[Neuropsychiatric manifestation of lupus: etiopathological complexities and difficulties of costs].
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Anti-Inflammatory Agents↗
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Results for “cost of complexity”
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Is renal replacement therapy for all possible in developing countries?
Chronic kidney disease is a worldwide public health problem. More than one million individuals in the world are on maintenance dialysis, a number that is estimated to double in the next decade. Access to dialysis is significantly different between developed and developing nations. Close to 80% of the world dialysis population is treated in Europe, North America, and Japan, representing 12% of the world's population. The remaining dialysis patients are treated in the developing world. This disparity is likely due to the high cost and complexity of renal replacement therapy (RRT). Dialysis is so costly that is out of reach for low-income countries, which are struggling to provide preventive and therapeutic measures for communicable diseases and other basic needs. Providing renal care to all developing nations, although a difficult task, is not impossible. A number of strategies are proposed. These include the prevention of kidney disease, as well as dialysis and transplantation. Dialysis programs should be decentralized, and kidney transplantation should be promoted as the treatment of choice. The use of generic immunosuppressive drugs can make this therapy more affordable. Peritoneal dialysis seems a good, affordable, therapy for patients living in areas where hemodialysis is not available. Governments should provide funds not only for RRT but also for the prevention of kidney failure. The provision of tax incentives and reaching a critical number of patients on RRT could be incentives for industry to lower the cost of dialysis. The challenges are enormous, but renal care for all could be achieved through a concerted effort between nephrologists, governments, patients, charitable organizations, and industry.
Developing Countries↗
CD4 cell monitoring for HIV/AIDS: old options; new insights.
Cost effective solutions are needed for laboratory monitoring that do not compromise on quality but address costs. Current recommended methods of CD4+ T cell enumeration are complex and costly. Monitoring typically utilises viral load assessment (PCR based) and CD4+ T cell counting to assess disease progression and response to therapy in HIV/AIDS. This paper reviews CD4 testing with the focus on different methods of CD4+ T cell enumeration including state-of-the-art flow cytometric testing, the advantages and disadvantages of these systems and quality control. Lastly, recent new work undertaken at the University of the Witwatersrand is discussed that addresses the problems of cost and precision and accuracy of CD4 T cell testing.
Acquired Immunodeficiency Syndrome↗
Consensus workshop on advanced diagnostic andrology techniques. ESHRE (European Society of Human Reproduction and Embryology) Andrology Special Interest Group.
The Workshop reviewed four areas of advanced diagnostic andrology identified in the World Health Organization's 1992 Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction as 'research tests'. These were computer-assisted sperm analysis (CASA), acrosome reaction tests, the zona-free hamster egg penetration test and sperm-zona pellucida binding tests. For each topic, the Workshop Report comprises an overview of the particular field, a chronicle of the discussion that followed and a statement of the specific consensus points that were established. Free discussion allowed the elaboration of several general concepts that are presented here as the Workshop participants' perceived framework for future work in this area. While it was recognized that large-scale screening of male partners using advanced sperm function tests is almost certainly totally impractical on grounds of cost and lack of adequate services, urgent consideration was recommended for the development of a sperm function testing strategy capable of providing the likelihood of pregnancy for given diagnostic situations within certain timeframes. Establishing a clear definition of the role of diagnostic andrology in male infertility should be a primary focus of the Special Interest Group's activities. Further initiatives, including training courses, workshops, symposia and multicentre research studies, will be accorded high priority. Similar consideration will also be given to protocols for facilitating rational management decisions to ensure cost-effective therapeutic strategies, including consideration of the hierarchy of complexity and cost versus predicted fecundity. In addition, it was recognized that we need a greater understanding of the genetic basis of male infertility and how this impacts on the achievement of a viable pregnancy, while also minimizing the burden of genetic defects on the next generation.
Acrosome↗
Comparison of seven screening methods in the diagnosis of bladder cancer.
