0.28 mm; 95% confidence interval (CI): -0.59 to 0.03; moderate certainty), angular deviation (MD = -3.88 degrees; 95% CI: -7.00 to -0.77; high certainty), coronal (MD = -0.6 mm; 95% CI: -1.21 to 0.01; low certainty) and apical (MD = -0.75 mm; 95% CI: -1.43 to -0.07; moderate certainty) three-dimensional bodily deviations, postoperative pain (MD = -17.09 mm on the visual analogue scale (VAS); 95% CI: -33.38 to -0.80; low certainty), postoperative swelling (MD = -6.59 mm on the VAS; 95% CI: -19.03 to 5.85; very low certainty), intraoperative discomfort (MD = -9.36 mm on the VAS; 95% CI: -17.10 to -1.61) and surgery duration (MD = -24.28 minutes; 95% CI: -28.62 to -19.95) in flapless sCAIP than in flapped FHIP/cPGIP. Despite being more accurate than flapped FHIP/cPGIP, flapless sCAIP still resulted in deviations with respect to the planned position (intragroup meta-analytic means: 0.76 mm in depth, 2.57 degrees in angular, 1.43 mm in coronal, and 1.68 in apical three-dimensional bodily position). Moreover, flapless sCAIP presented a 12% group-specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases. Evidence regarding more clinically relevant outcomes of efficacy (implant survival and success, prosthetically and biologically correct positioning), long-term prognosis, and costs, is currently scarce. When the objective is to guarantee minimal invasiveness at implant placement, clinicians could consider the use of flapless sCAIP. A proper case selection and consideration of a safety margin are, however, suggested.
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Affiliation(s)
- Mario Romandini
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Edwin Ruales-Carrera
- Clinic of Reconstructive Dentistry, University of Zürich, Zürich, Switzerland
- Department of Dentistry, Center for Education and Research on Dental Implants (CEPID), Federal University of Santa Catarina, Florianópolis, Brazil
| | - Sofya Sadilina
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
- Department of Oral and Maxillofacial Surgery, Pavlov University, Saint-Petersburg, Russia
| | | | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
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Baptistella A, Figueiredo HCES, de Mattos CA, Bittar CK. COST ANALYSIS OF MOTORCYCLE ACCIDENT VICTIMS AT A UNIVERSITY HOSPITAL: PERSPECTIVES FROM 2017 AND 2020. Acta Ortop Bras 2023; 31:e258318. [PMID: 37082153 PMCID: PMC10112349 DOI: 10.1590/1413-785220233101e258318] [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] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/28/2022] [Indexed: 04/22/2023]
Abstract
Introduction Motorcycle accidents constitute a public health problem that affects public and private health services due to the expenses of the victim's treatment and rehabilitation. Objective Evaluate the impact of motorcycle accident costs in a university hospital in 2020. Method Comparative analysis of the costs of motorcycle accident patients in 2020 and 2017. Results Among 151 patients included in the study, the average cost was U$3,083.54, and the average days of hospitalization were 5.3 days. The patient with the highest cost to the hospital spent U$22,504.05, and the patient with the lowest cost spent U$356.72. The longest stay among these patients was 41 days, and the shortest was one day. The average cost per patient per day for the entire sample was U$581.80. Conclusion The formulation and application of strategies that promote the reduction of motorcycle accidents in the city of Campinas are necessary. Level of evidence II, Retrospective study.
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Affiliation(s)
- Amanda Baptistella
- Pontifícia Universidade Católica de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brazil
| | | | - Carlos Augusto de Mattos
- Pontifícia Universidade Católica de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brazil
- Hospital PUC-Campinas, Campinas, SP, Brazil
| | - Cintia Kelly Bittar
- Pontifícia Universidade Católica de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brazil
- Hospital PUC-Campinas, Campinas, SP, Brazil
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Candido PBM, Peria FM, Nunes AA, Pinheiro RP, Costa HRT, Defino HLA. COSTS ANALYSIS OF SPINAL COLUMN METASTASES SURGICAL TREATMENT. Acta Ortop Bras 2022; 30:e251579. [PMID: 36506865 PMCID: PMC9721407 DOI: 10.1590/1413-785220223002e251579] [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] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022]
Abstract
Introduction End-of-life cancer treatment is associated with substantial healthcare costs. Objective This study aimed to analyze the surgical treatment cost of spinal metastasis and epidural compression patients undergoing surgical treatment. Methods A retrospective cost analysis of 81 patients with spinal metastasis and epidural compression undergoing surgical treatment. Cost evaluation was defined in the following categories: medications, laboratory and imaging tests, nursery, recovery room, intensive care unit, surgical procedure, and consigned material. The cost of pain improvement, functional activity, and survival was also evaluated. Results The total cost of surgical treatment for 81 patients was $3,604,334.26, and the average value for each patient was $44,497.95. The highest costs were related to implants (41.1%), followed by hospitalization (27.3%) and surgical procedure (19.7%). Conclusion The cost of surgical treatment for spinal metastases is one of the most expensive bone complications in cancer patients. The cost of treatment related to outcomes showed differences according to the outcome analyzed. Hospital stay, tests, drugs, and intensive care play an important role in some of the costs related to the specific outcome. Level of Evidence II, Retrospective Study .
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Affiliation(s)
- Priscila Barile Marchi Candido
- Universidade de São Paulo, Ribeirão Preto Medical School, Unimed-Limeira and Doctoral Student at Department of Medical Clinics, São Pulo, SP, Brazil
| | - Fernanda Maris Peria
- Universidade de São Paulo, Ribeirão Preto Medical School, Division of Clinical Oncology, Department of Medical Images, Hematology and Clinical Oncology, São Paulo, SP, Brazil
| | - Altacílio Aparecido Nunes
- Universidade de São Paulo, Ribeirão Preto Medical School, Department of Social Medicine, São Paulo, SP, Brazil
| | - Rômulo Pedroza Pinheiro
- Universidade de São Paulo, Ribeirão Preto Medical School, Department of Social Medicine, São Paulo, SP, Brazil
| | | | - Helton L A Defino
- Universidade de São Paulo, Ribeirão Preto Medical School, Department of Social Medicine, São Paulo, SP, Brazil
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Schulze L, Dubeux VT, Milfont JCA, Peçanha G, Ferrer P, Cavalcanti AG. Analysis of surgical and histopathological results of robot-assisted partial nephrectomy with use of three or four robotic arms: an early series results. Int Braz J Urol 2022; 48:493-500. [PMID: 35333488 PMCID: PMC9060166 DOI: 10.1590/s1677-5538.ibju.2021.0495] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/14/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives: The aim of this study was to evaluate whether criteria exist to guide election between the use the three- or four-arm technique in robotic partial nephrectomy (RPN) instead of just the surgeon’s preference. Material and Methods: We performed a retrospective review of 80 patients submitted to RPN from May 2016 to February 2020. The patients were divided into two groups of 40, the first submitted to the surgical procedure with use of three robotic arms and the second with four arms. The group division was performed independently of the complexity of the cases, age or gender of the patients and laterality of the renal lesions. Peri- and postoperative data were analyzed for comparison between the two groups. Results: Both techniques had similar oncological outcomes (positive tumor margins), renal function preservation (warm ischemia time) and hemorrhagic complications (estimated blood loss and renal artery pseudoaneurysm), with a small difference in the need for blood transfusion, favoring the technique with three arms. Conclusions: The two robotic partial nephrectomy techniques had similar oncological and postoperative outcomes, with minimal perioperative complications. The three-arm technique is safe and feasible regardless of the complexity and size of the tumor. Additionally, the use of the three-arm technique reduced surgery costs by US$ 413.00 per patient.
