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PubMed2002

[Complexity index and analysis of digestive endoscopies at a university hospital].

BACKGROUND: In Spain neither the cost of digestive endoscopies nor the complexity index (CI) have been objectively estimated. Consequently, the profitability of an endoscopy unit cannot be evaluated. OBJECTIVES: 1: To classify endoscopies according to the time taken to accomplish them in order to estimate the CI and determine the relative value unit (RVU). 2: To evaluate the cost of each examination in order to determine the profitability of endoscopy as a diagnostic and therapeutic tool. 3: To measure unnecessary delays in examinations and to determine whether there are differences in the time an examination takes according to the endoscopist's experience and the patient's age or sex. MATERIAL AND METHODS: The cost per hour of an endoscopy room was estimated by dividing the cost per year of employees, equipment, maintenance and the hospital's general costs between the hours of work per year of the endoscopy team. The time taken to perform endoscopies was estimated and the result was used to calculate the RVI, the CI and the cost of 500 consecutive endoscopies. RESULTS: The annual cost amounted to 349,617.69 E. Staffing costs represented 65.5%, of which 56.3% were direct costs. Gastroscopy was taken as the RVU (cost = 27.52 E). Anoscopy was the simplest procedure (RVU = 0.61, cost = 15.08 E) and colonoscopy plus polypectomy was the most complex procedure (RVU = 4.41, cost = 74.28 E). The greater the experience of the member of staff performing the procedure, the less time it took (p < 0.01). CONCLUSION: CI was lowest for anoscopy (URV = 0.61) and highest for total colonoscopy plus polypectomy (URV = 4.41). Cost and exploration time depended on the endoscopist's experience. Staff represented the highest percentage of cost.

Costs and Cost Analysis↗
PubMedDate not supplied

Characterization of interacting ferrocene-cyclodextrin systems and their role in mediated biosensors.

Inclusion complexes of 1,1'-dimethylferrocene (DMFe) with alpha-, 2-hydroxypropyl-beta- or gamma-cyclodextrins were formed in aqueous systems. For the first time, the interacting DMFe-cyclodextrin systems have been characterized using cyclic voltammetry which enabled the estimation of the complexation order, the formation constant and the diffusivity. Cyclic voltammetry was performed at a stationary electrode, yielding complexation ratios of 1:2 for DMFe with alpha-cyclodextrin and 1:1 with the other two cyclodextrins, as expected from the known cavity dimensions for the cyclodextrins. Formation constants of 4.4 x 10(4) M-2, 1.2 x 10(3) M-1 and 2.9 x 10(2) M-1 were then determined for the complexes between DMFe and the alpha-, beta- and gamma-cyclodextrins, respectively, in relative agreement with the literature. The maximum complexation efficiency, diffusivity and solubility were observed for the DMFe:2-hydroxypropyl-beta-cyclodextrin inclusion complex, which, combined with cost factors, resulted in the selection of this form for bioelectrocatalysis studies. The efficiency of the complex as a mediator for the glucose:glucose oxidase system was determined by measuring the rate constant (ks) for reaction of the oxidized DMFe with the reduced enzyme. The ks value decreased from 3.4 x 10(4) M-1 s-1 to 1.9 x 10(4) M-1 s-1 with an increase in 2-hydroxypropyl-beta-cyclodextrin concentration from 4 mM to 10 mM. In this range, the ks value is similar to that of free ferrocene, implying a high efficiency of the DMFe:2-hydroxypropyl-beta-cyclodextrin inclusion complex.

Biosensing Techniques↗
PubMed1995

Evaluating the cost of lasers for the treatment of benign prostatic hyperplasia.

Cost is an extremely complex equation with many variables, but itemized hospital bills are useful in analysis because they reflect costs as defined by an institution. Using this data source, we found that the total cost of an outpatient visual laser-assisted prostatectomy ($6,872.42) is almost the same as that of transurethral resection with a 3-day hospital stay ($6,925.00). Use of local anesthesia, improvement in the efficiency of tissue vaporization, and increases in fiber durability to permit multiple use would reduce laser prostatectomy costs. The true economic impact of laser prostatectomy awaits a long-term analysis that takes into account the costs of late complications and of reoperation.

Aged↗
PubMed2006

Spinal cord stimulation for complex regional pain syndrome: a systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors.

