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Pradhan M, Waghmare KT, Alghabshi R, Almahdouri F, Al Sawafi KM, M I, Alhadhramy AM, AlYaqoubi ER. Exploring the Economic Aspects of Hospitals: A Comprehensive Examination of Relevant Factors. Cureus 2024; 16:e54867. [PMID: 38533171 PMCID: PMC10964728 DOI: 10.7759/cureus.54867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Financial limitations in the hospital industry have the potential to exacerbate healthcare disparities, impede investments in cutting-edge medical treatments, as well as impair patient outcomes. The interdependent connection between a hospital economy and the general well-being of the community highlights the necessity of careful financial oversight and inventive healthcare policies. Effective collaboration among policymakers, healthcare administrators, and stakeholders is imperative in the development of sustainable economic models that give equal weight to fiscal prudence and optimal patient outcomes. This article aims to underscore the pivotal importance of strategic fund allocation guided by hospital administrators, accentuating several key initiatives capable of revolutionizing healthcare delivery and elevating the institution's stature within the medical community. The other important aspects discussed here are fund allocation in hospitals, the boom of online consultations, and emphasis on the use of sustainable and cost-effective modalities of energy.
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Affiliation(s)
- Madhur Pradhan
- Obstetrics and Gynaecology, Khoula Hospital, Muscat, OMN
| | | | | | | | | | - Iman M
- Obstetrics and Gynaecology, Khoula Hospital, Muscat, OMN
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Hijazi W, Vandenberk B, Rennert-May E, Quinn A, Sumner G, Chew DS. Economic evaluation in cardiac electrophysiology: Determining the value of emerging technologies. Front Cardiovasc Med 2023; 10:1142429. [PMID: 37180811 PMCID: PMC10169721 DOI: 10.3389/fcvm.2023.1142429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Cardiac electrophysiology is a constantly evolving speciality that has benefited from technological innovation and refinements over the past several decades. Despite the potential of these technologies to reshape patient care, their upfront costs pose a challenge to health policymakers who are responsible for the assessment of the novel technology in the context of increasingly limited resources. In this context, it is critical for new therapies or technologies to demonstrate that the measured improvement in patients' outcomes for the cost of achieving that improvement is within conventional benchmarks for acceptable health care value. The field of Health Economics, specifically economic evaluation methods, facilitates this assessment of value in health care. In this review, we provide an overview of the basic principles of economic evaluation and provide historical applications within the field of cardiac electrophysiology. Specifically, the cost-effectiveness of catheter ablation for both atrial fibrillation (AF) and ventricular tachycardia, novel oral anticoagulants for stroke prevention in AF, left atrial appendage occlusion devices, implantable cardioverter defibrillators, and cardiac resynchronization therapy will be reviewed.
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Affiliation(s)
- Waseem Hijazi
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Elissa Rennert-May
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amity Quinn
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glen Sumner
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Derek S. Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Mathiesen TI, Balak N, Samprón N, Broekman M, Bolger C. Ethico-legal regional differences in European neurosurgical practice: Part 1-pre-COVID-19 era. BRAIN & SPINE 2022; 2:100899. [PMID: 36248159 PMCID: PMC9562226 DOI: 10.1016/j.bas.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/30/2022] [Accepted: 06/02/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Professionalism entails expert knowledge, self-regulation, accountability, and professional ethics. These factors are influenced by culture, political observance, professional maturity, education, and occupation; ethical practices may thus vary between countries and affect how neurosurgery is practiced. RESEARCH QUESTION This paper aims to conduct a survey that addresses whether ethico-legal practices differ in European countries and whether existing ethical guidelines have been implemented. MATERIAL AND METHODS A questionnaire survey was used to examine the ethico-legal situation in 29 European countries or regions. The reports were validated by representatives of each nation. RESULTS Existing guidelines had been implemented to a minimal extent. Major regional and national differences were found in attitudes toward life and death, prioritization, and issues related to professional conduct. DISCUSSION AND CONCLUSION The results of this survey reveal inadequacies and weaknesses of policies and resources, which should spark national discussions to improve the conditions that influence professional ethics. Unfortunately, only a minority of neurosurgeons know the neurosurgical ethics guidelines and apply them in their decision making. Our findings highlight the importance of values and professional ethics in decision making.