BACKGROUND: We compared the validity (evaluated by sensitivity and specificity), reliability (evaluated by reproducibility) and yield (evaluated by predictive value, examining complexity and cost) of individual and combined tests for bladder tumour antigen stat (BTAstat), nuclear matrix protein 22 (NMP22), hyaluronic acid (HA), survivin, CD44v6, vascular endothelial growth factor (VEGF), and voided urine cytology (VUC) in detecting bladder cancer. And at the same time we evaluated the clinical value of these seven detecting methods in the diagnosis of bladder cancer. METHODS: The six markers and VUC were detected in the urine of cancer group (151 patients with bladder cancer) and two control groups (50 patients with benign urological diseases and 50 healthy controls). The sensitivity, specificity, predictive value, reproducibility, examining complexity and checking cost of each marker and combined markers were calculated. RESULTS: There was a significant difference between bladder cancer group and the two control groups. The sensitivity, specificity and positive predictive value were as follows: VUC (36.4%, 100.0%, 100%), BTAstat (76.8%, 87.0%, 89.9%), NMP22 (77.5%, 81.0%, 86.0%), HA (82.8%, 83.0%, 88.0%), survivin (70.2%, 85.0%, 87.6%), CD44v6 (50.3%, 79.0%, 78.4%), and VEGF (68.2%, 93.0%, 93.6%). The highest sensitivities were 91.4% for NMP22 + BTAstat and HA + NMP22, whereas the combined marker with the lowest sensitivity (62.3%) was VUC + CD44v6. The highest specificity was 93.0% for the combined use of VUC + VEGF and HA + CD44v6 had the lowest specificity (73.0%). The most convenient examining method was the detection for BTAstat, the lowest cost was the detection for HA, and the best reproducibility were the detection for BTAstat and VUC. CONCLUSIONS: All the markers have obvious clinical value in diagnosis of bladder cancer. The use of BTAstat + HA or NMP22 + BTAstat are better examining methods in terms of validity, reliability, and yield.
Adult↗
Congenital cystic tumors of the atrio-ventricular node: successful demonstration by an abbreviated dissection of the conduction system.
Pathologists are dissuaded from the pathological study of the conduction system by the high cost and complexity of a traditional complete study. However, a simplified, low-cost approach can produce concrete information when performed in carefully selected cases of atrioventricular block, as demonstrated in the two cases of congenital cystic tumor of the atrioventricular node described in this report.
Adolescent↗
Minimally invasive approaches to inguinal hernia repair.
The technique of laparoscopic inguinal hernia repair has evolved during the past decade to become an effective and safe alternative for inguinal herniorrhaphy. In experienced hands, the procedure can be performed with low morbidity and with recurrence rates comparable to those following open repair using mesh. Several studies have shown a significant advantage for the laparoscopic approach, with less postoperative analgesic requirement and earlier return to work. Its limitations continue to be higher cost and complexity and the requirement for general anesthesia. The results and cost-effectiveness are maximized when applied to properly chosen patients by surgeons experienced in the procedure.
Adolescent↗
Testing cervicography and cervicoscopy as screening tests for cervical cancer.
