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Salley A, Lee ML. Proactive Use of a Human Milk Fat Modular in the Neonatal Intensive Care Unit: A Standardized Feeding Protocol. Nutrients 2024; 16:1206. [PMID: 38674897 PMCID: PMC11054077 DOI: 10.3390/nu16081206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
An exclusive human milk diet (EHMD) and standardized feeding protocols are two critical methods for safely feeding very low birth weight (VLBW) infants. Our institution initiated a standardized feeding protocol for all VLBW infants in 2018. In this protocol, a human milk fat modular was used only reactively when an infant had poor weight gain, fluid restriction, or hypoglycemia. As part of our NICU quality improvement program, internal utilization review data revealed a potential opportunity to improve growth and reduce costs. While maintaining the EHMD, a simple feeding guideline process change could provide cost savings without sacrificing caloric density or growth. We examined this process change in pre-post cohorts of VLBW infants. METHODS Our revised feeding protocol, established in October 2021, called for a human milk fat modular (Prolact CR) to be added to all infant feeding when parenteral nutrition (PN) and lipids were discontinued. The human milk fat modular concentration is 4 mL per 100 mL feed, providing approximately an additional 2 kcal/oz. We tracked data to compare (1) the use of the human milk fat modular, (2) the use of the human milk +8 fortifier, (3) overall growth before and after feeding protocol changes, and (4) cost differences between protocols. RESULTS Thirty-six VLBW infants were followed prospectively upon the introduction of the revised feeding protocol. In the revised era, the need for human milk +8 fortifier decreased from 43% to 14%. The decrease in the cost of a more costly fortifier provided a cost savings of USD 2967.78 on average per infant. Overall growth improved from birth to discharge, with severe malnutrition declining from 3.3% to 2.7% and moderate malnutrition declining from 37% to 8%. CONCLUSIONS With the proactive use of a human milk fat modular in a standardized feeding protocol, our VLBW infants showed improved growth, lower malnutrition rates, and decreased use of higher caloric fortifiers.
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Affiliation(s)
- Amanda Salley
- Hinsdale Hospital, UChicago Medicine AdventHealth Hinsdale Hospital, Hinsdale, IL 60521, USA
| | - Martin L. Lee
- Prolacta Bioscience, City of Industry, CA 91746, USA
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA 90025, USA
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Sarrel K, Hameed D, Dubin J, Mont MA, Jacofsky DJ, Coppolecchia AB. Understanding economic analysis and cost-effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. J Comp Eff Res 2024; 13:e230040. [PMID: 38488048 PMCID: PMC11044952 DOI: 10.57264/cer-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
Aim: The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. Methods: We performed a systematic review of all health economic studies that compared CT-based robotic-arm assisted unicompartmental knee arthroplasty, total knee arthroplasty and total hip arthroplasty with manual techniques. The papers selected focused on various cost-utility measures. In addition, where appropriate, secondary aims encompassed various clinical outcomes (e.g., readmissions, discharges to subacute care, etc.). Only articles directly comparing CT-based robotic-arm assisted joint arthroplasty with manual joint arthroplasty were included, for a resulting total of 21 reports. Results: Almost all twenty-one studies demonstrated a positive effect of CT scan-guided robotic-assisted joint arthroplasty on health economic outcomes. For studies reporting on 90-day episodes of costs, 10 out of 12 found lower costs in the robotic-arm assisted groups. Conclusion: Robotic-arm assisted joint arthroplasty patients had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics. Payors would likely benefit from encouraging the use of this CT-based robotic technology.
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Affiliation(s)
- Kara Sarrel
- Department of Orthopaedic Surgery, Northwell Hospital Lenox Hill, New York City, NY 10075, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - David J Jacofsky
- The CORE Institute, Phoenix, AZ 85023, USA
- HOPCo, Phoenix, AZ 85023, USA
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Whittaker W, Goodwin M, Bashir S, Sutton M, Emsley R, Kelly MP, Tickle M, Walsh T, Pretty IA. Economic evaluation of a water fluoridation scheme in Cumbria, UK. Community Dent Oral Epidemiol 2024. [PMID: 38525802 DOI: 10.1111/cdoe.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/19/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES The addition of fluoride to community drinking water supplies has been a long-standing public health intervention to improve dental health. However, the evidence of cost-effectiveness in the UK currently lacks a contemporary focus, being limited to a period with higher incidence of caries. A water fluoridation scheme in West Cumbria, United Kingdom, provided a unique opportunity to study the contemporary impact of water fluoridation. This study evaluates the cost-effectiveness of water fluoridation over a 5-6 years follow-up period in two distinct cohorts: children exposed to water fluoridation in utero and those exposed from the age of 5. METHODS Cost-effectiveness was summarized employing incremental cost-effectiveness ratios (ICER, cost per quality adjusted life year (QALY) gained). Costs included those from the National Health Service (NHS) and local authority perspective, encompassing capital and running costs of water fluoridation, as well as NHS dental activity. The measure of health benefit was the QALY, with utility determined using the Child Health Utility 9-Dimension questionnaire. To account for uncertainty, estimates of net cost and outcomes were bootstrapped (10 000 bootstraps) to generate cost-effectiveness acceptability curves and sensitivity analysis performed with alternative specifications. RESULTS There were 306 participants in the birth cohort (189 and 117 in the non-fluoridated and fluoridated groups, respectively) and 271 in the older school cohort (159 and 112, respectively). In both cohorts, there was evidence of small gains in QALYs for the fluoridated group compared to the non-fluoridated group and reductions in NHS dental service cost that exceeded the cost of fluoridation. For both cohorts and across all sensitivity analyses, there were high probabilities (>62%) of water fluoridation being cost-effective with a willingness to pay threshold of £20 000 per QALY. CONCLUSIONS This analysis provides current economic evidence that water fluoridation is likely to be cost-effective. The findings contribute valuable contemporary evidence in support of the economic viability of water fluoridation scheme.
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Affiliation(s)
- William Whittaker
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Saima Bashir
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Rajagopalan K, Rashid N, Yakkala V, Doshi D. Analysis of Medicare Patients Treated with Pimavanserin versus Other Atypical Antipsychotics: A Cost-Offset Model Evaluating Skilled Nursing Facility Stays and Long-Term Care Admissions in Parkinson's Disease Psychosis. Clinicoecon Outcomes Res 2024; 16:149-159. [PMID: 38495124 PMCID: PMC10942018 DOI: 10.2147/ceor.s452162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Background Patients with Parkinson's disease psychosis (PDP) treated with pimavanserin (PIM) versus other atypical antipsychotics (AAPs) including quetiapine (QUE) may have health-care cost savings due to fewer skilled nursing facility-stays (SNF-stays) and long-term care admissions (LTCA). Methods A decision analytic model was developed using the 2019 Medicare Patient Driven Payment Model (PDPM) to estimate SNF-stays and LTCA associated per-patient- per-year (PPPY) facility and rehabilitation costs among patients that initiated PIM vs QUE or vs other-AAPs (i.e, quetiapine, risperidone, olanzapine, aripiprazole). Model inputs were derived for: (i) annual SNF-stay and LTCA rates from an analysis of Medicare beneficiaries with PDP, and (ii) annual mean rehabilitation and resident care-stay costs from PDPM case-mix adjusted value-based payment rates for 5 rehabilitation components (ie, physical-therapy, occupational-therapy, nursing, speech-language pathology, non-therapy ancillary), and an additional variable-per-diem for room/board services. PPPY costs were estimated from (i) SNF-stay and (ii) LTCA rates multiplied by annual mean costs of stay in 2022 USD. Probabilistic sensitivity analysis (PSA) was performed using 1000 Monte Carlo simulations. Results Overall SNF-stay rates of 20.2%, 31.4%, and 31.7%, and LTCA rates of 23.2%, 33.8%, 34.6% were observed for PIM, QUE, and other-AAPs, respectively. Based on annual mean costs, PPPY SNF-stay rehabilitation and resident related costs for PIM ($41,808) vs QUE ($65,172) or vs other-AAPs ($65,664), resulted in $23,364 and $23,856 PPPY cost savings, respectively. Similarly, PPPY LTCA rehabilitation and resident related costs for PIM ($47,957) vs QUE ($70,091) or vs other-AAPs ($71,566) resulted in $22,134 and $23,609 PPPY cost-savings for PIM, respectively. PSA suggested PIM would provide cost-savings vs QUE or other-AAPs in >99% of iterations. Conclusion In this analysis, PIM demonstrated nearly 36% and 32% lower PPPY SNF-stays and LTCA costs, respectively, vs QUE or other-AAPs. Research examining additional cost-offsets (i.e., fewer falls/fractures) associated with SNF-stay or LTCA may be needed.
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Affiliation(s)
| | - Nazia Rashid
- Medical Affairs, Acadia Pharmaceuticals Inc., San Diego, CA, USA
| | | | - Dilesh Doshi
- Medical Affairs, Acadia Pharmaceuticals Inc., San Diego, CA, USA
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Wynter-Adams DM, Thomas-Brown PG, Bromfield L, Williams M, Bunting-Clarke J. Retrospective review of medicine utilization for noncommunicable diseases in three public sector pharmacies in Jamaica. Rev Panam Salud Publica 2024; 48:e18. [PMID: 38464878 PMCID: PMC10921902 DOI: 10.26633/rpsp.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/15/2023] [Indexed: 03/12/2024] Open
Abstract
Objective The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. Methods In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. Results A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. Conclusions The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.
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Affiliation(s)
- Donna-Marie Wynter-Adams
- Faculty of Science and SportCaribbean School of Sport SciencesUniversity of TechnologyJamaicaFaculty of Science and Sport, Caribbean School of Sport Sciences, University of Technology, Jamaica
| | - Peta-Gaye Thomas-Brown
- College of Health SciencesSchool of PharmacyUniversity of TechnologyJamaicaCollege of Health Sciences, School of Pharmacy, University of Technology, Jamaica
| | - Lisa Bromfield
- College of Health SciencesSchool of PharmacyUniversity of TechnologyJamaicaCollege of Health Sciences, School of Pharmacy, University of Technology, Jamaica
| | - Marcia Williams
- College of Health SciencesSchool of PharmacyUniversity of TechnologyJamaicaCollege of Health Sciences, School of Pharmacy, University of Technology, Jamaica
| | - Janice Bunting-Clarke
- College of Health SciencesSchool of PharmacyUniversity of TechnologyJamaicaCollege of Health Sciences, School of Pharmacy, University of Technology, Jamaica
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Nguyen A, Burnett-Greenup S, Riddle D, Enderle J, Carman C, Rajendran R. Blood usage and wastage at an academic teaching hospital before the initial wave of COVID-19 and during and after its quarantine periods. Lab Med 2024; 55:198-203. [PMID: 37478411 DOI: 10.1093/labmed/lmad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Transfusion services aim to maintain sufficient blood inventory to support patients, even with challenges introduced by COVID-19. OBJECTIVES To review blood usage and wastage before, during, and after COVID-19 surges, and to evaluate effects on inventory. METHODS In a retrospective review, we evaluated the association between time periods corresponding to the initial wave of COVID-19 (pre-COVID-19, quarantine, and postquarantine) and blood usage/wastage. Data were stratified by period, and χ2 testing was used to examine the association between these time periods and blood usage/wastage. RESULTS In the period before COVID-19, the transfusion service used more units, and in the period after quarantine, more units went to waste. Across all time periods, the most-used product was RBCs, and the most wasted product was plasma. A statistically significant association existed between usage (χ2 [6/3209 (0.2%)]) = 24.534; P ≤.001; Cramer V = 0.62), wastage (χ2 [6/775 (0.8%)]) = 21.673; P = .001; Cramer V = 0.118), and time period. The postquarantine period displayed the highest wastage costs ($51,032.35), compared with the pre-COVID-19 period ($29,734.45). CONCLUSION Changes in blood inventory use and waste are significantly associated with the onset and continuation of COVID-19.
