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Results for “cost of complexity”

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At least 145 records · Page 8Linked to original sources
PubMed2002

Costs and gains of complex procedures to rehabilitate end stage ocular surface disease.

BACKGROUND: The management of patients with end stage ocular surface disease sometimes requires extensive surgical treatment that can only be provided by specialised ophthalmology. The authors discuss the costs and gains of such complex techniques based on a case of bilateral corneal blindness secondary to Stevens-Johnson syndrome. METHODS AND RESULTS: Despite multiple lid surgery for trichiasis and repeated corneal grafting for perforations a white female patient became bilaterally blind at the age of 29 years. She also suffered from disabling discomfort in the right dry eye. At the age of 52 a two stage osteo-odonto-keratoprosthesis achieved visual rehabilitation in the left eye and microvascular transplantation of an autologous, submandibular gland resulted in sufficient lubrication to alleviate her severe discomfort in the right eye. As a result of these procedures she was able to take up a regular job again. The total costs of rehabilitation were pound 13 661 which compare with annual gains and regains for society of pound 13 497. An additional pound 4625 was saved annually in guide dog costs. CONCLUSION: This estimate shows that despite the expense of these complex techniques gains are made well within the second year after rehabilitation. In view of the benefit in quality of life for the patient and monetary savings for society these procedures should be funded by national health services at specialist centres.

Adult↗
PubMed1998

[Basic principles of cost-benefit analysis in long-term treatment of risk factors].

Health care decision makers are increasingly forced to identify and implement the options for potential spendings and savings. Historically, preventive measures for cardiovascular diseases have been scrutinised a great deal. The main reason for this was that substantial financial investments would have to be undertaken long before the clinical benefits were apparent. In the past, most economic evaluations of lipid lowering therapy have been based on models combining logistic regression risk functions from epidemiological cohort studies, such as the Framingham study, with the extent of cholesterol reduction. Recently, however, data from the large controlled outcome studies (4S, CARE, LIPID, WOSCOPS) have been reported which allow a direct estimate of the economic benefits of cholesterol reduction in primary and secondary prevention. The economic evaluation of such therapies can be performed in several ways, from relatively easy cost-consequence analyses to more complex cost-effectiveness analysis. Initial economic analyses of the trials are already available. There are, however, still considerable practical and methodological issues which have to be taken into account in assessing lipid lowering drugs. Available pharmaco-economic data on lipid lowering therapies suggest that statins are a cost-effective option in primary and secondary coronary prevention.

Anticholesteremic Agents↗
PubMed1997

Design and experimental verification of thin acoustic lenses for the coagulation of large tissue volumes.

Large focal volumes are desired in ultrasound surgery to reduce the total treatment time when large tumours are thermally coagulated. Phased arrays are capable of producing enlarged focal volumes in addition to providing the ability for on-line modification of focal shape and location. Although phased arrays have several advantages over their non-phased counterparts, the complexity of these arrays also presents some disadvantages regarding cost and complexity. One less costly alternative is the use of thin acoustic lenses to alter the field shape of a single-focus transducer. Four polystyrene lenses have been designed using the sector-vortex principle developed for phased arrays by Cain and Umemura. Measurements of the acoustic fields produced with the lenses are in good agreement with the simulated fields. The transmission measurements through each of the four lenses ranged from 76% to 84%, and over 52 W of total acoustic power has been delivered through each of the lenses during in vivo experiments without any damage to the lenses or the transducer. The in vivo results showed an increase in rate of necrosis to 10.1 +/- 1.4 cm3 h-1 using the mode 4 lens, or 5.2 +/- 0.7 times higher than the focused transducer alone.

Acoustic Stimulation↗
PubMed1981

Tandem mass spectrometry in trace toxicant analysis.

Mass spectrometers coupled in series offer a promising technique for quantitative analysis of trace constituents in complex mixtures. Despite the relatively high cost and complexity of such instruments, this technique appears to be particularly promising in terms of the sensitivity, specificity, and speed of analysis for targeted compounds in body fluids, foods and other biological mixtures.

Body Fluids↗
PubMed2026

Molecular diagnostic tests for isoniazid-resistant tuberculosis: a scoping review.

