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Shao H, Shi L, Fonseca V, Alsaleh AJO, Gill J, Nicholls C. An exploratory analysis of the cost-effectiveness of insulin glargine 300 units/mL versus insulin glargine 100 units/mL over a lifetime horizon using the BRAVO diabetes model. Diabet Med 2024; 41:e15303. [PMID: 38470100 DOI: 10.1111/dme.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND This analysis assessed the cost-effectiveness of insulin glargine 300 units/mL (Gla-300) versus insulin glargine 100 units/mL (Gla-100) in insulin-naïve adults with type 2 diabetes (T2D) inadequately controlled with oral antidiabetic drugs (OADs). METHODS Costs and outcomes for Gla-300 versus Gla-100 from a US healthcare payer perspective were assessed using the BRAVO diabetes model. Baseline clinical data were derived from EDITION-3, a 12-month randomized controlled trial comparing Gla-300 with Gla-100 in insulin-naïve adults with inadequately controlled T2D on OADs. Treatment costs were calculated based on doses observed in EDITION-3 and 2020 US net prices, while costs for complications were based on published literature. Lifetime costs ($US) and quality-adjusted life-years (QALYs) were predicted and used to calculate incremental cost-effectiveness ratio (ICER) estimates; extensive scenario and sensitivity analyses were conducted. RESULTS Lifetime medical costs were estimated to be $353,441 and $352,858 for individuals receiving Gla-300 and Gla-100 respectively; insulin costs were $52,613 and $50,818. Gla-300 was associated with a gain of 8.97 QALYs and 21.12 life-years, while Gla-100 was associated with a gain of 8.89 QALYs and 21.07 life-years. This resulted in an ICER of $7522/QALY gained for Gla-300 versus Gla-100. Thus, Gla-300 was cost-effective versus Gla-100 based on a willingness-to-pay threshold of $50,000/QALY. Compared with Gla-100, Gla-300 provided a net monetary benefit of $3290. Scenario and sensitivity analyses confirmed the robustness of the base case. CONCLUSION Gla-300 may be a cost-effective treatment option versus Gla-100 over a lifetime horizon for insulin-naïve people in the United States with T2D inadequately controlled on OADs.
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Affiliation(s)
- Hui Shao
- Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Vivian Fonseca
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
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Gandhi DBC, Baggio JAO, D'Souza JV, Urimubenshi G, Vijayanand PJ. Global Access to Stroke Rehabilitation: A Narrative Synthesis of Comparative Highlights. Stroke 2024. [PMID: 38634278 DOI: 10.1161/strokeaha.123.045116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Dorcas B C Gandhi
- Department of Neurology and College of Physiotherapy, Christian Medical College & Hospital, Ludhiana, Punjab, India. (D.B.C.G.)
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Health Education, Karnataka, India (D.B.C.G.)
| | - Jussara A O Baggio
- Medical School of Federal University of Alagoas, Arapiraca, Brazil (J.A.O.B.)
| | - Jennifer V D'Souza
- Department of Physiotherapy, St. John's Medical College, Bengaluru, Karnataka, India (J.V.D.)
| | - Gerard Urimubenshi
- Department of Physiotherapy, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali (G.U.)
| | - Pranay J Vijayanand
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India. (P.J.V.)
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Wells C, Warren AC, Ashe Scott M. Development and implementation of ambulatory care pharmacy services at an internal medicine clinic. Am J Health Syst Pharm 2024:zxae102. [PMID: 38613410 DOI: 10.1093/ajhp/zxae102] [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: 04/04/2024] [Indexed: 04/14/2024] 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 This report describes the step-by-step process that led to expansion of ambulatory care pharmacy services at a newly established internal medicine clinic within a patient-centered medical home in North Carolina. SUMMARY Implementation of clinical pharmacist services at the clinic was led by a postgraduate year 2 (PGY2) pharmacy resident and guided by the 9 steps described in the book Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. After a needs assessment and review of the demographics and insurance status of the clinic's target population, it was determined that pharmacist services would focus on quality measures including diabetes nephropathy screening, diabetes eye examination, blood glucose control in diabetes, discharge medication reconciliation, annual wellness visits, and medication adherence in diabetes, hypercholesterolemia, and hypertension. Clinic appointments were conducted under 3 models: a pharmacist-physician covisit model, a "floor model" of pharmacist consultation on drug information or medication management issues during medical resident sign-out sessions with supervising physicians (medical residents could also see patients along with the pharmacist at a covisit appointment), and a covisit model of stacked physician and pharmacist appointments. The pharmacist's services were expanded from 2 half-day clinic sessions per week initially to 5 or 6 half-day clinic sessions by the end of the residency year. CONCLUSION By the fourth quarter of the first PGY2 residency year in which ambulatory care pharmacy services were provided in the clinic, the clinical and financial impact of those services justified the addition of a second full-time pharmacist to the clinic team.
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Affiliation(s)
- Casey Wells
- Department of Pharmacotherapy, Mountain Area Health Education Center, Asheville, NC, and Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Anne Carrington Warren
- Department of Pharmacotherapy, Mountain Area Health Education Center, Asheville, NC, and Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Mollie Ashe Scott
- Department of Pharmacotherapy, Mountain Area Health Education Center, Asheville, NC, and Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Cronin J, Moore S, Harding M, Whelton H, Woods N. A quality appraisal of economic evaluations of community water fluoridation: A systematic review. Community Dent Health 2024. [PMID: 38682565 DOI: 10.1922/cdh_00167cronin11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/04/2023] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To critically appraise the methodological conduct and reporting quality of economic evaluations (EE) of community water fluoridation (CWF). METHODS A systematic literature search was conducted in general databases and specialist directories of the economic literature. The Consensus on Health Economic Criteria list (CHEC) appraised the methodological quality while the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) assessed the reporting quality of included studies. RESULTS A total of 1,138 records were identified, of which 18 met the inclusion criteria. Cost analysis emerged as the most prevalent type of EE, though a growing trend towards conducting full EEs is observed. CHEC revealed the items most frequently unfulfilled were the study design, measurement and valuation of costs and outcomes, while CHEERS also identified reporting deficiencies in these aspects. Furthermore, the review highlights subtleties in methodological aspects that may not be discerned by CHEC, such as the estimation of the impact of fluoridation and the inclusion of treatment savings within cost estimates. CONCLUSIONS While numerous studies were conducted before publication of these assessment instruments, this review reveals that a noteworthy subset of studies exhibited good methodological conduct and reporting quality. There has been a steady improvement in the methodological and reporting quality over time, with recently published EEs largely adhering to best practice guidelines. The evidence presented will assist policymakers in leveraging the available evidence effectively to inform resource allocation decisions. It may also serve as a resource for researchers to enhance the methodological and reporting standards of future EEs of CWF.
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Affiliation(s)
- J Cronin
- Centre for Policy Studies, Cork University Business School, University College Cork, Ireland
| | - S Moore
- Centre for Policy Studies, Cork University Business School, University College Cork, Ireland
| | - M Harding
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Ireland
| | - H Whelton
- College of Medicine and Health, University College Cork, Ireland
| | - N Woods
- Centre for Policy Studies, Cork University Business School, University College Cork, Ireland
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Pinckaers FME, Grutters JPC, Huijberts I, Gabrio A, Boogaarts HD, Postma AA, van Oostenbrugge RJ, van Zwam WH, Evers SMAA. Cost and Utility Estimates per Modified Rankin Scale Score up to 2 Years Post Stroke: Data to Inform Economic Evaluations From a Societal Perspective. Value Health 2024; 27:441-448. [PMID: 38244981 DOI: 10.1016/j.jval.2024.01.001] [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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES Model-based health economic evaluations of ischemic stroke are in need of cost- and utility estimates related to relevant outcome measures. This study aims to describe societal cost- and utility estimates per modified Rankin Scale (mRS)-score at different time points within 2 years post stroke. METHODS Included patients had a stroke between 3 months and 2.5 years ago. mRS and EQ-5D-5L were scored during a telephone interview. Based on the interview date, records were categorized into a time point: 3 months (3M; 3-6 months), 1 year (Y1; 6-18 months), or 2 years (Y2; 18-30 months). Patients completed a questionnaire on healthcare utilization and productivity losses in the previous 3 months. Initial stroke hospitalization costs were assessed. Mean costs and utilities per mRS and time point were derived with multiple imputation nested in bootstrapping. Cost at 3 months post stroke were estimated separately for endovascular treatment (EVT)-/non-EVT-patients. RESULTS 1106 patients were included from 18 Dutch centers. At each time point, higher mRS-scores were associated with increasing average costs and decreasing average utility. Mean societal costs at 3M ranged from €11 943 (mRS 1, no EVT) to €55 957 (mRS 5, no EVT). For Y1, mean costs in the previous 3 months ranged from €885 (mRS 0) to €23 215 (mRS 5), and from €1655 (mRS 0) to €22 904 (mRS 5) for Y2. Mean utilities ranged from 0.07 to 0.96, depending on mRS and time point. CONCLUSIONS The mRS-score is a major determinant of costs and utilities at different post-stroke time points. Our estimates may be used to inform future model-based health economic evaluations.
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Affiliation(s)
- Florentina M E Pinckaers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | | | - Ilse Huijberts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | | | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
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Blough MJ, Rocha A, Bratberg J, Silcox J, Bolivar D, Floyd AS, Gray M, Green TC. The Cost of Safe Injection: Insights on Nonprescription Syringe Price Variability From Systematic Secret Shopping. Subst Use Addctn J 2024; 45:201-210. [PMID: 38258818 DOI: 10.1177/29767342231217831] [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] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Although the sale of nonprescription syringes in pharmacies is legal in most states, people who inject drugs (PWID) continue to face obstacles to syringe purchase like stigma, prohibitive costs, restrictive policies, and stocking issues. We examined the consistency of syringe pricing as another possible barrier. METHODS We analyzed data on syringe prices and other relevant variables from 153 unique secret shopper visits to 2 retail chain pharmacies in Massachusetts (MA), New Hampshire (NH), Oregon (OR), and Washington (WA) as part of the fidelity component of a large pharmacy-focused intervention study. Pretax prices from purchases made between August 2019 and May 2021 were adjusted for inflation to 2022 dollars, and a linear regression of the price of a 10-pack of syringes was constructed to examine the determinants of syringe pricing. RESULTS The average real price of a 10-pack of syringes across all states was $4.53 (SD = 0.99), with wide variability between pharmacies (max = $11.44, min = $1.70) and between states (mean OR = $5.76, WA = $4.74, MA = $4.33, NH = $4.30). Forty-seven percent (n = 72) of the purchases were taxed despite syringes being tax exempt in MA and WA, and not having a sales tax in NH or OR. The results of the regression suggest that certain needle gauges were associated with lower overall prices, while 1 pharmacy chain and 2 syringe brands were associated with higher overall prices. CONCLUSIONS The high variability in syringe pricing presents another barrier to pharmacy-based syringe access since high prices may leave PWID no choice but to reuse or share needles, especially in areas with limited alternatives or without a syringe service program. Leadership from healthcare systems, pharmacy chains, and state and local policymakers is essential to reduce stigma and to implement policies that streamline syringe purchases, eliminate the taxation of exempt syringes in accordance with state laws, and reduce the variation in syringe prices.