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Affiliation(s)
- Tiit I. Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Marike Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, The Hague, the Netherlands
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Ciarán Bolger
- Department of Clinical Neuroscience, Beaumont Hospital, Dublin, Ireland
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
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Bettinger B, Benneyan JC, Mahootchi T. Antibiotic stewardship from a decision-making, behavioral economics, and incentive design perspective. APPLIED ERGONOMICS 2021; 90:103242. [PMID: 32861088 DOI: 10.1016/j.apergo.2020.103242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
Antibiotic-resistant infections cause over 20 thousand deaths and $20 billion annually in the United States. Antibiotic prescribing decision making can be described as a "tragedy of the commons" behavioral economics problem, for which individual best interests affecting human decision-making lead to suboptimal societal antibiotic overuse. In 2015, the U.S. federal government announced a $1.2 billion National Action Plan to combat resistance and reduce antibiotic use by 20% in inpatient settings and 50% in outpatient settings by 2020. We develop and apply a behavioral economics model based on game theory and "tragedy of the commons" concepts to help illustrate why rational individuals may not practice ideal stewardship and how to potentially structure three specific alternate approaches to accomplish these objectives (collective cooperative management, usage taxes, resistance penalties), based on Ostrom's economic governance principles. Importantly, while each approach can effectively incentivize ideal stewardship, the latter two do so with 10-30% lower utility to all providers. Encouraging local or state-level self-managed cooperative stewardship programs thus is preferred to national taxes and penalties, in contrast with current trends and with similar implications in other countries.
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Affiliation(s)
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston MA, USA.
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Diaby V, Almutairi RD, Babcock A, Moussa RK, Ali A. Cost-effectiveness of treatments for HER2-positive metastatic breast cancer and associated metastases: an overview of systematic reviews. Expert Rev Pharmacoecon Outcomes Res 2020; 21:353-364. [PMID: 33213205 DOI: 10.1080/14737167.2021.1848553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Treatment of human epithelial growth factor receptor 2 (HER2)-positive breast cancer has rapidly evolved over the past decades with the addition of trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (T-DM1). These treatments have dramatically impacted the survival of HER2-positive metastatic breast cancer (mBC) patients. Nonetheless, these agents are associated with high price tags, begging the question, 'Are treatments for HER2-positive metastatic breast cancer and associated metastases cost-effective'?Areas covered: We examine evidence on the cost-effectiveness of treatments for HER2-positive metastatic breast cancer and associated metastases through a review of systematic reviews on the topic. Additionally, we discuss the implications of our findings and provide recommendations for future directions in the assessment of the cost-effectiveness of targeted directed agents for HER2-positive mBC.Expert opinion: Heterogeneous evidence from cost-effectiveness studies on the use of targeted directed agents for HER2-positive mBC across the world caution against cross-country comparisons of the value of such treatments. It also militates in favor of the production and use of cost-effectiveness analyses for local rather than global decision-making, thus ensuring that economic evaluations reflect the needs of local decision-makers and populations for which they are devised.
