Economic costs of drug abuse.
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Adolescent↗
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Results for “Direct Service Costs”
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Economic costs of neoplasms, arteriosclerosis, and diabetes in the United States.
Substantial economic resources are used for treatment of neoplasms, arteriosclerotic diseases, and diabetes (direct costs), and substantial productivity is lost due to morbidity and mortality (indirect costs). Costs of these disease groups in the U.S. in 1993 are estimated from national health expenditures from the Health Care Financing Administration and survey data from the National Center for Health Statistics. Based on primary diagnosis, direct costs are $37 billion for neoplasms, $126 billion for arteriosclerosis, and $15 billion for diabetes, and indirect costs are $70, $83, and $5 billion respectively. Costs would be higher, particularly for diabetes ($92-138 billion), if based on primary and secondary diagnosis.
Arteriosclerosis↗
Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care.
BACKGROUND: Many health-care institutions are emphasizing cost reduction programs as a primary tool for managing profitability. The goal of this study was to elucidate the proportion of anesthesia costs relative to perioperative costs as determined by charges and actual costs. METHODS: Costs and charges for 715 inpatients undergoing either discectomy (n = 234), prostatectomy (n = 152), appendectomy (n = 122) or laparoscopic cholecystectomy (n = 207) were retrospectively analyzed at Stanford University Medical Center from September 1993 to September 1994. Total hospital costs were separated into 11 hospital departments. Cost-to-charge ratios were calculated for each surgical procedure and hospital department. Hospitalization costs were also divided into variable and fixed costs (costs that do and do not change with patient volume). Costs were further partitioned into direct and indirect costs (costs that can and cannot be linked directly to a patient). RESULTS: Forty-nine (49%) percent of total hospital costs were variable costs. Fifty-seven (57%) percent were direct costs. The largest hospital cost category was the operating room (33%) followed by the patient ward (31%). Intraoperative anesthesia costs were 5.6% of the total hospital cost. The overall cost-to-charge ratio (0.42) was constant between operations. Cost-to-charge ratios varied threefold among hospital departments. Patient charges overestimated resource consumption in some hospital departments (anesthesia) and underestimated resource consumption in others (ward). CONCLUSIONS: Anesthesia comprises 5.6% of perioperative costs. The influence of anesthesia practice patterns on "downstream" events that influence costs of hospitalization requires further study.
Anesthesia↗
Developing a cost accounting system for a physician group practice.
Physicians in group practices must gain a competitive edge to survive in a healthcare environment in which cost efficiency has become critical to success. One tool that can help them is a cost accounting system that yields reliable, detailed data on the costs of delivering care. Such a system not only can enable physicians and group administrators to manage their operations more cost-effectively, but also can help them accurately assess the potential profitability of prospective managed care plans. An otolaryngology practice located in Mississippi provides a model for developing a cost accounting system that can be applied to physician group practices.
Accounting↗
Medicare program; adjustments to cost limits for skilled nursing facility inpatient routine service costs--HCFA. Proposed notice.
This notice proposes to eliminate an adjustment that we make to the Medicare cost limits for skilled nursing facility (SNF) routine services if the final rate of change in the market basket index for a calendar year that we use to set the limits differs from the estimated rate of change in the index by at least 0.3 percentage points. Elsewhere in this issue of the Federal Register is a separate final notice with comment period that explains the methodology we use to develop the cost limits and sets forth the cost limits applicable to cost reporting periods occurring on or after October 1, 1997.
Centers for Medicare and Medicaid Services, U.S.↗
[Costs of basic health services in a health district in Tunisia].
Information on the cost of health services is essential for good planning and management and the efficient use of resources. We calculated the total costs incurred in running primary health services for one year (1995) in the health district of Enfidha (Tunisia). The yearly operating expenditure for the health district was 1 219 099 Tunisian dinars and the cost per inhabitant was 17.494 dinars (US dollar 1 = Tunisian dinar 0.950 in 1995); 65.37% of total costs went on staff and 17.03% on drugs. Looked at another way, 84,96% went on curative services and 14.04% on preventive services. The cost of a consultation for curative care was 6.847dinars, for perinatal care was 2.764 dinars, for immunization was 3.680 and for school visit was 6.680 dinars. The study helps to identify ways in which cost analysis can be used to explore efficiency and resource adequacy in the district.
