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Campbell WA, Chick JFB, Shin DS, Makary MS. Value of interventional radiology and their contributions to modern medical systems. FRONTIERS IN RADIOLOGY 2024; 4:1403761. [PMID: 39086502 PMCID: PMC11288872 DOI: 10.3389/fradi.2024.1403761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey F. B. Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, United States
| | - David S. Shin
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Bozer J, Peng K, Magyer M, Niedermeier M, Makary MS. Interventional radiology education: Patient experience with an educational website. Clin Imaging 2024; 105:110026. [PMID: 37992626 DOI: 10.1016/j.clinimag.2023.110026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to examine the impact of an educational website on patient understanding of Interventional Radiology (IR). MATERIAL AND METHODS An informational website with descriptions and images of 12 common IR procedures was developed with the aim of educating patients. One hundred patients referred to a large, academic institution were randomly selected to participate. Anonymous 11-question, 5-point Likert-scale assessments were administered before and after engaging with the educational website. The survey evaluated patients' understanding of IR procedures and satisfaction with the website as an educational tool. RESULTS One hundred patients completed the pre-/post-implementation evaluations. Among matched questions, there was an increase in patient understanding of IR with mean score improvement from 2.10 to 4.57 (p < 0.001), their knowledge of common procedures from 1.74 to 4.66 (p < 0.001), and their consideration for their next procedure to be with IR from 2.24 to 4.62 (p < 0.001). Additionally, patients had an overall positive impression of the website (mean 4.80). Over 75% of patients found the descriptions and images "very helpful". CONCLUSION This study demonstrated that website use for patient education has the potential to be effective in increasing overall patient understanding of IR and familiarity with common interventional procedures.
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Affiliation(s)
- Jordan Bozer
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Kevin Peng
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Melissa Magyer
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Marilyn Niedermeier
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Mina S Makary
- Department of Radiology, The Ohio State Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA.
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3
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Roebuck DJ, McLaren CA. Pediatric interventional radiology - does it add value? Pediatr Radiol 2021; 51:570-573. [PMID: 33743040 DOI: 10.1007/s00247-020-04935-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 01/29/2023]
Abstract
Although attempts have been made to show that pediatric interventional radiology adds value in children's hospitals, none has been particularly persuasive. An analysis of individual procedures would seem to be the most scientific approach, but there are numerous problems, including the effects that different health care systems have on clinical practice and the difficulty of generalizing the results of a single-center study to other hospitals, even within the same type of health care system. It is unsurprising that there are no published randomized controlled trials comparing both the costs and outcomes of specific pediatric interventional radiology procedures with surgical alternatives, and in fact these may not be feasible. There is only anecdotal evidence of the value of pediatric interventional radiology in multidisciplinary teams in children's hospitals. Currently, the best justification may be the counterfactual: demonstrating what can go wrong if pediatric interventional radiology expertise is not available.
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Affiliation(s)
- Derek J Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Locked Bag 2010, Nedlands, 6009, Australia. .,Division of Paediatrics, Medical School, University of Western Australia, Crawley, Australia.