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Affiliation(s)
- Malcolm J Blough
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
| | - Amanda Rocha
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Joseph Silcox
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
- University of Massachusetts-Boston, Boston, MA, USA
| | - Derek Bolivar
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
| | - Anthony S Floyd
- University of Washington Addictions, Drug, and Alcohol Institute, Seattle, WA, USA
| | | | - Traci C Green
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
- COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI, USA
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Yang PF, Builth-Snoad L, Ng KS, Gu E, Errington B, McBride KE, Lee PJ. Optimizing theatre utilization for abscess drainage: going beyond priority categories. ANZ J Surg 2024; 94:648-654. [PMID: 38426392 DOI: 10.1111/ans.18919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Day-only emergency surgery for abscess drainage is poorly implemented in Australia. This study assessed the feasibility, outcomes, cost, and impact of an acute day-only surgery (ADOS) program. METHOD A retrospective pre-post implementation study of patients requiring abscess drainage in theatre was performed. Following implementation of an ADOS program for abscess management, eligible patients were discharged from the emergency department and prioritized first on the following day's emergency list. Outcomes from the first 12 months of the ADOS era were compared with those of the preceding 6 months (pre-ADOS). Primary outcome was length of hospital stay (LOS). Secondary outcomes included 30-day complications, admission costs, and impact on overall emergency theatre workflow (measured by emergency appendicectomy metrics). RESULTS Overall, 266 patients during the ADOS era (including 95 eligible for the ADOS pathway) were compared with 115 patients during the pre-ADOS era. Baseline characteristics were comparable. Median LOS was shorter during the ADOS era (21.9 h (IQR 11.8-43.3) vs. 30.1 h (IQR 24.7-48.8), P < 0.001). Median LOS was 10.2 h (IQR 8.9-13.1) for patients on the ADOS pathway. There were no significant differences in 30-day complications (9.3% vs. 9.5%), emergency department re-presentations (7.4% vs. 5.1%), or abscess recurrence (5.6% vs. 5.7%). Average cost per patient was lower during the ADOS era ($4155 vs. $4916, p = 0.005). ADOS did not appear to materially impact other emergency procedures. CONCLUSION ADOS for abscess drainage is feasible, safe, and produces cost savings, while being implemented without significant additional resources.
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Affiliation(s)
- Phillip F Yang
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- South West Sydney Clinical Campus, UNSW Sydney, New South Wales, Australia
| | - Lily Builth-Snoad
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Eva Gu
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Belinda Errington
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate E McBride
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter J Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Mortato E, Baratta S, Rubino L, De Caro AP, Loconsole F. Cost analysis in the management of moderate-to-severe psoriasis: comparison between conventional and biological systemic therapies. Dermatol Reports 2024; 16:9755. [PMID: 38623361 PMCID: PMC11017720 DOI: 10.4081/dr.2023.9755] [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: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 04/17/2024] Open
Abstract
Background. Psoriasis is a chronic inflammatory skin disease with an important socio-economic burden. Available therapies include conventional systemic drugs and biological drugs, such as Tumor Necrosis Factor (TNF)-α inhibitors, that are characterized by high costs. Aim. Perform a cost-estimation analysis of conventional treatment vs therapy with biosimilar TNF-α inhibitor between January 2021 and January 2022, according to the Apulia regional cost list. Methods. The average annual expenditure per patient on conventional treatment (cyclosporine and methotrexate) vs therapy with biosimilar TNF-α inhibitor was compared. The 'cost per responder' was determined by analyzing the percentages of 'responders' (patients achieving PASI 75 and PASI 90) and 'non-responders' (PASI <75) after one year of treatment. Results. The annual per capita expenditure with cyclosporin was €3,515.35, with methotrexate was €1,048.87, while for treatment with TNF-α biosimilar inhibitor drug was €3,030.11. The "cost per responder" analysis showed a value of €8,573 for cyclosporine, €2,834 for methotrexate, and €3,564 for TNF-α biosimilar inhibitor. Conclusions. Conventional drugs have a greater impact on healthcare expenditure than TNF-α biosimilar inhibitors.
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Affiliation(s)
| | | | | | | | - Francesco Loconsole
- Clinica Dermatologica Azienda Ospedaliera Universitaria Policlinico Consorziale Bari, Italy
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Averin A, Atwood M, Sato R, Yacisin K, Begier E, Shea K, Curcio D, Houde L, Weycker D. Attributable Cost of Adult Respiratory Syncytial Virus Illness Beyond the Acute Phase. Open Forum Infect Dis 2024; 11:ofae097. [PMID: 38486815 PMCID: PMC10939437 DOI: 10.1093/ofid/ofae097] [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: 11/17/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
Background Estimates of the cost of medically attended lower respiratory tract illness (LRTI) due to respiratory syncytial virus (RSV) in adults, especially beyond the acute phase, is limited. This study was undertaken to estimate the attributable costs of RSV-LRTI among US adults during, and up to 1 year after, the acute phase of illness. Methods A retrospective observational matched-cohort design and a US healthcare claims repository (2016-2019) were employed. The study population comprised adults aged ≥18 years with RSV-LRTI requiring hospitalization (RSV-H), an emergency department visit (RSV-ED), or physician office/hospital outpatient visit (RSV-PO/HO), as well as matched comparison patients. All-cause healthcare expenditures were tallied during the acute phase of illness (RSV-H: from admission through 30 days postdischarge; ambulatory RSV: during the episode) and long-term phase (end of acute phase to end of following 1-year period). Results The study population included 4526 matched pairs of RSV-LRTI and comparison patients (RSV-H: n = 970; RSV-ED: n = 590; RSV-PO/HO: n = 2966). Mean acute-phase expenditures were $42 179 for RSV-H (vs $5154 for comparison patients), $4409 for RSV-ED (vs $377), and $922 for RSV-PO/HO (vs $201). By the end of the 1-year follow-up period, mean expenditures-including acute and long-term phases-were $101 532 for RSV-H (vs $36 302), $48 701 for RSV-ED (vs $27 131), and $28 851 for RSV-PO/HO (vs $20 523); overall RSV-LRTI attributable expenditures thus totaled $65 230, $21 570, and $8327, respectively. Conclusions The cost of RSV-LRTI requiring hospitalization or ambulatory care among US adults is substantial, and the economic impact of RSV-LTRI may extend well beyond the acute phase of illness.
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Affiliation(s)
| | - Mark Atwood
- Policy Analysis Inc, Boston, Massachusetts, USA
| | - Reiko Sato
- Pfizer Inc, Collegeville, Pennsylvania, USA
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Shah E, Eswaran S, Harer K, Lee A, Nojkov B, Singh P, Chey WD. Percutaneous electrical nerve field stimulation for adolescents with irritable bowel syndrome: Cost-benefit and cost-minimization analysis. J Pediatr Gastroenterol Nutr 2024; 78:608-613. [PMID: 38284690 PMCID: PMC10954403 DOI: 10.1002/jpn3.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 01/30/2024]
Abstract
Abdominal pain drives significant cost for adolescents with irritable bowel syndrome (IBS). We performed an economic analysis to estimate cost-savings for patients' families and healthcare insurance, and health outcomes, based on abdominal pain improvement with percutaneous electrical nerve field stimulation (PENFS) with IB-Stim® (Neuraxis). We constructed a Markov model with a 1-year time horizon comparing outcomes and costs with PENFS versus usual care without PENFS. Clinical outcomes were derived from a sham-controlled double-blind trial of PENFS for adolescents with IBS. Costs/work-productivity impact for parents were derived from appropriate observational cohorts. PENFS was associated with 18 added healthy days over 1 year of follow-up, increased annual parental wages of $5,802 due to fewer missed work days to care for the child, and $4744 in cost-savings to insurance. Percutaneous electrical field nerve stimulation for adolescents with IBS appears to yield significant cost-savings to patients' families and insurance.
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Affiliation(s)
- Eric Shah
- Michigan Medicine, Ann Arbor, Michigan, USA
| | | | | | - Allen Lee
- Michigan Medicine, Ann Arbor, Michigan, USA
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Ditonno F, Franco A, Manfredi C, Sturgis M, Vourganti S, Cherullo EE, De Sio M, Porpiglia F, De Nunzio C, Antonelli A, Olweny E, Autorino R. Minimally Invasive Adrenalectomy: A Population-Based Analysis of Contemporary Trends, Outcomes, Costs, and Impact of Social Determinants of Health. Urol Pract 2024; 11:293-302. [PMID: 38305188 DOI: 10.1097/upj.0000000000000505] [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: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION We sought to analyze temporal trends in the utilization of minimally invasive vs open adrenalectomy in the United States; to assess costs, perioperative outcomes, and the determining factors influencing these variables. METHODS A retrospective analysis of claims data obtained from PearlDiver Mariner, a Health Insurance Portability and Accountability Act-compliant deidentified nationwide database of insurance billing records, was performed. Per-population utilization rates and trends were analyzed using negative binomial regression and trends tests respectively. Continuous and categorical variables were compared using 2-sided t tests and χ2 tests. Multivariable logistic regression analysis was conducted to identify predictors of perioperative complication. RESULTS A total of 10,753 patients were identified (mean age 53.3 ± 16.1 years). Using the 2011 to 2014 time frame as reference, utilization of adrenalectomy decreased over time (incidence rate ratio for 2015-2018: 0.65 [95% CI 0.62-0.68, P < .001]; incidence rate ratio for 2019-2021: 0.39 [95% CI 0.37-0.41, P < .001]). Minimally invasive adrenalectomies increased significantly over time (P < .001). A greater number of adrenalectomies were performed by general surgeons compared with urologists (70.4% vs 29.5%). Complications were not significantly predicted by any surgical specialty. Significant predictors for complication rates were Charlson comorbidity index > 1 (odds ratio [OR] 1.11, 95% CI 1.09-1.13), presence of social determinants of health (OR 1.5, 95% CI 1.18-1.88) and open approach (OR 1.54, 95% CI 1.34-1.77). CONCLUSIONS The number of adrenalectomies in the United States decreased over the past decade, with a shift towards minimally invasive approach. No difference in outcomes for general surgeons vs urologists can be observed. Social determinants of health are independent predictors of increased rate of complications.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, Illinois
- Department of Urology, University of Verona, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, Illinois
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, Illinois
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, Naples, Italy
| | - Morgan Sturgis
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Srinivas Vourganti
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, Naples, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | | | - Ephrem Olweny
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, Illinois
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Ida FS, Ferreira HP, Vasconcelos AKM, Furtado IAB, Fontenele CJPM, Pereira AC. Post-COVID-19 syndrome: persistent symptoms, functional impact, quality of life, return to work, and indirect costs - a prospective case study 12 months after COVID-19 infection. CAD SAUDE PUBLICA 2024; 40:e00022623. [PMID: 38381867 PMCID: PMC10877695 DOI: 10.1590/0102-311xpt026623] [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: 02/13/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 02/23/2024] Open
Abstract
The persistent symptoms of post-COVID-19 syndrome negatively impact health, quality of life, and productivity. This study aimed to describe the persistent symptoms of post-COVID-19 syndrome (especially neurological ones) and their 12-month post-infection cognitive, emotional, motor, quality of life, and indirect cost repercussions. Patients showing the first symptoms of COVID-19 from January to June 2021 who developed post-COVID-19 syndrome and sought care at the Fortaleza Unit (Ceará, Brazil) of the SARAH Network of Rehabilitation Hospitals were included in this study. Information was obtained at the baseline follow-up and by telephone interview 12 months post-infection. In total, 58 people participated in this study with an average age of 52.8±10.5 years, of which 60% required an ICU. The most frequent symptoms on admission included fatigue (64%), arthralgia (51%), and dyspnea (47%), whereas, after 12 months, fatigue (46%) and memory impairment (39%). The following scales/functional tests showed alterations: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, 6-minute walk, and handgrip. Indirect costs totaled USD 227,821.00, with 11,653 days of absenteeism. Moreover, 32% of patients were unable to return to work. Better TLS5x and higher SF-36 scores in the functional capacity, physical functioning, vitality, and pain dimensions were associated with return to work (p ≤ 0.05). The most frequent persistent symptoms referred to fatigue, arthralgia, dyspnea, anxiety, and depression, which negatively affected cognitive, emotional, and motor function and quality of life. These symptoms lasted for over a year, especially fatigue and memory alteration, the latter of which being the most reported after COVID-19 infections. Results also show a significant difficulty returning to work and indirect costs of USD 4,847.25 per person/year.
