Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “cost of complexity”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Methodologic principles of cost analyses in the nursing, medical, and health services literature, 1990-1996.

BACKGROUND: Cost analyses are needed to inform resource decisions. Oftentimes, however cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), cost-minimization analysis (CMA), and cost-utility analysis (CUA) are performed using untested techniques and adhering to a variety of questionable principles. OBJECTIVES: To analyze, compare, and present a set of useful principles for the main types and methods of cost analyses through a synthesis of current information in the published literature. METHODS: The area of interest included all reports of cost research published as full articles in professional journals from January 1990 to August 1996 in the nursing, medical, and health services fields. In all, 88 sampled articles met the criteria for inclusion. A four-page data collection guide with 28 items grouped as demographics, cost-analysis types, methods, and principles was designed for the review. Incremental testing for interrater reliability using the kappa statistic for two raters was performed. Sampling, process-oriented, construct, and correlational validity were assessed. RESULTS: The 88 articles included 4 from nursing, 59 from medical, and 25 from health services journals. Of these articles, 45 (51%) reported CBA, 36 (41%) CEA, 2 CMA, 4 CUA, and 1 both CBA and CEA. Three nursing studies were authored only by nurses. Three fourths of the medical and four fifths of the health services publications had interdisciplinary authorship. Existing databases were the primary source of data in 61 (69%) publications. Adherence to six main methodologic principles was apparent in 19 (22%) articles. None of the nursing studies adhered to all six principles, whereas 16% of the health services and 25% of the medical studies did. CONCLUSIONS: Funded cost analyses of nursing interventions that adhere to the six known methodologic principles are needed to inform policy-level health care decisions. Because of the complexity of cost analysis methodology, including sensitivity analysis, future interdisciplinary efforts using existing databases may prove most effective. The six methodologic principles presented in this article can be useful for future nursing education and cost-analysis research designed to control cost and increase the quality of health care.

Costs and Cost Analysis↗
PubMed1996

[Costs-proceeds calculation for radiotherapy; comment].

BACKGROUND: The Health Care Structure Bill (Gesundheitsstrukturgesetz) and the Federal Health Care Tariff Regulation (Bundespflegesatzverordnung) pose new challenges for the chief physician in charge, which he has to face on account of hospital management control with department-specific internal budgeting of services, expenditure and remittance. In view of the impending establishment of care-related lump sums (Fallpauschalen) and special allowances for radiation therapy (Sonderentgelte) as well as the introduction of an appropriate internal budget plan, we resolved to draw up the service-cost ratio for 11 tumor entities, implementing calculation based on process evaluation, and to match this calculation to the actual proceeds from outpatient treatment covered either by general health insurance or private care insurance. MATERIAL AND METHODS: The following 11 tumors were included in the analysis: Glioblastoma multiforme, squamous cell carcinoma of the head and neck, lung cancer, oesophageal cancer, breast cancer, rectal and prostate cancer, cancer of the anal canal and the uterine cervix, Hodgkin's disease and bone metastases. For the description of the services rendered and for the calculation of actual cost, the complex treatment regime was divided into the following steps: administration, medical radiation planning, radiation planning by physicist, workmanship, radiotherapy treatment and medical service. The calculation of costs was made either in- or excluding the cost of teatment facilities and basic investment. The proceeds were calculated according to the regulations of the EBM (dated 1. 10. 1994) for general health insurance patients (median point value 9.35 DPF) and the GOA (dated 1. 7. 1988) for private patients (point value 11 DPF). RESULTS: 1. Calculation by EBM standards: Excluding the cost of facilities and basic investment, there is a profit margin for the following tumor entities amounting to +1.6% (103.18 DM) for ENT tumors, +9.2% (671.90 DM) for carcinoma of the anal canal and +35.8% (1637.84 DM) for bone metastases. All other tumor entities cannot be treated cost-effectively. With the exception of glioblastoma, median loss comes to -20% (-14% to -27.4%, i.e. -809.48 to -1812.84 DM). Including in the calculation the cost of the facilities and investment, only bone metastases can be treated with a profit margin. For all other tumors, the mean loss amounts to -33% (-14.1% to -44.7%) or else -1308.26 to -4550.51 DM. 2. Calculation by GOA standards: Comparing cost and actual proceeds, there is a loss for all tumor entities. Excluding the cost of treatment facilities and investment, median loss amounts to -44% (-33.3% to -53.5%, or -1752.64 DM to -3488.18 DM), including both, mean loss comes to -56% (-47.8% to -53.3% or -3156.33 DM to -6332.43 DM). 3. Calculation of comprehensive cost and of the proceeds: For our own department, considering the cost-proceeds ratio for 1994, we ran up a deficit of 673,767.10 DM for outpatient care. This deficit can mainly be traced back to non-operational hours of the linear accelerator due to machine impairment, maintenance and dosimetric measurements by the physicists, leading to the loss of 53 work-days (14 hours each) amounting to 498,771.34 DM plus general costs of 271,000 DM added to the bill by hospital administration. CONCLUSIONS: As to the reviewed tumor entities, modern standard radiotherapy cannot be administrated cost-effectively. A considerable degree of under-funding is especially evident with the inclusion of cost of investment and of the facilities. The cost-proceeds ratio is most unsatisfactory as regards GOA calculation, which is obsolete as far as service description and service payment is concerned. As it in no way measures up to the required standard of modern radiotherapy, reform is therefore urgently needed.

