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K Kesteloot

Publications and source records attributed to K Kesteloot.

34 records · Page 2Linked to original sources
PubMed1996

Reimbursement for radiotherapy treatment in the EU countries: how to encourage efficiency, quality and access?

In this paper, the radiotherapy reimbursement systems actually used in the EU countries are compared. From this overview, it is concluded that up to date health care policy makers have not yet tapped all opportunities to encourage efficient, accessible radiotherapy delivery of high quality, through the reimbursement system. Therefore, some recommendations are given on how the reimbursement system can be designed in order to promote efficiency, accessibility and/or quality.

Europe↗
PubMed1996

A model for calculating the hospital costs for pediatric endoscopy.

BACKGROUND: Hospitals increasingly need, besides effectiveness data, accurate and reliable cost data to allocate their resources as efficiently as possible. In this article, a framework to calculate the hospital costs of setting up a new activity is presented and applied to pediatric endoscopy. METHODS: The cost calculations were based on a detailed registration of labor time, materials, space, and equipment needed to perform endoscopy in pediatric patients in a tertiary care hospital, the University Hospital in Leuven, Belgium. RESULTS: The initial investment expenses amount to 70,000 ECU ($91,000 in U.S. money), assuming that the facilities of the adult endoscopy unit can be shared. The additional variable cost for each procedure, including labor time and materials, varies between 100 and about 170 ECU ($130 and $221 U.S.), depending on the type of endoscopy (upper or lower, diagnostic or therapeutic). These basic data can be used to calculate the total costs for pediatric endoscopy under alternative scenarios (e.g., varying total number of procedures). CONCLUSIONS: The costing exercise has given the hospital better insights into the working procedures (and hence costs) of pediatric endoscopy. Other organizations will be able to apply this framework in their setting, since all included cost components, as well as volumes and unit prices, are reported separately.

Anesthesia Department, Hospital↗
PubMed1996

Clinical and cost comparison of three postoperative skin preparation protocols in CABG patients.

This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. Material and labor costs were calculated for each of the different aspects of the protocols. Clinical evaluation revealed that the clipper protocol (if necessary, in combination with cream depilation) is most convenient for depilation of patients with heavy hair growth. The depilatory cream protocol is an appropriate method to depilate patients with slight or moderate hair growth. The razor method should be eliminated from clinical practice due to previous documented evidence of an associated increased risk of postoperative wound infection. Cost calculations revealed that the median hospital cost (standardized for differences in hair growth index, working hours and nurse qualification levels) of the razor, clipper, and cream protocols is $6.13, $9.84, and $8.16 (U.S. dollars), respectively. In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.

Aged↗
PubMed1995

Comparison of plastic and Orfit masks for patient head fixation during radiotherapy: precision and costs.

PURPOSE: Two widely used immobilization systems for head fixation during radiotherapy treatment for ear-nose-throat (ENT) tumors are evaluated. METHODS AND MATERIALS: Masks made of poly vinyl-chloride (plastic) are compared to thermoplastic masks (Orfit) with respect to the accuracy of the treatment setup and the costs. For both types of material, a cut-out (windows corresponding to treatment fields) and a full mask (not cut out) are considered. Forty-three patients treated for ENT tumors were randomized into four groups, to be fixed by one of the following modalities: cut-out plastic mask (12 patients), full plastic mask (11 patients), cut-out Orfit mask (10 patients), and full Orfit mask (10 patients). RESULTS: Reproducibility of the treatment setup was assessed by calculating the deviations from the mean value for each individual patient and was demonstrated to be identical for all subgroups: no differences were demonstrated between the plastic (s = 2.1 mm) and the Orfit (s = 2.1 mm) group nor between the cut-out (s = 2.0 mm) and not cut-out (s = 2.1 mm) group. The transfer chain from similar to treatment unit was checked by comparing portal images to their respective simulation image, and no differences between the four subgroups (s = +/- 3.5 mm) could be detected. A methodology was described to compare the costs of both types of masks, and illustrated with the data for a department. It was found that Orfit masks are a cheaper alternative than plastic masks; they require much less investment expenses and the workload and material cost of the first mask for each patient is also lower. Cut-out masks are more expensive than full masks, because of the higher workload and the additional material required for second and third masks that are required in case of field modifications. CONCLUSIONS: No substantial difference in patient setup accuracy between both types of masks was detected, and cutting out the masks had no impact on the fixing capabilities. A first Orfit mask will typically be a cheaper alternative than a plastic mask for most departments (lower fixed and variable costs). The higher material cost of the subsequent Orfit masks, compared to the plastic masks, offset the lower investment expenses.