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Affiliation(s)
- Lucas Schulze
- Departamento de Urologia, Universidade Federal do Estado do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brasil.,Instituto de Urologia do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Victor Teixeira Dubeux
- Centro Biomédico, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil
| | - José C A Milfont
- Instituto de Urologia do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Gustavo Peçanha
- Instituto de Urologia do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Pedro Ferrer
- Centro Biomédico, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil
| | - Andre Guilherme Cavalcanti
- Disciplina de Urologia, Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Rio de Janeiro, RJ, Brasil
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Manimaran M, Arora A, Lovejoy CA, Gao W, Maruthappu M. Role of artificial intelligence and machine learning in haematology. J Clin Pathol 2022; 75:585-587. [PMID: 35470252 DOI: 10.1136/jclinpath-2021-208127] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Christopher A Lovejoy
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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Lee SY, Kim K, Park YB, Yoo KH. Does the Use of Asthma-Controller Medication in Accordance with Guidelines Reduce the Incidence of Acute Exacerbations and Healthcare Costs? Tuberc Respir Dis (Seoul) 2022; 85:11-17. [PMID: 35000364 PMCID: PMC8743641 DOI: 10.4046/trd.2021.0087] [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: 06/24/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background In asthma, consistent control of chronic airway inflammation is crucial, and the use of asthma-controller medication has been emphasized. Our purpose in this study is to compare the incidence of acute exacerbation and healthcare costs related to the use of asthma-controller medication. Methods By using data collected by the National Health Insurance Review and Assessment Service, we compared one-year clinical outcomes and medical costs from July 2014 to June 2015 (follow-up period) between two groups of patients with asthma who received different prescriptions for recommended asthma-controller medication (inhaled corticosteroids or leukotriene receptor antagonists) at least once from July 2013 to June 2014 (assessment period). Results There were 51,757 patients who satisfied our inclusion criteria. Among them, 13,702 patients (26.5%) were prescribed a recommended asthma-controller medication during the assessment period. In patients using a recommended asthma-controller medication, the frequency of acute exacerbations decreased in the follow-up period, from 2.7% to 1.1%. The total medical costs of the controller group decreased during the follow-up period compared to the assessment period, from $3,772,692 to $1,985,475. Only 50.9% of patients in the controller group used healthcare services in the follow-up period, and the use of asthma-controller medication decreased in the follow-up period. Conclusion Overall, patients using a recommended asthma-controller medication showed decreased acute exacerbation and reduced total healthcare cost by half.
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Affiliation(s)
- Suh-Young Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Division of Allergy and Clinical Immunology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Molecular Microbiology and Immunology, Brown University, Providence, RI, USA
| | - Kyungjoo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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12
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Gallini JW, Sata E, Zerihun M, Melak B, Haile M, Zeru T, Gessese D, Ayele Z, Tadesse Z, Callahan EK, Nash SD, Weiss PS. Optimizing cluster survey designs for estimating trachomatous inflammation-follicular within trachoma control programs. Int J Infect Dis 2021; 116:101-107. [PMID: 34965463 DOI: 10.1016/j.ijid.2021.12.355] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The World Health Organization recommends mass drug administration (MDA) with azithromycin to eliminate trachoma as a public health problem. MDA decisions are based on prevalence estimates from two-stage cluster surveys. Work remains to mathematically evaluate current trachoma survey designs. We aimed to characterize the effects of the number of units sampled on the precision and cost of trachomatous inflammation-follicular (TF) estimates. METHODS We simulated a population of 30 districts to represent the breadth of possible TF distributions in Amhara, Ethiopia. Samples of varying numbers of clusters (14-34) and households (10-60) were selected. Sampling schemes were evaluated on precision, proportion of incorrect and low MDA decisions made, and estimated cost. RESULTS Number of clusters sampled had a greater impact on precision than number of households. The most efficient scheme depended on the underlying TF prevalence in a district. For lower prevalence areas (<10%) the most cost efficient (providing adequate precision while minimizing cost) design was 20 clusters of 20-30 households. For higher prevalence areas (>10%), the most efficient design was 15-20 clusters of 20-30 households. CONCLUSIONS For longer-running programs, using context-specific survey designs would allow for practical precision while reducing survey costs. Sampling 15 clusters of 20-30 households in suspected moderate to high prevalence districts and 20 clusters of 20-30 households in districts suspected to be near the 5% threshold appears to be a balanced approach.
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Affiliation(s)
- Julia W Gallini
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- Amhara Public Health Institute, Bahir Dar, Amhara, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Amhara, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - E Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA
| | - Scott D Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA.
| | - Paul S Weiss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
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13
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Whedon JM, Kizhakkeveettil A, Toler A, MacKenzie TA, Lurie JD, Bezdjian S, Haldeman S, Hurwitz E, Coulter I. Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults. J Manipulative Physiol Ther 2021; 44:519-526. [PMID: 34876298 DOI: 10.1016/j.jmpt.2021.09.001] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT). METHODS We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias. RESULTS The study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001). CONCLUSIONS Adults aged 65 to 84 who initiated long-term treatment for cLBP via OAT incurred lower long-term costs for low back pain but higher long-term total healthcare costs under Medicare compared with patients who initiated long-term treatment with SMT.
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Affiliation(s)
- James M Whedon
- Health Services Research, Southern California University of Health Sciences, Whittier, California.
| | - Anupama Kizhakkeveettil
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
| | - Andrew Toler
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
| | - Todd A MacKenzie
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jon D Lurie
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Serena Bezdjian
- Health Services Research, Southern California University of Health Sciences, Whittier, California
| | - Scott Haldeman
- Southern California University of Health Sciences, Whittier, California
| | - Eric Hurwitz
- Southern California University of Health Sciences, Whittier, California
| | - Ian Coulter
- Southern California University of Health Sciences, Whittier, California
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14
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Graff V, Gabutti L, Treglia G, Pascale M, Anselmi L, Cafarotti S, La Regina D, Mongelli F, Saporito A. Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature. Braz J Anesthesiol 2021:S0104-0014(21)00366-3. [PMID: 34627828 DOI: 10.1016/j.bjane.2021.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/02/2021] [Accepted: 09/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. METHODS A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). RESULTS One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. CONCLUSIONS Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.
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Muszbek N, Evans R, Remak E, Brennan VK, Colaone F, Shergill S, Ross P, Mullan D. Changes in treatment pattern and costs in advanced hepatocellular carcinoma (HCC). Expert Rev Pharmacoecon Outcomes Res 2021; 22:147-154. [PMID: 34488517 DOI: 10.1080/14737167.2021.1973892] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While essential for cost-effectiveness analyses, there are no current resource use and cost data available for advanced hepatocellular carcinoma (HCC) and selective internal radiation therapy (SIRT). The study aims to assess current resource use and costs in HCC and for SIRT compared to historical survey data. AREAS COVERED To address this data gap, resource use was elicited via surveys and interviews with medical professionals experienced with HCC and SIRT in the United Kingdom. Unit costs were from publicly available databases. Resource use and costs were estimated and compared to prior surveys. EXPERT OPINION From eleven responses, pre-progression costs for SIRT and systemic therapy were £256.77 and £292.27/month, respectively. One-off progression and post-progression costs were £209.98 and £522.84/month. Monthly costs were 54%-79% lower than in previous surveys, due to reduction in hospitalizations and funded social care. Furthermore, substantial differences in resource use associated with SIRT between clinical practice and clinical trials were found. In conclusion, increased availability and familiarity with systemic treatments has led to important changes in HCC care and SIRT administration. The uncertainty from the use of expert opinion and the limited number of hospitals with SIRT experience can be addressed with future research using large databases, registries.