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Affiliation(s)
- Amber Nguyen
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Sarah Burnett-Greenup
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Diana Riddle
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Janet Enderle
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Carol Carman
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Rajkumar Rajendran
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
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Schloegel V, Harris L, Harris A, Dropkin B. Evaluation of Potential Urologic Prescription Drug Savings With Mark Cuban Cost Plus Drug Company. Urol Pract 2024; 11:276-282. [PMID: 38377158 DOI: 10.1097/upj.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/01/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Mark Cuban Cost Plus Drug Company (MCCPDC) launched in 2022 with a goal to decrease prescription drug costs. Thus far, research has focused on possible savings if Medicare purchased its annual volume of drugs at MCCPDC prices. The aim of this study is to analyze if MCCPDC can offer savings directly to urologic patients compared with other mail-order pharmacies, local pharmacies, and with patients using health insurance. METHODS Twelve drugs used to treat urological diseases available on MCCPDC were analyzed. Pricing data of 30-tab and 90-tab prescriptions from MCCPDC, other mail-order pharmacies, and local in-person pharmacies near our zip code 40508 (Lexington, Kentucky) were compiled. To compare if MCCPDC could offer savings to patients using health insurance to fill their prescriptions, out-of-pocket drug costs for patients from the 2020 and 2021 Medical Expenditure Panel Survey and the 2021 Medicare Part D spending data were extracted. RESULTS Greater savings at MCCPDC were found at 90-tab prescriptions, but overall variability in prices existed. When comparing without health insurance, 9 of 12 drugs at MCCPDC were cheaper at 90 tabs with solifenacin and tadalafil saving $20 and $12 per prescription. When considering patients using insurance, abiraterone, sildenafil, and tadalafil offered savings on out-of-pocket costs at 30- and 90-tab prescriptions. CONCLUSIONS MCCPDC may offer cheaper prices for patients filling urologic medications, especially at 90-tab prescriptions. This study is the first to show patients could save money using MCCPDC and has implications for physician counseling when prescribing common urologic drugs.
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Affiliation(s)
- Van Schloegel
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Loyall Harris
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Benjamin Dropkin
- Department of Urology, University of Kentucky, Lexington, Kentucky
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Moureau N. Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters. Expert Rev Med Devices 2024; 21:207-216. [PMID: 38445649 DOI: 10.1080/17434440.2024.2324885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION More than 30% of peripherally inserted central catheters (PICCs) and midline catheters experience complications. Most complications are related to thrombotic cellular adherence to catheter materials. AREAS COVERED This manuscript outlines PICC and midline catheter complications, the need to reduce complications and how hydrogel catheters may provide a solution to address these unmet needs based on available evidence. EXPERT OPINION Patients commonly require PICC or midline catheters for treatment to establish a reliable form of intravenous access. Catheters, while reliable in most cases, are not without complications, including occlusion, thrombosis and infection, each related to cellular adherence to the catheter material. Hydrophilic catheter coatings and composites have been developed to mitigate these thrombotic complications, reduce adherence of blood and bacterial cells to catheters and provide greater patient safety with these devices. Hydrogel materials are highly biocompatible and have been effective in reducing cellular adherence and the formation of biofilms on surfaces. Smooth hydrophilic catheter surfaces are potentially more comfortable for the patient, with reduced friction during insertion and removal. A catheter constructed of hydrophilic biomaterial, a hydrogel composite material, may minimize thrombotic complications in PICC and midline catheters, improving catheter performance and outcomes for patients.
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Affiliation(s)
- Nancy Moureau
- Nursing Research, PICC Excellence,Inc. Griffith University, Brisbane, Queensland, Australia
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Ryholt V, Soder J, Enderle J, Rajendran R. Assessment of appropriate use of amylase and lipase testing in the diagnosis of acute pancreatitis at an academic teaching hospital. Lab Med 2024:lmae008. [PMID: 38387024 DOI: 10.1093/labmed/lmae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Despite evidence-based guidelines stating that lipase alone should be used in the diagnosis of suspected acute pancreatitis, health care providers continue to order amylase or amylase and lipase together. The purpose of this study was to assess the utilization of appropriate laboratory testing related to the diagnosis of acute pancreatitis. METHODS The study used a retrospective cross-sectional design. The timeframe was from January 1, 2020, to December 31, 2020. A retrospective chart review was used to collect data for the following: patient-provider encounter notes, patient demographics, provider demographics, differential and final diagnosis, and laboratory test results. Data analysis include stratification of categorical variables and calculation of cost savings. RESULTS For the 12-month period, this study found 2567 (9.3%) of all amylase and lipase tests to be unnecessary. Amylase tests (1881; 73.2%) made up the most unnecessary tests followed by lipase tests (686; 26.7%). An analysis of test-ordering behavior by providers revealed that 81.5% of all unnecessary tests were ordered by MDs. Finally, this study estimated a total cost savings of $128,350 if all unnecessary tests were eliminated. CONCLUSION Our study demonstrated that amylase and lipase tests have been overutilized in the diagnosis of acute pancreatitis.
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Affiliation(s)
- Valerie Ryholt
- Department of Clinical Laboratory Sciences, Galveston, TX, US
| | - Julie Soder
- Department of Clinical Laboratory Sciences, Galveston, TX, US
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, US
| | - Janet Enderle
- Department of Clinical Laboratory Sciences, Galveston, TX, US
| | - Rajkumar Rajendran
- Department of Clinical Laboratory Sciences
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, US
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Brady RE, Giordullo EL, Harvey CA, Krabacher ND, Penick AM. Intravenous push antibiotics in the emergency department: Education and implementation. Am J Health Syst Pharm 2024:zxae039. [PMID: 38373159 DOI: 10.1093/ajhp/zxae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Intravenous push antibiotics can serve as an alternative to intravenous piggyback antibiotics while providing the same pharmacodynamics and adverse effect profile, easing shortage pressures and decreasing order to administration time, as well as representing a potential cost savings. The purpose of this study was to determine whether intravenous push antibiotics could decrease the time from an order to the start of administration compared to piggyback antibiotics in emergency departments. This study also measured the cost savings of antibiotic preparation and administration and assessed nursing satisfaction when using intravenous push antibiotics. METHODS Sample instances of use of intravenous push and piggyback antibiotics were identified. Patients were included if they were 18 years of age or older and received at least a single dose of intravenous push or piggyback ceftriaxone, cefepime, cefazolin, or meropenem in one of the institution's emergency departments. The primary outcome of the study was to compare the time from the order to the start of administration of intravenous push vs piggyback antibiotics. The secondary outcome was to compare the cost of antibiotic preparation for the 2 methods. RESULTS The intravenous push and piggyback groups each had 43 patients. The time from the order to the start of administration decreased from 74 (interquartile range, 29-114) minutes in the piggyback group to 31 (interquartile range, 21-52) minutes in the push group (P = 0.003). When the estimated monthly cost savings for ceftriaxone, cefepime, and meropenem were added together, across the emergency departments, an estimated $227,930.88 is saved per year when using intravenous push antibiotics. CONCLUSION Intravenous push antibiotics decrease the time from ordering to the start of administration and result in significant cost savings.
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Affiliation(s)
- Rachel E Brady
- Department of Pharmacy, St. Elizabeth Healthcare, Edgewood, KY, USA
| | | | - Charles A Harvey
- Department of Pharmacy, St. Elizabeth Healthcare, Edgewood, KY, USA
| | | | - Alyssa M Penick
- Department of Pharmacy, St. Elizabeth Healthcare, Edgewood, KY, USA
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Herledan C, Falandry C, Huot L, Poletto N, Baudouin A, Cerfon MA, Lorsche L, Bret J, Ranchon F, Rioufol C. Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer. J Am Geriatr Soc 2024; 72:567-578. [PMID: 37818698 DOI: 10.1111/jgs.18585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/22/2023] [Accepted: 08/19/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. METHOD RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. RESULTS From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). CONCLUSIONS The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.
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Affiliation(s)
- Chloé Herledan
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Claire Falandry
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, INSERM U1060/ INRAE U1397/Université Lyon 1, Université de Lyon, Pierre-Bénite, France
| | - Laure Huot
- Hospices Civils de Lyon, Pôle de Santé Publique, Service Evaluation Economique en Santé, Lyon, France
- Inserm U1290 Research on Healthcare Performance (RESHAPE), Université Lyon 1, Lyon, France
| | - Nicolas Poletto
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurie Lorsche
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Judith Bret
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
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12
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Zigmund B. Health Care Feels the Heat: A Primer for Radiologists on Climate Change-Related Regulatory and Policy Trends. J Am Coll Radiol 2024; 21:257-264. [PMID: 37952809 DOI: 10.1016/j.jacr.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023]
Abstract
In the ensuing decade, health care will encounter risks and opportunities stemming from a regulatory and policy environment that is increasingly shaped by the climate crisis. The startling multiplication of climate change-related extreme weather events has increased public support for action, creating pressure on policymakers and regulatory agencies to provide solutions. Health care must decarbonize along with other sectors of the economy; therefore, health care organizations should be prepared to respond to climate-related regulations and take advantage of abundant green energy incentives to achieve the largest greenhouse gas emissions reductions possible and capture financial opportunities related to the national green energy transition. Radiology is an energy-intensive specialty; therefore, radiologists can have a powerful voice in efforts to decarbonize their organizations and will be more effective advocates if they have a basic understanding of the broader national and international climate change-related regulatory and policy trends. The necessity to address climate change is ever clearer; we can either help our organizations lead in these efforts, or we can wait for policymakers and health care regulators to dictate our actions.
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Affiliation(s)
- Beth Zigmund
- Larner College of Medicine, University of Vermont, Burlington, Vermont; Division Chief of Cardiothoracic Radiology and Director of Lung Cancer Screening, University of Vermont Medical Center, Burlington, Vermont.
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13
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Itiola AJ, Cheng L, Zhang W, Gomes T, Shah BR, Law MR. The Impact of Blood Glucose Test Strips Reimbursement Limits on Utilization, Costs, and Health-care Utilization in British Columbia. Can J Diabetes 2024; 48:10-17.e5. [PMID: 37611660 DOI: 10.1016/j.jcjd.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE People living with diabetes and not using insulin may not derive clinically significant benefit from routine glucose self-monitoring. As a result, in 2015, British Columbia (BC) introduced quantity restrictions for blood glucose test strips (BGTS) coverage in public plans. We studied the impact of this policy on utilization, costs, and health-care utilization. METHODS We identified a cohort of adults (≥18 years old) with diabetes between 2013 and 2019. Using BC's administrative data, we studied utilization and costs among individuals with at least one PharmaCare-eligible BGTS claim. Using interrupted time-series analysis, we studied cost savings and determined the level of policy adherence. In addition, we investigated longitudinal changes in all-cause and diabetes-specific physician visits, all-cause hospitalizations, and health-care spending in the 3 to 5 years after policy implementation. RESULTS Over the study period, 279.7 million BGTS were eligible for PharmaCare coverage, on which the government spent $124.3 million. After policy implementation, we observed an immediate decline in average utilization and PharmaCare expenditure on BGTS, leading to an estimated $44.6 million in savings between 2015 and 2019 (95% confidence interval $16.9 to $72.3 million). We found no association between the policy's implementation and health services utilization or overall health-care spending over the long term. CONCLUSIONS Restricting reimbursement for BGTS in BC resulted in significant cost savings without any attendant increase in health services utilization over the subsequent 5 years. This disinvestment freed up resources that could be channeled toward other interventions.
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Affiliation(s)
- Ademola Joshua Itiola
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wei Zhang
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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14
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Yakti O, Al-Badriyeh D, Rijims M, Abdelaal M, Alsoukhni O, Al Hail M, Abdulrouf PV, El-Kassem W, Abounahia F, Kaddoura R, Abushanab D. Clinical pharmacists' interventions for preventing adverse events in critically ill neonates in Qatar: an economic impact analysis. J Pharm Policy Pract 2024; 17:170-190. [PMID: 38236554 PMCID: PMC10793632 DOI: 10.1080/20523211.2023.2291508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Objective This study aimed to assess the overall economic impact of clinical pharmacist interventions in the neonatal ICU (NICU) in Qatar. Methods A retrospective review of neonates' records was performed over a 3-month duration in the NICU of Qatar to determine the total economic benefit of clinical pharmacist interventions. The total benefit of interventions was calculated by considering the cost avoidance due to preventable adverse drug events (ADEs) and the cost savings associated with the revised resource use due to interventions. Sensitivity analyses were conducted to ensure the robustness and generalizability of the results. Results A total of 513 interventions were analyzed, involving 150 neonates. Most of the drug-related problems were related to therapy dosing, followed by drug choice appropriateness, the addition of prophylactic treatment, and administration frequency. The overall annual benefit was estimated at QAR 4,178,352 (1,147,584), which consisted of cost avoidance of QAR 1,050,680 (USD 288,648) and an overall cost saving of QAR -6091 (USD -1673). Conclusions While the clinical pharmacist interventions led to increased resource utilisation and associated costs, when considering the avoided costs of ADEs, the overall clinical pharmacist practices in the NICU setting were economically beneficial.