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Affiliation(s)
- Fernando Shizuo Ida
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | - Hebert Pereira Ferreira
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | | | - Iris Aline Brito Furtado
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | | | - Antonio Carlos Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, Brasil
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Terry PH, Campbell CA, Black JS, Stranix JT, Forster GL, DeGeorge BR. The Cost of Ambulatory Breast Reduction: Hospital Reimbursement Versus Surgeon Payments. Plast Surg (Oakv) 2024; 32:11-18. [PMID: 38433808 PMCID: PMC10902483 DOI: 10.1177/22925503221078716] [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: 03/05/2024] Open
Abstract
Introduction: Reduction mammoplasty (RM) is one of the most common operations performed in plastic surgery. While US national surgical expenditures have risen in recent years, studies have reported decreasing reimbursement rates for plastic surgeons. The purpose of this study is to characterize the trends in charges and payments for a common plastic surgery operation, ambulatory RM, for facilities and physicians. Methods: A Medicare patient records database was used to capture hospital, surgeon, and anesthesiologist charges and payments for ambulatory RM from 2005 to 2014. Values were adjusted for inflation. A ratio of hospital to surgeon charges and payments were calculated: charge multiplier (CM) and payment multiplier (PM), respectively. Charges, payments, Charlson comorbidity index, CM, and PM values were analyzed for trends. Results: This study included 1001 patients. During the study period, the facility charge for RM per patient increased from $8477 to $11,102 (31% increase; p < .0005), and the surgeon charge increased from $7088 to $7199 (2% increase; p = .0009). Facility payments increased from $3661 to $3930 (7% increase; p < .0005), and surgeon payments decreased from $1178 to $1002 (15% decrease; p < .0005). CM increased from 1.2 to 1.54, and PM increased from 3.11 to 3.92. Conclusions: Charges and payments to facilities for ambulatory RM increased disproportionately to that of surgeons, likely due in part to rising administrative costs in health care delivery. This may disincentivize plastic surgeons from offering RM at hospital-based surgical centers, limiting patient access to this operation.
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Affiliation(s)
- Peyton H. Terry
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Christopher A. Campbell
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jonathan S. Black
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - John T. Stranix
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Grace L. Forster
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brent R. DeGeorge
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA, USA
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Williams TJ, Moy N, Kaazan P, Callaghan G, Holtmann G, Martin N. Cost-effectiveness of taurolidine-citrate in a cohort of patients with intestinal failure receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 2024; 48:165-173. [PMID: 38062902 DOI: 10.1002/jpen.2589] [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: 03/11/2023] [Revised: 10/05/2023] [Accepted: 12/05/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) in patients receiving home parenteral nutrition (HPN) for chronic intestinal failure (CIF) are associated with significant morbidity and financial costs. Taurolidine is associated with a reduction in bloodstream infections, with limited information on the cost-effectiveness as the primary prevention. This study aimed to determine the cost-effectiveness of using taurolidine-citrate for the primary prevention of CRBSIs within a quaternary hospital. METHODS All patients with CIF receiving HPN were identified between January 2015 and November 2022. Data were retrospectively collected regarding patient demographics, HPN use, CRBSI diagnosis, and use of taurolidine-citrate. The direct costs associated with CRBSI-associated admissions and taurolidine-citrate use were obtained from the coding department using a bottom-up approach. An incremental cost-effective analysis was performed, with a time horizon of 4 years, to compare the costs associated with primary and secondary prevention against the outcome of cost per infection avoided. RESULTS Forty-four patients received HPN within this period. The CRBSI rates were 3.25 infections per 1000 catheter days before the use of taurolidine-citrate and 0.35 infections per 1000 catheter days after taurolidine-citrate use. The incremental cost-effectiveness ratio indicates primary prevention is the weakly dominant intervention, with the base case value of $27.04 per CRBSI avoided. This held with one-way sensitivity analysis. CONCLUSION Taurolidine-citrate in the primary prevention of CRBSIs in patients with CIF receiving HPN is associated with reduced hospital costs and infection rates.
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Affiliation(s)
- Thomas J Williams
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Naomi Moy
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Patricia Kaazan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gavin Callaghan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Neal Martin
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
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Ellen M, Correia L, Levinson W. Choosing wisely 10 years later: reflection and looking ahead. BMJ Evid Based Med 2024; 29:10-13. [PMID: 37479242 DOI: 10.1136/bmjebm-2023-112266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Luis Correia
- Department of Internal Medicine, Center for Evidence-Based Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Wendy Levinson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Smith NR, Levy DE. Budget impact analysis for implementation decision making, planning, and financing. Transl Behav Med 2024; 14:54-59. [PMID: 37776567 DOI: 10.1093/tbm/ibad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023] Open
Abstract
Shelley et al. (in Accelerating integration of tobacco use treatment in the context of lung cancer screening: relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022;12:1076-1083) laid out how implementation science frameworks and methods can advance the delivery of tobacco use treatment services during lung cancer screening services, which until recently was mandated by the Centers for Medicare and Medicaid Services. Their discussion provides an important overview of the full process of implementation and highlights the vast number of decisions that must be made when planning for implementation of an evidence-based practice such as tobacco use treatment: what specific tobacco use treatment services to deliver, when to deliver those services within the lung cancer screening process, and what implementation strategies to use. The costs of implementation play a major role in decision making and are a key implementation determinant discussed in major implementation frameworks. When making decisions about what and how to implement, budget impact analyses (BIAs) can play an important role in informing decision making by helping practitioners understand the overall affordability of a given implementation effort. BIAs can also inform the development of financing strategies to support the ongoing sustainment of tobacco use treatment service provision. More attention is needed by the research community to produce high-quality, user-friendly, and flexible BIAs to inform implementation decision making in health system and community settings. The application of BIA can help ensure that the considerable time and effort spent to develop and evaluate evidence-based programs has the best chance to inform implementation practice.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Lin T, Zarate DA, Iribarren N, Lindau H, Ramos-Gomez F, Gansky S. Quality-Adjusted Life Year Proxies for Caries in Primary Dentition: A Discrete Choice Experiment. JDR Clin Trans Res 2024; 9:85-94. [PMID: 36789915 PMCID: PMC10850881 DOI: 10.1177/23800844221149337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Cost-utility analysis (CUA)-a method to evaluate intervention cost-effectiveness-transforms benefits of alternatives into a measure of quantity and quality of life, such as quality-adjusted life year (QALY), to enable comparison across heterogeneous programs. Measurement challenges prevent directly estimating utilities and calculating QALYs for caries in primary dentition. Proxy disease QALYs are often used as a substitute; however, there lacks quantitative evidence that these proxy diseases are comparable to caries. OBJECTIVE To employ a discrete choice experiment (DCE) to quantitatively determine the most comparable proxy disease for different levels of caries in primary dentition. METHODS A cross-sectional DCE survey was administered to respondents (N = 461) who resided in California, were aged ≥18 y, and were primary caretakers for ≥1 child aged 3 to 12 y. Four attributes were included: pain level, disease duration, treatment cost, and family life impacts. Mixed effects logistic regression and conditional logistic regression were used to analyze the survey data. RESULTS Respondents from the overall sample preferred no pain over mild (odds ratio [OR] = 0.50, P < 0.05), moderate (OR = 0.57, P < 0.05), and severe pain (OR = 0.48, P < 0.05). Acute gastritis (OR = 0.44, P < 0.05), chronic gastritis (OR = 0.31, P < 0.01), and cold sore (OR = 0.38, P < 0.05) were less preferred than stage 1 caries. Acute tonsilitis (OR = 0.43, P < 0.05), acute gastritis (OR = 0.38, P < 0.05), chronic gastritis (OR = 0.26, P < 0.01), and cold sore (OR = 0.33, P < 0.01) were less preferred than stage 2 caries. Chronic gastritis (OR = 0.42,P < 0.05) was less preferred than stage 4 caries. CONCLUSIONS Parents viewed the characteristics of many diseases with similar QALYs differently. Findings suggest that otitis media and its QALY-as commonly used in CUAs-may be a suitable proxy disease and substitute. However, other disease states with slightly different QALYs may be suitable. As such, the recommendation is to consider a range of proxy diseases and their QALYs when conducting a CUA for child caries interventions. KNOWLEDGE TRANSFER STATEMENT This study reviews and systematically compares pediatric diseases that are comparable to caries in primary dentition. The findings may inform future research using cost-utility analysis to examine the incremental cost-effectiveness ratio of interventions to prevent and treat caries as compared with an alternative.
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Affiliation(s)
- T.K. Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Center to Address Disparities in Children’s Oral Health, Department of Preventive Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - D.E. Arriola Zarate
- School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - N. Iribarren
- Center to Address Disparities in Children’s Oral Health, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - H. Lindau
- School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
- Center to Address Disparities in Children’s Oral Health, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - F. Ramos-Gomez
- School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
- Center to Address Disparities in Children’s Oral Health, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - S.A. Gansky
- Center to Address Disparities in Children’s Oral Health, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
- Center to Address Disparities in Children’s Oral Health, Department of Preventive Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
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Sakano T, Anzai T, Takahashi K, Fukui S. Impact of home-visit nursing service use on costs in the last 3 months of life among older adults: A retrospective cohort study. J Nurs Scholarsh 2024; 56:191-201. [PMID: 37642168 DOI: 10.1111/jnu.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home-visit nursing services at the end of life for community-dwelling older adults. We examined the use of home-visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long-term care costs (total costs) in the last 3 months of life. DESIGN This was a retrospective cohort study. METHODS We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long-term care insurance claims data. Participants were classified into five groups based on their history of home-visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not-early initiation/continuous use, (4) not-early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home-visit nursing service use. RESULTS Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home-visit nursing services. Multivariable linear regression analysis of the log10-transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). CONCLUSION Early initiation use of home-visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. CLINICAL RELEVANCE When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end-of-life care for community-dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home-visit nursing services, they provide a perspective from which to assess the use of home-visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home-care settings for older adults who prefer to spend their final days at home.
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Affiliation(s)
- Tomomi Sakano
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sakiko Fukui
- Department of Home and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Zafari A, Mehdizadeh P, Bahadori M, Dopeykar N, Teymourzadeh E, Ravangard R. Estimating the Costs of End-of-Life Care in Patients With Advanced Cancer From the Perspective of an Insurance Organization: A Cross-Sectional Study in Iran. Value Health Reg Issues 2023; 41:7-14. [PMID: 38154367 DOI: 10.1016/j.vhri.2023.11.006] [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: 06/07/2023] [Revised: 09/28/2023] [Accepted: 02/28/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES Cancers are significant medical conditions that contribute to the rising costs of healthcare systems and chronic diseases. This study aimed to estimate the average costs of medical services provided to patients with advanced cancers at the end of life (EOL). METHODS We analyzed data from the Sata insurance claim database and the Health Information System of Baqiyatallah hospital in Iran. The study included all adult decedents who had advanced cancer without comorbidities, died between March 2020 and September 2020, and had a history of hospitalization in the hospital. We calculated the average total cost of healthcare services per patient during the EOL period, including both cancer-related and noncancer-related costs. RESULTS A total of 220 patients met the inclusion criteria. The average duration of the EOL period for these patients was 178 days, with an average total cost of $8278 (SD $5698) for men and $9396 (SD $6593) for women. Cancer-related costs accounted for 64.42% of the total costs, including inpatient and outpatient services. Among these costs, hospitalization was the primary cost driver and had the greatest impact on EOL costs. This observation was supported by the multiple linear regression model, which suggested that hospitalization in the final days of life could potentially drive costs in these patients. Notably, no specialized palliative care was provided to the patients included in this study. CONCLUSIONS The results demonstrate that there is a significant rise in costs of care in patients receiving routine cancer care rather than optimized EOL care.
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Affiliation(s)
- Ali Zafari
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Iran, Tehran Province, Tehran
| | - Parisa Mehdizadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Iran, Tehran Province, Tehran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Iran, Tehran Province, Tehran.
| | - Nooredin Dopeykar
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Iran, Tehran Province, Tehran
| | - Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Iran, Tehran Province, Tehran
| | - Ramin Ravangard
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Iran, Fars Province, Shiraz
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Averin A, Law A, Shea K, Atwood M, Munjal I, Weycker D. Episodic Cost of Lower Respiratory Tract Illness Due to Respiratory Syncytial Virus Among US Infants During the First Year of Life. J Infect Dis 2023:jiad598. [PMID: 38133638 DOI: 10.1093/infdis/jiad598] [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: 08/25/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
A study using two healthcare claims databases (commercial, Medicaid) was undertaken to estimate episodic cost of lower respiratory tract illness due to respiratory syncytial virus (RSV-LRTI) among infants aged <12 months overall, by age, and by birth gestational age (weeks [wGA]). Among commercial-insured infants, mean costs were $28,812 for hospitalized episodes, $2,575 for emergency department episodes, and $336 for outpatient clinic episodes; costs were highest among infants aged <1 month and infants with wGA ≤32, and were comparable-albeit somewhat lower-among Medicaid-insured infants. Cost of RSV-LRTI during acute phase of illness is high, especially among youngest and premature infants.