The paucity of diagnostic tests for isoniazid-resistant tuberculosis is concerning, given its status as the most common form of drug-resistant tuberculosis and a gateway to multidrug-resistant diseases. Molecular drug-susceptibility testing has improved access to timely diagnosis of rifampicin-resistant tuberculosis, but testing for isoniazid-resistant tuberculosis still remains rare. In this Review, we assessed the characteristics of molecular drug-susceptibility testing for detection of isoniazid-resistant tuberculosis, referencing the WHO target product profiles. 9243 citations were screened to select 238 studies published between 2000 and 2024. The diagnostics options have expanded rapidly since 2020, with 27 nucleic acid amplification tests, eight line probe assays, five DNA microarrays, two targeted next-generation sequencing platforms, and two whole-genome sequencing platforms. Most of the evaluated molecular drug-susceptibility tests met diagnostic performance targets but were often complex and costly. Although a few low-complexity nucleic acid amplification tests met key target product profile criteria, additional field validation and greater efforts are needed to ensure optimal feasibility and affordability for low-resource settings.

Isoniazid↗
PubMed1998

An overview of implant marketing.

Implant dentistry is no longer a new field, but there is still plenty of room for it to grow. Over the years, implant dentistry has grown steadily but not as quickly as it could. Because of the high degree of complexity and high costs associated with practicing implant dentistry, the growth of composite bonding, for example, quickly surpassed that of implants. Although each is an answer to a desperate dental service need, composite bonding provided the only answer, whereas implants have much less costly and less complex alternatives, i.e., dentures. However, with the emergence of high technology in dentistry and young dentists who are motivated to use high technology and practice higher revenue-oriented dentistry, the author believes that implant dentistry will soon begin to grow much more quickly than it has over the last 10 years. As technology continually facilitates and improves the results of implant dentistry, patients will begin to realize the limitation of dentures and will become more comfortable with finding a permanent, more attractive, and more valuable alternative.

Dental Implantation↗
PubMed2005

Effect of congestion costs on shortest paths through complex networks.

We analyze analytically the effect of congestion costs within a physically relevant, yet exactly solvable, network model featuring central hubs. These costs lead to a competition between centralized and decentralized transport pathways. In stark contrast to conventional no-cost networks, there now exists an optimal number of connections to the central hub in order to minimize the shortest path. Our results shed light on an open problem in biology, informatics, and sociology, concerning the extent to which decentralized versus centralized design benefits real-world complex networks.

Journal Article↗
PubMed2005

Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: a case study using the National Surgical Quality Improvement Program (NSQIP) database.

OBJECTIVE: This single-center study tested the hypothesis that preoperative risk factors and surgical complexity predict more variation in hospital costs than complications. BACKGROUND: Complications after surgical operations have been shown to significantly increase hospital cost. The impact on complication-related costs of preoperative risk factors is less well known. METHODS: The National Surgical Quality Improvement Program (NSQIP) preoperative risk factors, surgical complexity, and outcomes, along with hospital costs, were analyzed for a random sample of 5875 patients on 6 surgical services. Operation complexity was assessed by work RVUs (Centers for Medicare and Medicaid Services Resource Based Relative Value Scale). The difference in mean hospital costs associated with all variables was analyzed. Multiple linear regression was used to determine the cost variation associated with all variables separately and combined. RESULTS: Fifty-one of 60 preoperative risk factors, work RVUs, and 22 of 29 postoperative complications were associated with higher variable direct costs (P < 0.05). Linear regressions showed that risk factors predicted 33% (P < 0.001) of cost variation, work RVUs predicted 23% (P < 0.001), and complications predicted 20% (P < 0.001). Risk factors and work RVUs together predicted 49% of cost variation (P < 0.001) or 16% more than risk factors alone. Adding complications to this combined model modestly increased prediction of costs by 4% for a total of 53% (P < 0.001). CONCLUSION: Preoperative risk factors and surgical complexity are more effective predictors of hospital costs than complications. Preoperative intervention to reduce risk could lead to significant cost savings. Payers and regulatory agencies should risk-adjust hospital cost assessments using clinical information that integrates costs, preoperative risk, complexity of operation, and outcomes.

