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Balkarlı E, Kıymet E, Böncüoğlu E, Şahinkaya Ş, Yılmaz Çelebi M, Apa H, Meşe T, Ağın H, Bayram SN, Devrim İ. The evaluation of the burden of multisystem inflammatory syndrome in children on health economics. Arch Rheumatol 2024; 39:10-19. [PMID: 38774689 PMCID: PMC11104748 DOI: 10.46497/archrheumatol.2023.10147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives This study aimed to evaluate the diagnostic tests and treatments applied in patients with multisystem inflammatory syndrome in children (MIS-C) and to determine the effect of the disease on health costs. Patients and methods This retrospective cohort study included 59 MIS-C patients (40 males, 19 females; mean age: 7.7±4.2 years; range, 4 months to 16.5 years) who were admitted and treated between April 1, 2020, and November 1, 2021. Demographic and clinical features with hospital costs and length of stay were retrospectively reviewed from the medical files and computerized system of the hospital. Direct medical care costs of items were calculated with the hospital perspective using a combination of microcosting technique (resource-based accounting method) and hospital list data. Cases were classified as mild, moderate, or severe, and the patients were divided into two groups: the mild group and the moderate-severe group. Classification was determined by the vasoactive inotropic score (VIS), degree of respiratory support, and evidence of organ damage. Results The mean age of the cases in the mild group was 6.5±3.7 years, and the mean age of the cases in the moderate-severe group was 9.2±4.3 years. Of 59 patients, 19 (32.2%) were followed up in the pediatric intensive care unit. The median duration of hospitalization in the hospital was 8 (interquartile range: 7-12) days. The total cost of the patients hospitalized with the diagnosis of MIS-C during the study period was 849,242.93$, and the mean cost per patient was 14,393.94±9,631.92$. In the distribution of the total cost of hospitalization according to expenses, the highest rate was pharmacy and blood products (51.99%) and IVIG costs (43.99%). While the mean total cost per person was 13,682.87±8,799.63$ in mild cases, it was 16,433.82±9,440.02$ in moderate-severe cases, and no statistically significant relationship was found between the two groups (p>0.05). There was no difference in the mean cost per patient between the cases with and without heart, lung, kidney, or neurologic involvement and advanced respiratory support (p>0.05). There was a strong positive correlation between the total costs and age (r=0.883, n=59, p<0.0001), with increased amount of costs with increased age. Conclusion In the study, no statistically significant correlation was found between the total cost of per person in the mild group and the moderate-severe group (p>0.05). This finding may be due to the wide use of IVIG in MIS-C treatment, in addition to low transfer rates to pediatric intensive care units due to high-flow nasal cannula usage.
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Affiliation(s)
- Ezgi Balkarlı
- Department of Child Health and Diseases, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Türkiye
| | - Elif Kıymet
- Department of Pediatric Infectious Diseases, Batman Training and Research Hospital, Batman, Türkiye
| | - Elif Böncüoğlu
- Department of Pediatric Infectious Diseases, Konya City Hospital, Konya, Türkiye
| | - Şahika Şahinkaya
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Miray Yılmaz Çelebi
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Hurşit Apa
- Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Timur Meşe
- Department of Pediatric Cardiology, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Hasan Ağın
- Pediatric Intensive Care, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Süleyman Nuri Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
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Abreu AA, Farah E, Nix R, Kethley D, Coble C, Wan Z, Alterio RE, Ngo F, Wadhwa A, Karagkounis G, Salgado Pogacnik J, Wang SC, Augustine M, Yopp AC, Zeh HJ, Polanco PM. Cost Analysis and Financial Implications of a Peritoneal Surface Malignancy Program in the USA. Ann Surg Oncol 2024; 31:630-644. [PMID: 37903950 DOI: 10.1245/s10434-023-14442-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/27/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND We aimed to describe the financial implications of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in the USA. MATERIALS AND METHODS We conducted a retrospective cost analysis of 100 CRS/HIPEC procedures to examine the impact of patient and procedural factors on hospital costs and reimbursement. A comparison of surgeons' work relative value units (wRVUs) between CRS/HIPEC and a representative sample of complex surgical oncology procedures was made to assess the physicians' compensation rate. Univariable and multivariable backward logistic regression was used to analyze the association between perioperative variables and high direct cost (HDCs). RESULTS The median direct cost per CRS/HIPEC procedure was US $44,770. The median hospital reimbursement was US $43,066, while professional reimbursement was US $8608, resulting in a positive contribution margin of US $7493/procedure. However, the contribution margin significantly varied with the payer mix. Privately insured patients had a positive median contribution margin of US $23,033, whereas Medicare-insured patients had a negative contribution margin of US $13,034. Length of stay (LOS) had the most significant association with HDC, and major complications had the most significant association with LOS. Finally, CRS/HIPEC procedures generated a median of 13 wRVU/h, which is significantly lower than the wRVU/h generated by open pancreatoduodenectomies, open gastrectomies, and hepatectomies. However, higher operation complexity and multiple visceral resections help compensate for the relatively low wRVU/h. CONCLUSIONS CRS/HIPEC is an expensive operation, and prolonged LOS has the most significant impact on the total cost of the procedure. High-quality care is essential to improve patient outcomes and maintain the economic sustainability of the procedure.
