The Cost-Effectiveness of a Stroke Unit in Providing Enhanced Patient Outcomes in an Australian Teaching Hospital

Abstract Aims: This study evaluated and compared the cost-effectiveness of rehabilitation interventions in patients with stroke in the three alternatives of hospitals, units and homes due to the fact that one of the stroke management challenges is how to provide a rehabilitation service to these patients in Iran. Methods: This is a cost-effectiveness analysis from the perspective of a health system. A Markov model with a 20-year time horizon in 3-month cycles was used to analyze the costs and outcomes. Cost data were collected from the 210 patients undergoing rehabilitation in the hospital, home and unit. Utility data were extracted from previously published literature with the same setting. The cost-effectiveness analysis was conducted by calculating ICER using TreeAge Software. Basic and probabilistic sensitivity analyses were also conducted at the end. Results: The average cost of rehabilitation in home strategy ($ 2306) was less than hospital ($2955) and unit ($3485) strategies. Furthermore, the utility of home strategy (26.03) was 8 units higher than hospital utility (17.99) and 19 units higher than utility of the stroke unit (7.03). The Acer values of hospital, stroke unit and home groups were $11424, $33159 and $7233 per utility, respectively. According to the results, the home-based rehabilitation strategy is cost effective compared to hospital and unit rehabilitation strategy. The results of the probabilistic sensitivity analysis also showed that the ICER of home strategy is always cost-effective than the other strategies. Limitation: : limitation of the present study was the reliance on utility values of other studies. Conclusion: Rehabilitation at home is the most cost-effective strategy for stroke patients. Given the high rates of this disease in Iran and the high cost of it, it is suggested that policy makers lay the groundwork for providing these services at home.

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Cost-effectiveness evaluation of compliance therapy for people with psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.172.5.420 ◽

1998 ◽

Vol 172 (5) ◽

pp. 420-424 ◽

Cited By ~ 38

Author(s):

Andrew Healey ◽

Martin Knapp ◽

Jack Astin ◽

Jennifer Beecham ◽

Roisin Kemp ◽

...

Keyword(s):

Cost Effectiveness ◽

Patient Outcomes ◽

Psychological Intervention ◽

Cost Effective ◽

Controlled Study ◽

Societal Costs ◽

Randomised Controlled Study ◽

Improve Compliance ◽

Randomised Controlled ◽

The Cost

BackgroundNon-compliance rates with antipsychotic medication can be high, and the personal and societal costs are considerable. A new psychological intervention, compliance therapy seeks to improve compliance and patient outcomes and reduce treatment costs.MethodA randomised controlled study examined the cost-effectiveness of compliance therapy compared to nonspecific counselling over 18 months for 74 people with psychosis admitted as inpatients at the Maudsley Hospital. Bivariate and multivariate analyses were conducted to test for differences and to explore inter-patient cost variations.ResultsCompliance therapy is more effective and is no more expensive. Consequently, compliance therapy is more cost-effective than non-specific counselling at six, 12 and 18 months.ConclusionsThere are compliance, outcome and cost-effectiveness arguments in favour of compliance therapy in preference to non-specific counselling.

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The Cost Effectiveness of Mobile Stroke Unit in the United States

Health Services Research ◽

10.1111/1475-6773.13392 ◽

2020 ◽

Vol 55 (S1) ◽

pp. 47-47

Author(s):

S. Sriudomporn ◽

R. Rachmad Nugraha ◽

N. Ahuja ◽

E. Drabo

Keyword(s):

United States ◽

Cost Effectiveness ◽

Stroke Unit ◽

The United States ◽

Mobile Stroke Unit ◽

The Cost

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Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study

BMJ Open ◽

10.1136/bmjopen-2021-057468 ◽

2022 ◽

Vol 12 (1) ◽

pp. e057468

Author(s):

Evans Otieku ◽

Ama Pokuaa Fenny ◽

Felix Ankomah Asante ◽

Antoinette Bediako-Bowan ◽

Ulrika Enemark

Keyword(s):

Cost Effectiveness ◽

Surgical Site Infection ◽

Outcome Measures ◽

Teaching Hospital ◽

Phone Call ◽

Site Infection ◽

Surgical Wound ◽

Healthcare Associated Infection ◽

Provider Perspectives ◽

The Cost

ObjectiveTo assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study.DesignBefore and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire.SettingKorle-Bu Teaching Hospital (KBTH), Ghana.ParticipantsAll prospective patients who underwent surgical procedures at the general surgical unit of the KBTH.Main outcome measuresThe primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel.ResultsBefore-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually.ConclusionThe intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.

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New model of integrated care for uncontrolled type 2 diabetes in a retrospective, underserved adult population in the USA: a study protocol for an effectiveness and cost-effectiveness analysis

BMJ Open ◽

10.1136/bmjopen-2020-038084 ◽

2020 ◽

Vol 10 (7) ◽

pp. e038084

Author(s):

Rita Bosetti ◽

Laila Tabatabai ◽

George Naufal ◽

Rosbel Brito ◽

Bita Kash

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Patient Outcomes ◽

Diabetes Care ◽

Institutional Review Board ◽

New Model ◽

Institutional Review ◽

The Usa ◽

The Cost

IntroductionType 2 diabetes prevalence is increasing in the USA, especially in underserved populations. Patient outcomes can be improved by providing access to specialty care within Federally Qualified Health Centers, possibly improving the cost-effectiveness of diabetes care.Methods and analysisA new model of diabetes care based on multidisciplinary teams of clinical fellows, supported by an endocrinologist for underserved adult populations, is presented. The study uses a retrospective, non-randomised cohort of patients with diabetes who visited the community clinic between 1 January 2012 and 31 December 2018. A quasi-experimental method to analyse the causal evidence of the effect of the new model is presented. Discontinuity regression is used to compare two interventions, the intervention by a Clinical Fellow Endocrinology Programme and usual care by a primary care physician. Patients are referred to the Clinical Fellow Endocrinology Programme in case of uncontrolled diabetes (glycated haemoglobin (HbA1c)≥9%). The regression discontinuity design allows the construction of a treatment group for patients with an HbA1c equal or above the threshold in comparison with a control group for patients with an HbA1c below the threshold. The patient outcomes and cost-effectiveness of the new model are analysed. Regression models will be used to assess the differences between treatment and control groups.Ethics and disseminationQuantitative patient data are received by the study team in a de-identified format for analysis via an institutional review board-approved protocol. The quantitative study has been approved by the Houston Methodist Research Institute Institutional Review Board, Houston, Texas, USA. Anticipated results will not only provide evidence about the impact of patient outcomes in underserved diabetic populations, but also give an idea of the cost-effectiveness of the new model and whether or not cost savings can be attained for patients, third-party payers and society. The results will help set up evidence-based policy guidelines in diabetes care. Results will be disseminated through papers, conferences and public health/policy fora.

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