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Affiliation(s)
| | - Amy Law
- Pfizer Inc., Collegeville, PA, USA
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Jureidini R, Namur GN, Ribeiro TC, Bacchella T, Stolzemburg L, Jukemura J, Ribeiro Junior U, Cecconello I. ROBOTIC ASSISTED VERSUS LAPAROSCOPIC DISTAL PANCREATECTOMY: A RETROSPECTIVE STUDY. Arq Bras Cir Dig 2023; 36:e1783. [PMID: 38088728 PMCID: PMC10712921 DOI: 10.1590/0102-672020230065e1783] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP) is associated with less blood loss and faster functional recovery. However, the benefits of robotic assisted distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) are unknown. AIMS To compare RDP versus LDP for surgical treatment of benign lesions, pre-malignant and borderline malignant pancreatic neoplasias. METHODS This is a retrospective study comparing LDP with RDP. Main outcomes were overall morbidity and overall costs. Secondary outcomes were pancreatic fistula (PF), infectious complications, readmission, operative time (OT) and length of hospital stay (LOS). RESULTS Thirty patients submitted to LDP and 29 submitted to RDP were included in the study. There was no difference regarding preoperative characteristics. There was no difference regarding overall complications (RDP - 72,4% versus LDP - 80%, p=0,49). Costs were superior for patients submitted to RDP (RDP=US$ 6,688 versus LDP=US$ 6,149, p=0,02), mostly due to higher costs of surgical materials (RDP=US$ 2,364 versus LDP=1,421, p=0,00005). Twenty-one patients submitted to RDP and 24 to LDP developed pancreatic fistula (PF), but only 4 RDP and 7 LDP experienced infectious complications associated with PF. OT (RDP=224 min. versus LDP=213 min., p=0.36) was similar, as well as conversion to open procedure (1 RDP and 2 LDP). CONCLUSIONS The postoperative morbidity of robotic distal pancreatectomy is comparable to laparoscopic distal pancreatectomy. However, the costs of robotic distal pancreatectomy are slightly higher.
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Affiliation(s)
- Ricardo Jureidini
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Guilherme Naccache Namur
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Thiago Costa Ribeiro
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Telesforo Bacchella
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Lucas Stolzemburg
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - José Jukemura
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ulysses Ribeiro Junior
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ivan Cecconello
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
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Lopes SG, Poveda VDB. Model proposal for calculating waste associated with processing consigned surgical instruments. Rev Lat Am Enfermagem 2023; 31:e4061. [PMID: 38055587 PMCID: PMC10695286 DOI: 10.1590/1518-8345.6716.4061] [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: 02/23/2023] [Accepted: 08/31/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to evaluate the waste generated from processing surgical instruments consigned in elective orthopedic surgeries and propose a model for calculating waste associated with processing consigned surgical instruments. METHOD a quantitative, descriptive-exploratory case study carried out in a large university hospital in two phases: (1) retrospective by consulting administrative records of canceled elective orthopedic surgeries, with provision for the use of consigned materials for identification of the sub-specializations with the greatest demand; and (2) prospective through direct, non-participant observations of processing consigned surgical instruments prepared for the identified surgeries and proposition of a model for calculating waste associated with processing these materials. RESULTS hip arthroplasty, spine arthrodesis and knee arthroplasty surgeries were identified as presenting the greatest demand, resulting in 854 boxes of consigned surgical instruments processed and unused. Processing waste was estimated at R$34,340.18 (US$6,359.30). CONCLUSION the proposed equation made it possible to calculate the waste related to the production and non-use of boxes of surgical instruments consigned for orthopedic procedures and can equip nurses for planning based on institutional, care and financial data, aiming to make better use of resources through waste identification.
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Affiliation(s)
- Simone Garcia Lopes
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Centro Universitário Faculdade de Medicina do ABC, Faculdade de Enfermagem, Santo André, SP, Brasil
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Kerver N, Karssies E, Krabbe PFM, van der Sluis CK, Groen H. Economic evaluation of upper limb prostheses in the Netherlands including the cost-effectiveness of multi-grip versus standard myoelectric hand prostheses. Disabil Rehabil 2023; 45:4311-4321. [PMID: 36533430 PMCID: PMC10721225 DOI: 10.1080/09638288.2022.2151653] [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: 04/29/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the costs, quality of life, and user experiences associated with upper limb prosthesis use, and to evaluate the cost-effectiveness of multi-grip compared to standard myoelectric hand prostheses (MHPs/SHPs). MATERIALS AND METHODS The EQ-5D-5L to assess the quality of life, the patient-reported outcome measure to assess the preferred usage features of upper limb prosthesis (PUF-ULP), and a cost questionnaire (societal perspective) were completed by 242 prosthesis users (57% men; mean age = 58 years). Incremental cost-utility and cost-effectiveness ratios (ICUR/ICER) with respectively the EQ-5D-5L and PUF-ULP were calculated to compare MHPs with SHPs. Statistical uncertainty was estimated using bootstrapping. Netherlands Trial Registry number: NL7682. RESULTS The mean yearly total costs related to prosthesis use of MHPs (€54 112) and SHPs (€23 501) were higher compared to prostheses with tools/accessories (€11 977), body-powered (€11 298), and cosmetic/passive prostheses (€10 132). EQ-5D-5L and PUF-ULP scores did not differ between prosthesis types. ICUR was €-728 833 per quality-adjusted life year; ICER was €-187 798 per PUF-ULP point gained. CONCLUSIONS Myoelectric prostheses, especially MHPs, were most expensive compared to other prostheses, while no differences in quality of life and user experiences were apparent. MHPs were not cost-effective compared to SHPs. When prescribing MHPs, careful consideration of advantages over SHPs is recommended.
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Affiliation(s)
- Nienke Kerver
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise Karssies
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul F. M. Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K. van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Cheng E, Gereta S, Zhang TR, Zhu A, Basourakos SP, McKernan C, Xie S, Vickers AJ, Laviana AA, Hu JC. Same-Day Discharge vs Inpatient Robotic-Assisted Radical Prostatectomy: Complications, Time-Driven Activity-Based Costing, and Patient Satisfaction. J Urol 2023; 210:856-864. [PMID: 37639456 PMCID: PMC10840655 DOI: 10.1097/ju.0000000000003678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Historically, robotic-assisted radical prostatectomy is accompanied by an inpatient hospital admission. The COVID-19 pandemic necessitated a transition to same-day discharge robotic-assisted radical prostatectomy in some centers to free up critically needed inpatient beds. This study aims to compare complications, total health care costs, and patient satisfaction for same-day discharge vs inpatient robotic-assisted radical prostatectomy. MATERIALS AND METHODS We compared 392 consecutive robotic-assisted radical prostatectomies performed as same-day discharge (n = 206) vs inpatient (n = 186) from February 2020 to November 2022 at 2 academic medical centers. We utilized propensity score analysis to assess the impact of same-day discharge vs inpatient robotic-assisted radical prostatectomy on 30-day complications (primary outcome). Time-driven activity-based costing analysis was applied to compare total costs of robotic-assisted radical prostatectomy care, and we administered a validated Patient Satisfaction Outcome Questionnaire to compare satisfaction scores. RESULTS Inpatient robotic-assisted radical prostatectomy patients were more likely to be older, self-reported Black race or Hispanic ethnicity, and have higher American Society of Anesthesiologists classification. Complication rates were nonsignificantly lower for same-day discharge vs inpatient robotic-assisted radical prostatectomy (OR 0.87, 95% CI 0.35 to 2.21; P = .8). Same-day discharge vs inpatient robotic-assisted radical prostatectomy demonstrated a $2106 (19%) overall cost reduction. Median satisfaction survey scores were similar, and a clinically significant difference can be excluded. CONCLUSIONS Same-day discharge robotic-assisted radical prostatectomy is cost-effective and should be the preferred approach in appropriately selected patients.
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Affiliation(s)
- Emily Cheng
- Department of Urology, New York Presbyterian Hospital,
Weill Cornell Medicine, New York, NY, USA
| | - Sofia Gereta
- Department of Surgery & Perioperative Care, University
of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Tenny R. Zhang
- Department of Urology, New York Presbyterian Hospital,
Weill Cornell Medicine, New York, NY, USA
| | - Alec Zhu
- Department of Urology, New York Presbyterian Hospital,
Weill Cornell Medicine, New York, NY, USA
| | - Spyridon P. Basourakos
- Department of Urology, New York Presbyterian Hospital,
Weill Cornell Medicine, New York, NY, USA
| | - Chunmei McKernan
- Department of Urology, New York Presbyterian Hospital,
Weill Cornell Medicine, New York, NY, USA
| | - Siwen Xie
- Department of Urology, New York Presbyterian Hospital,
Weill Cornell Medicine, New York, NY, USA
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial
Sloan Kettering Cancer Center, New York, NY
| | - Aaron A. Laviana
- Department of Surgery & Perioperative Care, University
of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Jim C. Hu
- Department of Urology, New York Presbyterian Hospital,
Weill Cornell Medicine, New York, NY, USA
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da Silva PAL, Lima AFC. Direct costs of treating men with prostate cancer with High Intensity Focused Ultrasound. Rev Esc Enferm USP 2023; 57:e20230132. [PMID: 38009909 PMCID: PMC10680442 DOI: 10.1590/1980-220x-reeusp-2023-0132en] [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: 04/26/2023] [Accepted: 09/26/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To analyze the direct costs of materials, medicines/solutions and healthcare professionals required to treat men with prostate cancer using High Intensity Focused Ultrasound. METHOD Quantitative, exploratory-descriptive research, single case study type. Data were collected from electronic medical records/printed documentation from the Operating Room of a public teaching and research hospital. Health professionals estimated the respective time spent on activities in the following stages: "Before anesthetic induction", "Before performing thermal ablation", "During thermal ablation" and "After performing thermal ablation". Costs were calculated by multiplying the (estimated) time spent by the unit cost of direct labor, adding to the measured cost of materials, medicines/solutions. RESULTS The measured costs with materials corresponded to US$851.58 (SD = 2.17), with medicines/solutions to US$72.13 (SD = 25.84), and estimated personnel costs to US$196.03, totaling US$1119.74/procedure. CONCLUSION The economic results obtained may support hospital managers in the decision-making process regarding the adoption of the High Intensity Focused Ultrasound for the treatment of prostate cancer.
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Affiliation(s)
- Pâmela Adalgisa Lopes da Silva
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Gerenciamento em Enfermagem, São Paulo, SP, Brazil
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Romero M, Díaz A, Sánchez K, Amaya S, Godoy F, Rodríguez D. Application of the ASCO value framework to evaluate the clinical and economic value of enzalutamide and apalutamide in the early stages of prostate cancer in Colombia. Ecancermedicalscience 2023; 17:1614. [PMID: 38414970 PMCID: PMC10898893 DOI: 10.3332/ecancer.2023.1614] [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: 04/10/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction Prostate cancer has increased in recent years, increasing the costs associated with its treatment. Second-generation oral antiandrogens have emerged as an attractive therapeutic option. Objective To compare the health value provided by enzalutamide and apalutamide, by evaluating two stages of prostate cancer: non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC). Methods To establish, through the American Society of Clinical Oncology (ASCO) value framework, a contrast between two technologies in two stages of prostate cancer. The monthly cost of the two technologies was calculated according to the current price regulation norm in Colombia. Results Enzalutamide showed a higher net health benefit score compared to apalutamide for both nmCRPC (48.33 versus 33.46) and mHSPC (52.0 versus 40.75). The cost per net health benefit point for the nmCRPC stage was $214,723 Colombian Pesos (COP) ($54.84 USD) with enzalutamide compared to $291,925 COP ($74.56 USD) with apalutamide, and for the mHSPC stage was $199,692 COP ($51.00 USD) with enzalutamide and $239,701 COP ($61.22 USD) with apalutamide. Conclusion After comparing enzalutamide versus apalutamide in the nmCRPC and mHSPC stages through the ASCO value framework, enzalutamide showed a more prominent net clinical benefit and a lower investment per point awarded.