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Affiliation(s)
- Andres A Abreu
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emile Farah
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert Nix
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dustin Kethley
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Collin Coble
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zhihan Wan
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rodrigo E Alterio
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Fallon Ngo
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anupama Wadhwa
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Georgios Karagkounis
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Javier Salgado Pogacnik
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sam C Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Augustine
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam C Yopp
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Herbert J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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3
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Nair V, Lewis J, Daccarett M, Dirschl D, Hynes K, Strelzow J. Efficacy of Postoperative Radiographs After Intramedullary Nailing of the Tibia and Femur: When Are They Useful? J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00002. [PMID: 37285510 DOI: 10.5435/jaaosglobal-d-23-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Postoperative radiographs are used to monitor fractures of the tibia and femur after intramedullary fixation. This study sought to examine how frequently these radiographs change management. METHODS This was a single-center chart review of patients over a 4-year period at a level I trauma center. Radiographs were defined as either performed for routine surveillance or performed with some clinical correlate on history and examination. Participants received intramedullary nailing for diaphyseal fractures of the femur or tibia. Patients required at least one postoperative radiograph. All patients were subject to our institution's follow-up protocol: visits at 2, 6, 12, and 24 weeks. Radiographs that changed management were those that led to alterations in follow-up, directed counseling, or contributed to the decision to proceed with revision surgery. RESULTS A total of 374 patients were found. Two hundred seventy-seven received at least one post-op radiograph. The median follow-up was 23 weeks. Six hundred seventeen total radiographs were reviewed. Nine radiographs contributed to a change in management (9/617 = 1.5%). No surveillance radiograph taken before 14 weeks resulted in changes in management. DISCUSSION Our results suggest that radiographs taken in the first 3 months post-op in asymptomatic patients treated with lower extremity intramedullary rods do not result in changes to clinical management.
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Affiliation(s)
- Vivek Nair
- From the University of Chicago Pritzker School of Medicine, Chicago, IL (Mr. Nair), and the UChicago Medicine Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, IL (Ms. Lewis, Dr. Daccarett, Dr. Dirschl, Dr. Hynes, and Dr. Strelzow)
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Findeiss LK, Everett C, Azene E, Biggs K, Ignacio E, Matsumoto AH, Kay D, Kutsenko O, Liu R, Padha V, Soulez G, Swan T. Interventional Radiology Workforce Shortages Affecting Small and Rural Practices: A Report of the SIR/ACR Joint Task Force on Recruitment and Retention of Interventional Radiologists to Small and Rural Practices. J Am Coll Radiol 2022; 19:1322-1335. [PMID: 36216708 DOI: 10.1016/j.jacr.2022.08.004] [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: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 12/04/2022]
Abstract
Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists. Lack of access to interventional radiologic services results in a failure to meet the needs of patients, hospitals, and other community stakeholders. Acknowledging this challenge, the ACR's Commission on General, Small, Emergency and/or Rural Practice and Commission on Interventional and Cardiovascular Imaging and the Society of Interventional Radiology partnered to establish a joint task force to study this issue and identify strategies the ACR and the Society of Interventional Radiology should take to improve small and rural practice recruitment and retention of interventional radiologists. This report describes the deliberations and recommendations of the task force.