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Affiliation(s)
| | | | | | - Victoria K Brennan
- Health Economics, Pricing, Reimbursement & Market Access, SIRTEX Medical United Kingdom Ltd, London, UK
| | - Fabien Colaone
- Health Economics, Pricing, Reimbursement & Market Access, SIRTEX Medical United Kingdom Ltd, London, UK
| | - Suki Shergill
- Health Economics, Pricing, Reimbursement & Market Access, SIRTEX Medical United Kingdom Ltd, London, UK
| | - Paul Ross
- Department of Medical Oncology, Guy's & St Thomas' Nhs Foundation Trust, London, UK
| | - Damian Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
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16
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Evans CJ, Bone AE, Yi D, Gao W, Morgan M, Taherzadeh S, Maddocks M, Wright J, Lindsay F, Bruni C, Harding R, Sleeman KE, Gomes B, Higginson IJ. Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial. Int J Nurs Stud 2021; 120:103978. [PMID: 34146843 DOI: 10.1016/j.ijnurstu.2021.103978] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/25/2021] [Revised: 04/18/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Globally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. AIM To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. DESIGN Single-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. SETTING/PARTICIPANTS Four National Health Service general practices in England with recruitment of patients aged ≥75 years, with moderate to severe frailty, chronic noncancer condition(s) and ≥2 symptoms or concerns, and family caregivers when available. RESULTS 50 patients were randomly assigned to receive usual care (n = 26, mean age 86.0 years) or the intervention and usual care (n = 24, mean age 85.3 years), and 26 caregivers (control n = 16, mean age 77.0 years; intervention n = 10, mean age 77.3 years). Participants lived at home (n = 48) or care home (n = 2). Complete case analysis (n = 48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared = 0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n = 19) and caregiver (n = 9) interviews generated themes about the intervention of 'Little things make a big difference' with optimal management of symptoms and 'Care beyond medicines' of psychosocial support to accommodate decline and maintain independence. CONCLUSIONS This palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes. TRIAL REGISTRATION Controlled-Trials.com ISRCTN 45837097 Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England; Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, England.
| | - Shamim Taherzadeh
- Northbourne Medical Centre, 193A Upper Shoreham Road, Shoreham-by-Sea, BN43 6BT, England.
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Juliet Wright
- University of Sussex, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9RH, England.
| | - Fiona Lindsay
- Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Carla Bruni
- Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Katherine E Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Barbara Gomes
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
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17
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Vaegter HB, Johansen JV, Sopina L, Smith A, Kent P, Fuglsang KS, Pedersen JF, Schutze R, O’Sullivan P, Handberg G, Fatoye F, Ussing K, Stegemejer I, Thorlund JB. A Cognitive Functional Therapy+ Pathway Versus an Interdisciplinary Pain Management Pathway for Patients With Severe Chronic Low Back Pain (CONFeTTI Trial): Protocol for a Pragmatic Randomized Controlled Trial. Phys Ther 2021; 101:6277052. [PMID: 34003285 PMCID: PMC8427714 DOI: 10.1093/ptj/pzab132] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/26/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Chronic low back pain (cLBP) is the leading cause of disability. Interdisciplinary pain management is recommended for patients with severe/high-impact cLBP. Such programs are expensive, not easily accessible, and have limited effect; therefore, new cost-effective strategies are warranted. Cognitive functional therapy (CFT) has shown promising results but has not been compared with an interdisciplinary pain management approach. The primary aim of this randomized controlled trial is to investigate if a pathway starting with CFT including psychologist support (CFT+) with the option of additional usual care (if needed) is superior in improving disability and more cost-effective at 12 months compared with an interdisciplinary pain management pathway (usual care). METHODS This pragmatic, 2-arm, parallel-group randomized controlled trial will randomly allocate patients (n = 176) aged 18 to 75 years referred to an interdisciplinary pain center due to severe cLBP to 1 of 2 groups (1:1 ratio). Participants randomized to CFT+ will participate in a 3-month functional rehabilitation pathway with the option of additional usual care (if needed), and participants randomized to the interdisciplinary pain management pathway will participate in an individualized program of longer duration designed to best suit the individual's situation, needs, and resources. The primary outcome is the proportion of participants with an 8-point improvement in the Oswestry Disability Index score at 12 months. Exploratory outcomes are change in Oswestry Disability Index scores over time and an economic analysis of quality-adjusted life years using the 3-level version of the EuroQol EQ-5D. IMPACT The study evaluates the cost-effectiveness of CFT+ with the option of additional usual care (if needed) for individuals with severe cLBP. Findings can potentially improve future care pathways and reduce cost for the health care system.
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Affiliation(s)
- Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark,Address all correspondence to Dr Bjarke Vaegter at:
| | | | - Liza Sopina
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark,Danish Centre for Health Economics, DaCHE, Dept. of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia,Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | | | - Rob Schutze
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter O’Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Gitte Handberg
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark,Pain Center, Odense University Hospital, Odense, Denmark
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Kasper Ussing
- Spine Center of Southern Denmark, Hospital of Lillebaelt, Middelfart, Denmark
| | - Irene Stegemejer
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
| | - Jonas Bloch Thorlund
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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18
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Villarreal-Ríos E, Palacios-Mateos AF, Galicia-Rodríguez L, Vargas-Daza ER, Baca-Moreno C, Lugo-Rodríguez A. [Institutional cost of the patient with chronic kidney disease managed with hemodialysis]. Rev Med Inst Mex Seguro Soc 2020; 58:698-708. [PMID: 34705402 DOI: 10.24875/rmimss.m20000103] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Chronic kidney disease cost is considered high for health systems due to the amount of supplies required for treatment and increasing prevalence. OBJECTIVE Determine institutional cost of hemodialysis in chronic kidney disease. METHOD Cost design from the institutional perspective, in patients with chronic kidney disease managed with hemodialysis. The sample size was 269 and the sample technique for consecutive cases. Annual fixed average cost (times and movements technique) and annual variable average cost (microcosting technique) adjusted by use of services, helped to identify annual average cost by function of production and service, the sum of these resulted in annual cost of care. Statistical analysis included averages and projections. RESULTS The average annual cost of the patient with chronic kidney disease on hemodialysis varies between $223,183 and $257,000; the cost in life is $1,198,968. The institutional total cost it corresponds to between 1.47% and 1.73% of the budget. CONCLUSIONS Hemodialysis cost in chronic kidney disease is high for the institution, however, hemodialysis allows the survival of the patient.
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Affiliation(s)
- Enrique Villarreal-Ríos
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, "Unidad de Investigación en Epidemiología y Servicios de Salud". Queretaro
| | - Ana Fernanda Palacios-Mateos
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, "Unidad de Investigación en Epidemiología y Servicios de Salud". Queretaro
| | - Liliana Galicia-Rodríguez
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, "Unidad de Investigación en Epidemiología y Servicios de Salud". Queretaro
| | - Emma Rosa Vargas-Daza
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, "Unidad de Investigación en Epidemiología y Servicios de Salud". Queretaro
| | - Carolina Baca-Moreno
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1, Servicio de Nefrología. Querétaro, Querétaro, México
| | - Ariosto Lugo-Rodríguez
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1, Servicio de Nefrología. Querétaro, Querétaro, México
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19
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Lee JK, Kwak BO, Choi JH, Choi EH, Kim JH, Kim DH. Financial Burden of Hospitalization of Children with Coronavirus Disease 2019 under the National Health Insurance Service in Korea. J Korean Med Sci 2020; 35:e224. [PMID: 32567260 PMCID: PMC7308138 DOI: 10.3346/jkms.2020.35.e224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in an ongoing pandemic; however, the socioeconomic burden of COVID-19 treatment in the pediatric population remains unclear. Thus, the aim of this study was to determine the hospitalization periods and medical costs among children with COVID-19. In total, 145 billing statements for pediatric patients receiving healthcare services because of COVID-19 from February 1, 2020 to March 31, 2020 were used. The study showed that individual treatment costs for children with COVID-19 are approximately USD 2,192 under the Korean National Health Insurance Service System. This study revealed the differences in cost among age groups, determined by the type of hospital wherein admission occurred, as a trend of increasing age, increasing hospitalization time, and increasing cost was observed. Tailored COVID-19 treatment strategies by age group may lower costs and increase the effectiveness of resource allocation.
