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 829 records · Page 46Linked to original sources
PubMed2002

[Measuring case severity with a DRG-based reimbursement system].

BACKGROUND: The Australian Refined Diagnosis-Related Groups (AR-DRGs) will be the model for the German DRGs (G-DRGs). Their system to measure severity of illness will be a major point of interest. METHOD: The most common systems for measuring severity of illness are presented and compared with the AR-DRGs based on criteria regarding applicability. RESULTS: None of the systems for measuring severity of illness fits all the criteria. They can be used for reimbursement of inpatient care or for quality assurance, but not for both at the same time. The designated areas for the use of the systems should not be exceeded. CONCLUSION: AR-DRGs are very complex in measuring the costs per case (severity of illness in terms of efficiency). They are not able to support quality assessment by risk adjustment (severity of illness in terms of medical complexity). A less complex system would have been easier to transfer to Germany with the same incentives for providing effective care.

Diagnosis-Related Groups↗
PubMed2005

Uncovering the molecular mode of action of the antimalarial drug atovaquone using a bacterial system.

Atovaquone is an antiparasitic drug that selectively inhibits electron transport through the parasite mitochondrial cytochrome bc1 complex and collapses the mitochondrial membrane potential at concentrations far lower than those at which the mammalian system is affected. Because this molecule represents a new class of antimicrobial agents, we seek a deeper understanding of its mode of action. To that end, we employed site-directed mutagenesis of a bacterial cytochrome b, combined with biophysical and biochemical measurements. A large scale domain movement involving the iron-sulfur protein subunit is required for electron transfer from cytochrome b-bound ubihydroquinone to cytochrome c1 of the cytochrome bc1 complex. Here, we show that atovaquone blocks this domain movement by locking the iron-sulfur subunit in its cytochrome b-binding conformation. Based on our malaria atovaquone resistance data, a series of cytochrome b mutants was produced that were predicted to have either enhanced or reduced sensitivity to atovaquone. Mutations altering the bacterial cytochrome b at its ef loop to more closely resemble Plasmodium cytochrome b increased the sensitivity of the cytochrome bc1 complex to atovaquone. A mutation within the ef loop that is associated with resistant malaria parasites rendered the complex resistant to atovaquone, thereby providing direct proof that the mutation causes atovaquone resistance. This mutation resulted in a 10-fold reduction in the in vitro activity of the cytochrome bc1 complex, suggesting that it may exert a cost on efficiency of the cytochrome bc1 complex.

Antimalarials↗
PubMedDate not supplied

Pharmacogenetics and the concept of individualized medicine.

Adverse drug reaction in patients causes more than 2 million hospitalizations including 100,000 deaths per year in the United States. This adverse drug reaction could be due to multiple factors such as disease determinants, environmental and genetic factors. In order to improve the efficacy and safety and to understand the disposition and clinical consequences of drugs, two rapidly developing fields--pharmacogenetics (focus is on single genes) and pharmacogenomics (focus is on many genes)--have undertaken studies on the genetic personalization of drug response. This is because many drug responses appear to be genetically determined and the relationship between genotype and drug response may have a very valuable diagnostic value. Identification and characterization of a large number of genetic polymorphisms (biomarkers) in drug metabolizing enzymes and drug transporters in an ethnically diverse group of individuals may provide substantial knowledge about the mechanisms of inter-individual differences in drug response. However, progress in understanding complex diseases, its negative psychosocial consequences, violation of privacy or discrimination, associated cost and availability and its complexity (extensive geographic variations in genes) may become potential barriers in incorporating this pharmacogenetic data in risk assessment and treatment decisions. In addition, it requires increased enthusiasm and education in the clinical community and an understanding of pharmacogenetics itself by the lay public. Although individualized medications remain as a challenge for the future, the pharmacogenetic approach in drug development should be still continued. If it becomes a reality, it delivers benefits to improve public health and allow genetically subgroup diseases thereby avoiding adverse drug reactions (by knowing in advance who should be treated with what drug and how).

Cytochrome P-450 Enzyme System↗
PubMed2002

Prevention of human immunodeficiency virus-related opportunistic infections in France: a cost-effectiveness analysis.