Costs and Cost Analysis↗
PubMed1995

The reimbursement of the expenses for medical treatment received by 'transnational' patients in EU-countries.

The number of 'transnational' EU-patients, i.e. EU-citizens receiving medical treatment in another country than their working state--where they contribute for social security--is growing steadily. This article describes the EU and member states' rules governing the reimbursement of the expenses for medical treatment received abroad, for the case where patients travel abroad with the sole purpose of medical care in the framework of the national health insurance (treatment authorised by E112-form). It is illustrated that some countries' national rules comply with the EU-rules, a number of countries apply stricter rules, while other EU-members have established legislation that is more favourable for their citizens, than the EU-rules. Furthermore, the financial burden of treatment abroad also differs widely, since some countries reimburse travel and living expenses for the patient, and sometimes also for an accompanying person, while other countries do not provide such reimbursements. The article concludes with some policy implications.

Eligibility Determination↗
PubMed1994

A cost comparison of the use of fixed versus non-fixed versus individualised shielding blocks in radiotherapy.

The investment and operating costs for the manufacturing and application of routine shielding techniques in patients receiving radiotherapy are described. It was found that the operating cost of a fixed block is lower than that of the other types of blocks. Non-fixed and individualised blocks have similar operating costs. Whereas the manufacturing costs are much lower for non-fixed blocks than for individualised blocks, their application costs (for daily placement) are much higher, implying that the cost per piece of both types of blocks is more or less identical. Departments that have all the equipment for the manufacturing of individual blocks available are recommended to use standard-fixed blocks in patients where there is no clear preference for a specific type of block. Individual blocks, because of their higher cost, should be used only when they are judged to be superior for the patient. Investment decisions for equipment can be based on a similar strategy. Only if one intends to use blocks in very few patients (less than 60/year), are non-fixed blocks the cheapest alternative. If more blocks are used, it is sufficient to invest in standard-fixed blocks equipment, unless individual blocks are recommended for medical reasons.

Costs and Cost Analysis↗
PubMed1994

Costs and effects of tracheoesophageal speech compared with esophageal speech in laryngectomy patients.

The hospital costs and the effects on speech are compared for tracheoesophageal (TE) speech and esophageal (E) speech in laryngectomy patients. TE-speech is more intelligible and the rehabilitation is faster (four versus nine months), but it is more expensive for the hospital. E-speech needs more speech rehabilitation sessions (average of 23,422 BF/patient) than TE-speech (7,157 BF). TE-speech involves primary (6,192 BF) or secondary placement (25,357 BF), replacement (average of 19,443 BF/patient/year) and in about ten percent closure of the fistula (39,135 BF/patient) and switching over to E-speech. On the basis of these data the expected average costs per patient can be calculated. These are definitely higher for the TE-speech than for E-speech.

Aged↗
PubMed1994

[The role of economic analysis in health care].

Since the needs in health care are much larger than the resources available to satisfy these needs, economic analysis can play a useful role in health care. Economic analysis can contribute to a better allocation of the available resources, through a comparison of the relative costs of different forms of health care delivery. A combination of correct, detailed information about the costs and effects of health care interventions is a necessary condition for an improved allocation of resources in health care, which is illustrated with a comparison of the effects and costs of open versus laparoscopic cholecystectomies. A better view on the cost structure of different techniques can result in a (more) efficient allocation of scarce resources. A multidisciplinary approach is a necessary condition for successful economic evaluations in health care.

Cholecystectomy↗
PubMed1993

The costs and effects of open versus laparoscopic cholecystectomies.

The costs and effects of open versus laparoscopic cholecystectomies are compared, from the point of view of hospitals and patients, for a consecutive series of 47 patients undergoing a cholecystectomy in the University Hospital Gasthuisberg, in Belgium. For the patients the laparoscopic technique is superior, since effects are better and direct costs are lower than for the open technique. From a financial viewpoint, hospitals have to weigh the higher costs of the laparoscopic equipment against the lower variable costs due to the shorter postoperative length of stay. Total hospital costs would be lower in case all cholecystectomies were performed with the laparoscopic rather than with the open technique if at least 140 cholecystectomies are done annually with the electrocautery technique, or 300 procedures with laser. However, more recent data reveal that the operating time reduces with the number of laparoscopic procedures (learning effects), implying that the laparoscopic electrocautery procedure would already be the cheaper alternative if more than 70 cholecystectomies are done annually, if disposables are used (or if 50 procedures are done with re-usables). It can be concluded that, once sufficient experience with laparoscopy has been achieved, most hospitals could realise cost savings by switching, as much as is medically justified, to laparoscopic procedures. This will also hold for hospitals performing few cholecystectomies, as long as re-usables and electrocautery are used.