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Affiliation(s)
- Martín Romero
- Grupo Proyectame S.A.S. Bogotá, D.C. 111121, Colombia
- https://orcid.org/0000-0001-6158-6090
| | - Andrea Díaz
- Grupo Proyectame S.A.S. Bogotá, D.C. 111121, Colombia
- https://orcid.org/0000-0002-4007-1976
| | - Karen Sánchez
- Grupo Proyectame S.A.S. Bogotá, D.C. 111121, Colombia
- https://orcid.org/0000-0002-1469-9655
| | - Sandra Amaya
- Astellas Farma Bogotá, D.C. 111121, Colombia
- https://orcid.org/0000-0003-3524-2889
| | - Fabián Godoy
- Instituto Nacional de Cancerología E.S.E Bogotá, D.C. 111121, Colombia
- https://orcid.org/0000-0002-4814-5255
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Peterson C, Xu L, Grosse SD, Florence C. Professional Fees for U.S. Hospital Care, 2016-2020. Med Care 2023; 61:644-650. [PMID: 37943519 PMCID: PMC10653007 DOI: 10.1097/mlr.0000000000001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND The latest comprehensive diagnosis-specific estimates of hospital professional fees relative to facility fees are from 2004 to 2012. OBJECTIVE Update professional fee ratio (PFR) estimates to improve cost analysis opportunities with hospital discharge data sources and compare them with previous PFR estimates. SUBJECTS 2016-2020 MarketScan inpatient admissions and emergency department (ED) treat and release claims. MEASURES PFR was calculated as total admission or ED visit payment divided by facility-only payment. This measure can be multiplied by hospital facility costs to yield a total cost estimate. RESEARCH DESIGN Generalized linear regression models controlling for selected patient and service characteristics were used to calculate adjusted mean PFR per admission or ED visit by health payer type (commercial or Medicaid) and by selected diagnostic categories representing all clinical diagnoses (Major Diagnostic Category, Diagnostic Related Group, and Clinical Classification Software Revised). RESULTS Mean 2016-2020 PFR was 1.224 for admissions with commercial payers (n = 6.7 million admissions) and 1.178 for Medicaid (n = 4.2 million), indicating professional payments on average increased total payments by 22.4% and 17.8%, respectively, above facility-only payments. This is a 9% and 3% decline in PFR, respectively, compared with 2004 estimates. PFR for ED visits during 2016-2020 was 1.283 for commercial payers (n = 22.2 million visits) and 1.415 for Medicaid (n = 17.7 million). This is a 12% and 5% decline in PFR, respectively, compared with 2004 estimates. CONCLUSIONS Professional fees comprise a declining proportion of hospital-based care costs. Adjustments for professional fees are recommended when hospital facility-only financial data are used to estimate hospital care costs.
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Affiliation(s)
- Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
| | - Likang Xu
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Curtis Florence
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Projections of costs and quality adjusted life years lost due to dementia from 2020 to 2050: A population-based microsimulation study. Alzheimers Dement 2023; 19:4532-4541. [PMID: 36916447 DOI: 10.1002/alz.13019] [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: 10/04/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Efficient healthcare planning requires reliable projections of the future increase in costs and quality-adjusted life years (QALYs) lost due to dementia. METHODS We used the microsimulation model MISCAN-Dementia to simulate life histories and dementia occurrence using population-based Rotterdam Study data and nationwide birth cohort demographics. We estimated costs and QALYs lost in the Netherlands from 2020 to 2050, incorporating literature estimates of cost and utility for patients and caregivers by dementia severity and care setting. RESULTS Societal costs and QALYs lost due to dementia are estimated to double between 2020 and 2050. Costs are incurred predominantly through institutional (34%), formal home (31%), and informal home care (20%). Lost QALYs are mostly due to shortened life expectancy (67%) and, to a lesser extent, quality of life with severe dementia (14%). DISCUSSION To limit healthcare costs and quality of life losses due to dementia, interventions are needed that slow symptom progression and reduce care dependency.
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Affiliation(s)
- Chiara C Brück
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Center, Erasmus MC, Rotterdam, The Netherlands
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Albert GP, McHugh DC, Hwang DY, Creutzfeldt CJ, Holloway RG, George BP. National Cost Estimates of Invasive Mechanical Ventilation and Tracheostomy in Acute Stroke, 2008-2017. Stroke 2023; 54:2602-2612. [PMID: 37706340 DOI: 10.1161/strokeaha.123.043176] [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] [Received: 03/09/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Patients with stroke receiving invasive mechanical ventilation (IMV) and tracheostomy incur intense treatment and long hospitalizations. We aimed to evaluate US hospitalization costs for patients with stroke requiring IMV, tracheostomy, or no ventilation. METHODS We performed a retrospective observational study of US hospitalizations for acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage receiving IMV, tracheostomy, or none using the National Inpatient Sample, 2008 to 2017. We calculated hospitalization costs using cost-to-charge ratios adjusted to 2017 US dollars for inpatients with stroke by ventilation status (no IMV, IMV alone, tracheostomy). RESULTS Of an estimated 5.2 million (95% CI, 5.1-5.3) acute stroke hospitalizations, 2008 to 2017; 9.4% received IMV alone and 1.4% received tracheostomy. Length of stay for patients without IMV was shorter (median, 4 days; interquartile range [IQR], 2-6) compared with IMV alone (median, 6 days; [IQR, 2-13]), and tracheostomy (median, 25 days; [IQR, 18-36]; P<0.001). Mortality for patients without IMV was 3.2% compared with 51.2% for IMV alone and 9.8% for tracheostomy (P<0.001). Median hospitalization costs for patients without IMV was $9503 (IQR, $6544-$14 963), compared with $23 774 (IQR, $10 900-$47 735) for IMV alone and $95 380 (IQR, $63 921-$144 019) for tracheostomy. Tracheostomy placement in ≤7 days had lower costs compared with placement in >7 days (median, $71 470 [IQR, $47 863-$108 250] versus $102 979 [IQR, $69 563-$152 543]; P<0.001). Each day awaiting tracheostomy was associated with a 2.9% cost increase (95% CI, 2.6%-3.1%). US hospitalization costs for patients with acute stroke were $8.7 billion/y (95% CI, $8.5-$8.9 billion). For IMV alone, costs were $1.8 billion/y (95% CI, $1.7-$1.9 billion) and for tracheostomy $824 million/y (95% CI, $789.7-$858.3 million). CONCLUSIONS Patients with acute stroke who undergo tracheostomy account for 1.4% of stroke admissions and 9.5% of US stroke hospitalization costs. Future research should focus on the added value to society and patients of IMV and tracheostomy, in particular after 7 days for the latter procedure given the increased costs incurred and poor outcomes in stroke.
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Affiliation(s)
- George P Albert
- Department of Neurology, University of Rochester Medical Center, NY (G.P.A., D.C.M., R.G.H., B.P.G.)
| | - Daryl C McHugh
- Department of Neurology, University of Rochester Medical Center, NY (G.P.A., D.C.M., R.G.H., B.P.G.)
| | - David Y Hwang
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill (D.Y.H.)
| | | | - Robert G Holloway
- Department of Neurology, University of Rochester Medical Center, NY (G.P.A., D.C.M., R.G.H., B.P.G.)
| | - Benjamin P George
- Department of Neurology, University of Rochester Medical Center, NY (G.P.A., D.C.M., R.G.H., B.P.G.)
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Jackson H, Grzeskowiak LE, Enticott J, Callander E. Pharmacoepidemiology and costs of medications dispensed during pregnancy: A retrospective population-based study. BJOG 2023; 130:1317-1327. [PMID: 37039252 PMCID: PMC10952169 DOI: 10.1111/1471-0528.17472] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To describe the pharmacoepidemiology and costs associated with medications dispensed during pregnancy. DESIGN Pharmacoepidemiological study and cost analysis. SETTING Queensland, Australia. POPULATION All women who gave birth in Queensland between January 2013 and June 2018. METHODS We used a whole-of-population linked administrative dataset, Maternity1000, to describe medications approved for public subsidy that were dispensed to 255 408 pregnant women. We describe the volume of medications dispensed and their associated costs from a Government and patient perspective. MAIN OUTCOME MEASURES Prevalence of medication use; proportion of total dispensings; total medication costs in AUD 2020/21 ($1AUD = $0.67USD/£0.55GBP in December 2022). RESULTS During pregnancy, 61% (95% CI 60.96-61.29%) of women were dispensed at least one medication approved for public subsidy. The mean number of items dispensed per pregnancy increased from 2.14 (95% CI 2.11-2.17) in 2013 to 2.47 (95% CI 2.44-2.51) in 2017; an increase of 15%. Furthermore, mean Government cost per dispensing increased by 41% from $21.60 (95% CI $20.99-$22.20) in 2013 to $30.44 (95% CI $29.38-$31.49) in 2017. These factors influenced the 53% increase in total Government expenditure observed for medication use during pregnancy between 2013 and 2017 ($2,834,227 versus $4,324,377); a disproportionate rise compared with the 17% rise in women's total out-of-pocket expenses observed over the same timeframe ($1,880,961 versus $2,204,415). CONCLUSIONS Prevalence of medication use in pregnancy is rising and is associated with disproportionate and rapidly escalating cost implications for the Government.
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Affiliation(s)
- Hannah Jackson
- Monash Centre for Health Research and Implementation (MCHRI), School of Public health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Luke E. Grzeskowiak
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation (MCHRI), School of Public health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Emily Callander
- Monash Centre for Health Research and Implementation (MCHRI), School of Public health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
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Ito Suffert SC, Motke BB, Linhares AB, Vargens AF, Alano TS, Lutz AT, Boff Borges R, Bica CG, Vargas Alves RJ. Evaluation of Direct Medical Costs and Associated Factors Within the Last 30 days of Life of Hospitalized Cancer Patients. Am J Hosp Palliat Care 2023; 40:1098-1105. [PMID: 36564870 DOI: 10.1177/10499091221147906] [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: 12/25/2022] Open
Abstract
Background: An estimated 9.6 million people died from cancer globally in 2018, which is a reflection of the quality of patients' end-of-life care and its costs. Aim: To estimate direct medical costs of the last 30 days of oncology patients admitted to an inpatient clinic and to evaluate factors associated with medical costs at the end of life. Design: Cost-of-illness study with data from a retrospective cohort. Setting/Participants: We included patients aged 18 and older who were diagnosed with incurable cancer and who were admitted to a tertiary hospital in Brazil between January 1, 2018 and December 31, 2019. Results: Our sample included 109 patients with an average age of 69 (61‒76). The median overall survival was 4.3 (.9‒12.9) months. The median cost per patient per day related to hospitalization was BRL 119 (73‒181)/United States dollars [USD] 21 (13‒33). The cost of medication was BRL 66 (40‒105)/USD 12 (7‒19), representing 55.46% of costs while that of materials and supplies was BRL 30 (18‒49)/USD 5 (3‒9). In the multivariate analysis, when the limitation of interventions was recorded in the medical record, the median cost is reduced by BRL 50 (USD 9) per patient per day. Conclusions: The median cost per patient per day was BRL 119 (73‒181). The recording of limitations of therapeutic interventions in the medical record was a predictor variable that influenced the final medical cost of patients, suggesting that medical practice and decision-making in end-of-life care impact costs.
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Affiliation(s)
- Soraya C Ito Suffert
- Programa de Pós Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Bruna B Motke
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
| | - Armani B Linhares
- Undergraduate Program in Medicine. Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - André F Vargens
- Undergraduate Program in Medicine. Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Tainá S Alano
- Undergraduate Program in Medicine. Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Andreas T Lutz
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
| | - Rogério Boff Borges
- Unidade de Bioestatística, Diretoria de Pesquisa, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Claudia G Bica
- Programa de Pós Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, Brasil
| | - Rafael José Vargas Alves
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brasil
- Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brasil
- National Institute for Health Technology Assessment-IATS/CNPq, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Dhyppolito IM, Nadanovsky P, Cruz LR, de Oliveira BH, Dos Santos APP. Economic evaluation of fluoride varnish application in preschoolers: A systematic review. Int J Paediatr Dent 2023; 33:431-449. [PMID: 36695007 DOI: 10.1111/ipd.13049] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/20/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. AIM To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. DESIGN We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. RESULTS Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness. CONCLUSION We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).