A simulation model of human immunodeficiency virus (HIV) disease, which incorporated French data on the progression of HIV disease in the absence of antiretroviral therapy and on cost, was used to determine the clinical impact and cost-effectiveness of different strategies for the prevention of opportunistic infections in French patients who receive highly active antiretroviral therapy (HAART). Compared with use of no prophylaxis, use of trimethoprim-sulfamethoxazole (TMP-SMZ) increased per-person lifetime costs from euro 185,600 to euro 187,900 and quality-adjusted life expectancy from 112.2 to 113.7 months, for an incremental cost-effectiveness ratio of euro 18,700 per quality-adjusted life-year (euro/QALY) gained. Compared with use of TMP-SMZ alone, use of TMP-SMZ plus azithromycin cost euro 23,900/QALY gained; adding fluconazole cost an additional euro 54,500/QALY gained. All strategies that included oral ganciclovir had cost-effectiveness ratios that exceeded euro 100,000/QALY gained. In the era of HAART, on the basis of French data, prophylaxis against Pneumocystis carinii pneumonia, toxoplasmic encephalitis, and Mycobacterium avium complex bacteremia is cost-effective. Prophylaxis against fungal and cytomegalovirus infections is less cost-effective than are other therapeutic options for HIV disease and should remain of lower priority.

AIDS-Related Opportunistic Infections↗
PubMed1998

Effects of contracting and local markets on costs of public mental health services in California.

OBJECTIVE: This study examined the factors that determine whether mental health services provided under contracts with private providers are more cost-efficient than services provided directly by public mental health agencies. METHODS: Data on service costs for 1993 were obtained from the California Department of Mental Health cost reporting and data collection system and from a survey of local mental health departments. Ordinary least-squares regression was used to estimate the effect of contracting, local market conditions, and contracting procedures on unit costs of seven core mental health services: psychiatric inpatient care, rehabilitative day service, intensive day service, individual therapy, medication management, crisis intervention, and case management. RESULTS: Contracts with private providers significantly reduced costs for six core mental health services, but not for inpatient care. However, the extent of savings was affected by local market conditions, including the concentration of providers in an area, the provider organization's size, and the scope of services that the provider offered, as well as by contracting procedures-whether there was a formal contract review process and whether prices were negotiated with the majority of providers. CONCLUSIONS: The amount of cost savings that can be achieved from contracting with private providers is influenced by several factors, including competitive conditions in local markets. In some areas, direct provision of services by public mental health agencies may cost less. Contracting is a complex process that cannot be viewed as a panacea for improving cost-efficiency.

California↗
PubMed1998

Devices and methods for administering carbon dioxide-enriched air in experimental and clinical settings.

Although researchers successfully have used carbon dioxide-enriched air in experimental and clinical preparations, its functional properties may differ across laboratories due to procedural differences. Additionally, current procedures may be too simplistic for more complex experimental designs. To address these issues, we present three devices for administering carbon dioxide-enriched air. Although these devices differ concerning variables such as mode of operation, ease and cost of implementation, and complexity of experimental designs that may be undertaken, a reasonable level of standardization may be achieved because the inhalations experienced by participants are functionally equivalent across devices. We discuss advantages and disadvantages of these devices regarding experimental panic provocation and aversive conditioning preparations.

Carbon Dioxide↗
PubMed2005

Rapid on-chip postcolumn labeling and high-resolution separations of DNA.

When performing genetic analysis on microfluidic systems, labeling the sample DNA for detection is a critical preparation step. Labeling procedures often involve fluorescently tagged primers and PCRs, which lengthen experimental run times and introduce higher levels of complexity, increasing the overall cost per analysis. Alternatively, on-chip labeling techniques based on intercalating dyes permit rapid labeling of DNA fragments. However, as noted in the literature, the stochastic nature of dye-DNA complex formation hinders the native electrophoretic migration of DNA fragments, degrading the separation resolution. In this study, we present a novel method of controllably labeling DNA fragments at the end of the electrophoretic separation channel in a glass microfluidic chip. Permitting the DNA to separate and labeling just before detection, achieves the rapid labeling associated with intercalators while maintaining the high resolution of native DNA separations. Our analyses are completed in minutes, rather than the hours typical of sample prelabeling. We demonstrate an electrophoretic microchip-based intercalator labeling technique that achieves higher resolution performance than reported in the literature to date.

DNA↗
PubMedDate not supplied

[The evaluation of the complexity of clinical-diagnostic in-patient processes within the framework of diagnostically associated groups].

A new method for the differentiation of patients within diagnostically related groups is proposed, which differentiates the patients with consideration for the complexity, resource capacity, and cost of the therapeutic and diagnostic process. The intensity of drug therapy expressed through the number of drugs prescribed to a patient during hospitalization is regarded as an integral characteristic of the complexity and resource capacity of the process of management of a patient. The proposed criterion of treatment multiplicity (complexity) includes not only medical, but economic information as well. The informative value and high selective capacity of the treatment complexity criterion are demonstrated. The authors present the results of comparative analysis of the complexity grading and disease staging methods, the latter one being based on grouping patients within diagnostically related groups by the severity of condition.

Diagnosis-Related Groups↗
PubMed2002

Cost characteristics of hospitals.

