Hospital Usage of Parenteral Antimicrobial Agents: A Gradated Utilization Review and Cost Containment Program

1985 ◽  
Vol 6 (6) ◽  
pp. 226-230 ◽  
Author(s):  
Lawrence L. Pelletier
Keyword(s):  
Adverse Drug Reaction ◽  
Antimicrobial Agents ◽  
Cost Effective ◽  
Cost Of Care ◽  
Utilization Review ◽  
Hospital Infections ◽  
Control Programs ◽  
Antimicrobial Utilization ◽  
The Cost ◽  
And Control

AbstractForty percent to 60% of antimicrobial agents administered in hospitals without effective antimicrobial review and control programs are not needed. Excessive use of antimicrobial agents in the hospital promotes colonization of patients with resistant organisms, needlessly exposes them to the risk of an adverse drug reaction, and increases the cost of care. A gradated antimicrobial utilization review program is presented that determines hospital usage, develops guidelines for appropriate cost-effective drug administration, provides several options for implementation, and monitors outcome so that measures can be modified for specific situations. The techniques used are basic epidemiologic measures currently used to assess hospital infections.

In-line filtration reduced phlebitis associated with peripheral venous cannulation: Focus on cost-effectiveness and patients’ perspectives

2019 ◽  
Vol 21 (2) ◽  
pp. 154-160
Author(s):  
Gianluca Villa ◽  
Rosa Giua ◽  
Timothy Amass ◽  
Lorenzo Tofani ◽  
Cosimo Chelazzi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vascular Access ◽  
Cost Effective ◽  
Causative Factor ◽  
Control Group ◽  
Previous Trial ◽  
Venous Cannulation ◽  
Group A ◽  
The Cost ◽  
And Control

Background: In a previous trial, in-line filtration significantly prevented postoperative phlebitis associated with short peripheral venous cannulation. This study aims to describe the cost-effectiveness of in-line filtration in reducing phlebitis and examine patients’ perception of in-hospital vascular access management with and without in-line filtration. Methods: We analysed costs associated with in-line filtration: these data were prospectively recorded during the previous trial. Furthermore, we performed a follow-up for all the 268 patients enrolled in this trial. Among these, 213 patients responded and completed 6 months after hospital discharge questionnaires evaluating the perception of and satisfaction with the management of their vascular access. Results: In-line filtration group required 95.60€ more than the no-filtration group (a mean of € 0.71/patient). In terms of satisfaction with the perioperative management of their short peripheral venous cannulation, 110 (82%) and 103 (76.9%) patients, respectively, for in-line filtration and control group, completed this survey. Within in-line filtration group, 97.3% of patients were satisfied/strongly satisfied; if compared with previous experiences on short peripheral venous cannulation, 11% of them recognised in-line filtration as a relevant causative factor in determining their satisfaction. Among patients within the control group, 93.2% were satisfied/strongly satisfied, although up to 30% of them had experienced postoperative phlebitis. At the qualitative interview, they recognised no difference than previous experiences on short peripheral venous cannulation, and mentioned postoperative phlebitis as a common event that ‘normally occurs’ during a hospital stay. Conclusion: In-line filtration is cost-effective in preventing postoperative phlebitis, and it seems to contribute to increasing patient satisfaction and reducing short peripheral venous cannulation–related discomfort

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Jorge A. H. Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário O. Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs. new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

Inspection Manpower Planning for X & S Control Charts

2012 ◽  
Vol 488-489 ◽  
pp. 1624-1630
Author(s):  
Wen An Yang ◽  
Wen He Liao ◽  
Yu Guo
Keyword(s):  
Control Charts ◽  
Cost Effective ◽  
Manpower Planning ◽  
Sampling Interval ◽  
Optimal Number ◽  
Optimization Strategy ◽  
Effective Manner ◽  
Time Required ◽  
The Cost ◽  
And Control

A method of determining the optimal number of inspectors and/or working time required on a specific SPC activity is presented in the study. The issue of inspection manpower planning is handled as a constrained optimization problem. The optimization strategy is not only to minimize the avoidable surplus quality loss due to failure of detecting the out-of-control states but to determine the cost of inspection manpower from the perspective of deploying an appropriate amount of inspection manpower in a cost-effective manner, and meanwhile the values of sample size, sampling interval and control limits of control charts are also determined. The result obtained indicates that the total cost (or loss) can be substantially reduced if implementing control charts was equipped with adequate inspection manpower.

American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care

2009 ◽  
Vol 27 (23) ◽  
pp. 3868-3874 ◽  
Author(s):  
Neal J. Meropol ◽  
Deborah Schrag ◽  
Thomas J. Smith ◽  
Therese M. Mulvey ◽  
Robert M. Langdon ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Clinical Oncology ◽  
Cancer Care ◽  
Cost Effective ◽  
The United States ◽  
Cost Of Care ◽  
High Quality ◽  
American Society ◽  
The Cost

Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that the following steps be taken to address immediate needs: recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care; the design of educational and support tools for oncology providers to promote effective communication about costs with patients; and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options. Looking to the future, this Guidance Statement also recommends that ASCO develop policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care.

scholarly journals Costing and Cost-Effectiveness of a Mobile Health Intervention (ImTeCHO) in Improving Infant Mortality in Tribal Areas of Gujarat, India: Cluster Randomized Controlled Trial