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Affiliation(s)
- Ola Yakti
- Pharmacy Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammed Rijims
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Omar Alsoukhni
- Pharmacy Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Moza Al Hail
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Wessam El-Kassem
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Fouad Abounahia
- Neonatal Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar
| | - Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
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15
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Varnado OJ, Gulati T, Wheeler A, Hoyt M. Treatment Patterns, Healthcare Resource Utilization, and Direct Costs Among Patients Initiating Concomitant Use of a Calcitonin Gene-Related Peptide Monoclonal Antibody (CGRP mAb) and Novel Acute Medication in the United States. Patient Prefer Adherence 2023; 17:3449-3459. [PMID: 38143945 PMCID: PMC10741746 DOI: 10.2147/ppa.s435782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose To describe treatment patterns, all-cause and migraine-related healthcare resource utilization (HCRU), and direct costs among people with migraine treated with concomitant calcitonin gene-related peptide monoclonal antibody (CGRP mAb) and novel acute migraine medications (ubrogepant, rimegepant, lasmiditan) in the United States (US). Patients and Methods This retrospective, observational cohort study utilized data from the IBM MarketScan® Research Databases and included adults initiating CGRP mAb or novel acute migraine medication as index medications between May 01, 2018, and Feb 28, 2021. All-cause and migraine-related HCRU (number of visits) and costs at baseline (12 months pre-index) and at follow-up (12 months post-index) were descriptively analyzed; differences between values at follow-up and baseline were reported. Results Of 4,167 included in the analysis (mean [SD] age: 43.7 [11.2] years), 89.2% were women, and 59.7% had chronic migraine. Adherence to the indexed CGRP mAb was 47% (using proportion of days covered [PDC]) and 80.1% (using medication possession ratio [MPR]); mean (SD) persistence was 273.4 (115.3) days). At follow-up, 43.9% of the patients discontinued their index preventive medication of which 80.2% switched to a different preventive migraine medication; 17.0% restarted their index preventive medication. Reductions in all-cause inpatient HCRU, all-cause inpatient and outpatient costs, and migraine-related outpatient HCRU were observed at follow-up vs. baseline, whereas increases in all-cause outpatient HCRU, all-cause medication costs, migraine-related inpatient HCRU, and migraine-related inpatient, outpatient, and medication costs were observed. Conclusion In this study, observed treatment patterns with the indexed CGRP mAb were consistent with prior reports. Concomitant treatment with CGRP mAb and novel acute migraine medications led to reductions in some outcomes of HCRU and direct costs, however, increases were also observed. Treatment utilization, reductions in HCRU and cost savings identified in this study in favor of concomitant CGRP mAb and novel acute medications may help clinicians and other healthcare decision makers assessing appropriate therapeutic options for migraine management.
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Affiliation(s)
- Oralee J Varnado
- Value Evidence Outcomes – Research & Neuroscience, Indianapolis, IN, USA
| | - Tania Gulati
- Value Evidence Outcomes, Real World Evidence, Eli Lilly Services India, Private Limited, Bengaluru, Karnataka, India
| | - Anthony Wheeler
- Value Evidence Outcomes – Outcomes Liaisons, Indianapolis, IN, USA
| | - Margaret Hoyt
- Value Evidence Outcomes – Research & Neuroscience, Indianapolis, IN, USA
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16
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Emanuele E, Minoretti P. Measuring the Impact of Data Sharing: From Author-Level Metrics to Quantification of Economic and Non-tangible Benefits. Cureus 2023; 15:e50308. [PMID: 38205488 PMCID: PMC10777335 DOI: 10.7759/cureus.50308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
In early 2023, the National Institutes of Health (NIH) implemented its Data Management and Sharing (DMS) Policy, requiring researchers to share scientific data produced with NIH funding. The policy's objective is to amplify the benefits of public investment in research by promoting the dissemination and reusability of primary data. Given this backdrop, identifying a robust methodology to assess the impact of data sharing across diverse research domains is essential. In this review, we adopted two methodological paradigms, the bottom-up and top-down strategies, and employed content analysis to pinpoint established methodologies and innovative practices within this intricate field. Although numerous author-level metrics are available to gauge the impact of data sharing, their application is still limited. Non-traditional metrics, encompassing economic (e.g., cost savings) and intangible benefits, presently appear to hold more potential for evaluating the impact of primary data sharing. Finally, we address the primary obstacles encountered by open data policies and introduce an innovative "Shared model for shared data" framework to bolster data sharing practices and refine evaluation metrics.
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17
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Abushanab D, Gulied A, Hamad A, Abu-Tineh M, Abdul Rouf PV, Al Hail M, El-Kassem W, El Hajj MS, Al-Badriyeh D. Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital. J Oncol Pharm Pract 2023; 29:1935-1943. [PMID: 36946146 DOI: 10.1177/10781552231160275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The economic benefit of the clinical pharmacist's role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to cancer management. We sought to evaluate the overall economic impact of clinical pharmacist interventions in the main cancer setting in Qatar. METHODS The total economic benefit of the clinical pharmacy interventions were analyzed from the public hospital perspective. Patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care and Research, Qatar. The total benefit from interventions was the total cost avoidance due to preventable adverse drug events plus any cost savings associated with therapeutic-based resource use. Sensitivity analyses confirmed the results' robustness and increased generalizability. RESULTS A total of 1352 interventions based on 281 patients were analyzed. The majority of the drug-related problems were related to the appropriateness of therapy, followed by dosing and administration. The total population benefit over the 3-months study period was QAR 4,879,185 (USD 1,336,763), constituting cost avoidance of QAR 4,234,012 (USD 1,160,003) and negative resource-use cost savings of -QAR 645,174 (-USD 176,760). Projected annual overall benefit was QAR 14,355,354 (USD 3,932,974). The increase in resource use with therapies was mostly because of the addition of other medications. Cost avoidance was mostly driven by recommending additional medications and discontinuation of medications. The uncertainty analysis demonstrated the robustness of outcomes. CONCLUSIONS The clinical pharmacist intervention increased resource use and its cost. In overall, however, taking avoided cost of adverse drug events in consideration, it is an economically beneficial practice in the National Center for Cancer Care and Research setting, associated with adverse drug events prevention and substantial economic benefits.
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Affiliation(s)
- Dina Abushanab
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
| | - Amaal Gulied
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Qatar
| | - Anas Hamad
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Qatar
| | - Mohammad Abu-Tineh
- Department of Medical Oncology-Hematology and Bone Marrow Transplantation Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Qatar
| | - Palli V Abdul Rouf
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
| | - Moza Al Hail
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
| | - Wessam El-Kassem
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
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18
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Jandhyala R. Commercial impact of adding real-world evidence to clinical trials at regulatory approval: a Markovian-like transition model. Curr Med Res Opin 2023; 39:1559-1566. [PMID: 36715502 DOI: 10.1080/03007995.2023.2174330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Regulatory use of real-world evidence (RWE) has been recognized as a useful supplement to clinical trial evidence and could benefit patients by reducing time to treatment. However, commercial benefits have not been documented. The aim was to determine commercial impact of regulatory RWE, using ambrisentan as an illustrative example. METHODS A Markovian-like transition model was constructed to simulate the drug development workflow across a simulation time of t = 20 years. RWE was assumed to be incorporated at pII-pIII and pII-pIII-pIV, and its multiplicative median transition rate was determined by biopharma expert opinion. Each model was subjected to "with" and "without" RWE rates. Commercial impact was estimated using potential decrease in time to launch. Time to first medicine adoption and potential lives saved were also estimated. RESULTS Based on cumulative first prescriptions for ambrisentan among pulmonary arterial hypertension patients (N = 487), in comparison to standard drug development, RWE incorporation has the potential to expedite first medicine adoption by 10.4 weeks. The duration of market launch was estimated at 2.5-3.0 years earlier than standard, and approximately 9% of patients would benefit in survival. Potential earnings for an earlier launch would be GBP £43,597.86 per patient, with launch being brought forward from 2009 to 2007. CONCLUSIONS Regulatory RWE has the potential to increase overall survival rates and potential earnings by reducing time to launch. This study provides further support for industry efforts to generate RWE in time for regulatory approval.
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Affiliation(s)
- Ravi Jandhyala
- Centre for Pharmaceutical Medicine Research, King's College University, London, UK
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19
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Nguyen AL. Impact of oral chemotherapy pharmacists on cost avoidance of oral oncolytics in an integrated health system. J Oncol Pharm Pract 2023; 29:1369-1373. [PMID: 36002947 DOI: 10.1177/10781552221122034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the impact of oncology pharmacist interventions on patient outcomes has been well-documented in previous studies, there is a scarcity of articles relating to oncology pharmacists' impact on cost avoidance of oral oncolytics within an integrated health care system. Cost savings and cost avoidance studies are needed to help promote the expansion of clinical services provided by the oncology pharmacy department. OBJECTIVE The primary objective of this study was to analyze interventions made by oncology pharmacists in the Oral Chemotherapy Treatment Program (OCTP) at the Kaiser Permanente-San Diego Service Area and determine the direct cost avoidance effects over one year. A secondary objective was to evaluate oncologists' satisfaction with OCTP. METHODS This was a retrospective, observational, single-arm study where the drug cost avoidance impact resulting from oncology pharmacists' interventions was calculated. A report containing all documented oncology pharmacist interventions made in OCTP from 1 January to 31 December 2021 were reviewed for study inclusion. A retrospective chart review was conducted to verify that the interventions were made by the oncology pharmacists. The average wholesale price of drugs listed on Lexicomp as of 1 November 2021 was used to calculate drug cost avoidance values. RESULTS A total of 238 OCTP oncology pharmacist interventions associated with direct drug cost avoidance values were identified, amounting to a total cost avoidance of $2,521,844 and an annual return on investment of 440%.
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Affiliation(s)
- Analia L Nguyen
- Kaiser Permanente-San Diego Service Area, San Diego, CA, USA
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20
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Phongphithakchai A, Liabsuetrakul T, Boonsrirat U. Cost-utility analysis of separated continuous renal replacement therapy systems versus intermittent hemodialysis in critically ill patients with acute kidney injury in a low-resource setting. Artif Organs 2023; 47:1522-1530. [PMID: 37120798 DOI: 10.1111/aor.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The aim of this study is to perform a cost-utility analysis of separated continuous renal replacement therapy (CRRT) compared with intermittent hemodialysis (IHD) in critically ill patients with acute kidney injury (AKI). METHODS Cost and clinical data were gathered from adult patients with AKI who received separated CRRT or IHD at a tertiary hospital in Thailand. We applied a Markov model in this study. Our primary outcome was the incremental cost-effectiveness ratio (ICER). We performed sensitivity analysis to assess the influence of parameter uncertainty. RESULTS We enrolled 199 critically ill patients with AKI. Of these patients, 129 underwent separated CRRT, and the rest underwent IHD. The mortality rate and dialysis dependence status were not significantly different between the groups. The total costs of separated CRRT were lower than IHD ($73 042.20 vs. $89 244.37). We estimated that separated CRRT increased quality-adjusted life years (QALYs) by 0.21 compared with IHD. The ICER of -74 035.16 USD/QALY gained in the case-based analysis indicated that separated CRRT is superior to IHD due to the lower cost and more cumulative QALYs. After performing sensitivity analysis by varying parameter ranges, separated CRRT remained a cost-saving approach. CONCLUSIONS Separated CRRT is a cost-saving modality compared with IHD in critically ill patients with AKI. This approach can be applied in resource-limited settings.
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Affiliation(s)
- Atthaphong Phongphithakchai
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Tippawan Liabsuetrakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Ussanee Boonsrirat
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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21
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Haynesworth A, Gilmer TP, Brennan JJ, Weaver EH, Tolia VM, Chan TC, Killeen JP, Castillo EM. Clinical and financial outcome impacts of comprehensive geriatric assessment in a level 1 geriatric emergency department. J Am Geriatr Soc 2023; 71:2704-2714. [PMID: 37435746 DOI: 10.1111/jgs.18468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The aging population has led to an increase in emergency department (ED) visits by older adults who have complex medical conditions and high social needs. The purpose of this study was to assess if comprehensive geriatric evaluation and management impacted service utilization and cost by older adults admitted to the ED. METHODS This is a retrospective matched case-control study at a level 1 geriatric ED (GED) from January 1, 2018-March 31, 2020. Geriatric nurse specialists (GENIEs) provided comprehensive evaluations and management for GED patients. Propensity score matching was used to match patients receiving GENIE consultations to ED patients who did not receive a GENIE consult. Regression was used to assess the impact of the GENIE services on inpatient admissions, ED revisits and cost of inpatient and ED care from the payor perspective. RESULTS GENIE consults were associated with a 13.0% reduction in absolute risk of admission through the ED at index (95% confidence interval [CI] -17.0%, -9.0%, p < 0.001) and a reduction in risk for total admissions at 30 and 90-days post discharge (-11.3%, 95% CI -15.6%, -7.1%, p-value < 0.001; and -10.0, 95% CI -13.8%, -6.0%; p < 0.001 respectively), both driven by reduced risk of admission at the index visit. GENIE consults were associated with a 4% increase in absolute risk of revisits to the ED within 30 days (95% CI 0.6%, 7.3%; p = 0.001). GENIE consults were associated with a decrease in cost of inpatient and ED care, with savings of $2344 within 30 days (95% CI $2247, $2441, p < 0.001) and savings of $2004 USD within 90 days (95% CI $1895, $2114, p < 0.001), driven by reduced costs at the index visit. CONCLUSIONS GENIE consults were associated with decreased inpatient admissions through the ED, modestly increased ED revisits, and decreased cost of inpatient and ED care. The results of this study can be useful for EDs considering approaches to better serve older adults. They can also be of interest to payers as an area of potential cost savings.