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Affiliation(s)
- Izabel Monteiro Dhyppolito
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laís Rueda Cruz
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Branca Heloisa de Oliveira
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana Paula Pires Dos Santos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Shao H, Shi L, Fonseca V, Alsaleh AJO, Gill J, Nicholls C. Cost-effectiveness analysis of once-daily insulin glargine 300 U/mL versus insulin degludec 100 U/mL using the BRAVO diabetes model. Diabet Med 2023; 40:e15112. [PMID: 37035994 DOI: 10.1111/dme.15112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
AIMS A cost-effectiveness analysis was conducted to compare insulin glargine 300 U/mL (Gla-300) versus insulin degludec 100 U/mL (IDeg-100) in insulin-naïve adults with type 2 diabetes (T2D) sub-optimally controlled with oral anti-diabetic drugs (OADs). METHODS The BRAVO diabetes model was used to assess costs and outcomes for once-daily Gla-300 versus once-daily IDeg-100 from a US healthcare sector perspective. Baseline clinical data were based on BRIGHT, a 24-week, non-inferiority, randomised control trial comparing Gla-300 and IDeg-100 in adults with T2D sub-optimally controlled with OADs (with or without glucagon-like peptide-1 receptor agonists). Treatment costs were based on doses observed in BRIGHT as well as net prices. Costs associated with complications were based on published literature. Lifetime costs (US$) and quality-adjusted life-years (QALYs) were predicted and used to calculate incremental cost-effectiveness ratio estimates; extensive scenario and sensitivity analyses were conducted. RESULTS Overall lifetime medical costs were estimated to be $327,904 and $330,154 for people receiving Gla-300 and IDeg-100, respectively; insulin costs were $43,477 and $44,367, respectively. People receiving Gla-300 gained 8.024 QALYs and 18.55 life-years, while people receiving IDeg-100 gained 7.997 QALYs and 18.52 life-years. Because Gla-300 was associated with a cost-saving of $2250 and 0.027 additional QALYs, it was considered to be dominant compared with IDeg-100. Results of the scenario and sensitivity analyses confirmed the robustness of the base case results. CONCLUSION Gla-300 was the dominant treatment option compared with IDeg-100 based on the willingness-to-pay threshold of $50,000/QALY. Results remained robust against a wide range of alternative assumptions on key parameters.
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Affiliation(s)
- Hui Shao
- Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Vivian Fonseca
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
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Loureiro RB, Guidoni LM, Fregona GC, de Oliveira SMDVL, Sacramento D, Pinheiro JDS, Gomes D, Maciel ELN. Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household. J Bras Pneumol 2023; 49:e20220368. [PMID: 37610956 PMCID: PMC10578937 DOI: 10.36416/1806-3756/e20220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. METHODS This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). RESULTS A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). CONCLUSIONS Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.
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Affiliation(s)
- Rafaela Borge Loureiro
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Leticia Molino Guidoni
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Geisa Carlesso Fregona
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Programa de Tuberculose, Hospital Universitário Cassiano Antônio Moraes - HUCAM - Vitória (ES) Brasil
| | - Sandra Maria do Valle Leone de Oliveira
- . Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul - UFMS - Campo Grande (MS) Brasil
- . Fiocruz Mato Grosso do Sul, Campo Grande (MS) Brasil
| | - Daniel Sacramento
- . Núcleo de Controle da Tuberculose, Secretaria Municipal de Saúde de Manaus, Manaus (AM) Brasil
| | - Jair dos Santos Pinheiro
- . Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (AM) Brasil
- . Programa Estadual de Controle da Tuberculose do Amazonas/Fundação de Vigilância em Saúde - Dra. Rosemary Costa Pinto, Manaus (AM) Brasil
| | - Denise Gomes
- . Centro de Referência à Tuberculose - CRTB - GCC/SCS, Porto Alegre (RS) Brasil
| | - Ethel Leonor Noia Maciel
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
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Døving M, Anandan S, Rogne KG, Utheim TP, Brunborg C, Galteland P, Sunde K. Cost Analysis of Open Surgical Bedside Tracheostomy in Intensive Care Unit Patients. Ear Nose Throat J 2023; 102:516-521. [PMID: 34006128 DOI: 10.1177/01455613211018578] [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: 11/15/2022] Open
Abstract
OBJECTIVES Open surgical tracheostomy (OST) is a common procedure performed on intensive care unit (ICU) patients. The procedure can be performed bedside in the ICU (bedside open surgical tracheostomy, BeOST) or in the operating room (operating room open surgical tracheostomy, OROST), with comparable safety and long-term complication rates. We aimed to perform a cost analysis and evaluate the use of human resources and the total time used for both BeOSTs and OROSTs. METHODS All OSTs performed in 2017 at 5 different ICUs at Oslo University Hospital Ullevål were retrospectively evaluated. The salaries of the personnel involved in the 2 procedures were obtained from the hospital's finance department. The time taken and the number of procedures performed were extracted from annual reports and from the electronic patient record system, and the annual expenditures were calculated. RESULTS Altogether, 142 OSTs were performed, of which 122 (86%) and 20 (14%) were BeOSTs and OROSTs, respectively. A BeOST cost 343 EUR (95% CI: 241.4-444.6) less than an OROST. Bedside open surgical tracheostomies resulted in an annual cost efficiency of 41.818 EUR. In addition, BeOSTs freed 279 hours of operating room occupancy during the study year. Choosing BeOST instead of OROST made 1 nurse, 2 surgical nurses, and 1 anesthetic nurse redundant. CONCLUSION Bedside open surgical tracheostomy appears to be cost-, time-, and resource-effective than OROST. In the absence of contraindications, BeOSTs should be performed in ICU patients whenever possible.
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Affiliation(s)
- Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Steven Anandan
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, University of Oslo, Oslo, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjetil Sunde
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital Ullevål, Oslo, Norway
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Joyce DD, Schulte PJ, Kwon ED, Dusetzina SB, Moses KA, Sharma V, Penson DF, Tilburt JC, Boorjian SA. Coping Mechanisms for Financial Toxicity Among Patients With Metastatic Prostate Cancer: A Survey-based Assessment. J Urol 2023; 210:290-298. [PMID: 37416955 DOI: 10.1097/ju.0000000000003506] [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: 07/08/2023]
Abstract
PURPOSE Assessments of financial toxicity among patients with metastatic prostate cancer are lacking. Using patient surveys, we sought to identify coping mechanisms and assess characteristics associated with lower financial toxicity. MATERIALS AND METHODS Surveys were administered to all patients seen at a single center's Advanced Prostate Cancer Clinic over a 3-month period. Surveys included the COST-FACIT (COmprehensive Score for Financial Toxicity) and coping mechanism questionnaires. Patients with metastatic disease (lymph nodes, bone, visceral) were included for analysis. Coping mechanisms were compared between patients experiencing low (COST-FACIT >24) vs high (COST-FACIT ≤24) financial toxicity using Fisher's exact test. Multivariable linear regression was used to evaluate characteristics associated with lower financial toxicity. RESULTS Overall, 281 patients met inclusion criteria of which 79 reported high financial toxicity. In multivariable analysis, characteristics associated with lower financial toxicity included older age (estimate: 0.36, 95%CI: 0.21-0.52), applying for patient assistance programs (estimate: 4.42, 95%CI: 1.72-7.11), and an annual income of at least $100,000 (estimate: 7.81, 95%CI: 0.97, 14.66). Patients with high financial toxicity were more likely to decrease spending on basic goods (35% vs 2.5%, P < .001) and leisure activities (59% vs 15%, P > .001), as well as use savings (62% vs 17%, P < .001) to pay for their treatment. CONCLUSIONS In this cross-sectional study, patients with metastatic prostate cancer and high financial toxicity were more likely to decrease spending on basic goods and leisure activities and use savings to pay for care. Understanding the impact of financial toxicity on patients' lives is crucial to inform shared decision-making and interventions designed to mitigate financial toxicity in this population.
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Affiliation(s)
- Daniel D Joyce
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Phillip J Schulte
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, Arizona
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
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Reichenbach R, Sgarioni A, Gullo MC, Giovanardi HJ, Moura GS. Clinical and economic comparative analysis of laparotomy versus laparoscopy in the first gastric bypass surgeries in a bariatric and metabolic surgery service in a city in southern Brazil. Rev Col Bras Cir 2023; 50:e20233513. [PMID: 37531502 PMCID: PMC10508681 DOI: 10.1590/0100-6991e-20233513-en] [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: 12/16/2022] [Accepted: 05/07/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION this paper aims to evaluate the main direct and indirect costs of the first laparotomies and laparoscopies in bariatric surgeries with a clinical-economical retrospective and cross-sectional analysis from 2017 to 2020 at a hospital with specialties besides the basic ones in southern Brazil. METHODS the study sample included 26 participants. The first 13 laparotomies, and the first 13 laparoscopies performed at the bariatric surgery service of the institution were evaluated. The values evaluated in such comparison analyzed the costs of operation and hospitalization. It is important to highlight that, in addition to the cost benefit, other costs take significance in the health area, such as: cost-utility, cost-effectiveness and cost-minimization, in addition to the cost-opportunity that is reassessed in the observation of the broad context associating all the values raised here. The software used for data analysis was Excel version® 365. The economic analysis was performed evidencing the profile of the patients and the direct and indirect costs involved in each segmentation. RESULTS the direct and indirect costs of videolaparoscopy amounted to BRL 10,108.10 and laparoscopy to the amount of BRL 12,568.14. CONCLUSION it was concluded that laparoscopy presents more savings in the aspects of all health valuations to the detriment of laparotomy. It was concluded that the videolaparoscopy presents more savings in the aspects of all health valuations than the laparotomy.
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Affiliation(s)
- Ricardo Reichenbach
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
- - Pontifícia Universidade Católica, Pós-Graduaçao - Porto Alegre - RS - Brasil
- - Universidade de Caxias do Sul, Medicina - Caxias do Sul - RS - Brasil
| | - Augusto Sgarioni
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
- - Universidade de Caxias do Sul, Medicina - Caxias do Sul - RS - Brasil
| | | | - Henrique João Giovanardi
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
- - Universidade de Caxias do Sul, Medicina - Caxias do Sul - RS - Brasil
| | - Gisele Silva Moura
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
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Brinjikji W, Kottenmeier E, Kabiri M, Khaled A, Pederson JM, Al-Bayati AR. Estimating the impact of balloon guide catheter with mechanical thrombectomy for acute ischemic stroke: A U.S. cost analysis. Interv Neuroradiol 2023:15910199231191034. [PMID: 37499196 DOI: 10.1177/15910199231191034] [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] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Balloon guide catheters (BGCs) can be used adjunctively during mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Evaluating the potential economic impact associated with adjunctive BGC use is an important consideration for resource allocation. METHODS Decision tree models were used to estimate the economic value of BGC use in MT through its impact on functional outcomes. Healthcare utilization cost estimates in the short- and long-term for patients with different 90-day mRS scores were analyzed for MT-only and MT + BGC scenarios. Deterministic (one-way) and probabilistic sensitivity analyses were performed to evaluate the robustness and uncertainty of model parameters. RESULTS Per-patient index hospitalization cost was estimated at $65,260 for MT-only and $62,883 for MT + BGC scenarios. Per-patient one-year post-index hospitalization cost was estimated at $27,569 for MT-only and $24,830 for MT + BGC. MT + BGC had a total cost savings of $5117 compared with MT-only. Deterministic (one-way) sensitivity analysis demonstrated that cost saving per patient was most sensitive to the proportion of patients in the mRS 0-2 category in both MT + BGC and MT-only. In a probabilistic sensitivity analysis, mean per-patient costs for the index hospitalization were estimated at $63,737 for MT-only and $61,425 for MT + BGC. Mean per-patient cost estimates one-year post-index hospitalization was $27,445 for MT-only and $24,715 for MT + BGC. MT + BGC had a total cost savings of $5043 compared with MT-only. CONCLUSION Mechanical thrombectomy with adjunctive BGC use may reduce short-term and long-term patient costs due to improved functional outcomes when compared to MT treatment alone for AIS.