Modern hospitals are complex multi-product organisations. The analysis of a hospital's production and/or cost structure should therefore use the appropriate techniques. Flexible functional forms based on the neo-classical theory of the firm seem to be most suitable. Using neo-classical cost functions implicitly assumes minimisation of (variable) costs given that input prices and outputs are exogenous. Local and global properties of flexible functional forms and short-run versus long-run equilibrium are further issues that require thorough investigation. In order to put the results based on econometric estimations of cost functions in the right perspective, it is important to keep these considerations in mind when using flexible functional forms. The more recent studies seem to agree that hospitals generally do not operate in their long-run equilibrium (they tend to over-invest in capital (capacity and equipment)) and that it is therefore appropriate to estimate a short-run variable cost function. However, few studies explicitly take into account the implicit assumptions and restrictions embedded in the models they use. An alternative method to explain differences in costs uses management accounting techniques to identify the cost drivers of overhead costs. Related issues such as cost-shifting and cost-adjusting behaviour of hospitals and the influence of market structure on competition, prices and costs are also discussed shortly.

Capital Expenditures↗
PubMedDate not supplied

[Effectiveness of rehabilitation measures from the orthopedic viewpoint].

The investigations reported here were prompted by the rapid increase in the amount of rehabilitation treatment performed in recent years and the high costs it incurs. The patients considered had all undergone orthopedic treatment. Rehabilitation treatment lasted between 4 and 6 weeks. On the basis of certain criteria (alleviation of pain, improvement of function) it was attempted to show what degree of success can be achieved with rehabilitation measures following disc operations, total hip and knee-joint replacements and degenerative changes of the spine. In view of their high cost rehabilitation measures would not be justifiable if equally satisfactory results could be achieved by less costly methods. However, a complex therapeutic program generally cannot be carried out adequately on an outpatient basis. While surveys of effectiveness conducted by numerous authors have shown that considerable savings are possible in terms of general and insurance costs (Gercke 1977), accurate indication and careful assessment of the necessity for a cure are essential. The authors' investigations in 4 rehabilitation groups revealed that in a high percentage of the patients not only subjective alleviation of pain but also genuine, measurable functional improvements were achieved. Rehabilitation is one of the most important elements of pension insurance schemes: the dictum here is that "rehabilitation has priority over pensions". Nevertheless, the low chance of success assumed by pension applicants during rehabilitation should be taken into account. These patients, who are only interested in the success of their pension applications, regard the chances of success as practically non-existent.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed2003

Cost analyses in assistive technology research.

Economic evaluation has become one of the principal methodologies in outcomes research within the health care field in general and specifically in assistive technology. Efforts to define and develop a consistent methodology for assistive technology economic evaluations have been hampered by lack of familiarity with the various terms and concepts associated with cost analysis, an essential aspect of economic evaluations. Adapting these concepts, which were constructed to suit a medical model, to the needs of the assistive technology field has been a challenge as well. This article outlines terms and concepts basic to cost analysis. The authors then consider five studies that relate costs to outcomes in order to illustrate the challenges, choices, and trade-offs researchers make when adapting this methodology to assistive technology. The article concludes by seeking to stimulate further discussion of the complexity inherent in assessing costs in assistive technology outcomes research and calling for the development of a standardized and consistent economic evaluation methodology.

Costs and Cost Analysis↗
PubMed1998

New drugs in anaesthesia: can we afford them?

The most important challenge facing physicians today is the dilemma of providing high quality care in a fiscally responsible fashion. Cost can no longer be ignored. Pharmacoeconomics is a fundamental component of medical education. Economic issues should be an integral part of the drug development and clinical trials. While anaesthetists are concerned that the use of less expensive drugs may compromise patient outcome and satisfaction there is little evidence to support such concerns. This is a fertile area for intense future research. Pharmacoeconomics is a dynamic. The cost of drugs is not static, patterns of drug use shift rapidly and clinical practice is in a state of constant change. The answer to cost containment is not simply to cut, cap, delist or merely hope for the best, but rather to manage and modify practice while accommodating changing needs. Educational programmes, guidelines, department policies, system changes and financial incentives can be implemented to ensure consistent and enduring adherence to the principles of pharmacoeconomics and value based care. Some suggest that national societies should create guidelines for cost-beneficial practice. Others favour physician autonomy in drug selection. Changing physician behaviour is difficult. This change will occur gradually and will be the topic of many emotionally charged philosophical debates. There will be great reluctance to deny patients pharmacologically superior drugs based on cost alone, especially since drugs are such a small portion of the total costs. We must exercise caution to ensure that we don't become penny wise and pound foolish. Drug acquisition costs are only one element in a large and complex equation. Concentrating on acquisition drug cost may be dangerous, even naive if we fall prey to knowing the cost of everything but the value of nothing.