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Affiliation(s)
- Joon Kee Lee
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
| | - Byung Ok Kwak
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jae Hong Choi
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hyun Kim
- Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
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20
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Rautiainen E, Ryynänen OP, Laatikainen T, Kekolahti P. Factors Associated with 5-Year Costs of Care among a Cohort of Alcohol Use Disorder Patients: A Bayesian Network Model. Healthc Inform Res 2020; 26:129-145. [PMID: 32547810 PMCID: PMC7278506 DOI: 10.4258/hir.2020.26.2.129] [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: 01/29/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives To examine the direct effects of risk factors associated with the 5-year costs of care in persons with alcohol use disorder (AUD) and to examine whether remission decreases the costs of care. Methods Based on Electronic Health Record data collected in the North Karelia region in Finland from 2012 to 2016, we built a non-causal augmented naïve Bayesian (ANB) network model to examine the directional relationship between 16 risk factors and the costs of care for a random cohort of 363 AUD patients. Jouffe’s proprietary likelihood matching algorithm and van der Weele’s disjunctive confounder criteria (DCC) were used to calculate the direct effects of the variables, and sensitivity analysis with tornado diagrams and analysis maximizing/minimizing the total cost of care were conducted. Results The highest direct effect on the total cost of care was observed for a number of chronic conditions, indicating on average more than a €26,000 increase in the 5-year mean cost for individuals with multiple ICD-10 diagnoses compared to individuals with less than two chronic conditions. Remission had a decreasing effect on the total cost accumulation during the 5-year follow-up period; the percentage of the lowest cost quartile (42.9% vs. 23.9%) increased among remitters, and that of the highest cost quartile (10.71% vs. 26.27%) decreased compared with current drinkers. Conclusions The ANB model with application of DCC identified that remission has a favorable causal effect on the total cost accumulation. A high number of chronic conditions was the main contributor to excess cost of care, indicating that comorbidity is an essential mediator of cost accumulation in AUD patients.
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Affiliation(s)
- Elina Rautiainen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olli-Pekka Ryynänen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,General Practice Unit, Kuopio University Hospital, Primary Health Care, Kuopio, Finland
| | - Tiina Laatikainen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Joensuu, Finland
| | - Pekka Kekolahti
- Department of Communications and Networking, School of Electrical Engineering, Aalto University, Espoo, Finland
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Abstract
OBJECTIVES This paper describes the principles of economics and their application to the promotion, protection and restoration of oral health in populations and the planning, management and delivery of oral health care. After illustrating the economic determinants of oral health, the demand for oral health care is discussed with particular reference to asymmetric information between patient and provider. The reasons for the market failure in (oral) health care and their implications for efficiency and equity are explained. We go on to describe how economic evaluation contributes to policies aimed at maximising oral health gains where resources are constrained. The behavioural aspects of patients´ demand for and dental professionals´ provision of oral health services are discussed. Finally, we outline methods for planning the dental workforce in ways that reflect system goals.
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Affiliation(s)
- S Listl
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Quality and Safety of Oral Health Care.,Heidelberg University Clinics, Section for Translational Health Economics, Heidelberg, Germany
| | - J I Grytten
- University of Oslo, Department of Community Dentistry , Oslo, Norway.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital
| | - S Birch
- The University of Queensland, Centre for the Business and Economics of Health, Brisbane, Australia.,School of Community Based Medicine, University of Manchester, Manchester, UK
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22
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Kim J, Lim JY. [Development and Application of Cost Management Program for Visiting Nursing Centers Using Time-Driven Activity-Based Costing]. J Korean Acad Nurs 2019; 49:586-600. [PMID: 31672952 DOI: 10.4040/jkan.2019.49.5.586] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to develop a web-based cost management program for visiting nursing centers (CMP-VNC), using time-driven activity-based costing (TD-ABC), and to analyze effects of the program. METHODS The CMP-VNC was developed using the combined prototyping approach and system developing life cycle method following four stages: need analysis with comprehensive literature reviews and focus group interviews, design and development of program algorithm, evaluation of the developed program validity using experts and users group, and application and effects analysis. The non-equivalent control group pretest-posttest design was used to analyze the effects of the program. The program demonstration was conducted for four weeks with 60 visiting nurses in 35 visiting centers. RESULTS The web-based program was developed. It has five interfaces with basic and special functions using TD-ABC, namely, input, visiting nursing activity, visiting nursing activity cost, cost efficiency, and cost calculation report. The experimental group showed significantly higher cost perception and cost confidence than control group. CONCLUSION We found that the CMP-VNC can be an effective tool to increase visiting nurses' competency of costing and enhance efficiencies of visiting nursing centers.
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Affiliation(s)
- Juhang Kim
- Department of Nursing, Far East University, Eumseong, Korea
| | - Ji Young Lim
- Department of Nursing, Inha University, Incheon, Korea.
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23
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Monteverde M, Tarragona S. Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018. Salud Colect 2019; 15:e2275. [PMID: 32022132 DOI: 10.18294/sc.2019.2275] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/24/2022] Open
Abstract
During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.
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Affiliation(s)
- Malena Monteverde
- Doctora en Economía, Posdoctorado en Demografía. Investigadora Adjunta, Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Universidad Nacional de Córdoba. Unidad Ejecutora, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina.
| | - Sonia Tarragona
- Economista, Magíster en Finanzas Públicas Provinciales y Municipales. Directora, Fundación QUANT. Directora, Maestría de Farmacopolíticas, Universidad ISALUD, Ciudad Autónoma de Buenos Aires, Argentina.
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24
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Langer B, Kunow C. Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study. Pharm Pract (Granada) 2019; 17:1579. [PMID: 31592298 PMCID: PMC6763311 DOI: 10.18549/pharmpract.2019.3.1579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/30/2019] [Accepted: 09/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background: In Germany over-the-counter medications (OTC) – which since 2004 are no longer subject to binding prices – can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications. Objective: The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient’s approach (symptom-based versus medication-based request) in determining the outcome of these aspects. Methods: A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids. Results: In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an ‘adequate intake of fluids’ in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified – for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53. Conclusions: Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated.
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Affiliation(s)
- Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg. Neubrandenburg (Germany).
| | - Christian Kunow
- Research Associate. Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg. Neubrandenburg (Germany).
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Yu M. 3 Steps to a Strong Pricing Strategy. Manag Care 2019; 28:49. [PMID: 31188103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The need for a strong pricing strategy is a foregone conclusion. Hospitals and health systems have a window of opportunity now to craft a thoughtful approach to pricing that avoids common pitfalls and ultimately creates a competitive advantage in the market.
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Kelley T. Prices: High, Confusing, and Opaque. Would Transparency Even Help? Manag Care 2019; 28:24-29. [PMID: 31188107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Too often, the prices of health care services and drugs are cloaked in mystery. A growing consensus demands that patients be given a clearer sense, in advance, of what things will cost. But there are obstacles-and some stakeholders benefit from the present confusion.
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27
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Ladika S. Beware of the CAR-T Hitches. Manag Care 2019; 28:35-37. [PMID: 31188109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The two CAR-T therapies approved for certain blood cancers have price tags of $475,000 and $373,000-and those prices don't include other costs for services that are integral to the treatments, such as harvesting a patient's T cells. Moreover, patients typically have a lengthy hospital stay after treatment.
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28
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Thomas C. Cost of Immunosuppressive Drugs and the Patient with a Kidney Transplant. Clin J Am Soc Nephrol 2019; 14:317-318. [PMID: 30819669 PMCID: PMC6419284 DOI: 10.2215/cjn.00760119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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Kelley T. How Medicare Advantage Plans Are Paid: The Devils-and the Insights-Are in the Details. Manag Care 2019; 28:22-29. [PMID: 30883320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Is Medicare Advantage a ripoff of taxpayers, a godsend for integrated, cost-effective care, or somehow both? Contributing Editor Timothy Kelley walks you through the details of quality star ratings, preliminary adjustments, the quartile system, regional plans, risk scores, coding intensity adjustments, and rebate percentages.