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Affiliation(s)
- Laura K Findeiss
- Chief of Radiology, Grady Health System, Emory University School of Medicine, Atlanta, Georgia.
| | - Catherine Everett
- Managing Partner, Coastal Radiology, New Bern, North Carolina; Member-at-Large, ACR Board of Chancellors; Associate Chief Medical Officer, Practice Analytics, RadPartners, El Segundo, California; and Secretary, American Association for Women Radiologists. https://twitter.com/cjeverett
| | - Ezana Azene
- Chair, Commission on Cancer, Gundersen Health System, La Crosse, Wisconsin. https://twitter.com/AceneMD
| | - Kelly Biggs
- Chief of Radiology, James E. VanZandt VA Medical Center, State College, Pennsylvania
| | - Elizabeth Ignacio
- Hawaii Pacific Health, Kahului, Hawaii; and Member, ACR Council Steering Committee. https://twitter.com/ElizabethAnnig1
| | - Alan H Matsumoto
- Chair and Theodore E. Keats Professor of Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, and Virginia; Vice Chair, ACR Board of Chancellors
| | - Dennis Kay
- System Chair, Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Oleksandra Kutsenko
- Miami Cardiac and Vascular Institute, Miami, Florida. https://twitter.com/kutsenkoMD
| | - Ray Liu
- Massachusetts General Hospital, Boston, Massachusetts; and Vice President, Massachusetts General Brigham Global Advisory. https://twitter.com/rwliu
| | - Vivek Padha
- Chief of Radiology West Virginia University, Martinsburg, West Virginia
| | - Gilles Soulez
- Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Director of the Imaging and Engineering Research Axis, CHUM Research Center; and President, Canadian Association of Radiologists
| | - Tim Swan
- Marshfield Clinic Health System, Marshfield, Wisconsin; and Member-at-Large, ACR Board of Chancellors. https://twitter.com/TimSwanMD
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Bedard NA, Katz JN, Losina E, Opare-Addo MB, Kopp PT. Administrative Data Use in National Registry Efforts: Blessing or Curse? J Bone Joint Surg Am 2022; 104:39-46. [PMID: 36260043 DOI: 10.2106/jbjs.22.00565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
"Big data" refers to a growing field of large database research. Administrative data, a subset of big data, includes information from insurance claims, electronic medical records, and registries that can be useful for investigating novel research questions. While its use provides salient advantages, potential researchers relying on big data would benefit from knowing about how these databases are coded, common errors they may encounter, and how to best use large data to address various research questions. In the first section of this paper, Dr. Nicholas A. Bedard addresses the four major pitfalls to avoid with diagnosis and procedure codes in administrative data. In the next section, Dr. Jeffrey N. Katz et al. focus on the strengths and limitations of administrative data, suggesting methods to mitigate these limitations. Lastly, Dr. Elena Losina et al. review the uses and misuses of large databases for cost-effectiveness research, detailing methods for careful economic evaluations.