Direct Service Costs↗
The cost of preventing diabetes: what do we know and what do we need to know?
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Diabetes Mellitus↗
[A cost analysis of diagnostic screening for the differentiation of type-1 and type-2 diabetics aged 30 to 45. A health economics modelling calculation].
BACKGROUND AND OBJECTIVE: Because of its chronic course and increasing incidence diabetes mellitus is assuming increasing importance not only for medical reasons but also on health policy. Early recognition of carriers of autoantibodies among type 2 diabetics (noninsulin-dependent; NIDDM) and the resulting optimization of blood glucose could lead to a reduction of secondary diseases. A health-economic model for calculating costs was used to test the socioeconomic significance of a screening programme for identifying carriers of antibodies against glutamic acid decarboxylase among NIDDM diabetics. PATIENTS AND METHODS: Health-economic analysis was based on the incidence of positive autoantibody tests among diabetics aged between 30 and 45 years. Results for a cohort of diabetics who had been screened were compared with those obtained in a control group without screening. A time-span of 20 years was chosen because of the late manifestations of diseases secondary to DM. The model calculations used a cost analysis. Data were based on interventional clinical and epidemiological studies. Cost of treatment of secondary diseases was confined to a one-year period. In the first instance the direct medical costs and additionally the indirect economic costs, generated by patients' loss of production and disability to work were calculated. One-dimensional sensitivity analysis was used to check the assumptions underlying the model. RESULTS: Per patient in the model, total costs of the screening programme over a period of 20 years were calculated at DM 31,278, of which DM 7,799 were direct and DM 23,479 indirect costs. The calculated costs for the control subjects (no screening) were DM 35,290, of which DM 10,984 were direct and DM 24,306 indirect costs. CONCLUSIONS: Extrapolating to the entire population, with an investment by the statutory health insurance of ca. DM 22.8 million, employing a full screening programme would lead to a saving of DM 2.6 billion.
Adult↗
The direct medical cost of type 2 diabetes.
OBJECTIVE: To describe the direct medical costs associated with type 2 diabetes, as well as its treatments, complications, and comorbidities. RESEARCH DESIGN AND METHODS: We studied a random sample of 1,364 subjects with type 2 diabetes who were members of a Michigan health maintenance organization. Demographic characteristics, duration of diabetes, diabetes treatments, glycemic control, complications, and comorbidities were assessed by surveys and medical chart reviews. Annual resource utilization and costs were assessed using health insurance claims. The log-transformed annual direct medical costs were fitted by multiple linear regression to indicator variables for demographics, treatments, glycemic control, complications, and comorbidities. RESULTS: The median annual direct medical costs for subjects with diet-controlled type 2 diabetes, BMI 30 kg/m(2), and no microvascular, neuropathic, or cardiovascular complications were 1,700 dollars for white men and 2,100 dollars for white women. A 10-kg/m(2) increase in BMI, treatment with oral antidiabetic or antihypertensive agents, diabetic kidney disease, cerebrovascular disease, and peripheral vascular disease were each associated with 10-30% increases in cost. Insulin treatment, angina, and MI were each associated with 60-90% increases in cost. Dialysis was associated with an 11-fold increase in cost. CONCLUSIONS: Insulin treatment and diabetes complications have a substantial impact on the direct medical costs of type 2 diabetes. The estimates presented in this model may be used to analyze the cost-effectiveness of interventions for type 2 diabetes.
Aged↗
The cost-effectiveness of treatment for congenital diaphragmatic hernia.