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30
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Villarreal-Ríos E, Julián-Hernández YJ, Vargas-Daza ER, Tapia-Mendoza F, Galicia-Rodríguez L, Martínez-González L. [Cost of medical attention in patients with Chronic Obstructive Pulmonary Disease]. Rev Med Inst Mex Seguro Soc 2018; 56:371-378. [PMID: 30521740] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The chronic obstructive pulmonary disease is a preventable entity, when it develops the patient suffers severe complications, with a high economic impact for the patient and for health services. OBJETIVE To determine the cost of medical care in patients with chronic obstructive pulmonary disease (COPD). METHODS Using a cost design, the files of patients with COPD who attended the pulmonology clinic were analyzed. The size of the sample (n = 265) was calculated with the formula of averages of a finite population. The sample units were captured with the simple random technique. The study variables were: sociodemographic characteristics, characteristics of COPD, annual use profile, unit cost per service, total cost per service and total cost of medical care. The analysis plan included averages, percentages, confidence intervals and health expenditure projections. RESULTS The average annual cost of patient care with COPD was $ 89 479.08, of which $ 61 267.63 corresponded to medications. With a COPD prevalence of 25% in a population of 46 million, the calculated cost of care was $ 347 805 183 960. CONCLUSION The cost of medical care in patients with COPD was high, at the expense of medications.
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Affiliation(s)
- Enrique Villarreal-Ríos
- Instituto Mexicano del Seguro Social, Unidad de Investigación Epidemiológica y en Servicios de Salud. Querétaro, Querétaro, México
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31
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Alston M, Pyenson B. Pharma APMs: A Learning Curve Awaits You, Pharma. Manag Care 2018; 27:36-37. [PMID: 30309446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There are some valuable lessons for pharmaceutical manufacturers in provider alternative payment models (APMs), but whether pharmaceutical APMs succeed or fail will depend on finding solutions to operational and logistical challenges-some of which are unique to the pharmaceutical industry. Pharmaceutical APMs may require the collection of information beyond the claims data that many provider APMs depend on.
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Abbas Y, Smith G, Trinidade A. Audiologist-led screening of acoustic neuromas in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus: our experience in 1126 patients. J Laryngol Otol 2018; 132:786-9. [PMID: 30198461 DOI: 10.1017/S0022215118001561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether patients within an otolaryngology department presenting with asymmetrical sensorineural hearing loss and/or unilateral tinnitus can be safely and cost-efficiently screened for acoustic neuroma by audiologists as a first or only point of contact. METHODS A prospective case series and cost analysis were conducted at a tertiary referral centre. Between April 2013 and March 2017, 1126 adult patients presented to the audiology department with asymmetrical sensorineural hearing loss and/or unilateral tinnitus. All were screened for acoustic neuroma with magnetic resonance imaging, based on pre-determined criteria. The main outcome measure was the presence of acoustic neuroma or other pathology on magnetic resonance imaging. RESULTS Twenty-five patients (2.22 per cent) were found to have an acoustic neuroma (size range: 3-20 mm) and were referred to the otolaryngologist for further assessment. The remaining patients were appropriately managed and discharged by the audiologists without ENT input. This resulted in an overall cost saving of £164 850. CONCLUSION Patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus can be safely screened for acoustic neuroma and independently managed by audiologists as a first or only point of contact, resulting in considerable departmental cost savings.
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Burns J. The Few. The Effective. The Cheapest. The Waste-Free Formulary. Manag Care 2018; 27:17-18. [PMID: 30142058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Pacific Business Group on Health in developing a "waste-free formulary" that it hopes all purchasers could use. Such a formulary would be limited to drugs with proven clinical utility and among those, the low-cost alternatives. It is using a number of algorithms to evaluate medications.
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Coronado PJ, Rychlik A, Martínez-Maestre MA, Baquedano L, Fasero M, García-Arreza A, Morales S, Lubian DM, Zapardiel I. Role of lymphadenectomy in intermediate-risk endometrial cancer: a matched-pair study. J Gynecol Oncol 2018; 29:e1. [PMID: 29185259 PMCID: PMC5709519 DOI: 10.3802/jgo.2018.29.e1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/05/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the impact of lymph node dissection (LND) on morbidity, survival, and cost for intermediate-risk endometrial cancers (IREC). METHODS A multicenter retrospective cohort of 720 women with IREC (endometrioid histology with myometrial invasion <50% and grade 3; or myometrial invasion ≥50% and grades 1-2; or cervical involvement and grades 1-2) was carried out. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched pair analysis identified 178 pairs (178 with LND and 178 without it) equal in age, body mass index, co-morbidities, American Society of Anesthesiologist score, myometrial invasion, and surgical approach. Demographic data, pathology results, perioperative morbidity, and survival were abstracted from medical records. Disease-free survival (DFS) and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analysis. Cost analysis was carried out between both groups. RESULTS Both study groups were homogeneous in demographic data and pathologic results. The mean follow-up in patients free of disease was 61.7 months (range, 12.0-275.5). DFS (hazard ratio [HR]=1.34; 95% confidence interval [CI]=0.79-2.28) and OS (HR=0.72; 95% CI=0.42-1.23) were similar in both groups, independently of nodes count. In LND group, positive nodes were found in 10 cases (5.6%). Operating time and late postoperative complications were higher in LND group (p<0.05). Infection rate was significantly higher in no-LND group (p=0.035). There were no statistical differences between both groups regarding operative morbidity and hospital stay. The global cost was similar for both groups. CONCLUSION Systematic LND in IREC has no benefit on survival, although it does not show an increase in perioperative morbidity or global cost.
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Affiliation(s)
- Pluvio J Coronado
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain.
| | - Agnieszka Rychlik
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | | | - Laura Baquedano
- Service of Obstetrics and Gynecology, Hospital Miguel Servet, Zaragoza, Spain
| | - María Fasero
- Service of Obstetrics and Gynecology, Hospital Sanitas La Zarzuela, Madrid, Spain
| | - Aida García-Arreza
- Service of Obstetrics and Gynecology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Sara Morales
- Service of Obstetrics and Gynecology, Hospital Infanta Leonor, Madrid, Spain
| | - Daniel M Lubian
- Service of Obstetrics and Gynecology, Hospital de Puerto Real, Cádiz, Spain
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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Kirkner RM. Must Sky-High Prices 'Come on Down' Before the Price Is Right? Manag Care 2018; 27:16-19. [PMID: 29989894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The pipeline for gene therapies is flush. Clinical-Trials.gov lists 721 gene therapy trials. Last year, the FDA received 106 new drug applications for gene therapies, up 34% from 2016. There is no shortage of diseases for gene therapies to target. But the costs of these therapies will break the bank.
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Limberger LF, Faria FP, Campos LS, Anzolch KMJ, Fornari A. Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques. Int Braz J Urol 2018; 44:109-113. [PMID: 29135411 PMCID: PMC5815540 DOI: 10.1590/s1677-5538.ibju.2017.0232] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/07/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. Objective To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Materials and Methods Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Results Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (p<0.001). Conclusion Burch surgery was more expensive than ambulatory synthetic transobturator sling surgery, even when the cost of the synthetic sling was considered.
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Affiliation(s)
| | | | | | | | - Alexandre Fornari
- Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.,Ambulatório de Disfunções miccionais da Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil
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Blythe R, Cook D, Graves N. Scepticaemia: The impact on the health system and patients of delaying new treatments with uncertain evidence; a case study of the sepsis bundle. F1000Res 2018; 7:500. [PMID: 29904596 PMCID: PMC5989143 DOI: 10.12688/f1000research.14619.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A sepsis care bundle of intravenous vitamin C, thiamine, and hydrocortisone was reported to improve treatment outcomes. The data to support it are uncertain and decision makers are likely to be cautious about adopting it. The objective of this study was to model the opportunity costs in dollars and lives of waiting for better information before adopting the bundle. METHODS A decision tree was built using information from the literature. We modelled the impact of bundle adoption under three scenarios using a simulation in which the bundle was effective as reported in the primary trial, less effective based on other information, and ineffective. The measurements were health services costs, quality-adjusted life years, and transition probabilities. RESULTS If the bundle proves to be effective under either scenario, it will save billions of dollars and millions of life-years in the United States. This is the opportunity cost of delaying an adoption decision and waiting for better quality evidence. We suggest that hospital decision-makers consider implementing the bundle on a trial basis while monitoring costs and outcomes data even while the evidence base is uncertain. CONCLUSIONS If the decision maker is unwilling to use the best available evidence now, but rather wishes to wait for definitive evidence they are risking incurring large costs for health care systems and for the patients they serve. An explicit analysis of uncertain clinical outcomes is a useful adjunct to guide decision making where there is clinical ambiguity. This approach offers a valid alternative to the default of clinical inactivity when faced with uncertainty.
