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PubMedDate not supplied

A method for the measurement of outpatient resource utilization.

A method for measuring outpatient resource utilization in terms of the amounts of time different categories of patients spend with various providers is described. Patients are categorized based on selected attributes, but other attributes could be used. The method is based on two important and measurable variables: 1) frequencies of usage of different resources (e.g., nurse practitioners, physicians, x-ray), and 2) amounts of time used, by each provider type and by ancillary services (x-ray). Using the quantitative measures described, an algorithm is developed for measuring the direct labor costs of delivering primary care to different types of primary care patients.

Algorithms↗
PubMed2000

The cost of work-related physical assaults in Minnesota.

OBJECTIVE: To describe the long-term productivity costs of occupational assaults. DATA SOURCES/STUDY SETTING: All incidents of physical assaults that resulted in indemnity payments, identified from the Minnesota Department of Labor and Industry (DLI) Workers' Compensation system in 1992. Medical expenditures were obtained from insurers, and data on lost wages, legal fees, and permanency ratings were collected from DLI records. Insurance administrative expenses were estimated. Lost fringe benefits and household production losses were imputed. STUDY DESIGN: The human capital approach was used to describe the long-term costs of occupational assaults. Economic software was used to apply a modified version of Rice, MacKenzie, and Associates' (1989) model for estimating the present value of past losses from 1992 through 1995 for all cases, and the future losses for cases open in 1996. PRINCIPAL FINDINGS: The total costs for 344 nonfatal work-related assaults were estimated at $5,885,448 (1996 dollars). Calculation of injury incidence and average costs per case and per employee identified populations with an elevated risk of assault. An analysis by industry revealed an elevated risk for workers employed in justice and safety (incidence: 198/100,000; $19,251 per case; $38 per employee), social service (incidence: 127/100,000; $24,210 per case; $31 per employee), and health care (incidence: 76/100,000; $13,197 per case; $10 per employee). CONCLUSIONS: Identified subgroups warrant attention for risk factor identification and prevention efforts. Cost estimates can serve as the basis for business calculations on the potential value of risk management interventions.

Adult↗
PubMed1998

Utilisation of mental health services and costs of patients with schizophrenia in three areas of Spain.

BACKGROUND: The analysis of the costs of schizophrenia and its treatment under different mental health care structures will facilitate the improved allocation of the limited resources available for the treatment of schizophrenia. The research we present compares health service use and total health care costs of three cohorts of subjects with schizophrenia which are representative of three areas of Spain (Burlada in Navarra, Cantabria and the Eixample of Barcelona). METHOD: We selected first-time contacts with any psychiatric service who received a diagnosis of schizophrenia. Subjects were evaluated in the third year after onset. RESULTS: The mean number of out-patient visits per patient per year was 10.7 and the mean in-patient days were 9.5. The mean direct cost per patient in the third year of treatment was US$2243. Costs were higher for single subjects and for people who had a relapse. Costs of subjects with better functioning were lower than costs of subjects with a worse state. CONCLUSIONS: Direct costs of care in Spain were lower than the reported figures from other western European countries. Costs were greater in the two centres with greater community mental health service development. Some of the findings may be explained by service availability.

Adult↗
PubMedDate not supplied

Dollars and sense: a practical guide to cost analysis for hospital epidemiology and infection control.

This paper explains practical approaches for collecting inpatient cost data for cost-of-illness and cost-effectiveness analyses. The economic definition of cost of an item is the value of the resources that are consumed in its production. Cost analysis should collect the resources hypothesized to be affected by the illness or intervention. The dollar value of these resources can also be estimated. Diagnosis-related group (DRG) reimbursements are not helpful when all study patients have the same DRG or when no DRG exists (e.g., nosocomial infection). Hospital charges are not a good surrogate for costs. Hence, data needed include resources used, charges, and cost-to-charge ratios, so that cost can be estimated. Resources used can be obtained from hospital information systems. For some resource use (e.g., physician services, pharmacy, and intravenous fluids), charges or cost-to-charge ratios may not be available, and an external standard may be needed to estimate the dollar value. For many types of resources, hospital financial systems provide both charges and cost-to-charge ratios. This yields an estimate of average cost (total cost divided by patient days) when marginal cost (change in variable cost per day of patient stay) is a better estimate of the value of the resources consumed. However, cost-to-charge ratios remain the only practical way of estimating cost in many circumstances and are commonly used in economic studies. Cost-of-illness estimates vary among the various nonrandomized study designs used. "Real-world" randomized trials are potentially useful to obtain advantages of randomization but avoid the protocol-induced biases of traditional double-blind controlled trials.