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Affiliation(s)
- Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy (POP), College of Pharmacy, HPNP 3317, University of Florida, Gainesville, FL, USA
| | - Reem D Almutairi
- Department of Pharmaceutical Business and Administration Sciences, MCPHS University, Boston, MA, USA
| | - Aram Babcock
- Department of Pharmaceutical Outcomes and Policy (POP), College of Pharmacy, HPNP 3317, University of Florida, Gainesville, FL, USA
| | - Richard K Moussa
- Université De Cergy-Pontoise, France and Ecole Nationale Supérieure De Statistiques Et d'Economie Appliquée (ENSEA), Côte d'Ivoire
| | - Askal Ali
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, USA
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Alali AS. Commentary: Neurosurgical Coverage for Emergency and Trauma Call. Neurosurgery 2019; 84:987-988. [PMID: 30551222 DOI: 10.1093/neuros/nyy612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/20/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aziz S Alali
- Department of Neurological Surgery, University of Washington, Seattle, Washington
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To identify trends in spinal procedure reimbursement in our practice since 2010. SUMMARY OF BACKGROUND DATA In an uncertain healthcare climate with continuous reform, trends in physician reimbursement are unclear. Market forces of supply and demand, legislation imposing penalties for quality measures, local competition, and geographic location have the potential to affect reimbursement. An emphasis on quality-of-care and cost reduction is placed on providers and insurers. In a high-cost area such as spine surgery, it is unknown what the reimbursement trends have been over the last 7 years of major healthcare reforms. METHODS We collected payments received data for the 20 most commonly billed Current Procedural Terminology (CPT) codes for spinal surgery from January 2010 to December 2016. Payments were adjusted for inflation using the Consumer Price Index for Medical Care in the Northeastern United States. Insurers were separated into four groups: Medicare, Medicaid, Private Insurance, and Workers Compensation and No Fault (WC/NF). Using a weighted average to adjust for variation in procedures performed, average payments were trended over time. Average payments were trended by insurance group averaged by CPT code. RESULTS After adjusting for inflation, average overall payments for spinal claims from 2010 to 2016 increased 13.6%. Average reimbursement declined 1.9% from 2010 to 2013 and rose 16.8% from 2014 to 2016. Average Medicaid payments increased 150.1% since 2010 whereas average Medicare payments rose 4.9%. Average reimbursement from private insurers and WC/NF claims decreased 16.2% and 8.5%, respectively, from 2010 to 2013; increasing 14.2% and 12.5%, respectively, from 2014 to 2016. From 2010 to 2016, reimbursement for private insurance decreased 9.3% and increased 8.2% for WC/NF claims. CONCLUSION Since 2010, inflation-adjusted reimbursement for spinal procedures increased in our practice. There was a decline from 2010 to 2013. Increases occurred from 2014 to 2016 across all insurers. Medicaid payments more than doubled since 2010. LEVEL OF EVIDENCE 3.
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Min A, Scott LD, Park C, Vincent C, Ryan CJ, Lee T. Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units. Int J Health Plann Manage 2018; 33:733-745. [PMID: 29635856 DOI: 10.1002/hpm.2528] [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] [Received: 10/29/2017] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 11/08/2022] Open
Abstract
This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors.
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Affiliation(s)
- Ari Min
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Linda D Scott
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Chang Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Catherine Vincent
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Catherine J Ryan
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Taewha Lee
- College of Nursing, Yonsei University, Seoul, South Korea
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Abstract
AIM To report an analysis of the concept of value of nursing care. BACKGROUND Value-based health care delivery and reimbursement models are focused on value as a product of quality and cost. Nursing care provides tangible and intangible contributions to patient and organizational outcomes. The nursing profession must be able to proactively and effectively communicate the value of nursing care. DESIGN Concept analysis. DATA SOURCES Thirty-five separate sources were chosen from database searches of CINAHL Complete and ABI/INFORM Complete. Key terms utilized for the search were "nursing value" OR "nursing care value" OR "value of nursing". METHODS Caron and Bowers' (2000) dimensional analysis method was used as a guide for the project. RESULTS Dimensions identified from this concept analysis included: (a) economic, (b) relational, and (c) societal. CONCLUSION Direct care nurses experience the relational and societal dimensions of the value of nursing care. Patients and/or families experience the relational dimension of value in nursing care. Health care administrators, third-party payers, and nurse researchers interpret value from the economic dimension. Future nursing research should better quantify the economic value of nursing care. Qualitative research which focuses on how patients and families experience the value of nursing care would also contribute to further refinement of this concept.