Databases as Topic↗
PubMedDate not supplied

The four faces of mass customization.

Virtually all executives today recognize the need to provide outstanding service to customers. Focusing on the customer, however, is both an imperative and a potential curse. In their desire to become customer driven, many companies have resorted to inventing new programs and procedures to meet every customer's request. But as customers and their needs grow increasingly diverse, such an approach has become a surefire way to add unnecessary cost and complexity to operations. Companies around the world have embraced mass customization in an attempt to avoid those pitfalls. Readily available information technology and flexible work processes permit them to customize goods or services for individual customers in high volumes at low cost. But many managers have discovered that mass customization itself can produce unnecessary cost and complexity. They are realizing that they did not examine thoroughly enough what kind of customization their customers would value before they plunged ahead. That is understandable. Until now, no framework has existed to help managers determine the type of customization they should pursue. James Gilmore and Joseph Pine provide managers with just such a framework. They have identified four distinct approaches to customization. When designing or redesigning a product, process, or business unit, managers should examine each approach for possible insights into how to serve their customers best. In some cases, a single approach will dominate the design. More often, however, managers will need a mix of some or all of the four approaches to serve their own particular set of customers.

Administrative Personnel↗
PubMed2004

Bivalirudin: an anticoagulant option for percutaneous coronary intervention.

Coronary artery thrombosis is usually triggered by platelet-rich thrombus superimposed on a spontaneously or mechanically disrupted atherosclerotic plaque. Thrombin and platelets both play a role in this process. Unfractionated heparin and aspirin have served as cornerstones in the prevention and treatment of intracoronary thrombus, but unfractionated heparin has several limitations that necessitate the use of adjunctive therapies, such as glycoprotein IIb/IIIa receptor inhibitors and clopidogrel, in order to reduce the risk of ischemic events. These combination therapies, however, typically increase the risk for bleeding complications, as well as the cost and complexity of treatment. Bivalirudin (Angiomax, The Medicines Company), a thrombin-specific anticoagulant, does not share heparin's limitations. Bivalirudin appears to provide clinical advantages over unfractionated heparin therapy in acute coronary syndrome patients and those undergoing percutaneous coronary intervention, without increasing cost or complexity of treatment for most patients.

Acute Disease↗
PubMedDate not supplied

Assessing uncertainty in cost-effectiveness analyses: application to a complex decision model.

A framework for quantifying uncertainty about costs, effectiveness measures, and marginal cost-effectiveness ratios in complex decision models is presented. This type of application requires special techniques because of the multiple sources of information and the model-based combination of data. The authors discuss two alternative approaches, one based on Bayesian inference and the other on resampling. While computationally intensive, these are flexible in handling complex distributional assumptions and a variety of outcome measures of interest. These concepts are illustrated using a simplified model. Then the extension to a complex decision model using the stroke-prevention policy model is described.

Bayes Theorem↗
PubMed2001

Changing the status of drugs from prescription to over-the-counter availability.

The availability of drugs on an over-the-counter basis, including those previously available only by prescription, provides patients with improved access to effective therapies. Removal of the requirement for prescriptions saves both the health care professional and the patient time. However, the overall effect on health care costs is complex. One such effect may be that costs shift from third-party payers to patients. In addition, short-term cost savings may be offset over the long term by problems due to inappropriate use or suboptimal therapy. Optimal therapy with an over-the-counter drug requires that the consumer diagnose the underlying condition correctly and use the drug in a manner that minimizes risk. Assessment of the ability of patients to use drugs in this manner is a critical component of the regulatory review of over-the-counter drugs. The available data arouse the concern that without the supervision of a health care professional, some patients may not be able to use over-the-counter drugs appropriately for certain diagnoses or chronic conditions or in high-risk situations. On the other hand, the widespread use of over-the-counter aspirin on a long-term basis for cardiovascular-risk reduction illustrates the potential value of increased drug availability for long-term therapy. Advances in technology may facilitate the growth of over-the-counter drug therapy. For example, the wide availability and acceptance of reliable methods for measuring serum cholesterol in nonmedical settings may eventually contribute to the safety and effectiveness of over-the-counter treatments for hyperlipidemia. Thus, the future promises increases in the number of drugs available over the counter and in the variety of indications for their use.