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Affiliation(s)
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Maame B Opare-Addo
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul T Kopp
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Schwartz PB, Stahl CC, Vidri RJ, Leverson GE, Puckett Y, Zafar SN, Varley P, Ronnekleiv-Kelly SM, Al-Niaimi A, Weber SM, Abbott DE. Rethinking Routine Intensive Care After Cytoreductive Surgery With Heated Intraperitoneal Chemotherapy: The Fiscal Argument. Ann Surg Oncol 2022; 29:6606-6614. [PMID: 35672624 DOI: 10.1245/s10434-022-11967-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients undergoing cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) are frequently admitted to the intensive care unit (ICU) for mitigation of potential complications, although ICU length of stay (LOS) is a significant driver of cost. This study asked whether a fiscal argument could be made for the selective avoidance of ICU admission after CRS/HIPEC. METHODS Prospective data for select low-risk patients (e.g., lower peritoneal cancer index [PCI]) admitted to the intermediate care unit (IMC) instead of the ICU after CRS/HIPEC were matched with a historic cohort routinely admitted to the ICU. Cohort comparisons and the impact of the intervention on cost were assessed. RESULTS The study matched 81 CRS/HIPEC procedures to form a cohort of 49 pre- and 15 post-intervention procedures for patients with similar disease burdens (mean PCI, 8 ± 6.7 vs. 7 ± 5.1). The pre-intervention patients stayed a median of 1 day longer in the ICU (1 day [IQR, 1-1 day] vs. 0 days [IQR, 0-0 days]) and had a longer LOS (8 days [IQR, 7-11 days] vs. 6 days [IQR, 5.5-9 days]). Complications and complication severity did not differ statistically. The median total hospital cost was lower after intervention ($30,845 [IQR, $30,181-$37,725] vs. $41,477 [IQR, $33,303-$51,838]), driven by decreased indirect fixed cost ($8984 [IQR, $8643-$11,286] vs. $14,314 [IQR, $12,206-$18,266]). In a weighted multiple variable linear regression analysis, the intervention was associated with a savings of $2208.68 per patient. CONCLUSIONS Selective admission to the IMC after CRS/HIPEC was associated with $2208.68 in savings per patient without added risk. In this era of cost-conscious practice of medicine, these data highlight an opportunity to decrease cost by more than 5% for patients undergoing CRS/HIPEC.
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Affiliation(s)
- Patrick B Schwartz
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
| | - Christopher C Stahl
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Roberto J Vidri
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Glen E Leverson
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Yana Puckett
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Syed N Zafar
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Patrick Varley
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sean M Ronnekleiv-Kelly
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ahmed Al-Niaimi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sharon M Weber
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Daniel E Abbott
- Department of Surgery, Division of Surgical Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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7
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Aiken TJ, Stahl CC, Lemaster D, Casias TW, Walker BJ, Nichol PF, Leys CM, Abbott DE, Brinkman AS. Intercostal nerve cryoablation is associated with lower hospital cost during minimally invasive Nuss procedure for pectus excavatum. J Pediatr Surg 2021; 56:1841-1845. [PMID: 33199059 PMCID: PMC8053720 DOI: 10.1016/j.jpedsurg.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 01/12/2023]
Abstract
UNLABELLED Minimally invasive repair of pectus excavatum (Nuss procedure) is associated with significant pain, and efforts to control pain impact resource utilization. Bilateral thoracic intercostal nerve cryoablation has been proposed as a novel technique to improve post-operative pain control, though the impact on hospital cost is unknown. METHODS We conducted a retrospective study of patients undergoing a Nuss procedure from 2016 to 2019. Patients who received cryoablation were compared to those that received traditional pain control (patient-controlled analgesia or epidural). Outcome variables included postoperative opioid usage (milligram morphine equivalents, MME), length of stay (LOS), and hospital cost. RESULTS Thirty-five of 73 patients studied (48%) received intercostal nerve cryoablation. LOS (1.0 vs 4.0 days, p < 0.01) and total hospital cost ($21,924 versus $23,694, p = 0.04) were decreased in the cryoablation cohort, despite longer operative time (152 vs 74 min, p < 0.01). Cryoablation was associated with decreased opioid usage (15.0 versus 148.6 MME, p < 0.01) during the 24 h following surgery and this persisted over the entire postoperative period, including discharge opioid prescription (112.5 vs 300.0 MME, p < 0.01). CONCLUSION Bilateral intercostal nerve cryoablation is associated with decreased postoperative opioid usage and decreased resource utilization in pediatric patients undergoing a minimally invasive Nuss procedure for pectus excavatum. LEVEL OF EVIDENCE Retrospective comparative study, level III.
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Affiliation(s)
- Taylor J. Aiken
- Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI USA 53792
| | - Christopher C. Stahl
- Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI USA 53792
| | - Deborah Lemaster
- Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI USA 53792
| | - Timothy W. Casias
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI USA 53792
| | - Benjamin J. Walker
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI USA 53792
| | - Peter F. Nichol
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI USA 53792
| | - Charles M. Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI USA 53792
| | - Daniel E. Abbott
- Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI USA 53792
| | - Adam S. Brinkman
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI USA 53792
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8
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Feletti F, Mellini L, Pironi F, Carnevale A, Parenti GC. Role of the cytopathologist during the procedure of fine-needle aspiration biopsy of thyroid nodules. Insights Imaging 2021; 12:111. [PMID: 34370089 PMCID: PMC8350303 DOI: 10.1186/s13244-021-01053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/05/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules. Materials and methods We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance. Results We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p < 0.001). The cytopathologist's absence was correlated with the number of TIR 1 (Pearson correlation, product–moment correlation r = 0.059; critical value 5%, C = 0.008; p < 0.001). The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€. Conclusion The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance. Supplementary information The online version contains supplementary material available at 10.1186/s13244-021-01053-y.