OBJECTIVE: To review the clinical and cost-effectiveness of spinal cord stimulation (SCS) in the management of patients with complex regional pain syndrome (CRPS) and identify the potential predictors of SCS outcome. DESIGN: Systematic review of the literature and meta-regression. METHODS: Electronic databases were searched for controlled and uncontrolled studies and economic evaluations relating to the use of SCS in patients with either CRPS type I or II. RESULTS: One randomised controlled trial, 25 case series and one cost-effectiveness study were included. In the randomised controlled trial in type I CRPS patients, SCS therapy lead to a reduction in pain intensity at 24 months of follow-up (mean change in VAS score -2.0), whereas pain was unchanged in the control group (mean change in VAS score 0.0) (p<0.001). In the case series studies, 67% (95% CI 51%, 84%) of type I and type II CRPS patients implanted with SCS reported pain relief of at least 50% over a median follow-up period of 33 months. No statistically significant predictors of pain relief with SCS were observed in multivariate meta-regression analysis across studies. An economic analysis based on the randomised controlled trial showed a lifetime cost saving of approximately 58,470 (60,800 US dollars) with SCS plus physical therapy compared with physical therapy alone. The mean cost per quality-adjusted life-year at 12-month follow-up was 22,580 (23,480 US dollars). CONCLUSIONS: SCS appears to be an effective therapy in the management of patients with CRPS type I (Level A evidence) and type II (Level D evidence). Moreover, there is evidence to demonstrate that SCS is a cost-effective treatment for CRPS type I.

Complex Regional Pain Syndromes↗
PubMed2000

Pharmacoeconomics of pneumonia.

Because diagnosis and treatment are so intimately linked, the pharmacoeconomics of treatment of ventilator-associated pneumonia (VAP) is impossible to discuss without discussing the cost-effectiveness of VAP diagnosis. The cost of VAP treatment is more complex than simply drug acquisition and administration costs. The critical factor in cost-effective therapy is the avoidance of inappropriate or ineffective therapy. The second most important benefit of a more accurate diagnostic strategy, such as the use of quantitative cultures, is the ability either to stop or to withhold antibiotics if the quantitative culture is negative. Therefore, the benefit of any diagnostic strategy must be evaluated principally from the aspect of these resultant changes in management. Reassurance or concern about an alternative site of infection or cause of fever will also add to the benefit or cost of more accurate diagnosis of VAP. The baseline antibiotic treatment strategy of the specific intensive care unit (ICU) will determine, to a large degree, the cost of antibiotics and the efficacy of empiric regimens. In the final analysis, pharmacy costs and cost of diagnostic testing for VAP must be based on outcome analysis, including comparison of the more expensive aspects of care, such as mortality, length of mechanical ventilation, and length of ICU stay.

Cost of Illness↗
PubMed2000

Pharmacoeconomics of pneumonia.

Because diagnosis and treatment are so intimately linked, the pharmacoeconomics of treatment of ventilator-associated pneumonia (VAP) is impossible to discuss without discussing the cost-effectiveness of VAP diagnosis. The cost of VAP treatment is more complex than simply drug acquisition and administration costs. The critical factor in cost-effective therapy is the avoidance of inappropriate or ineffective therapy. The second most important benefit of a more accurate diagnostic strategy, such as the use of quantitative cultures, is the ability either to stop or to withhold antibiotics if the quantitative culture is negative. Therefore, the benefit of any diagnostic strategy must be evaluated principally from the aspect of these resultant changes in management. Reassurance or concern about an alternative site of infection or cause of fever will also add to the benefit or cost of more accurate diagnosis of VAP. The baseline antibiotic treatment strategy of the specific intensive care unit (ICU) will determine, to a large degree, the cost of antibiotics and the efficacy of empiric regimens. In the final analysis, pharmacy costs and cost of diagnostic testing for VAP must be based on outcome analysis, including comparison of the more expensive aspects of care, such as mortality, length of mechanical ventilation, and length of ICU stay.

Journal Article↗
PubMed2006

The high cost of implantable defibrillators.

Increased use of ICDs in patients with cardiac disease has the potential to strain national health care budgets because of the large numbers of eligible patients and the high cost of the ICDs. Randomized trials show ICDs increase life-expectancy in some groups of patients and also increase total medical costs significantly. ICDs exemplify the role of new technology as the main force behind rising health care costs. ICDs have not been used in all eligible patients, in part because of cost, but also because of patient resistance and a shortage of specialists able to implant and manage complex ICDs. The cost-effectiveness of ICDs would be improved by development of simpler and cheaper devices, and by better tools to identify patients who benefit from an ICD.

Arrhythmias, Cardiac↗
PubMedDate not supplied

How to avoid the high costs of physician turnover.

Physician recruitment is a complex, time consuming and competitive activity that is costly in terms of incurred expenses, administrative and physician time and lost revenue. Judith Berger and Robert Boyle, FACMGA, describe how to develop a well-designed retention and recruitment plan to avoid such costs.

Data Collection↗
PubMed2002

Assessment of the infectious diseases surveillance system of the Republic of Armenia: an example of surveillance in the Republics of the former Soviet Union.