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Affiliation(s)
- Austin Haynesworth
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Todd P Gilmer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA
| | - Jesse J Brennan
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Emily H Weaver
- Clinical Research Department, West Health Institute, San Diego, California, USA
| | - Vaishal M Tolia
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Theodore C Chan
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - James P Killeen
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Edward M Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
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Chanthong P, Punlee K, Kowkachaporn P, Intharakosum A, Nuanming P. Comparison of direct medical care costs between patients receiving care in a designated palliative care unit and the usual care units. Asia Pac J Clin Oncol 2023; 19:493-498. [PMID: 36333492 DOI: 10.1111/ajco.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/03/2022] [Indexed: 07/21/2023]
Abstract
AIM The need for palliative services is increasing throughout Thailand. A few palliative care units have been established in the nation so far. An economic evaluation of palliative care units has never been explored. This study compared between the medical costs of terminally ill patients receiving palliative care in a palliative care unit and the usual care units during their final admissions. METHODS This study was a retrospective observational study comparing the costs of care for patients who died in a tertiary hospital. The study group comprised patients who died in a palliative care unit, then matched with deceased patients from other units by diagnosis-related groups. Patients not indicating of having received palliative care in the medical records were excluded. The direct medical costs of the patients' care and their data were collected from the finance department database and by medical chart review. Data were entered into the SPSS statistical database. The costs of the control group were calculated from the day when palliative care was initiated RESULTS: The total cost of care was significantly lower in the palliative care unit by 45 percent. The cost reduction notably was from the shorter length of stay and lower expenditure on medication and investigations in the palliative care unit. The utilization of aggressive treatment was higher in the usual units. CONCLUSIONS The palliative care unit was associated with cost savings in caring for terminally ill patients in a tertiary hospital in Thailand.
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Affiliation(s)
- Pratamaporn Chanthong
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kesaree Punlee
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Phornpich Kowkachaporn
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | | | - Pratoom Nuanming
- Division of Information and technology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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23
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Ambade PN, Thavorn K, Pakhale S. COVID-19 Pandemic: Did Strict Mobility Restrictions Save Lives and Healthcare Costs in Maharashtra, India? Healthcare (Basel) 2023; 11:2112. [PMID: 37510552 PMCID: PMC10379405 DOI: 10.3390/healthcare11142112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Maharashtra, India, remained a hotspot during the COVID-19 pandemic. After the initial complete lockdown, the state slowly relaxed restrictions. We aim to estimate the lockdown's impact on COVID-19 cases and associated healthcare costs. METHODS Using daily case data for 84 days (9 March-31 May 2020), we modeled the epidemic's trajectory and predicted new cases for different phases of lockdown. We fitted log-linear models to estimate the growth rate, basic (R0), daily reproduction number (Re), and case doubling time. Based on pre-restriction and Phase 1 R0, we predicted new cases for the rest of the restriction phases, and we compared them with the actual number of cases during each phase. Furthermore, using the published and gray literature, we estimated the costs and savings of implementing these restrictions for the projected period, and we performed a sensitivity analysis. RESULTS The estimated median R0 during the different phases was 1.14 (95% CI: 0.85, 1.45) for pre-lockdown, 1.67 (95% CI: 1.50, 1.82) for phase 1 (strict mobility restrictions), 1.24 (95% CI: 1.12, 1.35) for phase 2 (extension of phase 1 with no restrictions on agricultural and essential services), 1.12 (95% CI: 1.01, 1.23) for phase 3 (extension of phase 2 with mobility relaxations in areas with few infections), and 1.05 (95% CI: 0.99, 1.123) for phase 4 (implementation of localized lockdowns in high-case-load areas with fewer restrictions on other areas), respectively. The corresponding doubling time rate for cases (in days) was 17.78 (95% CI: 5.61, -15.19), 3.87 (95% CI: 3.15, 5.00), 10.37 (95% CI: 7.10, 19.30), 20.31 (95% CI: 10.70, 212.50), and 45.56 (95% CI: 20.50, -204.52). For the projected period, the cases could have reached 631,819 without the lockdown, as the actual reported number of cases was 64,975. From a healthcare perspective, the estimated total value of averted cases was INR 194.73 billion (USD 2.60 billion), resulting in net cost savings of 84.05%. The Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Year (QALY) for implementing the lockdown, rather than observing the natural course of the pandemic, was INR 33,812.15 (USD 450.83). CONCLUSION Maharashtra's early public health response delayed the pandemic and averted new cases and deaths during the first wave of the pandemic. However, we recommend that such restrictions be carefully used while considering the local socio-economic realities in countries like India.
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Affiliation(s)
- Preshit Nemdas Ambade
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Kednapa Thavorn
- Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Smita Pakhale
- Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
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Aiello A, Mariano EE, Prada M, Teruzzi C, Martone N, Capri S, Carli G, Siragusa S. Budget impact analysis for avatrombopag in the treatment of chronic primary immune thrombocytopenia in adult patients refractory to other treatments. J Mark Access Health Policy 2023; 11:2230663. [PMID: 37405228 PMCID: PMC10316730 DOI: 10.1080/20016689.2023.2230663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/31/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
Introduction: Primary immune thrombocytopenia is a rare autoimmune disease characterised by a decreased platelet count resulting in an increased risk of bleeding events and even life-threatening haemorrhages. Thrombopoietin receptor agonists (TPO-RAs) are the standard of care second-line therapy for adult patients with chronic immune thrombocytopenia. The first TPO-RAs approved and reimbursed in Italy, eltrombopag and romiplostim, while effective, pose some issues in terms of safety (e.g., hepatotoxicity) or general management (e.g., dietary restrictions). Avatrombopag, an effective and well-tolerated TPO-RA, was recently granted reimbursement. Methods: A 3-year (2023-2025) budget impact analysis (BIA) was conducted to estimate its impact on the Italian National Health Service (NHS). Two scenarios were compared, of which one represents the current situation, without avatrombopag, and the other provides for an increasing market share of avatrombopag (up to 26.6%). Results: BIA shows that the increase in the use of avatrombopag correlates with savings for NHS: in the first year, saving would be €1,300,564, increasing to €2,774,210 in the third year, for a total of €6,083,231 over the 3-year period. The sensitivity analysis confirmed these savings in the scenario with avatrombopag. Conclusions: Based on this BIA, the introduction and reimbursement of avatrombopag is an efficient and advantageous choice for the Italian NHS.
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Affiliation(s)
| | | | | | | | | | - Stefano Capri
- School of Economics and Management, LIUC University, Castellanza, Italy
| | - Giuseppe Carli
- Department of Haematology, “S. Bortolo” Hospital, Vicenza, Italy
| | - Sergio Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMise), University of Palermo, Palermo, Italy
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Graff JM, Cramer J, Kolb LL, Agherrabi Z, Burgess M. Evaluation of potential cost savings through chemotherapy and biotherapy dose-rounding at a pediatric institution. J Oncol Pharm Pract 2023:10781552231184583. [PMID: 37350075 DOI: 10.1177/10781552231184583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Rapidly increasing costs of medication acquisition can pose a challenge for health-system pharmacy budgets. The impact of dose-rounding in a pediatric oncology population has not previously been well documented and a retrospective review was undertaken to quantify the potential cost benefits. METHODS A retrospective chart review of patients with an oncologic diagnosis was performed for cytotoxic agents, asparaginase products, and biotherapy administered between January 1, 2014, and December 31, 2017. In the analysis, orders that could be rounded down to the nearest vial size by 5 or 10% were included. Medication pricing information was based on wholesale acquisition cost (WAC) and was provided by the Department of Pharmacy. Cost savings per medication were determined by multiplying the WAC of the medication by the number of vials saved. RESULTS Over a 4-year span, 347 patients were evaluated and 552 out of a possible 3110 orders (17.7%) met criteria for a theoretical cost savings of approximately $1,126,000 (∼$3200 per patient). Rounding down doses by up to 5% resulted in a potential savings of about $529,000. When rounding was extended to 5-10% of the originally ordered dose, an additional $597,000 of approximate cost savings could have been realized. The medications with the largest impact on cost savings were rituximab, pegaspargase, and erwinia asparaginase. CONCLUSIONS For pediatric oncology patients, there exists a unique potential cost savings opportunity if doses are rounded down within 5 or 10% of the originally ordered weight-based or body surface area-calculated dose.
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Affiliation(s)
- Justin M Graff
- Department of Pharmacy, Aurora St Luke's Medical Center, Milwaukee, WI, USA
| | - Jesse Cramer
- Department of Pharmacy, Children's Wisconsin, Milwaukee, WI, USA
| | - Lauren L Kolb
- Department of Pharmacy, Children's Wisconsin, Milwaukee, WI, USA
| | | | - McKenna Burgess
- Department of Pharmacy, Marshfield Clinic Health Systems, Marshfield, WI, USA
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26
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Beard JW, Sethi A, Jiao W, Hyatt HW, Yapici HO, Erslon M, Overdyk FJ. Cost savings through continuous vital sign monitoring in the medical-surgical unit. J Med Econ 2023:1-27. [PMID: 37249124 DOI: 10.1080/13696998.2023.2219156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
ABSTRACTObjective- This study aimed to determine the potential cost-savings for implementing continuous vital sign monitoring in a hospital's medical-surgical units.Methods- A cost-savings analysis was designed to calculate potential cost-savings for an average-sized U.S. community hospital (153 total beds) over a one-year time horizon. Analysis parameters were extracted from national databases and previous studies that compared outcomes for patients receiving continuous vital sign monitoring (SpO2, HR, and RR) or standard of care (intermittent vital sign measurements) in medical-surgical units based on a targeted literature review. Clinical parameters and associated costs served as analysis inputs. The analysis outputs were costs and potential cost-savings using a 50% and 100% adoption rate of continuous monitoring technologies across the medical-surgical unit.Results- Potential annual cost-savings for in-hospital medical-surgical stays were estimated at $3,414,709 (2022 USD) and $6,829,418 for a 50% and 100% adoption rate, respectively. The cost-savings for an adoption rate of 100% equated to a ∼14% reduction in the overall annual cost of medical-surgical unit stays for an average-sized hospital. The largest contribution to potential cost-savings came from patients that avoided serious adverse events that require transfer to the intensive care unit; this resulted in annual cost-savings from reduced average length of stay between $1,756,613 and $3,513,226 (50% and 100% adoption rate, respectively). Additional cost-savings can be attained from reductions in in-hospital cardiac arrest-associated hospitalizations and decreased rapid response team activation.Conclusions- Our findings demonstrate that there is the potential for cost-savings of over $6.8 million dollars per year in an average-sized US community hospital by improving patient outcomes through implementation of continuous monitoring technologies in medical-surgical units. Continuous vital sign monitoring technologies that increase patient mobility and facilitate recovery may further contribute to cost-savings and should be considered for economic analyses. Future research is needed to explore these health-related outcomes.
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Affiliation(s)
- John W Beard
- Patient Care Solutions, GE HealthCare, Milwaukee, Wisconsin, USA
| | - Antra Sethi
- Patient Care Solutions, GE HealthCare, Milwaukee, Wisconsin, USA
| | - Weiqi Jiao
- Department of Health Economics and Outcomes Research, Boston Strategic Partners Inc., Boston, MA, USA
| | - Hayden W Hyatt
- Department of Health Economics and Outcomes Research, Boston Strategic Partners Inc., Boston, MA, USA
| | - Halit O Yapici
- Department of Health Economics and Outcomes Research, Boston Strategic Partners Inc., Boston, MA, USA
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Al-Badriyeh D, Kaddoura R, AlMaraghi F, Homosy A, Hail MA, El-Kassem W, Rouf PVA, Fadul A, Mahfouz A, Alyafei SA, Abushanab D. Impact of clinical pharmacist interventions on economic outcomes in a cardiology setting in Qatar. Curr Probl Cardiol 2023:101838. [PMID: 37244514 DOI: 10.1016/j.cpcardiol.2023.101838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
We sought to investigate the economic impact of preventing adverse events in a cardiology setting in Qatar as an effect of the clinical pharmacist as an intervention. This is a retrospective study of interventions by clinical pharmacists within an adult cardiology setting in a public healthcare setting (i.e Hamad Medical Corporation). The study included interventions that took place in March 2018, July 15, 2018-August 15, 2018, and January 2019. The economic impact was measured via calculating the total benefit, defined as the sum of the cost savings and the cost avoidance. Sensitivity analyses were adopted to confirm the robustness of the results. The pharmacist intervened in 262 patients, resulting in 845 interventions, with appropriate therapy (58.6%) and dosing/administration (30.2%) being the most frequent categories of reported interventions. Cost savings and cost avoidance resulted in QAR-11,536 (USD-3,169) and QAR1,607,484 (USD 441,616), respectively, yielding a total benefit of QAR1,595,948 (USD438,447) per three months and QAR6,383,792 (USD1,753,789) per a year.