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Affiliation(s)
- Tracey K Dick
- PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Patricia A Patrician
- Donna Brown Banton Endowed Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Lori A Loan
- Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, AL
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Wenzler E, Wong JR, Goff DA, Jankowski CA, Bauer KA. Controversies in Antimicrobial Stewardship: Focus on New Rapid Diagnostic Technologies and Antimicrobials. Antibiotics (Basel) 2016; 5:E6. [PMID: 27025521 PMCID: PMC4810408 DOI: 10.3390/antibiotics5010006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/20/2015] [Accepted: 01/06/2016] [Indexed: 12/19/2022] Open
Abstract
Antimicrobial stewardship programs (ASPs) are challenged with ensuring appropriate antimicrobial use while minimizing expenditures. ASPs have consistently demonstrated improved patient outcomes and significant cost reductions but are continually required to justify the costs of their existence and interventions due to the silo mentality often adopted by hospital administrators. As new technologies and antimicrobials emerge, ASPs are in a constant tug-of-war between providing optimal clinical outcomes and ensuring cost containment. Additionally, robust data on cost-effectiveness of new rapid diagnostic technologies and antimicrobials with subsequent ASP interventions to provide justification are lacking. As the implementation of an ASP will soon be mandatory for acute care hospitals in the United States, ASPs must find ways to justify novel interventions to align themselves with healthcare administrators. This review provides a framework for the justification of implementing a rapid diagnostic test or adding a new antimicrobial to formulary with ASP intervention, reviews approaches to demonstrating cost-effectiveness, and proposes methods for which ASPs may reduce healthcare expenditures via alternative tactics.
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Affiliation(s)
- Eric Wenzler
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Jordan R Wong
- Department of Pharmacy, Grady Health System, Atlanta, GA 30303, USA.
| | - Debra A Goff
- Department of Pharmacy, The Ohio State University, Wexner Medical Center, Columbus, OH 43210, USA.
| | - Christopher A Jankowski
- Department of Pharmacy, University of Florida Health Jacksonville, Jacksonville, FL 32209, USA.
| | - Karri A Bauer
- Department of Pharmacy, The Ohio State University, Wexner Medical Center, Columbus, OH 43210, USA.
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Adebola SO, Sogebi OA, Adebola OE, Oyinloye IF, Oguntoye MS. Medication-related expenditures by individuals with allergic rhinitis in Nigeria. Otolaryngol Head Neck Surg 2015; 152:1061-7. [PMID: 25897007 DOI: 10.1177/0194599815581350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/20/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess the medication-related expenditures in individuals with allergic rhinitis (AR) and identify contributory factors that affect these expenditures. STUDY DESIGN Cross-sectional study from August 2013 to January 2014. SETTING Kwara state has 16 local government areas, a total land mass of 36,825 km(2), and a population of 2,591,555. SUBJECTS AND METHODS Of the 308 adult subjects, 66 had AR using the Score for Allergic Rhinitis (SFAR). Information on medication-related expenditure and associated factors in AR was obtained using a structured questionnaire. Descriptive and comparative analyses between AR and non-AR subjects were performed using an independent-sample t test and χ(2) test. Factors associated with cost of care were assessed using logistic regression analysis. RESULTS The AR crude prevalence rate was 21.4%. Of the subjects, the mean ± SD age was 37.6 ± 10.0 years, and 87.9% were married, 72.7% were self-employed, and 69.7% were in the low socioeconomic class. In total, 69.7% had intermittent symptoms, while 66.7% had a positive family history of allergy. Polypharmacy care was employed in 76.1%, and 30.3% had comorbidity with asthma. The mean monthly income was 842 US dollars (USD), while the mean monthly cost of care was 81 USD, constituting 9.6% of mean monthly income. All payments were through out-of-pocket-expenses. Factors associated with convenience of cost of care were positive family history (odds ratio [OR], 7.93; P = .021) and presence of intermittent symptoms (OR, 9.36; P = .013). CONCLUSION The medication-related expenditure of AR is burdensome with an average expenditure of almost 10% of monthly income.