BACKGROUND/PURPOSE: The cost-effectiveness of medical interventions is becoming an important issue for decision makers. Until recently, evidence of the cost-effectiveness of neonatal surgery was largely lacking. The authors analyzed the cost-effectiveness of neonatal surgery and subsequent treatment for congenital diaphragmatic hernia (CDH). METHODS: Both costs incurred inside and outside the health care sector (eg, out-of-pocket expenses and productivity losses) were included. Quality-adjusted life years (QALYs) were measured using the EuroQol EQ-5D questionnaire. Descriptive quality-of-life data were collected using a disease-specific questionnaire. Both costs and effects basically were measured in a life-time setting. RESULTS: Total costs of treatment average euro 42,658, mainly consisting of costs of the initial hospitalization. Productivity losses in both the patients and their caregivers appear to be minor. Treated CDH patients, even adults, suffer from respiratory difficulties and stomach aches. According to the EQ-5D, however, their quality of life does not differ from the general population, suggesting that these symptoms barely affect overall quality of life. Treatment results in a gain of 17.5 QALYs. Costs per QALY amount to euro 2,434. CONCLUSIONS: Treatment for CDH has favorable cost-effectiveness. Considering the growing importance of cost-effective medicine, these are important and encouraging results. Health economics outlines the inevitability of making choices that directly affect patient care and places relative values on different health care programs. The results of this study provide convincing evidence that treatment for CDH is indeed cost effective.
Direct Service Costs↗
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 inpatient routine service costs for which payment may be made under the Medicare program.
Centers for Medicare and Medicaid Services, U.S.↗
[Evaluation of direct hospital and extra-hospital cost of operative hysteroscopy and vaginal hysterectomy].
The objective of this work was to evaluate hospital and postoperative costs associated with gynecologic surgery for benign uterine pathologies. We studied operative hysteroscopy and vaginal hysterectomy. Hospital costs were broken down into several categories: operating room, postoperative hospitalization, pharmacy surgical instruments, sterilization of reused equipment, food and laundry, indirect costs. The mean total costs for the hospitalization time were 4609.8 francs for hysteroscopic surgery and 7920.3 francs for vaginal hysterectomy. Medical charges in recovery time were calculated with the help of the Social Security. These charges represented 5% of the total cost associated with the procedure.
Direct Service Costs↗
Direct cost assessments in subjects with seasonal allergic rhinitis living in Ankara, Turkey.
The characteristics of seasonal allergic rhinitis (SAR) including the severity at initial presentation and cost estimates are not established for Turkey. The aim of this study was to document the clinical features and direct cost of subjects with SAR when diagnosed and followed according to international treatment guidelines and to determine the effectiveness of treatment in relation to the regional pollen count in our country. The clinical features of SAR were determined cross-sectionally in 175 patients living in Ankara, Turkey. The direct medical cost analysis obtained by a symptom-medication score method was performed prospectively in a subgroup of patients evaluated at the beginning of the pollen season (n = 37). Airborne Gramineae pollen grains were counted also in the same period. SAR was mild in 12.6% of cases, moderate in 51.4% of cases, and severe in 36% of cases. Regional pollen counts were correlated with the number of patient visits and the initial severity of SAR. Mean cost of SAR per person without a comorbid disorder during a Gramineae pollen season for Ankara was 79.0 +/- 3.3 dollars, where it reached a mean of 138.60 +/- 0.5 dollars in the presence of asthma and/or conjunctivitis. No difference was observed among disease severity groups by means of total direct cost (p > 0.05). Regional pollen counts influence the initial severity of SAR in our country. Appropriate treatment seemed to induce effective symptom control. Hence, education of both public and primary care physicians about the international guidelines might provide better cost-effective management of SAR.
Adult↗
Health status and severity of illness as predictors of outcomes in primary care.
Two measures of health status and severity of illness were tested as indicators of patient case-mix to predict health-related outcomes in a rural primary care community health clinic, using a convenience sample of 413 ambulatory adults (mean age = 40.4 years: 58.6% women, and 47.2% black). At baseline; patients completed the Duke Health Profile, and providers completed the Duke Severity of Illness Checklist. During the 18-month follow-up study, patients experienced the following outcomes: at least one follow-up visit (74.3%), more than six visits (20.6%), at least one referral or hospital admission (17.3%), upper tertile severity scores (24.9%), and upper tertile office charges (24.9%). Baseline physical health, perceived health, and severity scores were statistically significantly predictive of all five outcomes. Predictive accuracy (i.e., area under the receiver operating characteristic curves) for outcome probabilities estimated from a case-mix model of physical health, severity, age, gender, and race was 72.3% for follow-up, 69.7% for frequent follow-up, 70.5% for referral and/or hospital stay, 65.7% for high follow-up severity of illness, and 67.6% for high follow-up charges. These data support health status and severity of illness as case-mix indicators and outcome predictors of follow-up utilization, severity of illness, and cost in the primary care setting.