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Affiliation(s)
| | - Emilie Kottenmeier
- Health Economics and Market Access, Johnson & Johnson MedTech, Irvine, CA, USA
| | - Mina Kabiri
- Health Economics and Market Access, Johnson & Johnson MedTech, Irvine, CA, USA
| | - Alia Khaled
- Health Economics and Market Access, Johnson & Johnson MedTech, Irvine, CA, USA
| | - John M Pederson
- Superior Medical Experts, St. Paul, MN, USA
- Nested Knowledge, St. Paul, MN, USA
| | - Alhamza R Al-Bayati
- University of Pittsburgh Medical Center, Neuroendovascular Surgery & Vascular Neurology, Pittsburgh, PA, USA
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Díaz JFR. Impact of outpatient radiotherapy on direct non-medical cost in patients in the Central Macro Region of Peru 2021. Ecancermedicalscience 2023; 17:1580. [PMID: 37533938 PMCID: PMC10393304 DOI: 10.3332/ecancer.2023.1580] [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: 05/31/2023] [Indexed: 08/04/2023] Open
Abstract
Background Financial toxicity arises in cancer patients due to the objective financial burden of the disease or treatment, being associated with worse clinical outcomes. Direct non-medical spending on cancer patients undergoing radiotherapy in Peru under its publicly funded health system has not been described. Objective To know the expenses related to the transfer of the radiotherapy outpatient. Methodology For patients who started radiation therapy in 2021, treatment demographics and expenses related to transporting the patient from home to the radiation therapy center were prospectively collected. Association and connection tests were used, such as the Mann-Whitney/Kruskal-Wallis U-test and Spearman's Rho. A value of p < 0.05 is considered statistically significant. Results 398 patients were collected, with average weekly expenses for transportation, lodging and food of $17.04, $6.69 and $45.91, respectively. Confirmation was positive between weekly spending and remoteness, likewise it was negative between effective teletherapy and remoteness, both analyses being statistically significant. Conclusion The expense associated with transfer for radiotherapy is high, exceeding the average monthly income of the patient, as a consequence they have a worse therapeutic result, and may cause financial toxicity in cancer patients.
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Affiliation(s)
- José Fernando Robles Díaz
- Regional Institute for Neoplastic Diseases, Central Region, Concepción, Junín 12731, Peru and Universidad Peruana Los Andes, Huancayo, Junín 12731, Perú
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Oliver-Fornies P, Sánchez-Viñas A, Gomez Gomez R, Ortega Lahuerta JP, Loscos-Lopez D, Aragon-Benedi C, Yamak Altinpulluk E, Fajardo Perez M, Aznar-Lou I. Cost Analysis of Low-Volume Versus Standard-Volume Ultrasound-Guided Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery. Cureus 2023; 15:e38534. [PMID: 37273354 PMCID: PMC10239207 DOI: 10.7759/cureus.38534] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
Background Economic evaluation has become an essential decision-making tool for health systems worldwide. This study was aimed at estimating the difference in the use of healthcare resources, days on sick leave, and costs between patients undergoing a standard-volume versus a low-volume ultrasound-guided interscalene brachial plexus block. Methods This is a post-hoc cost analysis of a double-blind, randomized, and controlled clinical trial. Forty-eight patients undergoing ultrasound-guided interscalene block received either 10 ml or 20 ml of levobupivacaine 0.25%. Analyses involved the public healthcare payer perspective (including visits to general practitioners, nursing staff, physiotherapy facilities, hospital admissions, outpatient diagnostic tests, etc.) and the limited societal perspective, including productivity losses (days on sick leave). Measurements were made at one-month and one-year follow-ups post-intervention. Differences in costs were estimated using two-part models adjusted by the costs incurred in the previous year. Results Subjects in the 10 ml group made greater use of general practitioner visits (mean difference [95% CI]: 3.35 [0.219 to 6.49]; p=0.036) and diagnostic tests (2.43 [0.601 to 4.26]; p=0.009), but less use of physical therapy (-12.9 [-21.7 to -4.06]; p=0.004). Mean (SD) cost differences from the public healthcare payer's perspective were 1,461.34 $ (1,541.62) and 1,024.08$ (943.83) for the 10 ml and 20 ml groups, respectively (p=0.293). From the limited societal perspective, the differences were as follows: 7,036.53$ (8,077.58) and 8,666.56$ (9,841.10), respectively (p=0.937). While there were no differences in the above parameters at the one-month follow-up. Conclusion The volume reduction proposed following interscalene block resulted in meaningful, albeit not statistically significant, clinical benefits and lower costs from a limited societal perspective for shoulder surgery. Thus, healthcare use and days on sick leave are variables to be taken into consideration when calculating the economic impact of surgical procedures.
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Affiliation(s)
- Pablo Oliver-Fornies
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Universitario de Mostoles, Madrid, ESP
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, ESP
| | - Roberto Gomez Gomez
- Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, ESP
| | - Juan Pablo Ortega Lahuerta
- Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, ESP
| | - Diego Loscos-Lopez
- Department of Anesthesiology, Critical Care and Pain Medicine, Lozano Blesa University Clinical Hospital, Zaragoza, ESP
| | - Cristian Aragon-Benedi
- Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, ESP
| | - Ece Yamak Altinpulluk
- Medicine, UltraDissection, Madrid, ESP
- Pain Medicine, Morphological Madrid Research Center (MoMaRC), Madrid, ESP
- Anesthesiology Research Office, Ataturk University Medical School, Erzurum, TUR
- Outcomes Research Consortium, Cleveland Clinic Foundation, Cleveland, USA
| | | | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Deu, Barcelona, ESP
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Takemura K, Ahmed NS, Stukalin I, Gupta M, Ma C, Heng DYC. Trends in health care spending on kidney cancer in the United States, 1996-2016. Cancer 2023. [PMID: 37005866 DOI: 10.1002/cncr.34770] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Paradigm shifts in kidney cancer management have led to higher health care spending. Here, total and per capita health care spending and primary drivers of change in health expenditures for kidney cancer in the United States between 1996 and 2016 are estimated. METHODS Public databases developed by the Institute for Health Metrics and Evaluation for the Disease Expenditure Project were used. The prevalence of kidney cancer was estimated from the Global Burden of Disease Study. Changes in health care spending on kidney cancer were assessed by joinpoint regression and expressed as annual percent changes (APCs). RESULTS In 2016, total health care spending on kidney cancer was $3.42 billion (95% CI, $2.91 billion to $3.89 billion) compared with $1.18 billion (95% CI, $1.07 billion to $1.31 billion) in 1996. Per capita spending had two inflection points in 2005 and 2008, close to the approval years of targeted therapies, which corresponded to APCs of +2.9% (95% CI, +2.3% to +3.6%; p < .001) per year, 1996-2005; +9.2% (95% CI, +3.4% to +15.2%; p = .004) per year, 2005-2008; and +3.1% (95% CI, +2.2% to +3.9%; p < .001) per year, 2008-2016. Inpatient care was the largest contributor to health expenditures, which accounted for $1.56 billion (95% CI, $1.19 billion to $1.95 billion) in 2016. Price and intensity of care was the primary driver of increased health expenditures, whereas service utilization was the primary driver of reduced health expenditures. CONCLUSIONS Prevalence-adjusted health care spending on kidney cancer continues to rise in the United States, which is primarily attributable to inpatient care and driven by the price and intensity of care over time.
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Affiliation(s)
- Kosuke Takemura
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Igor Stukalin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mehul Gupta
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Y C Heng
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Batalik L, Filakova K, Sladeckova M, Dosbaba F, Su J, Pepera G. The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review. Eur J Phys Rehabil Med 2023; 59:248-258. [PMID: 36692413 PMCID: PMC10167703 DOI: 10.23736/s1973-9087.23.07773-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 10/31/2022] [Revised: 11/28/2023] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets lead to cost-effectiveness analyses before implementation. They are appropriate in cases where there is evidence that the compared intervention provides a similar health benefit to usual care. This systematic review aimed to compare the cost-effectiveness of exercise-based telehealth CR interventions compared to standard exercise-based CR. EVIDENCE ACQUISITION PubMed and Web of Science databases were systematically searched up to August 2022 to identify randomized controlled trials assessing patients undergoing telehealth CR. The intervention was compared to standard CR protocols. The primary intent was to identify the cost-effectiveness. Interventions that met the criteria were home-based telehealth CR interventions delivered by information and communications technology (telephone, computer, internet, or videoconferencing) and included the results of an economic evaluation, comparing interventions in terms of cost-effectiveness, utility, costs and benefits, or cost-minimization analysis. The systematic review protocol was registered in the PROSPERO Registry (CRD42022322531). EVIDENCE SYNTHESIS Out of 1525 identified studies, 67 articles were assessed for eligibility, and, at the end of the screening process, 12 studies were included in the present systematic review. Most studies (92%) included in this systematic review found strong evidence that exercise-based telehealth CR is cost-effective. Compared to CBCR, there were no major differences, except for three studies evaluating a significant difference in average cost per patient and intervention costs in favor of telehealth CR. CONCLUSIONS Telehealth CR based on exercise is as cost-effective as CBCR interventions. Funding telehealth CR by third-party payers may promote patient participation to increase overall CR utilization. High-quality research is needed to identify the most cost-effective design.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic -
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic -
| | - Katerina Filakova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Michaela Sladeckova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, University Hospital of Brno, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Jingjing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Garyfallia Pepera
- School of Health Sciences, Department of Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, University of Thessaly, Lamia, Greece
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Satyanarayana S, Pretorius C, Kanchar A, Garcia Baena I, Den Boon S, Miller C, Zignol M, Kasaeva T, Falzon D. Scaling Up TB Screening and TB Preventive Treatment Globally: Key Actions and Healthcare Service Costs. Trop Med Infect Dis 2023; 8:214. [PMID: 37104339 PMCID: PMC10144108 DOI: 10.3390/tropicalmed8040214] [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: 02/14/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
The 2018 United Nations High-Level Meeting on Tuberculosis (UNHLM) set targets for case detection and TB preventive treatment (TPT) by 2022. However, by the start of 2022, about 13.7 million TB patients still needed to be detected and treated, and 21.8 million household contacts needed to be given TPT globally. To inform future target setting, we examined how the 2018 UNHLM targets could have been achieved using WHO-recommended interventions for TB detection and TPT in 33 high-TB burden countries in the final year of the period covered by the UNHLM targets. We used OneHealth-TIME model outputs combined with the unit cost of interventions to derive the total costs of health services. Our model estimated that, in order to achieve UNHLM targets, >45 million people attending health facilities with symptoms would have needed to be evaluated for TB. An additional 23.1 million people with HIV, 19.4 million household TB contacts, and 303 million individuals from high-risk groups would have required systematic screening for TB. The estimated total costs amounted to ~USD 6.7 billion, of which ~15% was required for passive case finding, ~10% for screening people with HIV, ~4% for screening household contacts, ~65% for screening other risk groups, and ~6% for providing TPT to household contacts. Significant mobilization of additional domestic and international investments in TB healthcare services will be needed to reach such targets in the future.