| | - Clare A McLaren
- Department of Medical Imaging, Perth Children's Hospital, Locked Bag 2010, Nedlands, 6009, Australia.,School of Molecular and Life Sciences, Curtin University, Bentley, Australia
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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Matsumoto AH. Capitalizing the Value of IR. J Vasc Interv Radiol 2020; 31:1864-1865. [DOI: 10.1016/j.jvir.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022] Open
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Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, Bernstein SJ, Ullman AJ. Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review. Pediatrics 2020; 145:S243-S268. [PMID: 32482738 DOI: 10.1542/peds.2019-3474h] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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Affiliation(s)
- Rebecca S Paterson
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of Hospital Medicine and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Makary MS, Gage D, Elliott ED, Dowell JD. Primary Care Provider Awareness of IR: A Single-Center Analysis. J Vasc Interv Radiol 2019; 30:1420-1427. [DOI: 10.1016/j.jvir.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/12/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022] Open
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Neira VM, Al Madhoun W, Ghaffari K, Barrowman N, Berrigan P, Splinter W. Efficacy of Malignant Hyperthermia Association of the United States–Recommended Methods of Preparation for Malignant Hyperthermia-Susceptible Patients Using Dräger Zeus Anesthesia Workstations and Associated Costs. Anesth Analg 2019; 129:74-83. [DOI: 10.1213/ane.0000000000003441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sarwar A, Hawkins CM, Bresnahan BW, Carlos RC, Guimaraes M, Krol KL, Kwan SW, Latif W, Liu R, Marder WD, Ray CE, Banovac F. Evaluating the Costs of IR in Health Care Delivery: Proceedings from a Society of Interventional Radiology Research Consensus Panel. J Vasc Interv Radiol 2018; 28:1475-1486. [PMID: 29056189 DOI: 10.1016/j.jvir.2017.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ammar Sarwar
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Brian W Bresnahan
- Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Ruth C Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan Health System, Ann Arbor, Michigan
| | - Marcelo Guimaraes
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Katharine L Krol
- Payment, Research, and Policy Taskforce, Society of Interventional Radiology, Herndon, Virginia
| | - Sharon W Kwan
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Raymond Liu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William D Marder
- Truven Health Analytics, IBM Watson Health, Cambridge, Massachusetts
| | - Charles E Ray
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Filip Banovac
- Department of Radiology, Vanderbilt University, Nashville, Tennessee
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10
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Bykowski MR, Sivak W, Garland C, Cladis FP, Goldstein JA, Losee JE. A Multimodal Preemptive Analgesic Protocol for Alveolar Bone Graft Surgery: Decreased Pain, Hospital Stay, and Health Care Costs. Cleft Palate Craniofac J 2018; 56:479-486. [PMID: 30071750 DOI: 10.1177/1055665618791943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate postoperative pain, hospital length of stay (LOS), and associated costs of multiple perioperative analgesic strategies following alveolar bone grafting (ABG). DESIGN Retrospective comparative cohort study. SETTING Tertiary care pediatric hospital. PATIENTS/PARTICIPANTS Iliac crest bone graft (ICBG) harvest techniques: "Open Harvest" (n = 22), "Trephine Only" (n = 14), or "Trephine + Pain Pump" (n = 25). INTERVENTION The "Open Harvest" group underwent open ICBG harvest with 3-walled osteotomies. For the other 2 treatment groups, a trephine drill was used to harvest iliac crest bone with a ropivacaine infusion pump into the hip donor site ("Trephine + Pain Pump") or without ("Trephine Only"). Patients who underwent ABG with only cadaveric allograft were analyzed as a comparison group ("No Harvest"). MAIN OUTCOMES MEASURES Outcomes were planned prior to data collection: maximum pain score, hospital LOS, and associated health care costs. RESULTS Maximum pain scores were significantly higher in the "Open Harvest" group (7.3/10) compared to "Trephine + Pain Pump" (1.8/10; P < .0001) and "No Harvest" groups (2.8/10; P < .01). Hospital LOS decreased from 2.4 days ("Open Harvest") to 0.5 days (Trephine + Pain Pump"; P < .0001). Twelve (48%) patients from "Trephine + Pain Pump" were discharged on the day of surgery. The "Trephine + Pain Pump" saved an estimated $5336 for a unilateral ABG and $7265 for a bilateral ABG compared to "Open Harvest." CONCLUSIONS The combined use of the trephine ICBG technique and ropivacaine infusion catheter effectively decreased pain, shortened hospital stay, and improved cost saving compared to patients who have undergone other methods of ICBG.