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Affiliation(s)
- Stephen Oluwatosin Adebola
- Department of Otorhinolaryngology, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria
| | - Olusola Ayodele Sogebi
- ENT Unit, Department of Surgery, College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Oyebola Eyitayo Adebola
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Isaac Femi Oyinloye
- Department of Otorhinolaryngology, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria
| | - Michael Sunday Oguntoye
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Dik JWH, Vemer P, Friedrich AW, Hendrix R, Lo-Ten-Foe JR, Sinha B, Postma MJ. Financial evaluations of antibiotic stewardship programs-a systematic review. Front Microbiol 2015; 6:317. [PMID: 25932024 PMCID: PMC4399335 DOI: 10.3389/fmicb.2015.00317] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction: There is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs). Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used. Methods: A systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list). Results: 1233 studies were found, of which 149 were read completely. Ninety-nine were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n = 23), costs for hospital stay (n = 18), and/or other costs (n = 19). Nine studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19. Conclusions: This review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future.
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Affiliation(s)
- Jan-Willem H Dik
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands
| | - Pepijn Vemer
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen Groningen, Netherlands ; Department of Epidemiology, Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen Groningen, Netherlands
| | - Alex W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands
| | - Ron Hendrix
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands ; Certe Laboratory for Infectious Diseases Groningen, Netherlands
| | - Jerome R Lo-Ten-Foe
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen Groningen, Netherlands ; Department of Epidemiology, Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen Groningen, Netherlands
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Da'ar OB, Al Shehri AM. Towards integration of health economics into medical education and clinical practice in Saudi Arabia. MEDICAL TEACHER 2015; 37 Suppl 1:S56-S60. [PMID: 25649100 DOI: 10.3109/0142159x.2015.1006611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. This article recognizes the dearth of knowledge and application of economic analyses in medical education and clinical practice in Saudi Arabia. In particular, it highlights the desirability of knowledge of health economics in ensuring certain competencies in medical education and the rationale for inviting doctors to apply knowledge of economics in Saudi Arabia. In addition, the article discusses challenges that hinder integrating health economics into clinical practice. Furthermore, the article typifies some of the important economic phenomena that physicians need to discern. Besides, the article provides implications for incorporating economic analysis into medical education and clinical practice in Saudi Arabia. Finally, the article concludes by demonstrating how health economics can enhance doctors' knowledge and recommends the country to move towards integrating health economics into medical education and clinical practice for best practice.
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Affiliation(s)
- Omar B Da'ar
- King Saud Bin Abdulaziz University for Health Sciences , Saudi Arabia
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Barnett AG, Graves N, Rosenthal VD, Salomao R, Rangel-Frausto MS. Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/653028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.
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Barnett AG, Graves N, Rosenthal VD, Salomao R, Rangel-Frausto MS. Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico. Infect Control Hosp Epidemiol 2015; 31:1106-14. [DOI: 10.1086/656593] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.
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Stewardson AJ, Harbarth S, Graves N. Valuation of hospital bed-days released by infection control programs: a comparison of methods. Infect Control Hosp Epidemiol 2014; 35:1294-7. [PMID: 25203185 DOI: 10.1086/678063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We performed a contingent valuation survey to elicit the opportunity cost of bed-days consumed by healthcare-associated infections in 11 European hospitals. The opportunity cost of a bed-day was significantly lower than the accounting cost; median values were €72 and €929, respectively (P < .001). Accounting methods overestimate the opportunity cost of bed-days.