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Affiliation(s)
- Robin Blythe
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Cook
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Kuo CY, Yu LC, Chen HC, Chan CL. Comparison of Models for the Prediction of Medical Costs of Spinal Fusion in Taiwan Diagnosis-Related Groups by Machine Learning Algorithms. Healthc Inform Res 2018; 24:29-37. [PMID: 29503750 PMCID: PMC5820083 DOI: 10.4258/hir.2018.24.1.29] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 12/11/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 12/22/2022] Open
Abstract
Objectives The aims of this study were to compare the performance of machine learning methods for the prediction of the medical costs associated with spinal fusion in terms of profit or loss in Taiwan Diagnosis-Related Groups (Tw-DRGs) and to apply these methods to explore the important factors associated with the medical costs of spinal fusion. Methods A data set was obtained from a regional hospital in Taoyuan city in Taiwan, which contained data from 2010 to 2013 on patients of Tw-DRG49702 (posterior and other spinal fusion without complications or comorbidities). Naïve-Bayesian, support vector machines, logistic regression, C4.5 decision tree, and random forest methods were employed for prediction using WEKA 3.8.1. Results Five hundred thirty-two cases were categorized as belonging to the Tw-DRG49702 group. The mean medical cost was US $4,549.7, and the mean age of the patients was 62.4 years. The mean length of stay was 9.3 days. The length of stay was an important variable in terms of determining medical costs for patients undergoing spinal fusion. The random forest method had the best predictive performance in comparison to the other methods, achieving an accuracy of 84.30%, a sensitivity of 71.4%, a specificity of 92.2%, and an AUC of 0.904. Conclusions Our study demonstrated that the random forest model can be employed to predict the medical costs of Tw-DRG49702, and could inform hospital strategy in terms of increasing the financial management efficiency of this operation.
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Affiliation(s)
- Ching-Yen Kuo
- Institute of Information Management, Yuan-Ze University, Taoyuan, Taiwan.,Department of Medical Administration, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Liang-Chin Yu
- Institute of Information Management, Yuan-Ze University, Taoyuan, Taiwan
| | - Hou-Chaung Chen
- Department of Orthopedics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chien-Lung Chan
- Institute of Information Management, Yuan-Ze University, Taoyuan, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan-Ze University, Taoyuan, Taiwan
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Nevárez-Sida A, Castro-Bucio AJ, García-Contreras F, Cisneros-González N. Costos medicos directos en pacientes con enfermedad pulmonar obstructiva Crónica en Mexico. Value Health Reg Issues 2017; 14:9-14. [PMID: 29254548 DOI: 10.1016/j.vhri.2017.03.004] [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: 06/02/2016] [Revised: 09/05/2016] [Accepted: 03/01/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION chronic obstructive pulmonary disease (COPD) is a progressive, incurable and potentially mortal. COPD generates a high burden of illness and decreased quality of life in patients. The aim of this study was to determine the direct medical cost of COPD and the primary variables associated. METHODOLOGY We conducted a multicenter clinical study, based in a retrospective cohort as base of a partial economic evaluation in patients diagnosed with moderate to severe COPD. It was considered an institutional point of view to determine medical costs, with an annual time horizon. For analysis of associations between explanatory and end point variables, a generalized lineal regression model was developed. RESULTS We analyzed data from 283 patients, Fifty-nine percent were women, the average age was 72 years ± 11, Sixty-five percent of patients had a history of smoking and 57.6 % were exposed to wood smoke. The annual direct medical costs (MXN 2016) was 20,754 and 41,887 for patients with moderate and severe COPD, respectively, this difference is mainly due to the use of oxygen as well as longer hospital stay (12.9 vs. 24.7 days) of patients with severe COPD. CONCLUSIONS Although the severity level is associated with greater health care costs, the quality of life of the patients should be considered carefully because it is inversely associated with the cost of care for patients with COPD.
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Affiliation(s)
- Armando Nevárez-Sida
- Unidad de Investigación en Epidemiología y Servicios de Salud Área de Envejecimiento. Coordinación de Investigación en Salud, IMSS. México D.F.
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Harfouche A, Silva S, Faria J, Araújo R, Gouveia A, Lacerda M, D'Orey L. [Breast Cancer: Value-Based Healthcare, Costs and Financing]. ACTA MEDICA PORT 2017; 30:762-768. [PMID: 29279067 DOI: 10.20344/amp.9093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/18/2017] [Accepted: 10/12/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Breast cancer is the second most common oncological disease worldwide. To analyse the new disease specific funding programme (breast cancer) implemented at the Francisco Gentil Portuguese Institute of Oncology, Lisbon Center (Instituto Português de Oncologia de Lisboa Francisco Gentil), the actual costs of the patients were examined using activity-based costing as a costing methodology. This study addresses the following question: "How much does it cost to treat breast cancer per 'patient-month' compared to the monthly fixed 'funding envelope'?". MATERIALS AND METHODS The study cohort consisted of 807 patients, corresponding to all the patients eligible for the new disease specific funding programme and who were enrolled during the first year of implementation. Activity-based costing was used to calculate the total real costs per stage of disease and per 'patient-month' as well as the deviation from the monthly fixed 'funding envelope'. RESULTS The total costs were 6.6 M€, whereas the total funding was 5.2 M€ for a total of 5648 'patient-months'. In 2014, the balance difference between the funding obtained and the actual costs was -1.4 €M for the cohort of 807 patients. DISCUSSION The extreme cases of differences in cost per 'patient-month' compared to the monthly fixed 'funding envelope' were (i) stage 0/Tis, with higher funding at 415.23 € per 'patient-month', and (ii) stage IIIC, with lower funding at 1062.79 € per 'patient-month'. CONCLUSION The 'patient-month' cost, regardless of disease stage was 1170.29 €. The median deviation per 'patient-month' was negative (241.21 €) compared to the monthly fixed 'funding envelope' of 929.08 € in the first year. Establishing activity-based costing - funding models will be crucial for the future sustainability of the healthcare sector.
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Affiliation(s)
- Ana Harfouche
- Instituto Superior de Ciências Sociais e Políticas. Universidade de Lisboa. Lisboa. Portugal; Concepção, Implementação e Desenvolvimento do Activity Based Costing por Actividades Clínicas. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Silvia Silva
- Serviço de Cirurgia Geral. Hospital da Marinha Portuguesa. Lisboa. Portugal. Serviço de Cirurgia Geral. Hospital Egas Moniz. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - João Faria
- Serviço de Cirurgia Geral. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Rui Araújo
- Activity Based Costing por Actividades Clínicas. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - António Gouveia
- Serviços Farmacêuticos. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Maria Lacerda
- Hospital de Dia. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
| | - Luís D'Orey
- Serviço de Cirurgia Geral. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal
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Augustovski F, Caporale J, Fosco M, Alcaraz A, Diez M, Thierer J, Peradejordi M, Pichon Riviere A. Uso de recursos y costos de hospitalizaciones por insufi ciencia card í aca: un estudio retrospective multic é ntrico en Argentina. Value Health Reg Issues 2017; 14:73-80. [PMID: 29254545 DOI: 10.1016/j.vhri.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/13/2016] [Revised: 08/01/2017] [Accepted: 08/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Heart failure has a great impact on health budget, mainly due to the cost of hospitalizations. Our aim was to describe health resource use and costs of heart failure admissions in three important institutions in Argentina. METHODS Multi-center retrospective cohort study, with descriptive and analytical analysis by subgroups of ejection fraction, blood pressure and renal function at admission. Generalized linear models were used to assess the association of independent variables to main outcomes. RESULTS We included 301 subjects; age 75.3±11.8 years; 37% women; 57% with depressed ejection fraction; 46% of coronary etiology. Blood pressure at admission was 129.8±29.7 mmHg; renal function 57.9±26.2 ml/min/1.73 m2. Overall mortality was 7%. Average length of stay was 7.82±7.06 days (median 5.69), and was significantly longer in patients with renal impairment (8.9 vs. 8.18; p=0.03) and shorter in those with high initial blood pressure (6.08±4.03; p=0.009). Mean cost per patient was AR$68,861±96,066 (US$=8,071; 1US$=AR$8.532); 71% attributable to hospital stay, 20% to interventional procedures and 6.7% to diagnostic studies. Variables independently associated with higher costs were depressed ejection fraction, presence of valvular disease, and impaired renal function. CONCLUSIONS Resource use and costs associated to hospitalizations for heart failure is high, and the highest proportion is attributable to the costs related to hospital stay.