Cost of Illness↗
PubMed1994

The hospital cost (fiscal year 1991/1992) of a simple perioperative allogeneic red blood cell transfusion during elective surgery at Duke University.

We sought to determine the actual cost to Duke University Medical Center of a perioperative red blood cell transfusion. A recent audit at Duke University Medical Center determined the base average direct and indirect hospital costs for providing a unit of red blood cells. The Transfusion Service's base cost for providing an allogeneic unit of red blood cells was $113.58. To obtain the actual hospital cost of transfusing a unit of red blood cells in the perioperative period, associated costs were calculated and added to the Transfusion Service's base cost. These associated costs included compatibility tests on multiple units per each unit transfused in the perioperative period, performing ABO and Rh typing and antibody screening on samples from patients who were not subsequently transfused, compatibility tests on units not issued, handling costs of units issued but not used, physically administering the blood, and the cost of the recipient contracting an infectious disease or developing a transfusion reaction. These associated costs increased the cost of transfusing an allogeneic unit of red blood cells in the perioperative period to $151.20. Perhaps the techniques described in the study can be used to quantify cost/benefit ratios associated with future changes in transfusion practice.

Blood Banks↗
PubMed1984

Patient costs in the prevention and treatment of post-cesarean section infection.

The total cost to the patient is an important consideration in the selection of antimicrobials for prevention and treatment of post-cesarean section endomyometritis. We compared the cost to the patient of commonly used therapeutic and prophylactic agents in a theoretical model population of 450 women who were delivered by cesarean section. Cost of the drug alone on a per gram, per dose, or per day of therapy basis is not an accurate way of estimating the cost eventually paid by the patient. The therapeutic efficacy, frequency of administration, and need for ancillary services for each treatment regimen affect significantly the patient's costs.

Anti-Bacterial Agents↗
PubMed1992

Medicare program; schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period.

This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility routine service costs for which payment may be made under the Medicare program. Section 1888(a) of the Social Security Act requires that for cost reporting periods beginning on or after October 1, 1992, and every two years thereafter, the Secretary update the per diem cost limits for skilled nursing facility routine service costs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1985

The economic costs of schizophrenia. Implications for public policy.

The direct and indirect costs associated with schizophrenia in Australia were calculated using the incidence approach and compared with similar costings of myocardial infarction in Australia and the United States. In Australia schizophrenia affects one-twelfth as many people as does myocardial infarction, yet costs half as much. This is because the stream of costs associated with each case of schizophrenia is six times the stream of costs associated with myocardial infarction. To illustrate the utility of this costing approach, the information was used to estimate the cost-benefit ratio likely to follow the introduction of social intervention strategies. The information also showed that Australian support for research in schizophrenia is inadequate when compared with that for myocardial infarction and quite out of proportion to the cost of schizophrenia to the community.

Adolescent↗
PubMed1996

Economic costs of anxiety disorders.

Anxiety disorders are estimated to affect 26.9 million individuals in the United States at some point during their lives. This study used the human capital approach to estimate the direct and indirect costs of these highly prevalent disorders. In 1990, costs associated with anxiety disorders were $46.6 billion, 31.5% of total expenditures for mental illness. Less than one-quarter of costs associated with anxiety disorders were for direct medical treatment; over three-quarters were attributable to lost or reduced productivity. Most of these indirect costs were associated with morbidity, as mortality accounted for just 2.7% of the total. Greater availability of effective, relatively low-cost outpatient treatment could substantially reduce the economic and social burden of these common and often crippling disorders.

Absenteeism↗
PubMed2002

Clinical and economic implications of adding HPV tests to the routine cytology follow-up and management of patients with histologically defined cervical intraepithelial neoplasia grade 1.