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Affiliation(s)
- Michael R Bykowski
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wesley Sivak
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catharine Garland
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Franklyn P Cladis
- 2 Department of Anesthesiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,3 Division of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph E Losee
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,3 Division of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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COST ANALYSIS OF PERIPHERALLY INSERTED CENTRAL CATHETER IN PEDIATRIC PATIENTS. Int J Technol Assess Health Care 2017; 34:38-45. [DOI: 10.1017/s026646231700109x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Purpose: A peripherally inserted central catheter (PICC) is a useful option in providing secure venous access, which enables patients to be discharged earlier with the provision of home care. The objective was to identify the costs associated with having a PICC from a societal perspective, and to identify factors that are associated with total PICC costs.Methods: Data were obtained from a retrospective cohort of 469 hospitalized pediatric patients with PICCs inserted. Both direct and indirect costs were estimated from a societal perspective. Insertion costs, complication costs, nurse and physician assessment costs, inpatient ward costs, catheter removal costs, home care costs, travel costs, and the cost associated with productivity losses incurred by parents were included in this study.Results: Based on catheter dwell time, the median total cost associated with a PICC per patient per day (including inpatient hospital costs) was $3,133.5 ($2,210.7–$9,627.0) in 2017 Canadian dollars ($1.00USD = $1.25CAD in 2017). The adjusted mean cost per patient per day was $2,648.2 ($2,402.4–$2,920.4). Excluding inpatient ward costs, the median total and adjusted costs per patient per day were $198.8 ($91.8–$2,475.8) and $362.7($341.0–$386.0), respectively. Younger age, occurrence of complications, more catheter dwell days, wards with more intensive care, and the absence of home care were significant factors associated with higher total PICC costs.Conclusions: This study has demonstrated the costs associated with PICCs. This information may be helpful for healthcare providers to understand PICC related cost in children and resource implications.
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Crocoli A, Sidro L, Zanaboni C, Rossetti F, Pittiruti M. Letter to the Editor. J Pediatr Surg 2017; 52:1535-1536. [PMID: 28526227 DOI: 10.1016/j.jpedsurg.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Alessandro Crocoli
- General and Thoracic Surgery Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy.
| | - Luca Sidro
- Department of Anesthesiology, Santobono-Pausilipon Children's Hospital of Naples, Italy.
| | - Clelia Zanaboni
- Department of Anesthesiology, Giannina Gaslini Institute, Genoa, Italy.
| | | | - Mauro Pittiruti
- Department of Surgery, "A. Gemelli" Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy.
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13
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Introduction to Cost Analysis in IR: Challenges and Opportunities. J Vasc Interv Radiol 2016; 27:539-545.e1. [PMID: 26922978 DOI: 10.1016/j.jvir.2015.12.754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Demonstration of value has become increasingly important in the current health care system. This review summarizes four of the most commonly used cost analysis methods relevant to IR that could be adopted to demonstrate the value of IR interventions: the cost minimization study, cost-effectiveness assessment, cost-utility analysis, and cost-benefit analysis. In addition, the issues of true cost versus hospital charges, modeling in cost studies, and sensitivity analysis are discussed.
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LaRoy JR, White SB, Jayakrishnan T, Dybul S, Ungerer D, Turaga K, Patel PJ. Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room. J Am Coll Radiol 2015; 12:563-71. [PMID: 26047398 PMCID: PMC4655878 DOI: 10.1016/j.jacr.2015.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR). METHODS This study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients' demographic information and chest port-related complications and/or infections. A total of 478 charts were reviewed (age range: 21-85 years; 309 women, 169 men). Univariate and bivariate analyses were performed to identify risk factors associated with an increased complication rate. Cost data on 149 consecutive Medicare outpatients (100 treated in the IR suite; 49 treated in the OR) who had isolated chest port insertions between March 2012 and February 2013 were obtained for both the operative services and pharmacy. Nonparametric tests for heterogeneity were performed using the Kruskal-Wallis method. RESULTS Early complications occurred in 9.2% (22 of 239) of the IR patients versus 13.4% (32 of 239) of the OR patients. Of the 478 implanted chest ports, 9 placed in IR and 18 placed in surgery required early removal. Infections from the ports placed in IR versus the OR were 0.25 versus 0.18 infections per 1000 catheters, respectively. Overall mean costs for chest port insertion were significantly higher in the OR, for both room and pharmacy costs (P < .0001). Overall average cost to place chest ports in an OR setting was almost twice that of placement in the IR suite. CONCLUSIONS Hospital costs to place a chest port were significantly lower in the IR suite than in the OR, whereas radiology and surgery patients did not show a significantly different rate of complications and/or infections.