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Affiliation(s)
- Andrew J Stewardson
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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17
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Asare KH, Aikins M. Health Facility Cost of Buruli Ulcer Wound Treatment in Ghana: A Case Study. Value Health Reg Issues 2014; 4:14-18. [PMID: 29702800 DOI: 10.1016/j.vhri.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the wound treatment cost borne by the Buruli Ulcer Treatment Centre of the Amasaman Government Hospital, Ghana. METHODS Three different types of data collection approaches were used, namely, 1) observation checklist, 2) in-depth interviews, and 3) expenditure data review. Wound dressing processes were observed. Retrospective health facility cost data of Buruli ulcer (BU) wound treatment for the year 2011 were used. Cost data gathered covered medical and nonmedical items. Cost analyses were carried out to determine the health facility's financial and economic costs. RESULTS The total annual financial cost was US $121,189.16, of which 99% was recurrent cost. This constitutes about 13% of the expenditure by the Amasaman Government Hospital for the year 2011. The total annual economic cost was US $143,609.22, of which 93% was recurrent cost. The main cost driver for both financial and economic costs was personnel. The annual BU wound treatment costs per capita were US $1615.86 for financial cost and US $1914.79 for economic cost, respectively. The study did not cover household patient costs. CONCLUSIONS The cost of BU wound treatment takes a considerable amount of the hospital's expenditure. This shows the importance of health facility cost as one of the decision-making tools for both resource allocation and mobilization. Hospital management must therefore constantly examine its staffing norms and the associated cost to improve the hospital's resource allocation.
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Affiliation(s)
| | - Moses Aikins
- Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
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18
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Matthews JT, Glass L. The Effect of Market-Based Economic Factors on the Adoption of Orphan Drugs Across Multiple Countries. Ther Innov Regul Sci 2013; 47:226-234. [PMID: 30227521 DOI: 10.1177/2168479012471945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Orphan drugs are designed to treat rare disease. Multiple countries have approved regulations that support the creation of new orphan drugs. The regulations directly and indirectly affect orphan drug markets and contribute to classifying a country as being more or less market based. A more market-based country is recognized as functioning closest to free market principles, where the actions of supply, demand, and pricing operate with minimal government involvement. However, little information exists on how country market differences affect the adoption of these orphan drugs. This study argues that relationships exist between country market-based economic factors and the adoption of orphan drugs. This research uses a combination of qualitative and quantitative methods, drawing on orphan drug adoption of 13 marketed orphan drugs in France, Germany, Spain, the UK, and the US. Results show a statistically significant but negative relationship between the degree to which a country is market based and the adoption of orphan drugs. Results suggest that governments and regulators in less market-based countries support market factors that result in a more efficient delivery of orphan drug products to patients with rare diseases.
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Affiliation(s)
| | - Lucas Glass
- 2 Routine Recovery LLC, Philadelphia, PA, USA
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19
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Page K, Graves N, Halton K, Barnett AG. Humans, 'things' and space: costing hospital infection control interventions. J Hosp Infect 2013; 84:200-5. [PMID: 23688708 DOI: 10.1016/j.jhin.2013.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts. AIM To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues. METHODS Previous literature and techniques in both health economics and psychology are reviewed and synthesized. FINDINGS This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed. CONCLUSION These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately.
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Affiliation(s)
- K Page
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
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20
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Epidemiology meets econometrics: using time-series analysis to observe the impact of bed occupancy rates on the spread of multidrug-resistant bacteria. J Hosp Infect 2010; 76:108-13. [DOI: 10.1016/j.jhin.2010.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 04/02/2010] [Indexed: 11/20/2022]
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21
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Abstract
TOPIC Economic theory is used to describe and explain decision making in the context of scarce resources. PURPOSE This paper presents two applications of economic theory to the delivery of nursing services in acute care hospitals and evaluates its usefulness in guiding nursing administration research. SOURCES OF INFORMATION The description of economic theory and the proposed applications for nursing are based on current nursing, healthcare, and economic literature. Evaluation of the potential usefulness of economic theory in guiding nursing administration research is based on the criteria of significance and testability as described by Fawcett and Downs. CONCLUSIONS While economic theory can be very useful in explaining how decisions about nursing time allocation and nursing care production are made, it will not address the issue of how they should be made. Normative theories and ethical frameworks also must be incorporated in the decision-making process around these issues. Economic theory and nursing administration are a good fit when balanced with the values and goals of nursing.