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Affiliation(s)
| | - Rasha Kaddoura
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima AlMaraghi
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Homosy
- Department of Pharmacy, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al Hail
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Wessam El-Kassem
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdalla Fadul
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Dina Abushanab
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar.
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Aiello A, Mariano EE, Prada M, Cioni L, Teruzzi C, Manna R. Budget impact analysis of anakinra in the treatment of familial Mediterranean fever in Italy. J Mark Access Health Policy 2023; 11:2176091. [PMID: 36819891 PMCID: PMC9930828 DOI: 10.1080/20016689.2023.2176091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease that significantly reduces occupational productivity and quality-of-life in affected patients. Italy has an estimated FMF prevalence of 1 in 60,000 people. While colchicine is the primary treatment for FMF, biologics are administered to intolerant and non-responder patients. Anakinra and canakinumab are the only biologics approved and reimbursed for FMF in Italy. Both medicines have demonstrated efficacy in FMF patients yet differ in treatment costs. This study aimed to perform a budget impact analysis (BIA) following anakinra's reimbursement for FMF treatment, considering pharmaceutical costs from the Italian National Healthcare Service (NHS) perspective. METHODS A 'Reference scenario' (all patients treated with canakinumab) was compared to an 'Alternative scenario', with increased anakinra market shares. The target population was estimated based on the Italian population, epidemiological and market research data. Drugs costs were estimated based on Summary of Product Characteristics and net ex-factory prices. Sensitivity analyses were implemented to test results' robustness. RESULTS The base case analysis showed an overall cumulative expenditure of €30,586,628 for 'Reference scenario' and € 16,465,548 for 'Alternative scenario'. A cumulative savings of €14,121,080 (46.2%) was calculated over 3 years as a result of the reimbursement and increasing uptake of anakinra. The sensitivity analyses, even considering a discount of 50% for canakinumab, confirmed the base case results. CONCLUSIONS Anakinra's introduction, in FMF treatment, provides a financially sustainable option for Italian patients, with savings increasing according to greater use of anakinra.
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Affiliation(s)
- A Aiello
- Intexo Società Benefit S.r.l, Milan, Italy
| | - EE Mariano
- Intexo Società Benefit S.r.l, Milan, Italy
| | - M Prada
- Intexo Società Benefit S.r.l, Milan, Italy
| | - L Cioni
- Swedish Orphan Biovitrum, Milan, Italy
| | - C Teruzzi
- Swedish Orphan Biovitrum, Milan, Italy
| | - R Manna
- Periodic Fevers Research Centre, Catholic University of the Sacred Heart, Rome, Italy
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29
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Morrow C, Wheeler D, Dooley M, Warr E, Kruis R, King K, Harvey J, Simpson KN. Contribution of Continuous Virtual Monitoring to Hospital Safety, Quality, and Value of Care for COVID-19 Patients. Telemed J E Health 2023; 29:293-297. [PMID: 35708582 PMCID: PMC9940802 DOI: 10.1089/tmj.2022.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The rapid onset of the COVID-19 pandemic increased hospital admissions and shortages for personal protective equipment (PPE) used to slow the spread of infections. In addition, nurses treating COVID-19 patients have time-consuming guidelines to properly don and doff PPE to prevent the spread. Methods: To address these issues, the Medical University of South Carolina repurposed continuous virtual monitoring (CVM) systems to reduce the need for staff to enter patient rooms. The objective of this study was to identify the economic implications associated with using the CVM program for COVID-19 patients. We employed a time-driven activity-based costing approach to determine time and costs saved by implementing CVM. Results: Over the first 52 days of the pandemic, the use of the CVM system helped providers attend to patients needs virtually while averting 19,086 unnecessary in-person interactions. The estimated cost savings for the CVM program for COVID-19 patients in 2020 were $419,319, not including potential savings from avoided COVID-19 transmissions to health care workers. A total of 19,086 PPE changes were avoided, with savings of $186,661. After accounting for cost of the CVM system, the net savings provided an outstanding return on investment of 20.6 for the CVM program for COVID-19 patient care. Conclusion: The successful and cost saving repurposing of CVM systems could be expanded to other infectious disease applications, and be applied to high-risk groups, such as bone marrow and organ transplant patients.
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Affiliation(s)
- Corey Morrow
- Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Wheeler
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mary Dooley
- Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Warr
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn King
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jillian Harvey
- Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kit N Simpson
- Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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Kim N, Estrada J, Chow I, Ruseva A, Ramasamy A, Burudpakdee C, Blanchette CM. The Relative Value of Anti-Obesity Medications Compared to Similar Therapies. Clinicoecon Outcomes Res 2023; 15:51-62. [PMID: 36726966 PMCID: PMC9886521 DOI: 10.2147/ceor.s392276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
Purpose To demonstrate a need for improved health insurance coverage for anti-obesity medications (AOMs) by comparing clinical and economic benefits of obesity treatments to covered medications for selected therapeutic areas. Methods Using a grey literature search, we identified and prioritized therapeutic areas and treatment analogues for comparison to obesity. A targeted literature review identified clinical and economic outcomes research across the therapeutic area analogues. Associated comorbidities, clinical evidence, indirect costs (ie, absenteeism and productivity loss), and direct medical costs were evaluated to determine the relative value of treating obesity. Results Four therapeutic areas/treatment analogues were selected for comparison to obesity: smoking cessation (varenicline), daytime sleepiness (modafinil), migraines (erenumab), and fibromyalgia (pregabalin). Obesity was associated with 17 comorbidities, more than migraine (9), smoking (8), daytime sleepiness (5), and fibromyalgia (2). Economic burden was greatest for obesity, followed by smoking, with yearly indirect and direct medical costs totaling $676 and $345 billion, respectively. AOMs resulted in cost savings of $2586 in direct medical costs per patient per year (PPPY), greater than that for varenicline at $930 PPPY, modafinil at $1045 PPPY, and erenumab at $468 PPPY; pregabalin utilization increased costs by $924 PPPY. AOMs were covered by 10-16% of United States health insurance plans, compared to 45-59% for the four comparators. Conclusion Compared to four therapeutic analogues, obesity represented the highest economic burden and was associated with more comorbidities. AOMs provide greater cost savings compared to selected analogues. However, AOMs have limited formulary coverage. Improved coverage of AOMs may increase access to these treatments and may help address the clinical and economic burden associated with obesity and its comorbidities.
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Affiliation(s)
- Nina Kim
- Novo Nordisk, Inc, Plainsboro, NJ, USA
| | | | | | - Aleksandrina Ruseva
- Novo Nordisk, Inc, Plainsboro, NJ, USA,Correspondence: Aleksandrina Ruseva, Novo Nordisk, Inc, 800 Scudders Mill Road, Plainsboro, NJ, 08536, USA, Tel +1 609-598-8146, Email
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Mavragani A, Schwab SD, Wilkes M, Yourk D, Zahradka N, Pugmire J, Wolfberg A, Merritt A, Boster J, Loudermilk K, Hipp SJ, Morris MJ. Financial and Clinical Impact of Virtual Care During the COVID-19 Pandemic: Difference-in-Differences Analysis. J Med Internet Res 2023; 25:e44121. [PMID: 36630301 PMCID: PMC9879318 DOI: 10.2196/44121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/03/2023] [Accepted: 01/11/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Virtual care (VC) and remote patient monitoring programs were deployed widely during the COVID-19 pandemic. Deployments were heterogeneous and evolved as the pandemic progressed, complicating subsequent attempts to quantify their impact. The unique arrangement of the US Military Health System (MHS) enabled direct comparison between facilities that did and did not implement a standardized VC program. The VC program enrolled patients symptomatic for COVID-19 or at risk for severe disease. Patients' vital signs were continuously monitored at home with a wearable device (Current Health). A central team monitored vital signs and conducted daily or twice-daily reviews (the nurse-to-patient ratio was 1:30). OBJECTIVE Our goal was to describe the operational model of a VC program for COVID-19, evaluate its financial impact, and detail its clinical outcomes. METHODS This was a retrospective difference-in-differences (DiD) evaluation that compared 8 military treatment facilities (MTFs) with and 39 MTFs without a VC program. Tricare Prime beneficiaries diagnosed with COVID-19 (Medicare Severity Diagnosis Related Group 177 or International Classification of Diseases-10 codes U07.1/07.2) who were eligible for care within the MHS and aged 21 years and or older between December 2020 and December 2021 were included. Primary outcomes were length of stay and associated cost savings; secondary outcomes were escalation to physical care from home, 30-day readmissions after VC discharge, adherence to the wearable, and alarms per patient-day. RESULTS A total of 1838 patients with COVID-19 were admitted to an MTF with a VC program of 3988 admitted to the MHS. Of these patients, 237 (13%) were enrolled in the VC program. The DiD analysis indicated that centers with the program had a 12% lower length of stay averaged across all COVID-19 patients, saving US $2047 per patient. The total cost of equipping, establishing, and staffing the VC program was estimated at US $3816 per day. Total net savings were estimated at US $2.3 million in the first year of the program across the MHS. The wearables were activated by 231 patients (97.5%) and were monitored through the Current Health platform for a total of 3474 (median 7.9, range 3.2-16.5) days. Wearable adherence was 85% (IQR 63%-94%). Patients triggered a median of 1.6 (IQR 0.7-5.2) vital sign alarms per patient per day; 203 (85.7%) were monitored at home and then directly discharged from VC; 27 (11.4%) were escalated to a physical hospital bed as part of their initial admission. There were no increases in 30-day readmissions or emergency department visits. CONCLUSIONS Monitored patients were adherent to the wearable device and triggered a manageable number of alarms/day for the monitoring-team-to-patient ratio. Despite only enrolling 13% of COVID-19 patients at centers where it was available, the program offered substantial savings averaged across all patients in those centers without adversely affecting clinical outcomes.
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Affiliation(s)
| | - Stephen D Schwab
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, United States.,Department of Economics, Baylor University, Waco, TX, United States
| | - Matt Wilkes
- Current Health Ltd, Edinburgh, United Kingdom
| | | | | | | | | | - Amanda Merritt
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, United States
| | - Joshua Boster
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, United States
| | - Kevin Loudermilk
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, United States
| | - Sean J Hipp
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, United States
| | - Michael J Morris
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, United States
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Ospel JM, Kunz WG, McDonough RV, van Zwam W, Pinckaers F, Saver JL, Hill MD, Demchuk AM, Jovin TG, Mitchell P, Campbell BCV, White P, Muir K, Achit H, Bracard S, Brown S, Goyal M. Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration. Stroke 2023; 54:226-233. [PMID: 36472199 DOI: 10.1161/strokeaha.121.038407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2. METHODS Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed. RESULTS EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only. CONCLUSIONS From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.