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Affiliation(s)
- Srinath Satyanarayana
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), New Delhi 110016, India
| | - Carel Pretorius
- Centre for Modelling and Analysis, Avenir Health, Glastonbury, CT 06033, USA
| | - Avinash Kanchar
- Global TB Programme (GTB), World Health Organization, 1211 Geneva, Switzerland
| | - Ines Garcia Baena
- Global TB Programme (GTB), World Health Organization, 1211 Geneva, Switzerland
| | - Saskia Den Boon
- Global TB Programme (GTB), World Health Organization, 1211 Geneva, Switzerland
| | - Cecily Miller
- Global TB Programme (GTB), World Health Organization, 1211 Geneva, Switzerland
| | - Matteo Zignol
- Global TB Programme (GTB), World Health Organization, 1211 Geneva, Switzerland
| | - Tereza Kasaeva
- Global TB Programme (GTB), World Health Organization, 1211 Geneva, Switzerland
| | - Dennis Falzon
- Global TB Programme (GTB), World Health Organization, 1211 Geneva, Switzerland
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Dawson L, Nehme E, Nehme Z, Zomer E, Bloom J, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor A, Kaye D, Cullen L, Smith K, Stub D. Healthcare cost burden of acute chest pain presentations. Emerg Med J 2023; 40:437-443. [PMID: 36918268 DOI: 10.1136/emermed-2022-212674] [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: 06/20/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND This study aimed to estimate the direct healthcare cost burden of acute chest pain attendances presenting to ambulance in Victoria, Australia, and to identify key cost drivers especially among low-risk patients. METHODS State-wide population-based cohort study of consecutive adult patients attended by ambulance for acute chest pain with individual linkage to emergency and hospital admission data in Victoria, Australia (1 January 2015-30 June 2019). Direct healthcare costs, adjusted for inflation to 2020-2021 ($A), were estimated for each component of care using a casemix funding method. RESULTS From 241 627 ambulance attendances for chest pain during the study period, mean chest pain episode cost was $6284, and total annual costs were estimated at $337.4 million ($68 per capita per annum). Total annual costs increased across the period ($310.5 million in 2015 vs $384.5 million in 2019), while mean episode costs remained stable. Cardiovascular conditions (25% of presentations) were the most expensive (mean $11 523, total annual $148.7 million), while a non-specific pain diagnosis (49% of presentations) was the least expensive (mean $3836, total annual $93.4 million). Patients classified as being at low risk of myocardial infarction, mortality or hospital admission (Early Chest pain Admission, Myocardial infarction, and Mortality (ECAMM) score) represented 31%-57% of the cohort, with total annual costs estimated at $60.6 million-$135.4 million, depending on the score cut-off used. CONCLUSIONS Total annual costs for acute chest pain presentations are increasing, and a significant proportion of the cost burden relates to low-risk patients and non-specific pain. These data highlight the need to improve the cost-efficiency of chest pain care pathways.
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Affiliation(s)
- Luke Dawson
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emily Nehme
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Ziad Nehme
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Shelley Cox
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - David Anderson
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.,Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Michael Stephenson
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Jeffrey Lefkovits
- Department of Cardiology, Melbourne Health, Parkville, Victoria, Australia
| | - Andrew Taylor
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karen Smith
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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45
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Kim J, Cadilhac DA, Thompson S, Gommans J, Davis A, Barber PA, Fink J, Harwood M, Levack W, McNaughton H, Abernethy V, Girvan J, Feigin V, Denison H, Corbin M, Wilson A, Douwes J, Ranta A. Comparison of Stroke Care Costs in Urban and Nonurban Hospitals and Its Association With Outcomes in New Zealand: A Nationwide Economic Evaluation. Stroke 2023; 54:848-856. [PMID: 36848424 DOI: 10.1161/strokeaha.122.040869] [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: 03/01/2023]
Abstract
BACKGROUND Although geographical differences in treatment and outcomes after stroke have been described, we lack evidence on differences in the costs of treatment between urban and nonurban regions. Additionally, it is unclear whether greater costs in one setting are justified given the outcomes achieved. We aimed to compare costs and quality-adjusted life years in people with stroke admitted to urban and nonurban hospitals in New Zealand. METHODS Observational study of patients with stroke admitted to the 28 New Zealand acute stroke hospitals (10 in urban areas) recruited between May and October 2018. Data were collected up to 12 months poststroke including treatments in hospital, inpatient rehabilitation, other health service utilization, aged residential care, productivity, and health-related quality of life. Costs in New Zealand dollars were estimated from a societal perspective and assigned to the initial hospital that patients presented to. Unit prices for 2018 were obtained from government and hospital sources. Multivariable regression analyses were conducted when assessing differences between groups. RESULTS Of 1510 patients (median age 78 years, 48% female), 607 presented to nonurban and 903 to urban hospitals. Mean hospital costs were greater in urban than nonurban hospitals ($13 191 versus $11 635, P=0.002), as were total costs to 12 months ($22 381 versus $17 217, P<0.001) and quality-adjusted life years to 12 months (0.54 versus 0.46, P<0.001). Differences in costs and quality-adjusted life years remained between groups after adjustment. Depending on the covariates included, costs per additional quality-adjusted life year in the urban hospitals compared to the nonurban hospitals ranged from $65 038 (unadjusted) to $136 125 (covariates: age, sex, prestroke disability, stroke type, severity, and ethnicity). CONCLUSIONS Better outcomes following initial presentation to urban hospitals were associated with greater costs compared to nonurban hospitals. These findings may inform greater targeted expenditure in some nonurban hospitals to improve access to treatment and optimize outcomes.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Australia (J.K., D.A.C.).,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (J.K., D.A.C.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Australia (J.K., D.A.C.).,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (J.K., D.A.C.)
| | - Stephanie Thompson
- Department of Medicine, University of Otago, Wellington, New Zealand (S.T., W.L., A.R.)
| | - John Gommans
- Department of Medicine, Hawkes's Bay Hospital, Hastings, New Zealand (J. Gommans)
| | - Alan Davis
- Department of Medicine, Whangarei Hospital, New Zealand (A.D.)
| | - P Alan Barber
- Department of Medicine, University of Auckland, New Zealand (P.A.B.)
| | - John Fink
- Department of Neurology, Christchurch Hospital, New Zealand (J.F.)
| | - Matire Harwood
- Department of General Practice and Primary Healthcare, University of Auckland, New Zealand (M.H.)
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand (S.T., W.L., A.R.)
| | - Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand (H.M.)
| | | | | | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (V.F.)
| | - Hayley Denison
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand (H.D., M.C., J.D.)
| | - Marine Corbin
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand (H.D., M.C., J.D.)
| | - Andrew Wilson
- Department of Medicine, Wairau Hospital, Blenheim, New Zealand (A.W.)
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand (H.D., M.C., J.D.)
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand (S.T., W.L., A.R.).,Department of Neurology, Wellington Hospital, New Zealand (A.R.)
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Aksenov LI, Dionise ZR, Yafi F, Lentz AC. Routine office cystoscopy prior to penile prosthesis surgery is a low value practice. J Sex Med 2023; 20:118-120. [PMID: 36763953 DOI: 10.1093/jsxmed/qdac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Leonid I Aksenov
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, United States
| | - Zachary R Dionise
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, United States
| | - Faysal Yafi
- Department of Urology, University of California Irvine, Newport Beach, CA, United States
| | - Aaron C Lentz
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, United States
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Pollock RF, Slættanes AK, Brandi H, Grand TS. A Cost-Utility Analysis of SQ ® Tree SLIT-Tablet versus Placebo in the Treatment of Birch Pollen Allergic Rhinitis from a Swedish Societal Perspective. Clinicoecon Outcomes Res 2023; 15:69-86. [PMID: 36761408 PMCID: PMC9904213 DOI: 10.2147/ceor.s377399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background and Aims Allergic rhinitis (AR) is an immunoglobulin E antibody-mediated inflammatory condition that arises in response to inhaled allergens such as pollen. Pollens from trees in the birch homologous group are the most common allergenic tree pollens in Northern and Central Europe and North America. SQ® Tree SLIT-Tablet (ITULAZAX®) is a sublingual immunotherapy tablet indicated for moderate-to-severe AR and/or conjunctivitis induced by pollen from the birch homologous group. The present analysis evaluated the cost-utility of treating adults with AR with SQ Tree SLIT-Tablet versus placebo, both in combination with symptom-relieving medications, from a Swedish societal perspective. Methods A model was developed to evaluate changes in cost and quality of life associated with using SQ Tree SLIT-Tablet relative to placebo in an adult population of individuals with AR. The model captured costs associated with symptom-relieving medications, healthcare professional interactions, SQ Tree SLIT-Tablet, and indirect costs arising from absenteeism and reduced workplace productivity. The analysis was conducted over 10 years with costs captured in 2021 Swedish Krona (SEK) and future costs and effects discounted at 3% per annum. One-way and probabilistic sensitivity analyses were conducted. Results Treatment with SQ Tree SLIT-Tablet resulted in an improvement of 0.041 quality-adjusted life years (QALYs) over 10 years versus placebo. From a Swedish societal perspective, costs increased by SEK 9077 over the same period, resulting in an incremental cost-utility ratio of SEK 223,445 per QALY gained. One-way sensitivity analysis showed that the model was most sensitive to assumptions around the disease-modifying effect of SQ Tree SLIT-Tablet. Conclusion SQ Tree SLIT-Tablet improved quality of life in moderate-to-severe AR and/or conjunctivitis induced by pollen from the birch homologous group in Sweden, with only a modest increase in societal costs over a medium-term time horizon, representing good value for money at a willingness-to-pay threshold of SEK 700,000 per QALY.
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Affiliation(s)
| | - Andreas K Slættanes
- ALK-Abelló A/S, Hørsholm, Denmark,Correspondence: Andreas K Slættanes, ALK-Abelló A/S, Bøge Allé 1, Hørsholm, DK-2970, Denmark, Tel +45 53638813, Email
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48
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Charlton V. All health is not equal: the use of modifiers in NICE technology appraisal. BMJ Evid Based Med 2023:bmjebm-2022-112159. [PMID: 36707223 DOI: 10.1136/bmjebm-2022-112159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Victoria Charlton
- Global Health and Social Medicine, King's College London, London, UK
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49
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Díaz JFR. Cost analysis of three-dimensional radiation therapy versus intensity-modulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens. Ecancermedicalscience 2023; 17:1531. [PMID: 37138970 PMCID: PMC10151083 DOI: 10.3332/ecancer.2023.1531] [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: 01/20/2023] [Indexed: 05/05/2023] Open
Abstract
Background and objectives The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy (CTRT) followed by high-dose-rate brachytherapy (HDRBT). The ideal scenario would be under novel intensity-modulated radiation therapy (IMRT) volumetric-modulated arc therapy (VMAT) radiation techniques over three-dimensional (3D) radiation therapy. However, radiotherapy (RT) centres in low- and middle-income countries have limited equipment for teletherapy services like HDRBT. This is why the 3D modality is still in use. The objective of this study was to analyse costs in a comparison of 3D versus IMRT versus VMAT based on clinical staging. Materials and methods From 02/01/2022 to 05/01/2023 a prospective registry of the costs for oncological management was carried out for patients with locally advanced CC who received CTRT ± HDRBT. This included the administration of radiation with chemotherapy. The cost associated with patient and family transfers and hours in the hospital was also identified. These expenses were used to project the direct and indirect costs of 3D versus IMRT versus VMAT. Results The treatment regimens for stage IIIC2, including 3D and novel techniques, are those with the highest costs. The administration of 3D RT for IIIC2 and novel IMRT or VMAT techniques, is $3,881.69, $3,374.76, and $2,862.80, respectively. The indirect cost from stage IIB to IIIC1 in descending order is IMRT, 3D and VMAT, but in IIIC2 the novel technique regimens reduce by up to 33.99% compared to 3D. Conclusion In RT centres with an available supply of RT equipment, VMAT should be preferred over IMRT/3D since it reduces costs and toxicity. However, in RT centres where demand exceeds supply in the VMAT technique planning systems, the use of 3D teletherapy over IMRT/VMAT could continue to be used in patients with stage IIB to IIIC1.
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Affiliation(s)
- José Fernando Robles Díaz
- Regional Institute for Neoplastic Diseases, Central Region, Concepción, Junín 12126, Peru and Los Andes Peruvian University, Huancayo 12002, Peru
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50
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Rao BR, Jung EH, Dickert NW. Getting Cost Discussions Right: Nudging Patients to Avoid Cognitive Pitfalls. Circ Cardiovasc Qual Outcomes 2023; 16:e009447. [PMID: 36472190 PMCID: PMC9884097 DOI: 10.1161/circoutcomes.122.009447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Birju R Rao
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., E.H.J., N.W.D.)
| | - Emily H Jung
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., E.H.J., N.W.D.)
| | - Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., E.H.J., N.W.D.)
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.W.D.)
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