AIMS AND BACKGROUND: Suboptimal sensitivity is currently reported for Pap test in screening for cervical cancer. Colposcopy is known to be more sensitive than cytology but its use as a screening test is not possible due to costs and complexity. Screening by cervicography has been suggested as a compromise being less costly and feasible. The present study evaluates the feasibility of screening by cervicography and cervicoscopy (naked eye examination of the cervix after acetic acid lavage) on a consecutive screening series. METHODS: Cervicography and cervicoscopy were performed by the smear taker in subjects consecutively attending a screening clinic. Women with abnormal cytology (atypia or more severe lesion) and/or abnormal cervicography or cervicoscopy (acetowhite lesion) underwent colposcopic assessment. The three screening methods were compared according to positivity rate, CIN 2-3 detection rate and positive predictive value. RESULTS: 2105 consecutive subjects were screened. Positivity rate was 3.8%, 15.3% or 25.4% for cytology, cervicography or cervicoscopy, respectively, 486 of 555 women attended the assessment phase, 281 directed biopsies were performed and 8 CIN 2-3 lesions were detected. Cytology, cervicography and cervicoscopy, detected 5.5, or 7 of 8 CIN 2-3 lesions, respectively. The positive predictive value was 0% for cytologic atypia, 25% for cytologic SIL, 1.75% for cervicography and 2.05% for cervicoscopy. Detecting one CIN 2-3 lesion at cytology cost $5,543. The cost per each additional cytologically negative CIN 2-3 lesion detected at cervicography or cervicoscopy was $12,947 or $3,916, respectively. CONCLUSIONS: The study confirms the limited sensitivity of cytology for CIN 2-3. The association of cervicography was not cost effective. Cervicoscopy was poorly specific but increased the detection rate of CIN 2-3 at relatively low costs. Cervicoscopy is worth further evaluation as a screening test.
Adolescent↗
Urinary incontinence in subacute care--a retrospective analysis of clinical outcomes and costs.
OBJECTIVE: To investigate the effect of incontinence on clinical outcomes and costs for patients in subacute care. DESIGN: Retrospective analysis of data collected over a 3-month period in 1996. SETTING: 54 medical facilities in Australia and New Zealand providing subacute care in an inpatient setting. PATIENTS: 6773 episodes of care provided to 6455 rehabilitation and geriatric evaluation and management patients. MAIN OUTCOME MEASURES: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthcare costs. RESULTS: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of care (rehabilitation: $185.60 [95% CI, $181-$190] per day for incontinent and $156.82 [95% CI, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% CI, $157-$172] for incontinent and $121.40 [95% CI, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P < 0.01] and motor function for stroke patients [P = 0.04]). CONCLUSION: The relationship between continence status and cost of care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.
Aged↗
Why are health costs really rising? The answers are complex.
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Health Care Costs↗
CEOs: there's no simple cure for billing and pricing woes.
Hospital billing and pricing practices are drawing increasing heat from lawmakers, employers and consumers. In a four-part package, we explore various aspects of this issue. First, an overview. With public dissatisfaction growing, leaders on Capitol Hill are delving into hospital administrative costs and practices as never before. Second, the pricing controversy. Hospitals have three antidotes to the problem: streamline their charge structures, keep prices closely tied to costs, and explain the complexities of cost-shifting to businesses. Many hospitals are already moving forward on this. On page 29, the consumer angle. While a number of lawsuits in Florida have alleged overcharging by hospitals, Nevada has begun operating a new commission charged specifically with arbitrating patient billing disputes. On page 31, the receivables management story. Hospitals must carefully examine the efficiency of all their business office functions to make billing and collection improvements, experts say; relying on automation alone will not work.
Accounts Payable and Receivable↗
Meeting the medical necessity requirement.
Establishing the medical necessity of a procedure is increasingly important--and complex--because medical techniques are evolving faster each year. Add the rising number, cost, and complexity of innovative and experimental medical treatments to the easy accessibility of medical information now available to consumers and you have all the criteria for confusing medical fact with medical potential. It's difficult for specialists and subspecialist physicians to keep up with their field--and impossible for case managers.
Blepharoplasty↗
Implicit solvent simulations of DNA and DNA-protein complexes: agreement with explicit solvent vs experiment.
Molecular dynamics simulations of biomolecules with implicit solvent reduce the computational cost and complexity of such simulations so that longer time scales and larger system sizes can be reached. While implicit solvent simulations of proteins have become well established, the success of implicit solvent in the simulation of nucleic acids has not been fully established to date. Results obtained in this study demonstrate that stable and efficient simulations of DNA and a protein-DNA complex can be achieved with an implicit solvent model based on continuum dielectric electrostatics. Differences in conformational sampling of DNA with two sets of atomic radii that are used to define the dielectric interface between the solute and the continuum dielectric model of the solvent are investigated. Results suggest that depending on the choice of atomic radii agreement is either closer to experimental data or to explicit solvent simulations. Furthermore, partial conformational transitions toward A-DNA conformations when salt is added within the implicit solvent framework are observed.