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Affiliation(s)
- Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Joaquín Caporale
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Mirta Diez
- Instituto Cardiovascular de Buenos Aires (ICBA), Argentina
| | - Jorge Thierer
- Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC)
| | | | - Andrés Pichon Riviere
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires, Argentina
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Abstract
Type 2 diabetic kidney disease (DKD) is the most common cause of CKD and ESRD worldwide, and carries with it enormous human and societal costs. The goal of this review is to provide an update on the diagnosis and management of DKD based on a comprehensive review of the medical literature. Topics addressed include the evolving presentation of DKD, clinical differentiation of DKD from non-DKD, a state-of-the-art evaluation of current treatment strategies, and promising emerging treatments. It is expected that the review will help clinicians to diagnose and manage patients with DKD.
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MESH Headings
- Antihypertensive Agents/adverse effects
- Antihypertensive Agents/therapeutic use
- Bariatric Surgery
- Blood Pressure/drug effects
- Caloric Restriction
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/epidemiology
- Diabetic Nephropathies/diagnosis
- Diabetic Nephropathies/drug therapy
- Diabetic Nephropathies/epidemiology
- Diabetic Nephropathies/physiopathology
- Diagnosis, Differential
- Glomerular Filtration Rate/drug effects
- Humans
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Kidney/drug effects
- Kidney/physiopathology
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/drug therapy
- Kidney Failure, Chronic/etiology
- Predictive Value of Tests
- Renal Agents/adverse effects
- Renal Agents/therapeutic use
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/drug therapy
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/physiopathology
- Treatment Outcome
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Affiliation(s)
- Simit M Doshi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Olusesi AD, Oyeniran O. Outcome and cost analysis of bilateral sequential same-day cartilage tympanoplasty compared with bilateral staged tympanoplasty. J Laryngol Otol 2017; 131:399-403. [PMID: 28294080 DOI: 10.1017/S0022215117000585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few studies have compared bilateral same-day with staged tympanoplasty using cartilage graft materials. METHODS A prospective randomised observational study was performed of 38 chronic suppurative otitis media patients (76 ears) who were assigned to undergo bilateral sequential same-day tympanoplasty (18 patients, 36 ears) or bilateral sequential tympanoplasty performed 3 months apart (20 patients, 40 ears). Disease duration, intra-operative findings, combined duration of surgery, post-operative graft appearance at 6 weeks, post-operative complications, re-do rate and relative cost of surgery were recorded. RESULTS Tympanic membrane perforations were predominantly subtotal (p = 0.36, odds ratio = 0.75). Most grafts were harvested from the conchal cartilage and fewer from the tragus (p = 0.59, odds ratio = 1.016). Types of complication, post-operative hearing gain and revision rates were similar in both patient groups. CONCLUSION Surgical outcomes are not significantly different for same-day and bilateral cartilage tympanoplasty, but same-day surgery has the added benefit of a lower cost.
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Grabner M, Bodhani A, Khandelwal N, Palli S, Bonine N, Khera M. Clinical Characteristics, Health Care Utilization and Costs Among Men with Primary or Secondary Hypogonadism in a US Commercially Insured Population. J Sex Med 2016; 14:88-97. [PMID: 27939338 DOI: 10.1016/j.jsxm.2016.10.012] [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: 08/24/2016] [Revised: 10/26/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hypogonadism is broadly associated with increases in chronic comorbid conditions and health care costs. Little is known about the specific impact of primary and secondary hypogonadism on health care costs. AIM To characterize the health care cost and utilization burden of primary and secondary hypogonadism in a population of US men with commercial insurance. METHODS Newly diagnosed patients with International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with specific medical conditions known to have a high prevalence of testosterone deficiency (ie, relating to primary or secondary hypogonadism) or who had fills for testosterone replacement therapy from January 1, 2007 through April 30, 2013 were identified in administrative claims data from the HealthCore Integrated Research Database. A cohort of patients without hypogonadism was matched on demographics and comorbidities. The matched hypogonadism and non-hypogonadism cohorts (n = 5,777 in each cohort) were compared during a 12-month follow-up period. MAIN OUTCOME MEASURES Direct health care expenditures and utilization were assessed for all causes and for hypogonadism-related claims. Costs included out-of-pocket patient expenditures and those paid by the insurer. RESULTS Hypogonadism and matched non-hypogonadism cohorts were similar in demographics (mean age = 50 years) and diagnosed comorbid conditions in the 12 months preceding the index date. In the year after the index date, mean all-cause expenditures for patients with hypogonadism increased by 62% (from $5,425 to $8,813) compared with 25% for the matched controls (from $4,786 to $5,992; P < .01 for follow-up difference between groups). Approximately 16% of total mean costs ($1,377), primarily outpatient and pharmacy costs, were identifiable as related to hypogonadism. CONCLUSION These data from a population of US men with commercial insurance coverage showed a greater resource use burden for patients with primary and secondary hypogonadism compared with similar patients without hypogonadism. Additional management might be required to address unmet need and decrease the cost burden for patients with hypogonadism.
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Affiliation(s)
| | | | | | - Swetha Palli
- CTI Clinical Trial and Consulting Services, Cincinnati, OH, USA
| | | | - Mohit Khera
- Baylor College of Medicine Medical Center, Houston, TX, USA
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Abstract
OBJECTIVE The research describes an extensible method of evaluating and cancelling electronic journals during a budget shortfall and evaluates implications for interlibrary loan (ILL) and user satisfaction. METHODS We calculated cost per use for cancellable electronic journal subscriptions (n=533) from the 2013 calendar year and the first half of 2014, cancelling titles with cost per use greater than $20 and less than 100 yearly uses. For remaining titles, we issued an online survey asking respondents to rank the importance of journals to their work. Finally, we gathered ILL requests and COUNTER JR2 turnaway reports for calendar year 2015. RESULTS Three hundred fifty-four respondents completed the survey. Because of the level of heterogeneity of titles in the survey as well as respondents' backgrounds, most titles were reported to be never used. We developed criteria based on average response across journals to determine which to cancel. Based on this methodology, we cancelled eight journals. Examination of ILL data revealed that none of the cancelled titles were requested with any frequency. Free-text responses indicated, however, that many value free ILL as a suitable substitute for immediate full-text access to biomedical journal literature. CONCLUSIONS Soliciting user feedback through an electronic survey can assist collections librarians to make electronic journal cancellation decisions during slim budgetary years. This methodology can be adapted and improved upon at other health sciences libraries.
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Vavrek DA, Sharma R, Haas M. Cost analysis related to dose-response of spinal manipulative therapy for chronic low back pain: outcomes from a randomized controlled trial. J Manipulative Physiol Ther 2014; 37:300-11. [PMID: 24928639 DOI: 10.1016/j.jmpt.2014.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/04/2014] [Accepted: 03/04/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP). METHODS We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data. RESULTS Lost productivity accounts for most societal costs of chronic LBP. Cost of treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age (P = .03), greater disability (P = .01), lower quality-adjusted life year scores (P = .01), and higher costs in the period preceding enrollment (P < .01). Pain-free and disability-free days were greater for all SMT doses compared with control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days (P = .03) and 19.8 disability-free days (P = .04). No statistically significant group differences in quality-adjusted life years were noted. CONCLUSIONS A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.