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Affiliation(s)
- Johanna M Ospel
- Department of Neuroradiology, University Hospital Basel, Switzerland (J.M.O.).,Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Germany (W.G.K.)
| | - Rosalie V McDonough
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Wim van Zwam
- Department of Radiology, Maastricht University Medical Center, the Netherlands (W.v.Z.)
| | | | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Michael D Hill
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
| | - Tudor G Jovin
- Department of Neurology, Cooper University Health Care, Camden (T.G.J.)
| | - Peter Mitchell
- Department of Radiology (P.M.), Royal Melbourne Hospital, University of Melbourne, Australia
| | - Bruce C V Campbell
- Department of Neurology (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Australia
| | - Phil White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (P.W.)
| | - Keith Muir
- Department of Neurology, University of Glasgow, Scotland (K.M.)
| | - Hamza Achit
- Department of Medicine (H.A.), Nancy University Hospital, France
| | - Serge Bracard
- Department of Neuroradiology (S.B.), Nancy University Hospital, France
| | - Scott Brown
- Altair Biostatistics, St Louis Park' MN (S.B.)
| | - Mayank Goyal
- Department of Clinical Neurosciences (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada.,Department of Diagnostic Imaging (J.M.O., R.V.M., M.D.H., A.M.D., M.G.), University of Calgary, Canada
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Ordóñez JE, Ordóñez A. A cost-effectiveness analysis of pneumococcal conjugate vaccines in infants and herd protection in older adults in Colombia. Expert Rev Vaccines 2023; 22:216-225. [PMID: 36812426 DOI: 10.1080/14760584.2023.2184090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Pneumococcal diseases have a clinical and economic impact on the population. Until this year, a 10-valent pneumococcal vaccine (PCV10) used to be applied in Colombia, which does not contain serotypes 19A, 3, and 6A, the most prevalent in the country. Therefore, we aimed to assess the cost-effectiveness of the shift to the 13-valent pneumococcal vaccine (PCV13). RESEARCH DESIGN AND METHODS A decision model was used for newborns in Colombia between 2022-2025 and adults over 65 years. The time horizon was life expectancy. Outcomes are Invasive Pneumococcal Diseases (IPD), Community-Acquired Pneumonia (CAP), Acute Otitis Media (AOM), their sequelae, Life Gained Years (LYGs), and herd effect in older adults. RESULTS PCV10 covers 4.27% of serotypes in the country, while PCV13 covers 64.4%. PCV13 would avoid in children 796 cases of IPD, 19,365 of CAP, 1,399 deaths, and generate 44,204 additional LYGs, as well as 9,101 cases of AOM, 13 cases of neuromotor disability and 428 cochlear implants versus PCV10. In older adults, PCV13 would avoid 993 cases of IPD and 17,245 of CAP, versus PCV10. PCV13 saves $51.4 million. The decision model shows robustness in the sensitivity analysis. CONCLUSION PCV13 is a cost-saving strategy versus PCV10 to avoid pneumococcal diseases.
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Affiliation(s)
| | - Angélica Ordóñez
- Instituto de Evaluación Tecnológica en Salud, Bogotá, D.C, Colombia
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Patel S, Olatunji E, Mallum A, Benjika BB, Joseph AO, Joseph S, Lasebikan N, Mahuna H, Ngoma M, Ngoma TA, Nnko G, Onwualu C, Vorster M, Ngwa W. Expanding radiotherapy access in Sub-Saharan Africa: an analysis of travel burdens and patient-related benefits of hypofractionation. Front Oncol 2023; 13:1136357. [PMID: 37143940 PMCID: PMC10151787 DOI: 10.3389/fonc.2023.1136357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The purpose of this project was to examine the travel burdens for radiotherapy patients in Nigeria, Tanzania, and South Africa, and to assess the patient-related benefits of hypofractionated radiotherapy (HFRT) for breast and prostate cancer patients in these countries. The outcomes can inform the implementation of the recent Lancet Oncology Commission recommendations on increasing the adoption of HFRT in Sub-Saharan Africa (SSA) to enhance radiotherapy access in the region. Methods Data were extracted from electronic patient records at the NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria and the Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, from written records at the University of Nigeria Teaching Hospital (UNTH) Oncology Center in Enugu, Nigeria, and from phone interviews at Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. Google Maps was used to calculate the shortest driving distance between a patient's home address and their respective radiotherapy center. QGIS was used to map the straight-line distances to each center. Descriptive statistics were used to compare transportation costs, time expenditures, and lost wages when using HFRT versus conventionally fractionated radiotherapy (CFRT) for breast and prostate cancer. Results Patients in Nigeria (n=390) traveled a median distance of 23.1 km to NLCC and 86.7 km to UNTH, patients in Tanzania (n=23) traveled a median distance of 537.0 km to ORCI, and patients in South Africa (n=412) traveled a median distance of 18.0 km to IALCH. Estimated transportation cost savings for breast cancer patients in Lagos and Enugu were 12,895 Naira and 7,369 Naira, respectively and for prostate cancer patients were 25,329 and 14,276 Naira, respectively. Prostate cancer patients in Tanzania saved a median of 137,765 Shillings in transportation costs and 80.0 hours (includes travel, treatment, and wait times). Mean transportation cost savings for patients in South Africa were 4,777 Rand for breast cancer and 9,486 Rand for prostate cancer. Conclusion Cancer patients in SSA travel considerable distances to access radiotherapy services. HFRT decreases patient-related costs and time expenditures, which may increase radiotherapy access and alleviate the growing burden of cancer in the region.
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Affiliation(s)
- Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Saloni Patel,
| | - Elizabeth Olatunji
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | | | - Adedayo O. Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Nwamaka Lasebikan
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Twalib Athumani Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Godwin Nnko
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Chinelo Onwualu
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Mariza Vorster
- College of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Wilfred Ngwa
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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Yousef CC, Khan MA, Almodaimegh H, Alshamrani M, Al-Foheidi M, AlAbdalkarim H, AlJedai A, Naeem A, Abraham I. Cost-efficiency analysis of conversion to biosimilar filgrastim for supportive cancer care and resultant expanded access analysis to supportive care and early-stage HER2+ breast cancer treatment in Saudi Arabia: simulation study. J Med Econ 2023; 26:394-402. [PMID: 36815700 DOI: 10.1080/13696998.2023.2183680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
AIMS This study estimated, for Saudi Arabia, the cost-efficiency of converting patients from reference Neupogen and Neulastim to one of two filgrastim biosimilars (Nivestim, Zarzio); the budget-neutral expanded access to supportive care with biosimilar filgrastim and therapeutic care to ado-trastuzumab emtansine thus afforded; and the number-needed-to-convert (NNC) to provide supportive or therapeutic treatment to one patient. MATERIALS AND METHODS Replicating prior studies, we modeled the cost-efficiencies gained from converting varying proportions of a hypothetical panel of 4,000 patients undergoing six cycles of cancer treatment from Neupogen or Neulastim to one of the two biosimilar G-CSF formulations, using national cost inputs. Cost-savings in USD were used to estimate the additional doses of biosimilar G-CSF and expanded access to ado-trastuzumab emtansine on a budget-neutral basis, and NNC to purchase one additional dose of supportive or therapeutic treatment. RESULTS Savings from conversion from reference to a biosimilar filgrastim were $3,086,400 (Nivestim) and $3,460,800 (Zarzio). With reference pegfilgrastim, savings from conversion were $11,712,240 (Nivestim) and $12,086,640 (Zarzio). Biosimilar conversion from reference to biosimilar filgrastim enabled expanded access to ado-trastuzumab emtansine ranging from 61 patients (5 days, Nivestim) to 191 patients (14 days, Zarzio). For supportive care, biosimilar conversion enabled expanded access ranging from 8,244 patients (5 days, Nivestim) to 25,882 patients (14 days, Zarzio). For biosimilar conversion from daily filgrastim, the NNC for treatment with ado-trastuzumab emtansine decreased as days of injections increased [5 days: 395 (Nivestim), 352 (Zarzio); 14 days: 141(Nivestim), 126 (Zarzio)]. Alternately, for biosimilar conversion from single-injection pegfilgrastim to daily biosimilar filgrastim, the NNC for treatment with ado-trastuzumab emtansine rose as days of injections increased, being highest under the 14-day scenario (146, Nivestim; 130, Zarzio). CONCLUSION This simulation study demonstrated significant potential cost-savings from biosimilar conversion. These savings provide budget-neutral increased access to supportive and therapeutic cancer care.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of National Guard - Health Affairs, Dammam, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Mansoor Ahmed Khan
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hind Almodaimegh
- College of Pharmacy, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Meteb Al-Foheidi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hana AlAbdalkarim
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Drug Policy and Economic Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Obuda University, Budapest, Hungary
| | - Ahmed AlJedai
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- Colleges of Pharmacy and Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Anjum Naeem
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
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Xie H, Yang YS, Tian SM, Wang BJ, Fu WM, Cheng LL, Jiang NN, Gu G, Zhao DW. Tranexamic versus aminocaproic acids in patients with total hip arthroplasty: a retrospective study. BMC Musculoskelet Disord 2022; 23:999. [PMID: 36401231 PMCID: PMC9675136 DOI: 10.1186/s12891-022-05922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Recently, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) have been applied in total hip arthroplasty (THA). However, doubts in clinicians’ minds about which medicine is more efficient and economical in THA need to be clarified. Therefore, this study compared the efficacy and cost of the intraoperative administration of TXA and EACA per surgery in decreasing perioperative blood transfusion rates in THA. Methods This study enrolled patients who underwent THA between January 2019 to December 2020. A total of 295 patients were retrospectively divided to receive topical combined with intravenous TXA (n = 94), EACA (n = 97) or control (n = 104). The primary endpoints included transfusions, estimated perioperative blood loss, cost per patient and the drop in the haemoglobin and haematocrit levels. Results Patients who received EACA had greater total blood loss, blood transfusion rates, changes in HGB levels and mean cost of blood transfusion per patient (P < 0.05) compared with patients who received TXA. In addition, both TXA and EACA groups had significantly fewer perioperative blood loss, blood transfusion, operation time and changes in haemoglobin and haematocrit levels than the control group (P < 0.05). Cost savings in the TXA and EACA groups were 736.00 RMB and 408.00 RMB per patient, respectively. Conclusions The application of perioperative antifibrinolytics notably reduces the need for perioperative blood transfusions. What’s more, this study demonstrated that TXA is superior to EACA for decreasing blood loss and transfusion rates while at a lower cost per surgery. These results indicate that TXA may be the optimum antifibrinolytics for THA in Chinese area rather than EACA. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05922-5.
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Affiliation(s)
- Hui Xie
- grid.459353.d0000 0004 1800 3285Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001 Liaoning Province People’s Republic of China
| | - Yu-Shen Yang
- grid.440706.10000 0001 0175 8217Dalian University Affiliated Xinhua Hospital, Dalian, 116000 Liaoning Province People’s Republic of China
| | - Si-miao Tian
- grid.459353.d0000 0004 1800 3285Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001 Liaoning Province People’s Republic of China
| | - Ben-jie Wang
- grid.459353.d0000 0004 1800 3285Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001 Liaoning Province People’s Republic of China
| | - Wei-min Fu
- grid.459353.d0000 0004 1800 3285Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001 Liaoning Province People’s Republic of China
| | - Liang-liang Cheng
- grid.459353.d0000 0004 1800 3285Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001 Liaoning Province People’s Republic of China
| | - Nan-nan Jiang
- grid.459353.d0000 0004 1800 3285Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001 Liaoning Province People’s Republic of China
| | - Guishan Gu
- grid.430605.40000 0004 1758 4110Department of Orthopaedic, The First Hospital of Jilin University, Changchun, 130021 Jilin Province People’s Republic of China
| | - De-wei Zhao
- grid.459353.d0000 0004 1800 3285Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001 Liaoning Province People’s Republic of China
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Browning AF, Chong L, Read M, Hii MW. Economic burden of complications and readmission following oesophageal cancer surgery. ANZ J Surg 2022; 92:2901-2906. [PMID: 36129457 DOI: 10.1111/ans.18062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/18/2022] [Accepted: 09/08/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oesophageal cancer is the seventh most prevalent malignancy globally, and the sixth most common cause of cancer-related death. Oesophageal cancer is also one of the most costly cancers to treat. The aim of this study was to assess the financial impact of post-operative morbidity and hospital readmissions following oesophagectomy for oesophageal cancer. METHODS A retrospective analysis was performed on a prospectively maintained database of patients with oesophageal cancer who underwent an oesophagectomy at a single centre between July 2014 and June 2019 (N = 56). Readmission costs were also assessed in this cohort for 12 months post-operatively. RESULTS The total median cost for oesophagectomy in this cohort was AU$57 250. Major complications occurred in 40% of patients, with a median total admission cost of AU$74 606, significantly higher than patients with either minor or no complications (median admission cost of AU$52 713, P < 0.001). Patients whose operation was complicated by an anastomotic leak had a higher median admission cost than those without a leak (AU$104 328 and AU$54 972 respectively, P < 0.001). Cost centres representing the greatest proportion of costs were theatre resources and surgical ward care (medical and nursing). A total of 110 readmissions in 25 patients were recorded in the 12 months post-operatively, the majority for gastroscopy and dilatation of anastomotic stricture. CONCLUSION Post-oesophagectomy morbidity greatly increases cost of care. In addition to the clinical benefits, interventions to minimize post-operative complications are likely to result in substantial cost savings.