Computer Simulation↗
[Drug costs in patients with chronic complex tinnitus].
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Costs and Cost Analysis↗
Cost of treating Mycobacterium avium complex infection in AIDS.
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Acquired Immunodeficiency Syndrome↗
Collecting psychiatric resources utilisation data to calculate costs of care: a comparison between a service receipt interview and a case register.
BACKGROUND: Economic assessment of interventions and policies is becoming increasingly common, in large measure because of the growing emphasis on cost containment within health care. Comprehensive and reliable outcome and cost data are required to advise policy makers and clinicians as to the best use of their limited resources. The process of costing can be broken down into three connected tasks: the collection of service receipt or utilisation data relative to individual clients or patients over a defined period; the costing of each of the services used; and the combination of these two sets of information in order to calculate individual costs. The aim of this study was to compare two methodologies of collecting data on individual service use - a customized interview schedule, ICAP, and the psychiatric case register (PCR) - and to calculate costs, testing the extent of agreement between them. METHOD: The agreement between the ICAP and the PCR costs measurement was evaluated using the concordance correlation coefficient rho(c). From all patients (n = 543) who had at least one contact with a psychiatrist or a psychologist during the period October-December 1996, 339 patients were interviewed using the ICAP. The overall number of patients in contact with the South-Verona CPS in the same period was 630. RESULTS: The agreement between the two sources was very different for each diagnostic group and each professional category. However, the overall agreement on total costs was satisfactory (rho(c) < 0.95). This result is probably due to the effect of the good agreement observed on more costly services: inpatient care and sheltered accommodation. CONCLUSION: The results suggested practical implications for the use of the service receipt interview: interviewers should be trained in order to avoid misinterpretation of the definitions given in the form; the sources of information should be clearly defined to tease out all the items of services provided for the users; the professionals (i.e. psychiatrists) could influence the reliability of data collection by underestimating services provided by different professionals (nurses, social workers, etc.). The findings confirm that it is possible to use this approach when the aim is to estimate the whole cost of the services; however, the importance of adopting adequate procedures for analysing the complexity of cost components should be pointed out. Only a trained interviewer who thoroughly knows each component of the health and social services provided could guarantee an accurate data collection.
Catchment Area, Health↗
Costs of amphotericin B lipid complex for kala-azar.
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Amphotericin B↗
Cost-effectiveness of anterotemporal lobectomy in medically intractable complex partial epilepsy.
PURPOSE: The value of high-cost health technologies is being increasingly scrutinized by providers of health care. An understanding of the costs and outcomes of high-technology epilepsy care is required to ensure efficient resource allocation. METHODS: Decision analysis was used to estimate the cost effectiveness of anterotemporal lobectomy (ATL) as compared with standard medical management in medically-intractable epilepsy. Local (Rochester, NY, U.S.A.) cost data were applied to a model of lifetime discounted costs and outcomes of evaluation, ATL, and follow-up in a hypothetical cohort of patients. RESULTS: Base case analysis yielded a marginal cost-effectiveness ratio (MECR) of $15.581/quality-adjusted life year (QALY). Extensive sensitivity analyses identified extreme conditions in which evaluation for ATL was dominant (more effective and less costly) or in which it might be considered not worth the cost (MCER > $50,000/QALY). CONCLUSIONS: Estimates of ATL cost effectiveness fall within a generally acceptable range, even when uncertainty about many model parameters is taken into account. Under assumptions based on available data in the literature, the cost effectiveness of ATL compares favorably with that of other health technologies. Prospective multicenter studies of regional-cost and practice variations; long-term probabilities of year-to-year transitions between seizure outcome states and their effects on quality of life (QOL), and the effect of nonsurgical treatments on seizure control and QOL are needed to provide the critical data to confirm and constrain these estimates.
Anticonvulsants↗