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Affiliation(s)
- F Feletti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy.
| | - L Mellini
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
| | - F Pironi
- DAMeTLab, Unit of Anatomical Pathology, S. M. Delle Croci Hospital, Ravenna, Italy
| | - A Carnevale
- Department of Radiology, University Radiology Unit, Sant'Anna University Hospital, Ferrara, Italy
| | - G C Parenti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
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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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10
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Aiken TJ, Stahl CC, Schwartz PB, Barrett J, Acher AW, Lemaster D, Leverson G, Weber S, Neuman H, Abbott DE. Sentinel lymph node biopsy is associated with increased cost in higher risk thin melanoma. J Surg Oncol 2020; 123:104-109. [PMID: 32939750 DOI: 10.1002/jso.26225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION National Comprehensive Cancer Network guidelines recommend that sentinel lymph node biopsy (SLNB) be discussed with patients with thin melanoma at higher risk for lymph node metastasis (T1b or T1a with positive deep margins, lymphovascular invasion, or high mitotic index). We examined the association between SLNB and resource utilization in this cohort. METHODS We conducted a retrospective cohort study of patients that underwent wide local excision for higher risk thin melanomas from 2009 to 2018 at a tertiary care center. Patients who underwent SLNB were compared to those who did not undergo SLNB with regard to resource utilization, including total hospital cost. RESULTS A total of 70 patients were included in the analysis and 50 patients (71.4%) underwent SLNB. SLNB was associated with increased hospital costs ($6700 vs. $3767; p < .01) and increased operative time (68.5 vs. 36.0 min; p < .01). This cost difference persisted in multivariable regression (p < .01). Of patients who underwent successful SLN mapping, 3 out of 49 patients had a positive SLN (6.1%). The cost to identify a single positive sentinel lymph node (SLN) was $47,906. CONCLUSION In patients with a higher risk of thin melanoma, SLNB is associated with increased cost despite a low likelihood of SLN positivity. These data better inform patient-provider discussions as the role of SLNB in thin melanoma evolves.
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Affiliation(s)
- Taylor J Aiken
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Christopher C Stahl
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Patrick B Schwartz
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - James Barrett
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Alexandra W Acher
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Deborah Lemaster
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Glen Leverson
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Sharon Weber
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Heather Neuman
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
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Schwartz PB, Stahl CC, Vande Walle KA, Pokrzywa CJ, Cherney Stafford LM, Aiken T, Barrett J, Acher AW, Leverson G, Ronnekleiv-Kelly S, Weber SM, Abbott DE. What Drives High Costs of Cytoreductive Surgery and HIPEC: Patient, Provider or Tumor? Ann Surg Oncol 2020; 27:4920-4928. [PMID: 32415351 DOI: 10.1245/s10434-020-08583-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is utilized for peritoneal malignancies and is associated with significant resource use. To address potentially modifiable factors contributing to excessive cost, we sought to determine predictors of high cost of care for patients undergoing CRS/HIPEC. METHODS An institutional CRS/HIPEC database was queried for adult patients from 2014 to 2018. Cost was defined as cost for the index hospitalization, and high-cost cases were defined as > 75th percentile for cost. Bivariate analyses for cost were performed, and all significant tumor, patient, and surgeon-specific variables were entered in a linear regression for cost. A separate linear regression was performed for length of stay (LOS). RESULTS In total, 59 patients underwent 61 CRS/HIPEC procedures. The median direct variable cost was $20,509 (16,395-25,240). Median length of stay (LOS) was 8 (7-11.5) days and ICU stay was 1 (1-1.5) day. LOS, length of ICU stay and operative time were predictive of cost. Factors associated with increased LOS were Clavien-Dindo grade II complications and ostomy creation. Patient-related factors, including age and BMI, tumor-related factors, such as PCI and CCR, and surgeon were not predictive of cost nor LOS. DISCUSSION Our results, the first to identify predictors of high cost of CRS/HIPEC-related care in the US, reveal cost was largely related to length and intensity of care. In turn, these drivers were influenced by complications and operative factors. Future work will focus on identifying an appropriate ERAS protocol following CRS/HIPEC and selection of those patients that may avoid routine ICU admission.