Costs and Cost Analysis↗
PubMed2004

Magnetoencephalography: an investigational tool or a routine clinical technique?

Magnetoencephalography (MEG) is a relatively novel noninvasive technique, with a much shorter history than EEG, that conveys neurophysiological information complementary to that provided by EEG, with high temporal and spatial resolution. Despite its a priori, highly competitive profile, the role of MEG in the clinical setting is still controversial. We briefly review the major obstacles MEG faces in becoming a routine clinical test and the different strategies needed to bypass them. The high cost and complexity associated with MEG equipment are powerful hindrances to wide acceptance of this relatively new technique in clinical practice. The most straightforward advantage is based on the relative facility of MEG recordings in the process of source localization, which also carries some degree of uncertainty, thus partly explaining why the development of clinical applications of MEG has been so slow. Obviously, a decrease in the cost and the elaboration of semiautomatic protocols that could reduce the complexity of the studies and favor the development of consensual strategies, as well as a major effort on the part of clinicians to identify clinical issues where MEG could be decisive, would be most welcome.

Behavior↗
PubMed2000

Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program.

Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment.

Cost-Benefit Analysis↗
PubMed1999

Imaging living cells and tissues by two-photon excitation microscopy.

Two-photon excitation microscopy provides attractive advantages over confocal microscopy for three-dimensionally resolved fluorescence imaging. Since two-photon excitation occurs only at the focal point of the microscope, it inherently provides three-dimensional resolution. This localization of excitation also minimizes photobleaching and photodamage, which are the ultimate limiting factors in imaging living cells. Furthermore, no pinhole is required to attain three-dimensional discrimination, so the efficiency of fluorescence collection is increased. These advantages allow experiments on thick living samples that would not be possible with other imaging techniques. The cost and complexity of the lasers required for two-photon excitation microscopy have limited its use, but appropriate turn-key lasers have now been introduced, and their cost should decrease. Finally, the recent introduction of commercial two-photon excitation laser-scanning microscope systems allows a much larger group of researchers access to this state-of-the-art methodology.

Animals↗
PubMed1992

Impact of the recommendations of the British Pacing and Electrophysiology Group on pacemaker prescription and on the immediate costs of pacing in the Northern Region.

BACKGROUND: The report from the Working Party of the British Pacing and Electrophysiology Group recommends the use of more sophisticated pacemakers in most patients. These proposals were initially circulated in September 1990 and are likely to have major cost implications. Their impact on pacing practice and the immediate costs of pacemaker hardware in the Northern Region were retrospectively audited. METHODS: The pacing records of 550 patients undergoing a first pacemaker insertion at the Freeman Hospital between March 1990 and August 1991 were reviewed. The patient's age, indication for pacing, pacing mode, and the cost of generator and lead(s) were recorded. The cost was compared with the costs of pacing with the optimal and alternative modes recommended by the Working Party. The costs were calculated from the actual mean cost of the recommended unit over the 18 month period of study multiplied by the number of patients who would have received that unit. RESULTS: 96% of patients were paced for sinus node dysfunction, atrioventricular block, or atrioventricular block and atrial fibrillation. The mean (SD) ages of patients in each diagnostic group were: sinus node dysfunction 69.4 (14), sinus node disease and atrioventricular block 67.2 (17.6), atrioventricular block 73.9 (12.5), atrial fibrillation and atrioventricular block 74.0 (13.9), and carotid sinus hypersensitivity 74.6 (11.6) years. Over the 18 month audit period there was an increase in physiological pacing. AAI pacing in patients with sinus node dysfunction increased by 100% and DDD pacing in atrioventricular block increased by atrioventricular block increased by 56%. Over the whole 18 month period the adoption of the British Pacing and Electrophysiology Groups optimal recommendations would have increased expenditure on pacemaker hardware in the Northern Region by 94% and the use of the alternative mode would have increased it by 61%. For the last six months alone the excess would be 78% and 48%. CONCLUSIONS: The adoption of the recommendations of the British Pacing and Electrophysiology group in the Northern Region would greatly increase the cost of pacing hardware. The greater part of this increase would be attributable to the routine use of dual chamber pacing in patients with atrioventricular block and the increased use of rate responsive units. The benefits of sophisticated pacing in a predominantly elderly population need to outweigh the disadvantages of the increased cost and complexity of follow up.