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Affiliation(s)
- Alison F Browning
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Lynn Chong
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Matthew Read
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michael W Hii
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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Al-Maqbali JS, Taqi A, Al-Ajmi S, Al-Hamadani B, Al-Hamadani F, Bahram F, Al-Balushi K, Gamal S, Al-Lawati E, Al Siyabi B, Al Siyabi E, Al-Sharji N, Al-Zakwani I. The Impacts of Clinical Pharmacists' Interventions on Clinical Significance and Cost Avoidance in a Tertiary Care University Hospital in Oman: A Retrospective Analysis. Pharmacy (Basel) 2022; 10:pharmacy10050127. [PMID: 36287448 PMCID: PMC9611954 DOI: 10.3390/pharmacy10050127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Pharmaceutical interventions are implicit components of the enhanced role that clinical pharmacists provide in clinical settings. We aimed to study the clinical significance and analyze the presumed cost avoidance achieved by clinical pharmacists’ interventions. Methods: A retrospective study of documented clinical pharmacists’ interventions at a tertiary care hospital in Oman was conducted between January and March 2022. The interventions were electronically recorded in the patients’ medical records as routine practice by clinical pharmacists. Data on clinical outcomes were extracted and analyzed. Cost implications were cross checked by another clinical pharmacist, and then, cost avoidance was calculated using the Rx Medi-Trend system values. Results: A total of 2032 interventions were analyzed, and 97% of them were accepted by the treating physicians. Around 30% of the accepted interventions were for antimicrobials, and the most common type was dosage adjustment (30%). Treatment efficacy was enhanced in 60% and toxicity was avoided in 22% of the interventions. The presumed cost avoided during the study period was USD 110,000 with a projected annual cost avoidance of approximately USD 440,000. Conclusion: There was an overall positive clinical and financial impact of clinical pharmacists’ interventions. Most interventions have prevented moderate or major harm with a high physician acceptance rate. Optimal documentation of the interventions is crucial for emphasizing clinical pharmacists’ value in multi-specialty hospitals.
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Affiliation(s)
- Juhaina Salim Al-Maqbali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
- Correspondence: or
| | - Aqila Taqi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Samyia Al-Ajmi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | | | - Farhat Al-Hamadani
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Fatima Bahram
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Kifah Al-Balushi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Sarah Gamal
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Esra Al-Lawati
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Bushra Al Siyabi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Ekram Al Siyabi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Nashwa Al-Sharji
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
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Liu H, Zou L, Song Y, Yan J. Cost analysis of implementing a vial-sharing strategy for chemotherapy drugs using intelligent dispensing robots in a tertiary Chinese hospital in Sichuan. Front Public Health 2022; 10:936686. [PMID: 36211656 PMCID: PMC9534289 DOI: 10.3389/fpubh.2022.936686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Chemotherapy drug wasting is a huge problem in oncology that not only results in excessive expenses on chemotherapy drugs but also increases the cost of disposing of chemotherapy waste and the risk of occupational exposure in the environment. The main objective of this study was to evaluate the potential for hospitals in China to employ a real-time vial-sharing strategy that can save drug costs. Method This study was conducted retrospectively at Pharmacy Intravenous Admixture Services (PIVAS), People's Hospital of Sichuan Province, China, from September to November 2021. Data on prescription drugs wasted were collected from the Hospital Information System (HIS). To assess the real-time vial-sharing strategy, we estimated drug wastage and drug waste costs using intelligent robots that dispense multiple prescriptions simultaneously. Results 24 of the 46 wasted drugs were cost-saved. The vial-sharing strategy saved 186,067 mg of drugs, or ~59.08% of the total amount wasted, resulting in savings of 150,073.53 China Yuan (CNY), or 47.51% of the cost of the total waste. Conclusion Our investigation established that employing a real-time vial-sharing strategy using an intelligent robot to dispense multiple prescriptions simultaneously is cost-effective. Additionally, this approach presented no safety issue concerns, such as the introduction of impurities to sterile compounding via repeated interspersing or the incorrect registration of information during drug storage, often encountered with traditional vial-sharing strategies.
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Affiliation(s)
- Hui Liu
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Linke Zou
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yujie Song
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Junfeng Yan
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China,Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu, China,*Correspondence: Junfeng Yan
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Kirk PS, Wang A, Raskolnikov D, Psutka SP, Gore JL, Nyame YA, Kelly J, Wright JL. Naloxegol versus Alvimopan for Enhancing Postoperative Recovery following Radical Cystectomy for Bladder Cancer. Urol Pract 2022; 9:364-370. [PMID: 37145718 DOI: 10.1097/upj.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION µ-Opioid-receptor antagonists are a standard component of enhanced recovery after surgery (ERAS) pathways following radical cystectomy (RC) as they reduce ileus and shorten length of stay (LOS). Prior studies have used alvimopan; however, naloxegol is a less expensive medication in the same class. We compared differences in postoperative outcomes between patients receiving alvimopan or naloxegol following RC. METHODS We retrospectively reviewed all patients undergoing RC over 20 months at an academic center during which standard practice transitioned from using alvimopan to naloxegol, while maintaining all other components of our ERAS pathway. We utilized bivariate comparisons as well as negative binomial and logistic regression to compare return of bowel function, rates of ileus and LOS following RC. RESULTS Of 117 eligible patients, 59 (50%) received alvimopan and 58 (50%) received naloxegol. There were no differences in baseline clinical, demographic or perioperative factors. Median postoperative LOS was 6 days in each group (p=0.3). Time to flatus (2 versus 2 days, p=0.2) and ileus (14% versus 17%, p=0.6) were similar between the alvimopan and naloxegol groups, respectively. In multivariable models controlling for patient and surgical factors, µ-opioid antagonist agent was associated with neither LOS nor ileus. Cost difference was -$344.20/day, equivalent to a $2,065.20 savings over a 6-day hospital stay with naloxegol. CONCLUSIONS In patients undergoing RC managed with a standard ERAS pathway, there were no differences in postoperative recovery based on the use of alvimopan versus naloxegol. Substitution of naloxegol for alvimopan may allow for significant cost savings without compromising outcomes.
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Affiliation(s)
- Peter S Kirk
- Department of Urology, University of Washington, Seattle, Washington
| | - Austin Wang
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Dima Raskolnikov
- Department of Urology, University of Washington, Seattle, Washington
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington, Seattle, Washington
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janet Kelly
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
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Rossi NA, Freeman CG, Ohlstein JF, Daram S, Darling RA, McKinnon BJ, Pine HS. Surgeon Preference on Sending Routine Tonsillectomy Specimens for Pathological Evaluation. Ear Nose Throat J 2022:1455613221112761. [PMID: 35939505 DOI: 10.1177/01455613221112761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite the presence of a growing body of literature suggesting cost-ineffectiveness of routine pathologic analysis of tonsillectomy specimens, little is known about common institutional policies and practice patterns of pediatric otolaryngologists. The objectives of this study were to determine the prevalence of routine pathological evaluation of tonsillectomy specimens for uncomplicated pediatric adenotonsillectomy procedures and to evaluate opinions regarding this controversy among board-certified pediatric otolaryngologists. METHODS This was a cross-sectional survey study sent to board-certified pediatric otolaryngologists currently practicing and registered with the American Society of Pediatric Otolaryngology (ASPO) assessing their institutions' or practices' current policies on sending routine tonsillectomy specimens for pathology, their experience with this practice, and their opinions on whether routine pathologic analysis should be employed. Basic statistical analysis was then conducted. RESULTS Respondents mostly practiced in an academic setting (68.4%), with the next most common being academically affiliated private practice (21.8%), and private practice was the least common (9.8%). Most respondents (85.1%) did not agree with routine pathologic analysis of otherwise uncomplicated pediatric tonsillectomy specimens. CONCLUSION Most pediatric otolaryngologists who responded to this survey do not support routine pathological analysis of otherwise uncomplicated pediatric tonsillectomy specimens. However, the results are likely biased and should be interpreted carefully, since only a small percentage of pediatric otolaryngologists responded to the survey. Potential cost savings could be seen by patients, payers, and hospital systems with judicious use of surgical pathology, specifically in cases with concurrent signs or symptoms suspicious for malignancy.
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Affiliation(s)
- Nicholas A Rossi
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Cecilia G Freeman
- Department of Otolaryngology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jason F Ohlstein
- Department of Otolaryngology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Shiva Daram
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Robert A Darling
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian J McKinnon
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Harold S Pine
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Lavaysse LM, Imrisek SD, Lee M, Osborn CY, Hirsch A, Hoy-Rosas J, Nagra H, Goldner D, Dachis J, Sears LE. One Drop Improves Productivity for Workers With Type 2 Diabetes: One Drop for Workers With Type 2 Diabetes. J Occup Environ Med 2022; 64:e452-e458. [PMID: 35672921 PMCID: PMC9377500 DOI: 10.1097/jom.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Diabetes research on work productivity has been largely cross-sectional and retrospective, with only one known randomized controlled trial (RCT) published, to our knowledge. Secondary analysis of the Fit-One RCT tested the effect of One Drop's digital health program on workplace productivity outcomes, absenteeism, and presenteeism, for employees and specifically for older workers with type 2 diabetes. METHODS Analysis of the 3-month Fit-One trial data from employees who have type 2 diabetes explored productivity using logistic analyses and generalized estimating equations. RESULTS Treatment and control group comparisons showed that workers ( N = 125) using One Drop see direct benefits to workplace productivity, which leads to productivity savings for employers. CONCLUSION This was the first RCT to demonstrate that a mobile health application for managing type 2 diabetes can positively affect productivity at work.
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Cooper HJ, Bongards C, Silverman RP. Cost-Effectiveness of Closed Incision Negative Pressure Therapy for Surgical Site Management After Revision Total Knee Arthroplasty: Secondary Analysis of a Randomized Clinical Trial. J Arthroplasty 2022; 37:S790-S795. [PMID: 35288248 DOI: 10.1016/j.arth.2022.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/18/2022] [Accepted: 03/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The PROMISES (Post-market, Randomized, Open-Label, Multicenter, Study to Evaluate the Effectiveness of Closed Incision Negative Pressure Therapy Versus Standard of Care Dressings in Reducing Surgical Site Complications in Subjects With Revision of a Failed Total Knee Arthroplasty) randomized controlled trial compared closed incision negative pressure therapy (ciNPT) to standard of care (SOC) after revision total knee arthroplasty in high-risk patients. We assessed the costs associated with 90-day surgical site complications (SSCs) to determine the cost-benefit of ciNPT. METHODS A health economic model was used to determine mean per-patient costs to manage the surgical site, including the costs of postoperative dressings, surgical and non-surgical interventions, and readmission. A subanalysis was performed to examine cost-benefit in "lower risk" (Charlson Comorbidity Index < 2) and "higher risk" (Charlson Comorbidity Index ≥ 2) patients. RESULTS Patients with ciNPT experienced fewer SSCs (3.4% vs 14.3%; P = .0013) and required fewer surgical (0.7% vs 4.8%; P = .0666) and non-surgical (2.7% vs 12.9%; P = .0017) interventions compared to those with SOC. Readmission rates were significantly higher when patients experienced SSC (31% vs 4%; P = .0001). Using the economic model, respective per-patient costs for the ciNPT and SOC groups were $666 and $52 for postoperative dressings, $135 and $994 for surgical interventions, $231 and $970 for readmissions, and $15 and $70 for non-surgical interventions. Total per-patient costs for surgical site management were $1,047 for ciNPT and $2,036 for SOC. Among the lower risk population, mean per-patient cost was $1,066 for ciNPT and $1,474 for SOC. Among the higher risk population, mean per-patient cost was $676 for ciNPT and $3,212 for SOC. CONCLUSION Despite higher upfront costs for postoperative dressings, ciNPT was cost-effective in this health economic model, decreasing the costs of surgical site management after revision total knee arthroplasty by 49% in this study population and 79% in higher risk subgroup.
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Affiliation(s)
- Herbert J Cooper
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY
| | | | - Ronald P Silverman
- 3M Company, St. Paul, MN; University of Maryland School of Medicine, Baltimore, MD
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Troeger KA, Thiel ER, London RS. Optimizing Vaginitis Diagnosis to Reduce Health Care Costs in Nonpregnant Women Utilizing Molecular Diagnostics. Popul Health Manag 2022; 25:449-454. [PMID: 35819875 DOI: 10.1089/pop.2022.0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Vaginitis is a common condition that affects women of reproductive age. Early and accurate diagnosis and identification of the causative agents (ie, fungi, protozoa, bacterial species, etc.) help to avoid incorrect treatment and subsequent visits that add costs and therapies, which increase overall health care utilization. A prior study by Kong et al presented a cost analysis demonstrating that women who received a nucleic acid amplification test (NAAT) on the day of their vaginitis diagnosis had significantly lower 12-month follow-up costs than women who received a direct probe (DP) test or women who received clinical evaluation without the use of a molecular test. This prior analysis included pregnant women, which may have influenced the findings. The objective of this analysis is to determine whether the exclusion of pregnant women from the study cohort impacts the previously observed NAAT cost-savings results. The current analysis adds evidence that nonpregnant women diagnosed with NAAT at their initial visit have significantly lower 12-month overall health care costs than women evaluated through DP or other clinical methods.