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Affiliation(s)
- Patrick B Schwartz
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christopher C Stahl
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kara A Vande Walle
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Courtney J Pokrzywa
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda M Cherney Stafford
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Taylor Aiken
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - James Barrett
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alexandra W Acher
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glen Leverson
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sean Ronnekleiv-Kelly
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sharon M Weber
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel E Abbott
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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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: 6] [Impact Index Per Article: 1.0] [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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Dolmatch B, Hogan A, Ferko N. An Economic Analysis of Stent Grafts for Treatment of Vascular Access Stenosis: Point-of-Care and Medicare Perspectives in the United States. J Vasc Interv Radiol 2018; 29:765-773.e2. [PMID: 29706343 DOI: 10.1016/j.jvir.2018.01.777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To conduct an economic analysis on the impact of increased stent graft (SG) use for treatment of arteriovenous graft (AVG) anastomotic stenosis or arteriovenous fistula (AVF)/AVG in-stent restenosis (ISR) from United States point-of-care (POC) and Medicare perspectives. MATERIALS AND METHODS The analyses compared initial device and reintervention costs over 2 years between current and projected treatment mixes, including percutaneous transluminal angioplasty (PTA), bare metal stents (BMSs), and SGs. In projected scenarios, the absolute increase in SG use was approximately 3%. Costs included procedure reimbursement rates (Medicare) and device list prices (POC) for index procedures and reinterventions. Reintervention rates and types were informed by the RENOVA and RESCUE randomized trials. Reinterventions were primarily PTA only; however, stent use occurred a proportion of the time. BMS reintervention rates were assumed to be identical to PTA based on observational data. A population size of 1,000 patients was assumed. RESULTS To the POC (n = 1,000), increased SG use was predicted to result in cost savings ranging from $4,106 to $34,420 for AVG anastomotic stenosis. For AVF/AVG ISR, increased SG use was predicted to result in either a cost increase of $17,187 or a cost savings of $13,159. To Medicare (n = 1,000), increased SG use was predicted to save costs for both populations, with savings ranging from $57,401 to $169,544. CONCLUSIONS The use of SG for treatment of AVG anastomotic stenosis and AVF/AVG ISR appears to be economically favorable for POC providers and Medicare. Further data on reintervention rates are required from other SG trials to validate findings.
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Affiliation(s)
- Bart Dolmatch
- Department of Interventional Radiology, The Palo Alto Medical Foundation, Mountain View, California
| | - Andrew Hogan
- Cornerstone Research Group Inc., 3228 S Service Rd, Burlington, ON L7N 3H8, Canada
| | - Nicole Ferko
- Cornerstone Research Group Inc., 3228 S Service Rd, Burlington, ON L7N 3H8, Canada.
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Azar FE, Azami-Aghdash S, Pournaghi-Azar F, Mazdaki A, Rezapour A, Ebrahimi P, Yousefzadeh N. Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews. BMC Health Serv Res 2017; 17:413. [PMID: 28629461 PMCID: PMC5477275 DOI: 10.1186/s12913-017-2374-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 06/09/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods. METHODS In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: "lung cancer", "lung oncology", "lung Carcinoma", "lung neoplasm", "lung tumors", "cost- effectiveness", "systematic review" and "Meta-analysis". The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool. RESULTS Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11. CONCLUSIONS Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of Discounting will be necessary in the studies.
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Affiliation(s)
| | - Saber Azami-Aghdash
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Pournaghi-Azar
- Dental and Periodental Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Mazdaki
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Parvin Ebrahimi
- Department of Health service Management, School of Health Management and Information Sciences & Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Yousefzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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