Aged↗
PubMedDate not supplied

Production of polyhydroxyalkanoates from agricultural waste and surplus materials.

To be competitive with common plastics, the production costs of polyhydroxyalkanoates (PHAs) have to be minimized. Biotechnological polymer production occurs in aerobic processes; therefore, only about 50% of the main carbon sources and even a lower percentage of the precursors used for production of co-polyesters end up in the products wanted. A second cost factor in normally phosphate-limited production processes for PHAs is the costs for complex nitrogen sources. Both cheap carbon sources and cheap nitrogen sources are available from agricultural waste and surplus materials and make a substantial contribution for minimizing PHA production costs. In this study, fermentations for PHA production were carried out in laboratory-scale bioreactors on hydrolyzed whey permeate and glycerol liquid phase from the biodiesel production using a highly osmophilic organism. Without any precursor, the organism produced a poly[3(hydroxybutyrate-co-hydroxyvalerate)] copolyester on both carbon sources. During the accumulation phases, a constant 3-hydroxyvalerate content of 8-10% was obtained at a total PHA concentration of 5.5 g/L (on hydrolyzed whey permeate) and 16.2 g/L (glycerol liquid phase). In an additional fermentation, an expensive nitrogen source was substituted by meat and bone meal beside the glycerol liquid phase as a carbon source, resulting in a final PHA concentration of 5.9 g/L.

Agriculture↗
PubMed2002

Costs and effectiveness in the care of patients with oral and pharyngeal cancer: analysis of a paradox.

Oropharyngeal cancer is estimated to be the ninth most common cancer worldwide. Its prognosis is largely dependent upon tumour-stage at the time of diagnosis. Stage I and II oropharyngeal cancers are characterized by a 5-year survival rate ranging from 70% to 90%, and the management of these early carcinomas is usually of short duration, easy and very cost-effective. On the other hand, the diagnostic evaluation, treatment and management of complications and recurrences of advanced stage oral tumours (stage III and IV) are often very long, complex and costly. They also have very poor prognosis with survival figures dropping to about 20%. Nowadays, most oropharyngeal cancers are detected at a late stage with an overall 5-year survival rate of around 45-50%, and with a conspicuous increase in treatment costs and a worsening of prognosis. Even if formal and comprehensive cost-effectiveness and cost-benefit analyses are not currently available in the oropharyngeal cancer literature, it seems clear that, in the care of these patients, the enormous consumption of resources is not associated with acceptable outcomes. New initiatives should be evaluated, planned and developed for the care of patients with oral and pharyngeal cancer. These strategies should be directed at prevention and early diagnosis in order to increase patient survival and quality of life and decrease the consumption of health care resources.

Cost-Benefit Analysis↗
PubMed2000

Cost-effective strategies in the acute management of atrial fibrillation.

Atrial fibrillation is the most common sustained arrhythmia likely to be encountered in clinical practice. It is associated with significant morbidity and mortality. The treatment of patients with atrial fibrillation can be complex and costly, especially when patients are hospitalized for acute management of this arrhythmia. In this review, we summarize current approaches to the acute management of atrial fibrillation with an emphasis on the most cost-effective approaches. We review acute methods of heart rate control and cardioversion, including pharmacologic and other minimally invasive strategies. We believe that the most cost-effective approaches may require the use of standardized clinical pathways. This may help to ensure that patients with acute atrial fibrillation receive the most effective and efficient care.

Anti-Arrhythmia Agents↗
PubMed1980

Appropriate cost reporting: an indispensable link to accountability.