BACKGROUND: Before 1991, the infectious diseases surveillance systems (IDSS) of the former Soviet Union (FSU) were centrally planned in Moscow. The dissolution of the FSU resulted in economic stresses on public health infrastructure. At the request of seven FSU Ministries of Health, we performed assessments of the IDSS designed to guide reform. The assessment of the Armenian infectious diseases surveillance system (AIDSS) is presented here as a prototype. DISCUSSION: We performed qualitative assessments using the Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems. Until 1996, the AIDSS collected aggregate and case-based data on 64 infectious diseases. It collected information on diseases of low pathogenicity (e.g., pediculosis) and those with no public health intervention (e.g., infectious mononucleosis). The specificity was poor because of the lack of case definitions. Most cases were investigated using a lengthy, non-disease-specific case-report form Armenian public health officials analyzed data descriptively and reported data upward from the local to national level, with little feedback. Information was not shared across vertical programs. Reform should focus on enhancing usefulness, efficiency, and effectiveness by reducing the quantity of data collected and revising reporting procedures and information types; improving the quality, analyses, and use of data at different levels; reducing system operations costs; and improving communications to reporting sources. These recommendations are generalizable to other FSU republics. SUMMARY: The AIDSS was complex and sensitive, yet costly and inefficient. The flexibility, representativeness, and timeliness were good because of a comprehensive health-care system and compulsory reporting. Some data were questionable and some had no utility.

Armenia↗
PubMed2005

An analysis of high-cost users at an Australian public health service organization.

High-cost users generate extremely high costs when compared with average users in the same diagnostic-related group (DRG). They represent a major financial loss for a health service organization. The research was conducted using an area health service patient database for online analytical processing to produce descriptive statistics and graphs of 'high-cost' and 'non-high-cost users'. Trends and patterns were identified across key variables derived from clinical, financial and operational categories. The main results are: 20% of costs are spent by 3% of the population; elective admission is higher in the high-cost group; tracheostomy has the most number of cases and is the most expensive DRG; LOS is mostly longer for complex cases however, high costs can be attributed to other factors. In conclusion, these findings are potentially useful to patients, medical staff, management and health service decision-makers. The limitation of this study is the exclusion of profitability.

Costs and Cost Analysis↗
PubMed2004

Economics of antibiotic use policies.

Today more than ever, hospitals must effectively manage the use of antibiotics to control costs and preserve their usefulness. To achieve this goal, antibiotic management must evolve from overly simplistic antibiotic cost containment to more complex, multidisciplinary, appropriate use programs that are founded on clinical outcomes-based pharmacoeconomic analyses. This article addresses common cost-containment activities as they relate to antibiotics and examines their consequences. Examples of successful antimicrobial stewardship and the role of pharmacoeconomic analyses also are provided. Cost-effectiveness studies of cefepime are presented to illustrate the utility of these analyses and provide information that can form the basis for decisions regarding placement of cefepime on hospital formularies.

Anti-Bacterial Agents↗
PubMed1996

Implications of cost in treatment selection for patients with coronary heart disease.

BACKGROUND: The growth of managed care and other types of capitated payment systems for medical care has forced cost into the therapeutic equation. The benefits of treatment must now be balanced against their costs. Clinicians are being challenged to prove that what they do has sufficient "value." Particular targets for these challenges are surgeons and interventional cardiologists who, in aggregate, perform expensive high-volume procedures. METHODS: A cost analysis of percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, and medical management of coronary artery disease has been undertaken using the Duke University database of 4,000 patients. The costs of the three procedures were compared at several fixed time points. RESULTS: The costs for the three treatments are critically dependent on the time points selected for comparison. At 60 days, the cost of the medical group was about one quarter the cost of the bypass group, whereas the cost of the angioplasty group was on average 60% of that of the surgical group. By 1 year, the costs in the angioplasty group reached 66% of those in the bypass group, but both remained far above the costs of medical therapy alone. There is a significant cost gradient for percutaneous transluminal coronary angioplasty as the extent of the disease increases, which is not apparent for coronary artery bypass grafting. CONCLUSIONS: Medical costs arise in a complex manner, and their prediction is difficult. Unexpected events during or after the initial treatment are a major cause of increased costs, and complications often cannot be predicted. Patient-related factors have only a small effect on costs in comparison with the choice of treatment. High-risk, high-cost patients tend to get the most benefit.

Angioplasty, Balloon, Coronary↗
PubMed1997

Prescribing behaviour in general practice: the impact of promoting therapeutically equivalent cheaper medicines.