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Affiliation(s)
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thejus Jayakrishnan
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephanie Dybul
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dirk Ungerer
- Decision Support, Financial Department, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiran Turaga
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parag J Patel
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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15
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Charalel RA, McGinty G, Brant-Zawadzki M, Goodwin SC, Khilnani NM, Matsumoto AH, Min RJ, Soares GM, Cook PS. Interventional Radiology Delivers High-Value Health Care and Is an Imaging 3.0 Vanguard. J Am Coll Radiol 2015; 12:501-6. [DOI: 10.1016/j.jacr.2014.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/29/2014] [Indexed: 02/01/2023]
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Fotso Kamdem A, Nerich V, Auber F, Jantchou P, Ecarnot F, Woronoff-Lemsi MC. Quality assessment of economic evaluation studies in pediatric surgery: a systematic review. J Pediatr Surg 2015; 50:659-87. [PMID: 25840083 DOI: 10.1016/j.jpedsurg.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess economic evaluation studies (EES) in pediatric surgery and to identify potential factors associated with high-quality studies. METHODS A systematic review of the literature using PubMed and Cochrane databases was conducted to identify EES in pediatric surgery published between 1 June 1993 and 30 June 2013. Assessment criteria are derived from the Drummond checklist. A high quality study was defined as a Drummond score ≥7. Logistic regression analysis was used to determine factors associated with high quality studies. RESULTS 119 studies were included. 43.7% (n=52) of studies were full EES. Cost-effectiveness analysis was the most frequent (61.5%) type of full EES. Only 31.6% of studies had a Drummond score ≥7 and 73% of these were full EES. The factors associated with high quality were identification of costs (OR: 14.08; 95% CI: 3.38-100; p<0.001), estimation of utility value (OR: 8.13; 95% CI: 2.02-43.47; p=0.005) and study funding (OR: 3.50; 95% CI: 1.27-10.10; p=0.02). CONCLUSION This review shows that the number and the quality of EES are low despite the increasing number of studies published in recent years. In the current context of budget constraints, our results should encourage pediatric surgeons to focus more on EES.
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Affiliation(s)
- Arnaud Fotso Kamdem
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Virginie Nerich
- INSERM U645 EA-2284 IFR-133, Department of Pharmacy, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Frederic Auber
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Prévost Jantchou
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital, 3175, Chemin de la Côte Sainte-Catherine, H3T 1C5, Montréal, Quebec, Canada.
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besançon, France.
| | - Marie-Christine Woronoff-Lemsi
- UMR-INSERM-1098, Department of Clinical Research and Innovation, Besançon University Hospital, 2 place Saint Jacques, F-25000 Besançon, France.
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Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology. J Vasc Access 2014; 16:130-6. [PMID: 25362978 DOI: 10.5301/jva.5000314] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Treatment of pediatric malignancies is becoming progressively more complex, implying the adoption of multimodal therapies. A reliable, long-lasting venous access represents one of the critical requirements for the success of those treatments. Recent technical innovations-such as minimally invasive procedures for placement, new devices and novel materials-have rapidly spread for clinical use in adult patients, but are still not consistently used in the pediatric population. METHODS The Supportive Therapy Working Group of Italian Association of Hematology and Oncology (AIEOP) reviewed medical literature focusing on new aspects of central venous access devices (VADs) in pediatric patients affected by oncohematological diseases. RESULTS Appropriate recommendations for clinical use in these patients have been discussed and formulated. CONCLUSIONS The importance of the correct choice, management and use of VADs in pediatric oncohematological patients is a necessary prerequisite for an adequate standard of care, also considering the increased chances of cure and the longer life expectancy of those patients with modern therapies.