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22
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Emily M, Casez P, François O. Risk assessment for hospital-acquired diseases: a risk-theory approach. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2009; 29:565-575. [PMID: 19144063 DOI: 10.1111/j.1539-6924.2008.01176.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We introduce a new approach to hospital-acquired disease risk assessment from public health databases. In a spirit similar to actuarial risk theory, we define an adjustment coefficient that can quantify the risk associated with a hospital department, allowing comparisons of similar departments. The adjustment coefficient characterizes the tail of the distribution of the total patient length of stay in a department before the first disease event occurs. We show that this coefficient is the solution of a Lundberg-like equation, and we provide a nonparametric estimation procedure for this measure, based on a Cramér-Lundberg approximation for the tail of the distribution. Using simulations, we provide evidence of the robustness of the approximation to various individual risk models. In addition, we illustrate the relevance of this approach by evaluating the risk associated with a standard patient safety indicator in 20 hospitals of southeastern France.
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Affiliation(s)
- Mathieu Emily
- Bioinformatics Research Center, University of Aarhus, Building 1090, Hoegh Guldbergsgade 10 DK-8000 Aarhus C, Denmark
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23
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Diazgranados CA, Cardo DM, McGowan JE. Antimicrobial resistance: international control strategies, with a focus on limited-resource settings. Int J Antimicrob Agents 2008; 32:1-9. [PMID: 18550343 DOI: 10.1016/j.ijantimicag.2008.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 03/04/2008] [Indexed: 11/25/2022]
Abstract
Microorganisms resistant to multiple anti-infective agents have increased worldwide. These organisms threaten both optimal care of patients with infection as well as the viability of current healthcare systems. In addition, antimicrobials are valuable resources that enhance both prevention and treatment of infections. As resistance diminishes this resource, it is a societal goal to minimise resistance and therefore to reduce forces that produce resistance. This review considers strategies for minimising resistance that are needed at several different levels of responsibility, ranging from the patient care provider to international agencies. It then describes responses that might be appropriate according to the resources available for control, focusing on limited-resource settings. Antimicrobial resistance represents an international concern. Response to this problem demands concerted efforts from multiple sectors both in developed and developing countries, as well as the strengthening of multinational/international partnerships and regulations. Both medical and public health agencies should be in the forefront of these efforts.
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Affiliation(s)
- Carlos A Diazgranados
- Department of Medicine (Infectious Diseases), Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303, USA.
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24
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Abstract
The economics of preventing hospital-acquired infections is most often described in general terms. The underlying concepts and mechanisms are rarely made explicit but should be understood for research and policy-making. We define the key economic concepts and specify an illustrative model that uses hypothetical data to identify how two related questions might be addressed: 1) how much should be invested for infection control, and 2) what are the most appropriate infection-control programs? We aim to make explicit the economics of preventing hospital-acquired infections.
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Affiliation(s)
- Nicholas Graves
- Centre for Health Research-Public Health (CHR-PH), Queensland University of Technology, Kelvin Grove, Brisbane, Australia.
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Howard D, Cordell R, McGowan JE, Packard RM, Scott RD, Solomon SL. Measuring the economic costs of antimicrobial resistance in hospital settings: summary of the Centers for Disease Control and Prevention-Emory Workshop. Clin Infect Dis 2001; 33:1573-8. [PMID: 11577379 DOI: 10.1086/323758] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2001] [Revised: 06/28/2001] [Indexed: 11/03/2022] Open
Abstract
Health systems administrators and clinicians need refined calculations of the attributable cost of infections due to drug-resistant microorganisms to develop and assess cost-effective prevention strategies that deal with these infections. To date, however, efforts to provide this information have yielded widely variable and often conflicting estimates. This lack of reproducibility is largely attributable to problems in study design and in the methods used to identify and measure costs. Addressing these methodological issues was the focus of a workshop that included participants from a broad range of backgrounds, including economics, epidemiology, health care management, health care outcomes research, and clinical care. This workshop summary presents the advantages and disadvantages of various research designs as well as particular methodological issues related to the measurement of the economic cost of resistance in health care settings. Suggestions are made for needed common definitions and approaches, study areas for future research are considered, and priority investigations are identified.
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Affiliation(s)
- D Howard
- Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA
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