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Lee JY, Jo MW, Yoo WS, Kim HJ, Eun SJ. Evidence of a broken healthcare delivery system in korea: unnecessary hospital outpatient utilization among patients with a single chronic disease without complications. J Korean Med Sci 2014; 29:1590-6. [PMID: 25469056 PMCID: PMC4248577 DOI: 10.3346/jkms.2014.29.12.1590] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/20/2014] [Indexed: 01/12/2023] Open
Abstract
This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.
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Affiliation(s)
- Jin Yong Lee
- Public Health Medical Service, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Weon-Seob Yoo
- Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hyun Joo Kim
- Department of Public Health, Graduate School of Konyang University, Daejeon, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Abstract
OBJECTIVES To evaluate and compare full economic evaluation studies on the cost-effectiveness of enhanced asthma management (either as an adjunct to usual care or alone) vs. usual care alone. METHODS Online databases were searched for published journal articles in English language from year 1990 to 2012, using the search terms '"asthma" AND ("intervene" OR "manage") AND ("pharmacoeconomics" OR "economic evaluation" OR "cost effectiveness" OR "cost benefit" OR "cost utility")'. Hand search was done for local publishing. Only studies with full economic evaluation on enhanced management were included (cost consequences (CC), cost effectiveness (CE), cost benefit (CB), or cost utility (CU) analysis). Data were extracted and assessed for the quality of its economic evaluation design and evidence sources. RESULTS A total of 49 studies were included. There were 3 types of intervention for enhanced asthma management: education, environmental control, and self-management. The most cost-effective enhanced management was a mixture of education and self-management by an integrated team of healthcare and allied healthcare professionals. In general, the studies had a fair quality of economic evaluation with a mean QHES score of 73.7 (SD=9.7), and had good quality of evidence sources. CONCLUSION Despite the overall fair quality of economic evaluations but good quality of evidence sources for all data components, this review showed that the delivered enhanced asthma managements, whether as single or mixed modes, were overall effective and cost-reducing. Whilst the availability and accessibility are an equally important factor to consider, the sustainability of the cost-effective management has to be further investigated using a longer time horizon especially for chronic diseases such as asthma.
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Affiliation(s)
- Yee V Yong
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia ).
| | - Asrul A Shafie
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia ).
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Patel V, Lin FJ, Ojo O, Rao S, Yu S, Zhan L, Touchette DR. Cost-utility analysis of genotype-guided antiplatelet therapy in patients with moderate-to-high risk acute coronary syndrome and planned percutaneous coronary intervention. Pharm Pract (Granada) 2014; 12:438. [PMID: 25243032 PMCID: PMC4161409 DOI: 10.4321/s1886-36552014000300007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 03/28/2014] [Accepted: 08/15/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prasugrel is recommended over clopidogrel in poor/intermediate CYP2C19 metabolizers with acute coronary syndrome (ACS) and planned percutaneous coronary intervention (PCI), reducing the risk of ischemic events. CYP2C19 genetic testing can guide antiplatelet therapy in ACS patients. OBJECTIVE The purpose of this study was to evaluate the cost-utility of genotype-guided treatment, compared with prasugrel or generic clopidogrel treatment without genotyping, from the US healthcare provider's perspective. METHODS A decision model was developed to project lifetime economic and humanistic burden associated with clinical outcomes (myocardial infarction [MI], stroke and major bleeding) for the three strategies in patients with ACS. Probabilities, costs and age-adjusted quality of life were identified through systematic literature review. Incremental cost-utility ratios (ICURs) were calculated for the treatment strategies, with quality-adjusted life years (QALYs) as the primary effectiveness outcome. Relative risk of developing myocardial infarction and stroke between patients with and without variant CYP2C19 when receiving clopidogrel were estimated to be 1.34 and 3.66, respectively. One-way and probabilistic sensitivity analyses were performed. RESULTS Clopidogrel cost USD19,147 and provided 10.03 QALYs versus prasugrel (USD21,425, 10.04 QALYs) and genotype-guided therapy (USD19,231, 10.05 QALYs). The ICUR of genotype-guided therapy compared with clopidogrel was USD4,200. Genotype-guided therapy provided more QALYs at lower costs compared with prasugrel. Results were sensitive to the cost of clopidogrel and relative risk of myocardial infarction and stroke between CYP2C19 variant vs. non-variant. Net monetary benefit curves showed that genotype-guided therapy had at least 70% likelihood of being the most cost-effective alternative at a willingness-to-pay of USD100,000/QALY. In comparison with clopidogrel, prasugrel therapy was more cost-effective with <21% certainty at willingness-to-pay of >USD170,000/QALY. CONCLUSIONS Our modeling analyses suggest that genotype-guided therapy is a cost-effective strategy in patients with acute coronary syndrome undergoing planned percutaneous coronary intervention.
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Affiliation(s)
- Vardhaman Patel
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago . Chicago, IL, ( United States )
| | - Fang-Ju Lin
- Pharmerit North America LLC, Bethesda, MD ( United States )
| | - Olaitan Ojo
- Pharmacoeconomic Center, Department of Defense. Fort Sam Houston, TX ( United States )
| | - Sapna Rao
- Department of Epidemiology, University of North Carolina , Chapel Hill, NC ( United States )
| | - Shengsheng Yu
- Global Health Outcomes, Merck Sharp & Dohme Corp. Whitehouse Station, NJ ( United States )
| | - Lin Zhan
- Eisai Inc. Woodcliff Lake, NJ ( United States )
| | - Daniel R Touchette
- Departments of Pharmacy Practice and Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago . Chicago, IL ( United States ).
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van Vugt R, Kool DR, Brink M, Dekker HM, Deunk J, Edwards MJ. Thoracoabdominal computed tomography in trauma patients: a cost-consequences analysis. Trauma Mon 2014; 19:e19219. [PMID: 25337521 PMCID: PMC4199298 DOI: 10.5812/traumamon.19219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 03/31/2014] [Accepted: 04/26/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND CT is increasingly used during the initial evaluation of blunt trauma patients. In this era of increasing cost-awareness, the pros and cons of CT have to be assessed. OBJECTIVES This study was performed to evaluate cost-consequences of different diagnostic algorithms that use thoracoabdominal CT in primary evaluation of adult patients with high-energy blunt trauma. MATERIALS AND METHODS We compared three different algorithms in which CT was applied as an immediate diagnostic tool (rush CT), a diagnostic tool after limited conventional work-up (routine CT), and a selective tool (selective CT). Probabilities of detecting and missing clinically relevant injuries were retrospectively derived. We collected data on radiation exposure and performed a micro-cost analysis on a reference case-based approach. RESULTS Both rush and routine CT detected all thoracoabdominal injuries in 99.1% of the patients during primary evaluation (n = 1040). Selective CT missed one or more diagnoses in 11% of the patients in which a change of treatment was necessary in 4.8%. Rush CT algorithm costed € 2676 (US$ 3660) per patient with a mean radiation dose of 26.40 mSv per patient. Routine CT costed € 2815 (US$ 3850) and resulted in the same radiation exposure. Selective CT resulted in less radiation dose (23.23 mSv) and costed € 2771 (US$ 3790). CONCLUSIONS Rush CT seems to result in the least costs and is comparable in terms of radiation dose exposure and diagnostic certainty with routine CT after a limited conventional work-up. However, selective CT results in less radiation dose exposure but a slightly higher cost and less certainty.
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Affiliation(s)
- Raoul van Vugt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Corresponding author: Raoul van Vugt, Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. Tel: +31-243613871, Fax: +31-24354050, E-mail:
| | - Digna R. Kool
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique Brink
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Helena M. Dekker
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jaap Deunk
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael J. Edwards
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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