As a response to the call for accountability, social work administrators have turned to the use of tools which measure input and output developed for business administration, e.g., cost-benefit and cost-effectiveness analysis. Social work administrators have primarily been concerned with the difficulty of measuring social work outputs and neglected the difficulty of measuring costs. In order to promote a better understanding of costs and their complexity, the author describes five cost reporting approaches utilizing actual cost data. The results suggest that the choice of approach has a definite effect on the cost outcome. Therefore, in order to promote accountability, social work administrators must make every effort to understand and be involved in the measurement of costs as well as outputs.

Cost-Benefit Analysis↗
PubMed1993

[Cost of training a diabetes mellitus patient. Effects on the prevention of amputation].

Cost of disease is a complex notion: financial cost, psychological cost for those who have cope with a chronic disease. But there is also another cost which has not yet sufficiently been taken into account: the cost of resistance to change. It has largely been shown that patient education could result in major cost-saving as well as improvement of quality of life. Why is there such a resistance from health care providers, health policy planners for implementation of patients education programs? These resistances may well be part of the real cost of efficient control of a disease and like in the case of diabetes, prevention of acute and chronic complications. Education and training of patients has enabled us to decrease markedly lower extremities amputations: 12 times less above knee amputations, reduction by half of below knee amputations and a four fold decrease of toe amputations at the University Hospital of Geneva, Switzerland.

Age Factors↗
PubMed2001

Cryopreservation of Rh negative blood for improved storage & utilisation by means of indigenous freezing bags & solutions & manual deglycerolisation.

BACKGROUND & OBJECTIVES: Cryopreservation allows donor blood to be stored for years, rather than weeks as in liquid storage. This is an established procedure in countries with a developed blood transfusion service. Cryopreservation has not been introduced in India, possibly because of the presumed high cost and complexity of the procedure. An attempt is made in this study, to cryopreserve Rh negative blood in a mechanical freezer using indigenous bags and solutions and manual deglycerolisation to reduce the cost of preservation. METHODS: RBCs to be frozen were weighed and transferred by sterile welding to an 800 ml freezing bag. Based on RBC weight, 400-500 ml of glycerol (5.7 MpH 6.8) was added as cryopreservative. After extracellular and intracellular equilibration, excess glycerol was removed by centrifugation. Glycerolised RBCs were frozen at -80 degrees C in a mechanical freezer. Cryopreserved units were thawed at 37 degrees C and deglycerolised. Twenty one patients were transfused with the frozen deglycerolised RBCs after the usual pre-transfusion tests. RESULTS: Haematocrit (Hct) values of the frozen deglycerolised units, complied with required standards, before addition of glycerol and post glycerolisation. RBC recovery was more than 80 per cent and Hct 83.3 per cent after deglycerolisation. Twenty one patients transfused with the frozen deglycerolised blood experienced no adverse effects and showed a 24 h mean post transfusion Hb increment of 0.73 g/dl. INTERPRETATION & CONCLUSION: Cryopreservation, unlike liquid storage, allows Rh negative blood of the required ABO groups to be stocked. Cryopreservation also improves its utilisation, reduces wastage and helps supplement the liquid stocks of Rh negative blood. The use of indigenous freezing bags and manual deglycerolisation has resulted in an inexpensive procedure, which can be integrated, with minor inputs, into any blood bank that is already preparing blood components.

ABO Blood-Group System↗
PubMed2002

Do regular dental visits affect the oral health care provided to people with HIV?

BACKGROUND: Financial factors related to income and insurance coverage have been found to limit access to, and influence use of, oral health care services by people with human immunodeficiency virus, or HIV. METHODS: The authors determined if visiting a dentist regularly affected the oral health services provided to people with HIV when financial barriers were eliminated as an impediment to access. They analyzed dental claims data for services submitted for payment to the Minnesota Access to Dental Care Program. The analyses focused on comparisons of dental utilization patterns among 273 people classified as regular patients, or RPs, and 222 people classified as nonregular patients, or NRPs. RESULTS: RPs were found to have been provided more diagnostic and preventive care, and less restorative, endodontic, periodontic, removable prosthodontic and oral surgical treatment than were NRPs. Although the mean submitted cost per patient visit was much higher for NRPs, total mean submitted costs per patient for RPs and NRPs were not significantly different. Even though NRPs underwent fewer procedures and had fewer clinic visits than did RPs, the procedures provided to NRPs were more complex and costly. As indicated by differences in the mix of dental care services provided to RPs vs. NRPs, continuity of primary oral health care for RPs led to a better oral health result at no increase in cost over that for NRPs. CONCLUSIONS: The study findings provide substantial evidence regarding the value of regular oral health care for people with HIV. CLINICAL IMPLICATIONS: This study reinforces the need for dentists to educate and encourage people with HIV to integrate regular oral health care into the ongoing maintenance of their overall health and well-being.