Adult↗
Reduction of urinary incontinence in nursing homes: does it reduce or increase costs?
Labor and supply costs associated with the care of urinary incontinent patients in three nursing homes were measured. First, normal nursing home changing patterns and their associated costs were measured. Second, the costs were documented when patients were checked by research staff and changed on an hourly basis as needed. Nursing home staff changed patients significantly less frequently than patient voiding as detected by the hourly checking system. Thus, cost of incontinence during the hourly checking condition ($3.35) per 12-hour patient-day was significantly higher than the cost normally incurred in nursing homes ($1.52) per 12-hour patient-day. The cost of an incontinence rehabilitation program, which significantly reduced incontinence episodes, was contrasted to the cost of incontinence as measured under both of the previous conditions. The rehabilitation program produced significant labor and supply savings only when compared with the hourly checking and changing system. Maintaining patients in a more continent condition costs significantly more than the direct incontinence cost normally incurred by the nursing home. Quality of life and other second-order benefits must be considered if continence rehabilitation is to be judged cost-effective.
Aged↗
Transportable versus fixed platform CT scanners: comparison of costs.
PURPOSE: To compare the aggregate hospital technical costs of a transportable computed tomographic (CT) scanner used to image patients in an intensive care unit with those of a fixed platform CT scanner in the radiology department. MATERIALS AND METHODS: Direct fixed costs (ie, machine and service contract costs) and direct variable costs (ie, personnel costs) were calculated. Indirect costs, including space costs and departmental overhead, were calculated. Total costs were calculated as the sum of indirect, direct fixed, and direct variable costs. Personnel costs were calculated from time-motion analyses involving 95 patients who underwent brain CT with either a transportable (n = 51) or a fixed platform (n = 44) CT scanner. Costs per examination were calculated by using both low- and high-examination-volume models and compared with use of the Wilcoxon rank sum test. RESULTS: The total cost per examination for the transportable scanner ranged from 108.98 dollars to 167.20 dollars for the high- and low-volume models. Total cost per examination for the fixed platform scanner ranged from 75.24 dollars to 112.39 dollars for the high- and low-volume models. For the transportable scanner, direct fixed, variable, and overhead costs were 87.05 dollars, 70.73 dollars, and 9.42 dollars per examination, respectively, with the low-volume model. The corresponding costs for the fixed platform scanner were 46.66 dollars, 55.69 dollars, and 10.04 dollars, respectively. CONCLUSION: The technical cost of using an in-hospital transportable CT scanner is higher than that of using a fixed platform scanner.
Costs and Cost Analysis↗
The cost of head trauma in Olmsted County, Minnesota, 1970-74.
A study of the total cost of head injury in Olmsted County, Minnesota, with the costs projected to the United States population, revealed that the annual cost for head trauma in the US can be estimated at approximately +12.5 billion using a 6 per cent discount rate. The nonmedical costs accounted for more than 92 per cent (+11.5 billion) of the total cost, while direct medical costs amounted to +1.0 billion.
Adult↗
Abdominal aortic aneurysm: endovascular grafts offer a potential alternative to surgery.
Endovascular grafts are a new, experimental surgery for AAAs that alleviates the need for open abdominal surgery. They offer an important alternative for high risk patients who would be at a greater risk with the more invasive surgical procedure. However, this is based on limited evidence, and more randomized controlled trials are needed. The procedure may be cheaper than open surgery, because of the lengthy hospital stay and operating room time with the latter, provided that the costs of the devices are low enough. However, there is insufficient data on the outcomes with endovascular grafts in different patient groups. As with many new or minimally invasive techniques, there is a "learning curve" which will affect costs and outcomes. Endovascular grafting is no exception, and repeated practical applications are needed for competence, expertise and good outcomes. Continued monitoring of this technique is needed. A registry of elective AAA patients now has 10-year follow-up data on about a third of the Canadian patients operated on in 1988. Further development of such registries will provide more accurate information on success rates, costs, and long-term complications.
Aortic Aneurysm, Abdominal↗