Drug Approval↗
PubMed1992

Costs and complications in mandibular reconstruction.

Because of increasing concerns about the high cost of complex medical care, we compared the combined cost of ablation and reconstruction incurred using five different management strategies for patients undergoing mandibular resection. We also compared the rates of complication and failure for the methods used. The records of 69 patients undergoing segmental or total mandibulectomy between January 1, 1986, and June 30, 1990, were reviewed. Of these, 15 had reconstruction with soft tissue only (average cost, $36,137; complication rate, 33%), whereas 20 had immediate reconstruction with vascularized bone (average cost, $46,894; complication rate, 50%), and 15 had reconstruction with only a metal plate (average cost, $47,678; complication rate, 73%). Nine patients had plate reconstructions initially but subsequently underwent reconstructions with bone (average cost, $54,346; complication rate, 78%), whereas 10 patients had no initial reconstruction but subsequently underwent delayed reconstruction with bone (average cost, $52,486; complication rate, 70%). If reconstruction was performed with bone, immediate reconstruction was more cost effective than delayed reconstruction and had a lower complication rate as well.

Adult↗
PubMedDate not supplied

A novel standard-compliant audience response system for medical education.

Audience response systems (ARSs) have been suggested as a means to improve the effectiveness of didactic lectures, but their widespread use has been limited because of cost and complexity. The authors developed a simple, cost-effective ARS that relies completely on standard networking technology, is embedded easily into a PowerPoint presentation, and operates without the need for extensive server setup and configuration. A PowerPoint Add-in that capitalizes on WiFi (wireless fidelity) technology was created that allows lecturers to easily add interactive question and response slides to an existing PowerPoint presentation. In the system, audience members can submit responses by using any wireless network-enabled device (eg, laptop computer, cell phone). The system was designed to be easy to use, to be standard compliant, and to eliminate the high operating costs associated with current interactive ARSs.

Communication↗
PubMed2006

Development of a practical costing method for hospitals.

To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate results. The activity based costing (ABC) method introduced in the mid 1990s can prove more accurate results. With the ABC method, all events or transactions that cause costs are recognized as "activities", and a specific cost driver is prepared for each activity. Finally, the costs of activities are allocated to cost objects by the corresponding cost driver. However, it is much more complex and costly than other traditional cost accounting methods because the data collection for cost drivers is not always easy. In this study, we developed a simplified ABC (S-ABC) costing method to reduce the workload of ABC costing by reducing the number of cost drivers used in the ABC method. Using the S-ABC method, we estimated the cost of the laboratory tests, and as a result, similarly accurate results were obtained with the ABC method (largest difference was 2.64%). Simultaneously, this new method reduces the seven cost drivers used in the ABC method to four. Moreover, we performed an evaluation using other sample data from physiological laboratory department to certify the effectiveness of this new method. In conclusion, the S-ABC method provides two advantages in comparison to the VBC and ABC methods: (1) it can obtain accurate results, and (2) it is simpler to perform. Once we reduce the number of cost drivers by applying the proposed S-ABC method to the data for the ABC method, we can easily perform the cost accounting using few cost drivers after the second round of costing.

Accounting↗
PubMedDate not supplied

[Traditional analytic method for determining urinary mercapturic acids].

Until now, high-performance liquid chromatography (HPLC) and gas chromatography (GC) have been shown the most useful techniques for the determination of urinary mercapturic acids in humans. Preliminary sample treatment is often necessary, including liquid-liquid, solid phase (SPE) or on-line extraction, in order to obtain highly purified samples. The use of derivatizing reagents coupled with specific and sensitive detectors allowed to develop methods suitable for the measurement of mercapturic acids specific for a large number of xenobiotics. At present, however, the use of urinary mercapturic acid tests for biomonitoring purposes is limited because of the high costs and complexity of analyses. Further improvements, in terms of cost reduction, could come from the introduction of fully automated systems.

Acetylcysteine↗