Adult↗
PubMed2000

Benefit cost management in the new millennium.

The new millennium will bring new challenges to managing employee benefit plans. Costs are going up. The provider community is consolidating. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) have added cost and complexity to benefit plans. Employers expect strategic partnering and a high degree of flexibility while simultaneously reducing benefit managers' budgets and staff. This article provides specific strategies and tactics for managing benefit costs in this new era.

Adult↗
PubMed1988

Behavioral treatments for adult dental avoidance. A stepped-care approach.

The growing research literature dealing with the psychologic treatment of dental fear and avoidance suggests several interventions as effective, but provides little guidance in choosing among them. Under these circumstances, experienced psychologic practitioners may choose among these interventions on the basis of their own clinical impressions as to which treatment might be best suited to each patient they see. An alternative approach is the stepped-care approach in which the least expensive/most practical intervention is implemented, with more costly or complex procedures implemented only if the less expensive intervention proves unsuccessful. Each of the behavioral treatments for dental fear that has received researchers' attention is briefly described, and they are ordered in terms of their costs in professional time. Finally, an account of the special precautions needed to implement a stepped-care strategy for the reduction of dental fear is outlined.

Adult↗
PubMed2006

Joint project of the International Network of Agencies for Health Technology Assessment--Part 2: Managing the diffusion of positron emission tomography with health technology assessment.

OBJECTIVES: Since 1997, members of the International Network of Agencies for Health Technology Assessment (INAHTA) have collaborated on a Joint Project to track the diffusion, evaluation, and clinical policy of positron emission tomography (PET). Part 2 of this updated Joint Project report summarizes HTA-based strategies for directing the clinical use of PET and a discussion on the value of HTA in managing the diffusion of high cost diagnostic technologies, which were presented at an INAHTA-sponsored workshop at the Health Technology Assessment International Annual Meeting in 2004 on strategies for managing high cost diagnostic technologies. METHODS: A summary of the workshop proceedings is presented. CONCLUSIONS: Sharing assessment work, universal agreement in assessment conclusions, stakeholder input, and modeling techniques help manage the uncertainty in the evidence base while targeting clinical use of PET toward the most promising indications. Emphasis on HTA findings, linkage between financing of clinical PET and outcome evaluation, and targeted dissemination of scientific findings empower providers to reduce unnecessary utilization and contain costs within a quality improvement framework. Above all, a trustworthy source of HTA information and a process that is conducive to using scientific evidence as the basis for decision making are essential for managing the diffusion of complex and costly diagnostic technologies in patient care.

Capital Financing↗
PubMed1999

Mental health carve-outs: effects and implications.

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and states are implementing a "carve-out." Under this arrangement, the sponsor separates insurance benefits by disease or condition, service category, or population and contracts separately for the management of care and/or associated risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This article describes various carve-out models, discusses the potential advantages and disadvantages of a full carve-out, and summarizes recent public and private sector research regarding the strategy's effects on access and use, cost savings and shifting, and quality of care. It concludes by discussing approaches to the assessment and monitoring of the processes and outcomes associated with a MH/SA carve-out.

Contract Services↗
PubMed2000

Hemorrhoid banding using videoendoscopic anoscopy and a single-handed ligator: an effective, inexpensive alternative to endoscopic band ligation.

OBJECTIVE: We evaluated a technique of hemorrhoid banding using videoscopic anoscopy and a single-handed ligator that offers substantial cost savings over endoscope-mounted devices. METHODS: Patients with rectal bleeding from grade II/III hemorrhoids had videoscopic anoscopy, which provided a magnified view, allowing accurate localization of the hemorrhoids and the dentate line before banding, and a photographic record, if required. Banding was performed using a suction ligator that could be operated by one hand, allowing the other to control the anoscope. RESULTS: Of 39 patients with second- and third-degree hemorrhoids, 34 (87%) had no further bleeding after a single banding session and a further three had no recurrence after a second session. The only complications were pain (one patient) and infection (one patient). CONCLUSIONS: This method is convenient and effective, costing per procedure less than one-tenth of endoscope-mounted band ligators. We recommend its use in preference if magnified views and a photographic record are required. However, its cost and complexity, compared with traditional hemorrhoid banding, may mean that the latter is preferred in the office setting.

Adult↗