OBJECTIVE: The objective of this study was to evaluate the clinical and economic implications of adding human papillomavirus (HPV) testing to the follow-up and management protocol of women with a histological diagnosis of low-grade cervical intraepithelial neoplasia (CIN1). METHODS: The study cohort consisted of 314 women with histological diagnosis of CIN1 and who met the inclusion criteria. They were followed-up by pap smears and samples for HPV tests that were obtained and analyzed on the first visit after referral. HPV assessment was carried out later. Colposcopy and biopsies were performed when there were two consecutive abnormal pap results or positive HPV tests. Women with any degree of CIN underwent cone biopsies. RESULTS: The positive predictive value (PPV) of low-grade squamous intraepithelial lesion and high-grade squamous epithelial lesion to identify high-grade lesions (CIN2-3) were 48.9 and 95%, respectively. The PPV of low-risk HPV type for CIN1 and that of high-risk HPV type for CIN2-3 were both 97%. Of the 314 study participants, 68 (21.6%) patients were positive for HPV analysis, and 67 of these (98.5%) had either CIN1 or CIN2-3 on the cone biopsy, with an overall PPV of 95%. The cost effectiveness ratio was $1457 per additional case detected by the "HPV approach." CONCLUSIONS: Testing for the presence of high-risk HPV types is both clinically and economically more beneficial than cytology in the follow-up and management of patients with a diagnosis of CIN 1 because of its better sensitivity, specificity, and PPV reports.

Adolescent↗
PubMed1988

The cost of diabetes in France.

Within an economic framework it is possible to evaluate the direct cost of diabetes. In 1984, for 109 diabetics - 27 insulin-dependent patients (IDD) and 82 non-insulin-dependent patients (NIDD) - of the Paris area, the average cost of diabetes was 7711 francs (Fr) for the IDD and 5892 Fr for the NIDD. This cost is the sum of the medical visits, drugs and hospitalization. The medical expenditures of the NIDD is roughly the same as for the general population (6462 Fr). For the IDD, the main difference concerns the drug expenditures. Moreover, in 1984, there is more home-care than in 1978. Lastly, there is little difference between prescription use in the U.S. and in France. Such results allow us to discuss the reimbursement of the care needed for diabetics.

Costs and Cost Analysis↗
PubMed2006

A naturalistic comparison of amoxicillin/clavulanate extended release versus immediate release in the treatment of acute bacterial sinusitis in adults: A retrospective data analysis.

BACKGROUND: Choosing the most effective treatment for acute bacterial sinusitis (ABS) is helpful to avoid treatment failure. To date, studies comparing antibiotic options for ABS have compared amoxicillin/clavulanate (AMX/CA) immediate release (IR) versus other antibiotics, but have not included AMX/CA extended release (XR). OBJECTIVE: The purpose of this study was to determine whether the clinical advantages of AMX/CA XR found in a clinical trial setting translate to a naturalistic setting, relative to AMX/CA IR. METHODS: Data for this retrospective analysis were obtained from a managed care benchmark database that included >25 million patients from >30 health plans covering 7 US census divisions. Data from all patients aged > or =18 years with an index diagnosis of ABS between July 1, 2001, and December 31, 2003, were included. Episodes of ABS were classified as treatment successes (no additional prescriptions for antibiotics, ABS-related emergency department [ED] visits, or ABS-related inpatient hospitalizations within 30 days after the index prescription) or failures (> or =1 subsequent antibiotic prescription, an ABS-related ED visit, or an ABS-related inpatient hospitalization within 30 days after the index prescription). Treatment failures were subclassified as early or late. Mean costs were assessed for medical claims linked with a primary diagnosis of ABS and antibiotic pharmacy claims within the follow-up time period (through February 28, 2004). Descriptive statistics for demographic characteristics, utilization patterns, and success rates were calculated for each cohort. A multivariate general linear regression model was developed to assess differences in costs between the 2 cohorts. RESULTS: : Of the patients with an index antibiotic prescription filled within 3 days of ABS diagnosis (n = 241,511), a total of 3224 in the AMX/CA XR cohort (mean [SD] age, 41.8 [11.6] years; women, 57.7%) and 23,638 in the AMX/CA IR cohort (mean [SD] age, 41.9 [11.6] years; women, 62.7%) were included in the analysis. The rate of treatment success in patients treated with AMX/CA XR was 82.8% versus 81.0% in patients treated with AMX/CA IR (P < 0.015). Treatment success costs were significantly lower than treatment failure costs regardless of an early or late designation and ranged from 98 dollars to 110 dollars per episode (P < 0.001). After adjustment for background covariates, the mean cost of treating an episode of ABS was significantly lower for patients receiving AMX/CA XR versus those receiving AMX/CA IR (166.32 dollars vs 177.34 dollars [US 2004 dollars]; P < 0.001), representing a mean cost savings of 11.02 dollars per patient treated with AMX/CA XR over AMX/CA IR for ABS, regardless of treatment outcome. CONCLUSIONS: The results from this data analysis suggest that AMX/CA XR had significantly higher treatment success in ABS relative to AMX/CA IR in this naturalistic setting. AMX/CA XR was associated with significantly decreased total ABS-related costs in these adults.