Anesthetics↗
PubMed1987

A computer-based Markov decision analysis of the management of symptomatic bifascicular block: the threshold probability for pacing.

This review illustrates the use of computer-based Markov models to estimate cost-effectiveness and prognosis in a complex problem in clinical cardiology. Decision analysis and cost-effectiveness analysis were used to assess whether to implant a permanent cardiac pacemaker, treat with drugs, perform electrophysiologic studies or observe patients who have two clinical features--syncope and bifascicular block--that may or may not be causally related. Using a Markov process model, a computer program simulated the prognosis of five cohorts of such patients--one treated conservatively, one given empiric antiarrhythmic drug therapy, one receiving a pacemaker, one treated with empiric drugs and pacing and one tested with electrophysiologic studies. On the basis of data from published reports and expert opinion, quality-adjusted life expectancy was calculated by summing the average time a member of each cohort would survive with and without symptoms for each initial treatment choice. The costs were estimated from 1985 hospital charges. For patients with normal left ventricular function, electrophysiologic testing provides a benefit of 14 quality-adjusted months of life over observation, at an additional cost of $24,200. Empiric pacing would add 2.5 additional months, at a further cost of $14,300. In patients with poor left ventricular function, empiric drug therapy offers 1.5 additional quality-adjusted months over observation, at a cost of $6,900. Electrophysiologic testing provides a further 16.5 months at an additional cost of $16,900. These results hold when the relation between symptoms and arrhythmia is not firmly established. Varying the probabilities of underlying ventricular tachyarrhythmias, bradyarrhythmic conduction defects or noncardiac causes of syncope affects the cost-effectiveness relative to the alternative treatments.

Anti-Arrhythmia Agents↗
PubMed1994

Journalistic elder abuse: it's time to get rid of fictions, get down to facts.

The public debate on health care, as reported and carried on in the popular media, is frequently framed in terms of age. The assumption is that old age can be equated with high health care costs, and that increases in health care costs are determined solely by the growing numbers of older people in our society. A variety of studies suggest, however, that high-tech, high-cost care is not inevitably associated with advancing age. The public debate on health care must stop confusing demographic issues with health care cost issues, and focus instead on the real and complex problems of rising health care costs.

Aged↗
PubMed1994

Health care reform. The 1993-1994 evolution.

Health care costs in the United States continue to increase, as does the number of individuals who lack health care coverage. The magnitude of these critical problems assures that health reform of the health care system will continue to be debated over the next decade. Increasing health care costs are associated with increased complexity of services and a greater number of health care providers. As health costs increase and the number of individuals covered by private insurance decreases, states will face increasing pressure to develop effective methods of providing coverage for those without health insurance. Employer mandates will be viewed as one method of extending health coverage. Psychologists must be involved in policy issues so as to ensure the utilization of psychological knowledge and attention to psychological and behavioral health needs.

Health Care Costs↗
PubMed1994

Toward the incorporation of costs, cost-effectiveness analysis, and cost-benefit analysis into clinical research.

Most research in clinical psychology and related disciplines does not measure, report, or analyze costs, cost-effectiveness, or cost-benefit analysis. Reasons for this are discussed. It may be thought, for example, that costs are trivial to measure. Data are presented to show that the values of resources consumed in treatment (i.e., costs) actually can be quite complex to assess accurately and completely. Research findings are assembled to show that costs, as experienced by clients, may be beneficial to assess in that they can be significantly related to the outcomes of treatment. Empirical findings also show that costs also can be useful to measure because costs and outcomes can be related inversely rather than directly (i.e., clients may benefit most from treatments that cost less than several viable alternatives). Finally, perceived impediments to assessing costs and to cost-effectiveness and cost-benefit analysis in psychology are considered. Dialogue is encouraged on the scientific study of relationships between (a) monetary and other costs, (b) treatment techniques and treatment delivery systems, and (c) psychological and economic outcomes.

Costs and Cost Analysis↗
PubMed2004

The cost of a hospital ward in Europe: is there a methodology available to accurately measure the costs?

Costing health care services has become a major requirement due to an increase in demand for health care and technological advances. Several studies have been published describing the computation of the costs of hospital wards. The objective of this article is to examine the methodologies utilised to try to describe the basic components of a standardised method, which could be applied throughout Europe. Cost measurement however is a complex matter and a lack of clarity exists in the terminology and the cost concepts utilised. The methods discussed in this review make it evident that there is a lack of standardized methodologies for the determination of accurate costs of hospital wards. A standardized costing methodology would facilitate comparisons, encourage economic evaluation within the ward and hence assist in the decision-making process with regard to the efficient allocation of resources.

Cost Allocation↗