Adult↗
PubMed1993

A model for calculating the costs of in vivo dosimetry and portal imaging in radiotherapy departments.

The costs of in vivo dosimetry and portal imaging in radiotherapy are estimated, on the basis of a detailed overview of the activities involved in both quality assurance techniques. These activities require the availability of equipment, the use of material and workload. The cost calculations allow to conclude that for most departments in vivo dosimetry with diodes will be a cheaper alternative than in vivo dosimetry with TLD-meters. Whether TLD measurements can be performed cheaper with an automatic reader (with a higher equipment cost, but lower workload) or with a semi-automatic reader (lower equipment cost, but higher workload), depends on the number of checks in the department. LSP-systems (with a very high equipment cost) as well as on-line imaging systems will be cheaper portal imaging techniques than conventional port films (with high material costs) for large departments, or for smaller departments that perform frequent volume checks.

Belgium↗
PubMed1993

Quality assurance procedures in radiotherapy. Economic criteria to support decision making.

This paper details the costs of two types of quality assurance activities in radiotherapy: in vivo dosimetry, intended to check the delivered dose, and portal imaging to check the treated volume. For both activities, either on-line or off-line techniques may be used. Describing the costs allows the calculation of which techniques are most cost-efficient for different radiotherapy departments.

Costs and Cost Analysis↗
PubMedDate not supplied

Hospital costs of protective isolation procedures in heart transplant recipients.

BACKGROUND: This study details the hospital costs of strict reverse isolation procedures in heart transplant recipients. METHODS: In a prospective, descriptive design, a research protocol was developed, identifying all of the activities related to strict reverse isolation procedures in heart transplant recipients. For each separate activity, materials used and workload were registered, which allowed the calculation of the material and labor costs for each of the isolation procedures. RESULTS: The cost calculations show that the first day in isolation costs about $160 (for isolation procedures only) and about $65 for each consecutive isolation day. With a mean post-intensive care unit length of stay of 22 days, the mean cost of isolation procedures for heart transplant recipients amounts to $1535. Finally, a modified isolation protocol was developed, incorporating only those procedures with proven effectiveness. It was calculated that a switch to such a modified protocol would allow a savings of over 50% of the hospital resources devoted to isolation measures. CONCLUSIONS: Isolation procedures use a significant portion of hospital resources. Modifying isolation protocols in heart transplant recipients can be a source of considerable savings in a transplant program.

Belgium↗
PubMedDate not supplied

Costing methodology in laparoscopic surgery.

This paper provides some basic insights in economic evaluation and costing methodology by means of illustrations in the field of laparoscopic surgery. Some general methodological aspects are discussed, as well as their impact on the calculation of both societal and hospital costs of medical interventions. First, Health Care Technology Assessment is described, and several techniques of economic evaluation in health care are situated in this area. Two fundamental concepts in costing analysis are discussed : opportunity costs and marginal (or incremental) analysis. Furthermore, it is argued that in designing an economic analysis, sufficient attention should be given to delineating the alternative treatment options and to determining the perspective from which the study is performed (patient, hospital, insurer, society,...). Subsequently, it is argued that all price and wage data for activities performed within a certain period should apply to the same time period. Finally, in order to facilitate overview, re-calculation and interpretation of cost data, it is advised to distinguish fixed from variable costs. Different categories of societal costs are described, as well as a number of methodologies for their evaluation. In calculating hospital costs, the costs of all different resources used (e.g. buildings, equipment, staff, materials) must be identified precisely. The issues of annuitising initial investment expenses, calculating operating and maintenance costs, and allocating labour and overhead costs are discussed. Finally, it is argued that, in all studies, it should be investigated whether the results of the economic analysis are robust to the models' assumptions, by means of sensitivity analysis. This paper provides a practical toolkit for medical doctors, to allow a correct understanding and critical analysis of economic literature in the field of laparoscopic surgery.

Cost-Benefit Analysis↗