BACKGROUND: The volume and cost of prescribing varies considerably between practices. This variation is at least in part due to the prescribing behaviour of individual doctors, who are often faced with a range of therapeutically equivalent generic and brand-name drugs. AIM: To assess the impact on general practitioners' prescribing behaviour of promoting therapeutically equivalent lower cost prescribing in conjunction with an incentive scheme. METHOD: Annual prescribing data from before (1992-93) and after (1993-94) implementation of the incentive scheme were compared retrospectively for general practices in the former Northern Regional Health Authority. Main outcome measures were the practices' 1993-94 rates of prescribing relative to those in 1992-93 for 18 drugs prescribed by brand name, of which 10 were targeted in the promotion, and for 14 drugs or classes of drugs either with equivalent cheaper alternatives or of limited clinical value (10 targeted and four not). RESULTS: For 17 of the 18 drugs, brand name prescribing rates were significantly lower in 1993-94. Reductions in rates were greater for the 10 drugs appearing in the scheme's promotional literature. For other cost-saving measures, total prescribing rates were lower for seven classes of drugs, unchanged for one, but higher for the other six, all of which had been targeted. According to the growth in their overall per capita prescribing costs between the two study years, the 499 practices were categorized as low, average or high. Overall costs and individual prescribing rates for the majority of drugs studied were similar for these three practice groups in 1992-93. In 1993-94, practices' changes in prescribing volume differed between the groups, with the lowest increases in the low cost-growth group for all but one of the 32 classes of drugs. CONCLUSION: Generic substitution was more easily implemented than more complex hints regarding cost-saving substitutions. Practices with smaller overall cost growth were making greater use of cost-beneficial prescribing strategies, whether promoted or otherwise. Simple messages may improve the cost-effectiveness of prescribing in the UK. With information support and encouragement, many prescribers appear to have modified their prescribing habits.

Cost Control↗
PubMed2006

Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications.

We reviewed 78 femoral and tibial nonunions treated between January 1992 and December 2003. Of these, we classified 41 in 40 patients as complex cases because of infection (22), bone loss (6) or failed previous surgery (13). The complex cases were all treated with Ilizarov frames. At a mean time of 14.1 months (4 to 38), 39 had healed successfully. Using the Association for the Study and Application of the Methods of Ilizarov scoring system we obtained 17 excellent, 14 good, four fair and six poor bone results. The functional results were excellent in 14 patients, good in 14, fair in two and poor in two. A total of six patients were lost to follow-up and two had amputations so were not evaluated for final functional assessment. All but two patients were very satisfied with the results. The average cost of treatment to the treating hospital was approximately pound 30,000 per patient. We suggest that early referral to a tertiary centre could reduce the morbidity and prolonged time off work for these patients. The results justify the expense, but the National Health Service needs to make financial provision for the reconstruction of this type of complex nonunion.

Adolescent↗
PubMed2005

The role of pharmacoeconomic modeling in evidence-based and value-based formulary guidelines.

OBJECTIVE: To review evidence-based medicine (EBM) in the context of pharmacoeconomic (PE) decision making by health care organizations. SUMMARY: Pharmacoeconomics involves processes similar to EBM, but it deals with decisions on the population rather than the patient level. The overall goal of PE is to provide the most efficient use of resources, taking into account both the cost and the value derived from a given technology. These evaluations assist health care decision making because both cost and effectiveness are considered. New therapies are increasingly complex in terms of administration, effects, and cost. As a result, PE models are likely to become more complex as well. At present, there is no standard threshold for what constitutes cost-effective therapy, so each organization is likely to have its own criterion for acceptance. CONCLUSION: Clinical trial results define the safety and efficacy of therapy but cannot determine whether a given technology represents a good buy for a specific organization. This requires PE analysis.

Cost-Benefit Analysis↗
PubMed2002

Enzyme replacement therapy for the mucopolysaccharide storage disorders.

The mucopolysaccharide storage disorders are a group of lysosomal storage disorders associated with deficiencies of lysosomal enzymes required for the normal sequential degradation of glycosaminoglycans, formerly known as mucopolysaccharides. The accumulation of glycosaminoglycans in a wide variety of tissues results in a complex and progressive disease leading to death in the first or second decade in most patients. Studies of enzyme replacement in animal models of mucopolysaccharide disorders have demonstrated the potential of parenterally administered enzyme to reduce glycosaminoglycan storage and microscopic pathology. Clinical studies of enzyme replacement therapy are currently underway for mucopolysaccharidosis I, mucopolysaccharidosis VI and mucopolysaccharidosis II. The complexity and heterogeneity of the mucopolysaccharide disorders provide significant challenges for clinical study design and evaluation. Innovative clinical development strategies may be needed to lower the development cost and time for complex rare disease therapies to assure that such patients receive therapies they deserve.

Animals↗
PubMed2004

Room for improvement: tackling high-cost patients for high potential return.

Assuming that most DM programs do a decent job of managing the typical chronically ill patient, a California company decided to take on the atypical patient with a program that seeks out highly complex, at high-cost patients, and uses some non-traditional interventions to get these patients stabilized. In fact, pilot study results suggest developers may be on the right track with their "SWAT team" approach to care.

Cost Control↗