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Saran AK, Holden NA, Garrison SR. Concerns regarding tablet splitting: a systematic review. BJGP Open 2022:BJGPO. [PMID: 35193886 DOI: 10.3399/BJGPO.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Tablet splitting can provide dose flexibility and cost savings; however, pharmaceutical representatives typically discourage the practice. AIM To identify and summarise all published concerns related to tablet splitting and to present the experimental evidence that investigates those concerns. DESIGN & SETTING Systematic review and qualitative synthesis of tablet-splitting concerns and evidence. METHOD Medline and EMBASE databases were searched over all years of publication for articles in English discussing the splitting of tablets. Eligible articles included original research, narrative reviews, systematic reviews, and expert opinion. RESULTS After removing duplicates, 1837 potentially relevant articles underwent dual review, whereupon 1612 articles were excluded based on title and abstract. After examination of 225 full texts, 138 articles were included (one systematic review, four narrative reviews, 101 original research articles, and 32 opinion articles). The described concerns included difficulty breaking tablets, loss of mass, weight variability, chemical instability, overly rapid dosing if sustained-release medications are split, non-compliance, and patient confusion resulting in medication errors. No substantive evidence was found to support concerns regarding loss of mass, weight variability, chemical instability, or non-compliance. Evidence does support some older adults struggling to split tablets without tablet splitters, and the inappropriateness of splitting sustained-release preparations, given the potential for alteration of the rate of drug release for some products. CONCLUSION With the exception of sustained-release tablets, which should not be split, and excepting those older people who may struggle to split tablets based on physical limitations, there is little evidence to support tablet-splitting concerns.
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Schuetz P, Sulo S, Walzer S, Krenberger S, Stagna Z, Gomes F, Mueller B, Brunton C. Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure. Nutrients 2022; 14:nu14091703. [PMID: 35565669 PMCID: PMC9099480 DOI: 10.3390/nu14091703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background Malnutrition is a highly prevalent risk factor in hospitalized patients with chronic heart failure (CHF). A recent randomized trial found lower mortality and improved health outcomes when CHF patients with nutritional risk received individualized nutritional treatment. Objective To estimate the cost-effectiveness of individualized nutritional support in hospitalized patients with CHF. Methods This analysis used data from CHF patients at risk of malnutrition (N = 645) who were part of the Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial (EFFORT). Study patients with CHF were randomized into (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals) or (ii) a control group (receiving standard hospital food). We used a Markov model with daily cycles (over a 6-month interval) to estimate hospital costs and health outcomes in the comparator groups, thus modeling cost-effectiveness ratios of nutritional interventions. Results With nutritional support, the modeled total additional cost over the 6-month interval was 15,159 Swiss Francs (SF). With an additional 5.77 life days, the overall incremental cost-effectiveness ratio for nutritional support vs. no nutritional support was 2625 SF per life day gained. In terms of complications, patients receiving nutritional support had a cost savings of 6214 SF and an additional 4.11 life days without complications, yielding an incremental cost-effectiveness ratio for avoided complications of 1513 SF per life day gained. Conclusions On the basis of a Markov model, this economic analysis found that in-hospital nutritional support for CHF patients increased life expectancy at an acceptable incremental cost-effectiveness ratio.
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Affiliation(s)
- Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland;
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Correspondence: ; Fax: +41-62-838-4100
| | - Suela Sulo
- Abbott Nutrition, Chicago, IL 60045, USA; (S.S.); (C.B.)
| | - Stefan Walzer
- MArS Market Access & Pricing Strategy GmbH, 79576 Weil am Rhein, Germany; (S.W.); (S.K.)
- Health Care Management, State University Baden-Wuerttemberg, 70174 Loerrach, Germany
- Social Work & Health Care, University of Applied Sciences Ravensburg-Weingarten, 88250 Weingarten, Germany
| | - Sebastian Krenberger
- MArS Market Access & Pricing Strategy GmbH, 79576 Weil am Rhein, Germany; (S.W.); (S.K.)
| | - Zeno Stagna
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, 4001 Bern, Switzerland;
| | - Filomena Gomes
- NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal;
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland;
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Cory Brunton
- Abbott Nutrition, Chicago, IL 60045, USA; (S.S.); (C.B.)
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Brower CH, Baugh CW, Shokoohi H, Liteplo AS, Duggan N, Havens J, Askari R, Rehani MM, Kapur T, Goldsmith AJ. Point-of-care ultrasound-first for the evaluation of small bowel obstruction: National cost savings, length of stay reduction, and preventable radiation exposure. Acad Emerg Med 2022; 29:824-834. [PMID: 35184354 DOI: 10.1111/acem.14464] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Computed tomography (CT) has long been the gold standard in diagnosing patients with suspected small bowel obstruction (SBO). Recently, point-of-care ultrasound (POCUS) has demonstrated comparable test characteristics to CT imaging for the diagnosis of SBO. Our primary objective was to estimate the annual national cost saving impact of a POCUS-first approach for the evaluation of SBO. Our secondary objectives were to estimate the reduction in radiation exposure and emergency department (ED) length of stay (LOS). METHODS We created and ran 1000 trials of a Monte Carlo simulation. The study population included all patients presenting to the ED with abdominal pain who were diagnosed with SBO. Using this simulation, we modeled the national annual cost savings in averted advanced imaging from a POCUS-first approach for SBO. The model assumes that all patients who require surgery or have non-diagnostic POCUS exams undergo CT imaging. The model also conservatively assumes that a subset of patients with diagnostic POCUS exams undergo additional confirmatory CT imaging. We used the same Monte Carlo model to estimate the reduction in radiation exposure and total ED bed hours saved. RESULTS A POCUS-first approach for diagnosing SBO was estimated to save a mean (±SD) of $30.1 million (±8.9 million) by avoiding 143,000 (±31,000) CT scans. This resulted in a national cumulative decrease of 507,000 bed hours (±268,000) in ED LOS. The reduction in radiation exposure to patients could potentially prevent 195 (±56) excess annual cancer cases and 98 (±28) excess annual cancer deaths. CONCLUSIONS If adopted widely and used consistently, a POCUS-first algorithm for SBO could yield substantial national cost savings by averting advanced imaging, decreasing ED LOS, and reducing unnecessary radiation exposure in patients. Clinical decision tools are needed to better identify which patients would most benefit from CT imaging for SBO in the ED.
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Affiliation(s)
- Charles H. Brower
- Department of Emergency Medicine University of Cincinnati Medical Center Cincinnati Ohio USA
| | - Christopher W. Baugh
- Department of Emergency Medicine, Harvard Medical School Brigham and Women's Hospital Boston Massachusetts United States
| | - Hamid Shokoohi
- Department of Emergency Medicine, Harvard Medical School Massachusetts General Hospital Boston Massachusetts USA
| | - Andrew S. Liteplo
- Department of Emergency Medicine, Harvard Medical School Massachusetts General Hospital Boston Massachusetts USA
| | - Nicole Duggan
- Department of Emergency Medicine, Harvard Medical School Brigham and Women's Hospital Boston Massachusetts United States
| | - Joaquim Havens
- Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Harvard Medical School Brigham and Women's Hospital Boston Massachusetts USA
| | - Reza Askari
- Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Harvard Medical School Brigham and Women's Hospital Boston Massachusetts USA
| | - Madan M. Rehani
- Department of Radiology Massachusetts General Hospital Boston Massachusetts USA
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA
| | - Andrew J. Goldsmith
- Department of Emergency Medicine, Harvard Medical School Brigham and Women's Hospital Boston Massachusetts United States
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Ding R, Gafni A, Williams A. Cost Implications from an Employer Perspective of a Workplace Intervention for Carer-Employees during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:ijerph19042194. [PMID: 35206379 PMCID: PMC8872071 DOI: 10.3390/ijerph19042194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022]
Abstract
In developed countries, population aging due to advances in living standards and healthcare infrastructure means that the care associated with chronic and degenerative diseases is becoming more prevalent across all facets of society—including the labour market. Informal caregiving, that is, care provision performed by friends and family, is expected to increase in the near future in Canada, with implications for workplaces. Absenteeism, presenteeism, work satisfaction and retention are known to be worse in employees who juggle the dual role of caregiving and paid employment, representing losses to workplaces’ bottom line. Recent discourse on addressing the needs of carer-employees (CEs) in the workplace have been centred around carer-friendly workplace policies. This paper aims to assess the potential cost implication of a carer-friendly workplace intervention implemented within a large-sized Canadian workplace. The goal of the intervention was to induce carer-friendly workplace culture change. A workplace-wide survey was circulated twice, prior to and after the intervention, capturing demographic variables, as well as absenteeism, presenteeism, turnover and impact on coworkers. Utilizing the pre-intervention timepoint as a baseline, we employed a cost implication analysis to quantify the immediate impact of the intervention from the employer’s perspective. We found that the intervention overall was not cost-saving, although there were some mixed effects regarding some costs, such as absenteeism. Non-tangible benefits, such as changes to employee morale, satisfaction with supervisor, job satisfaction and work culture, were not monetarily quantified within this analysis; hence, we consider it to be a conservative analysis.
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Affiliation(s)
- Regina Ding
- School of Earth Environment and Society, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Correspondence:
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Allison Williams
- School of Earth Environment and Society, McMaster University, Hamilton, ON L8S 4L8, Canada;
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Kremenova Z, Svancara J, Kralova P, Moravec M, Hanouskova K, Knizek-Bonatto M. Does a Hospital Palliative Care Team Have the Potential to Reduce the Cost of a Terminal Hospitalization? A Retrospective Case-Control Study in a Czech Tertiary University Hospital. J Palliat Med 2022; 25:1088-1094. [PMID: 35085466 PMCID: PMC9248342 DOI: 10.1089/jpm.2021.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: More than 50% of patients worldwide die in hospitals and end-of-life care is costly. We aimed to explore whether support from the palliative team can influence end-of-life costs. Methods: This was a descriptive retrospective case–control study conducted at a Czech tertiary hospital. We explored the difference in daily hospital costs between patients who died with and without the support of the hospital palliative care team from January 2019 to April 2020. Big data from registries of routine visits were used for case–control matching. As secondary outcomes, we compared the groups over the duration of the terminal hospitalization, intensive care unit (ICU) days, intravenous antibiotics, magnetic resonance imaging/computed tomography scans, oncological treatment in the last month of life, and documentation of the dying phase. Standard descriptive statistics were used to describe the data, and differences between the case and control groups were tested using Fisher's exact test for categorical variables and the Mann–Whitney U test for numerical data. Results: In total, 213 dyads were identified. The average daily costs were three times lower in the palliative group (4392.4 CZK per day = 171.3 EUR) than in the nonpalliative group (13992.8 CZK per day = 545.8 EUR), and the difference was probably associated with the shorter time spent in the ICU (16% vs. 33% of hospital days). Conclusions: We showed that the integration of the palliative care team in the dying phase can be cost saving. These data could support the implementation of hospital palliative care in developing countries.
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Affiliation(s)
- Zuzana Kremenova
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Svancara
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Petra Kralova
- Economic Department, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Moravec
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Institute for Medical Humanities, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Hanouskova
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mayara Knizek-Bonatto
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Zaborowski N, Scheu A, Glowacki N, Lindell M, Battle-Miller K. Early Palliative Care Consults Reduce Patients' Length of Stay and Overall Hospital Costs. Am J Hosp Palliat Care 2022; 39:1268-1273. [PMID: 35061508 PMCID: PMC9527348 DOI: 10.1177/10499091211067811] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Palliative care improves health outcomes and satisfaction and supports decision-making for patients and families during challenging times in their lives. Earlier referral for consults has demonstrated increased costs savings.Hypothesis: Education proposing physicians order a palliative care consult within 3 days of patient hospital admission will decrease patient length of stay (LOS) and overall costs as well as expedite the transition to next level of care.Design/Method: A descriptive retrospective cohort study was completed using de-identified data originally captured for a system-wide initiative at a large acute care hospital in Illinois. Hospitalists were selected as the pilot group and received education encouraging physicians to order palliative care consults within 3 days of patient admission. Non-hospitalists (control group) did not receive the education. All results were compared to a 3-month baseline period.Results: A total of 711 patients were included in this study (367 baseline, 138 pilot, 206 controls). The baseline pre-consult LOS of 4.8 days was reduced to 3.7 days in the pilot group, representing a > 1 day decrease in the timing of palliative consult. The pilot demonstrated a direct cost savings of 26% over the 3-months pilot period. Additionally, a 2-day reduction in overall LOS was demonstrated in the pilot group compared to both the baseline and control groups.Conclusions: This pilot demonstrated an ability to change the timing of new palliative care consults, resulting in direct cost savings and LOS reduction. These results demonstrated the need for a larger study to confirm these findings.
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Affiliation(s)
| | - Amy Scheu
- Advocate Aurora Health, Hospice & Palliative Care, Lombard, IL, USA
| | - Nicole Glowacki
- Advocate Aurora Health, Research Institute, Downers Grove, IL, USA
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