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Biffi R, Pozzi S, Bonomo G, Della Vigna P, Monfardini L, Radice D, Rotmensz N, Zampino MG, Fazio N, Orsi F. Cost effectiveness of different central venous approaches for port placement and use in adult oncology patients: evidence from a randomized three-arm trial. Ann Surg Oncol 2014; 21:3725-31. [PMID: 24841352 DOI: 10.1245/s10434-014-3784-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND No randomized trials have so far investigated the cost effectiveness of different methods for implantation and use of central venous ports in oncology patients. PATIENTS AND METHODS Overall, 403 patients eligible for receiving intravenous chemotherapy for solid tumours were randomly assigned to implantation of a single type of port, either through a percutaneous landmark access to the internal jugular vein, an ultrasound (US)-guided access to the subclavian vein, or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Insertion and maintenance costs were estimated by obtaining the charges for an average implant and use, while the costs of the management of complications were analytically assessed. The total cost was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any. RESULTS A total of 401 patients were evaluable-132 with the internal jugular vein, 136 with the subclavian vein and 133 with the cephalic vein access. No differences were found for the rate of early complications. The US-guided subclavian insertion site had significantly lower failures. Infections occurred in 1, 3, and 3 patients (internal jugular, subclavian, and cephalic access, respectively; p = 0.464), whereas venous thrombosis was observed in 15, 8, and 11 patients, respectively (p = 0.272). Mean cost for purchase, implantation, diagnosis and treatment of complications in each patient was <euro>2,167.85 for subclavian US-guided, <euro>2,335.87 for cephalic, and <euro>2,384.10 for internal jugular access, respectively (p = 0.0001). CONCLUSION US real-time guidance to the subclavian vein resulted in the most cost-effective method of central venous port placement and use.
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Affiliation(s)
- Roberto Biffi
- Division of Abdomino-Pelvic and Minimally Invasive Surgery, European Institute of Oncology, Milan, Italy,
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Prabhakar AM, Harvey HB, Wicky S, Hirsch JA, Thrall JH, Oklu R. What's Brewing: How Interventional Radiologists Can Learn From the Reinvention of Starbucks. J Am Coll Radiol 2013; 10:559-61. [DOI: 10.1016/j.jacr.2012.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/26/2012] [Indexed: 11/28/2022]
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Russell HV, Panchal J, Vonville H, Franzini L, Swint JM. Economic evaluation of pediatric cancer treatment: a systematic literature review. Pediatrics 2013; 131:e273-87. [PMID: 23266919 DOI: 10.1542/peds.2012-0912] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although there is a growing national focus on health care cost containment and accountability in resource utilization, childhood cancer therapy costs continue to increase without proportionate survival improvements. Economic evaluations (EEs) such as cost and/or cost effectiveness analysis may identify areas to improve resource efficiency. This review aims to identify and characterize the EE studies performed in this field. METHODS We performed a structured literature search of the Medline, PubMed, and the National Health Service EE databases from 2000 to 2011. Concepts for the search included "cost analyses," "child," and "cancer." Studies were limited to original research, comparison of 2 or more treatments using monetary units, English language, and originating from economically developed countries. Identified studies were assessed by the Drummond checklist and characterized by the therapy studied, data sources, and research perspectives. RESULTS Forty studies met inclusion criteria. Eleven studied chemotherapy, surgery, or radiation. Twenty-nine studied supportive measures such as growth factor support or treatment of infection. The median Drummond score was 6 of 10 (range, 2-9). Only 15 (36%) included treatment outcomes when comparing costs. Methodological limitations were common. CONCLUSIONS A wide variety of topics and methodological limitations made comparisons between studies difficult. Strategies for increasing the generalizability of future EE studies are presented. Substantial opportunity exists for EE research in childhood cancer.
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Affiliation(s)
- Heidi V Russell
- Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas 77030, USA.
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