Acute Disease↗
PubMedDate not supplied

Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome.

A decision analytic study was conducted using computer simulation to project the outcomes in a simulated cohort of patients whose treatment for back surgery had failed. The objective of this study was to estimate the direct cost of intrathecal morphine therapy (IMT) delivered via an implantable pump relative to alternative therapy (medical management) over a 60-month course of treatment. IMT administered by way of an implantable pump can provide effective pain relief for selected patients whose less invasive treatment modalities have failed. Previous research suggested that a pump implant is less costly than alternative methods providing comparable analgesia for treatment exceeding 12 to 18 months. However, those analyses did not include the cost of complications or pump replacement. Scenarios representing the course of IMT, devised by a panel of experts, were represented as treatment pathways in a Monte Carlo simulation. Adverse event rates were drawn from published data supplemented by expert judgment. Direct costs were based on a health insurer paid claims perspective (direct costs) discounted at a 5% annual rate. The cost-effectiveness of IMT was calculated based on a report of 65% to 81% "good to excellent" pain relief relative to alternative (medical) management. With both adverse event probabilities and costs set at most likely (base case) values, the expected total cost of IMT over 60 months was $82,893 (an average of $1382 per month). In a sensitivity analysis, the best case (low adverse event rate, low cost) estimate was $53,468 ($891/mo), whereas the worst case (high adverse event rate, high cost) estimate was $125,102 ($2085/mo). Cost-effectiveness estimates ranged from $7212 (best case) to $12,276 (worst case) per year of pain relief. Results from a computer simulation designed to collect the costs not included in previous empiric research indicate that IMT appears to be cost-effective when compared with alternative (medical) management for selected patients when the duration of therapy exceeds 12 to 22 months.

Back↗
PubMed1998

The cost-effectiveness of octreotide acetate in the treatment of carcinoid syndrome and VIPoma.

Markov modeling was used to evaluate the cost-effectiveness of octreotide in treating carcinoid syndrome and VIPoma. For each condition, using octreotide was associated with doubled survival time. Octreotide was cost-effective for treating carcinoid tumor ($752 per additional year of life, two additional years on average), and cost saving for VIPoma.

Antineoplastic Agents, Hormonal↗
PubMed2005

Hemodialysis for end-stage renal disease: a cost-effectiveness analysis of treatment-options.

BACKGROUND: During 2001, over 32,000 patients in the United Kingdom received renal replacement therapy (RRT). Approximately half had a functioning transplant, with the remainder receiving dialysis therapy. The main form of dialysis is hemodialysis (HD), which is provided to 37.1 percent of the RRT population. HD is provided in three main settings: hospital (24.5 percent), satellite (10.9 percent), or home (1.7 percent). The objective of this study is to explore the cost-effectiveness of these different modalities. METHODS: By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the three different modalities. The model included direct health service costs and quality-adjusted life years (QALYs). Sensitivity analyses were performed to assess the robustness of the results. RESULTS: Satellite HD has lower costs 46,000 pounds sterling and 62,050 pounds sterling at 5 and 10 years than home HD 47,660 pounds sterling and 63,540 pounds sterling. The total effectiveness of home HD was slightly greater than for satellite HD, so the incremental cost per QALY of home versus satellite HD was modest at 6,665 pounds sterling at 5 years and 3,943 pounds sterling at 10 years. Both modalities dominated hospital HD. CONCLUSIONS: Results from the study reveal that satellite HD was less costly than home HD, and home HD was less costly than hospital HD. The lack of robust data on the effectiveness and new dialysis equipment, which were not included in this review, throws some caution on these results. Nonetheless, the results are supportive of a shift from hospital HD to satellite and home HD.

Aged↗