10.2196/17066 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e17066
Author(s):  
Dhiren Modi ◽  
Somen Saha ◽  
Prakash Vaghela ◽  
Kapilkumar Dave ◽  
Ankit Anand ◽  
...  
Keyword(s):  
Incremental Cost ◽  
Cost Effective ◽  
Health Centers ◽  
Infant Deaths ◽  
Live Births ◽  
Life Years ◽  
Cluster Randomized ◽  
The Cost ◽  
And Control ◽  
And Child Health

Background During 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. Objective In this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care programs. Methods A two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results Out of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. Conclusions Overall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial Registration Clinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27

scholarly journals Economic evaluation of Health Extension Program packages in Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246207
Author(s):  
Lelisa Fekadu Assebe ◽  
Wondesen Nigatu Belete ◽  
Senait Alemayehu ◽  
Elias Asfaw ◽  
Kora Tushune Godana ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Prevention And Control ◽  
Unit Cost ◽  
Family Health ◽  
Cost Effective ◽  
Health Extension Program ◽  
Per Capita ◽  
The Cost ◽  
And Control ◽  
Extension Program

Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program’s being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. Methods Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. All costs were collected in Ethiopian birr and converted to United States dollars (US$) using the average exchange rate for 2018 (US$1 = 27.67 birr). Both costs and health outcomes were discounted by 3%. Result The average unit cost of providing selected hygiene and sanitation, family health, and disease prevention and control services with the HEP was US$0.70, US$4.90, and US$7.40, respectively. The major cost driver was drugs and supplies, accounting for 53% and 68%, respectively, of the total cost. The average annual cost of delivering all the selected interventions was US$9,897. All interventions fall within 1 times GDP per capita per LYG, indicating that they are very cost-effective (ranges: US$22–$295 per LYG). Overall, the HEP is cost-effective by investing US$77.40 for every LYG. Conclusion The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning. This study found that the program is very cost-effective in delivering community health services.

Risks associated with pathogenic fungi isolated from surgical centers, intensive care units, and materials sterilization center in hospitals. Risks associated with pathogenic fungi isolated from critical hospital areas

2020 ◽  
Vol 58 (7) ◽  
pp. 881-886
Author(s):  
Mayk Teles de Oliveira ◽  
Nathany Kelly Ribeiro Batista ◽  
Eric de Souza Gil ◽  
Maria do Rosário Rodrigues Silva ◽  
Carolina Rodrigues Costa ◽  
...  
Keyword(s):  
Air Quality ◽  
Aspergillus Terreus ◽  
Antimicrobial Agents ◽  
Monitoring And Evaluation ◽  
Pathogenic Fungi ◽  
Hospital Environment ◽  
Hospital Infections ◽  
Fusarium Spp ◽  
And Control ◽  
Penicillium Spp

Abstract The hospital environment requires special attention to air quality, since it needs to be healthy for the protection of patients and health professionals in order to prevent them against hospital infections. The objective of this study was to isolate, identify and evaluate the susceptibility profile of isolated fungi from two hospitals. For air sampling the impaction (Spin Air, IUL®) and passive sedimentation methods were used. For the isolation of fungi from surfaces, contact plates (RODAC®) were used. The identification of the fungi was performed by observing the macroscopic and microscopic aspects of the colonies, whereas for better visualization of fruiting structures, the microculture technique was performed on slides. To evaluate the susceptibility profile, the broth microdilution test recommended by CLSI was performed. Thirty-five isolates were identified: Aspergillus flavus (12), Aspergillus fumigatus (11), Aspergillus niger (1), Aspergillus terreus (2), Penicillium spp. (7), and Fusarium spp. (2) in the hospitals evaluated. All isolates had a minimum inhibitory concentration (MIC) more than 128 μg/ml for fluconazole; 0.5 to 4.0 μg/ml for amphotericin B (hospital 1), and all isolates from haospital 2 had MIC ≥2.0 μg/ml. In hospital 1, MIC for posaconazole ranged from 0.25 μg/ml to ≥32 μg/ml, and hospital 2 ranged from 0.5 to 1.0 μg/ml. The monitoring and evaluation of air quality and surfaces are essential measures for prevention and control of hospital infections, as these microorganisms are becoming increasingly resistant to antimicrobial agents, thus making treatment difficult, especially in immunocompromised individuals.

Systematic review of diabetes mellitus prevalence and determinants of early detection in Africa

2018 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Dariya Mukamusoni ◽  
Eleazar Ndabarora
Keyword(s):  
Diabetes Mellitus ◽  
Early Detection ◽  
Premature Mortality ◽  
Cost Effective ◽  
Community Based Interventions ◽  
Community Based ◽  
Control Programs ◽  
Mesh Terms ◽  
And Control ◽  
Prevalence Of Diabetes Mellitus

Several studies have reported dramatic increase of the prevalence of diabetes mellitus in Africa, and barriers to early detection and treatment, which are cost-effective strategies to prevent and control diabetes mellitus and combat its morbidity and premature mortality. The paper aimed to review the literature on the prevalence of diabetes mellitus and determinants of early detection in Africa. MeSH terms in the PUBMED Medline, LISTA (EBSCO), Cochrane, and Google Scholar in order to identify recent literature published from the year 2012 to 2017. Seven articles were reviewed, and high increase of the prevalence of diabetes mellitus in Africa was found. Evidences of cost-effectiveness with early detection and treatment were found; however, early detection is hindered by several factors that need to be addressed. In addition, the paucity of articles on early detection of diabetes mellitus and community-based prevention and control programs was observed. There is an increasing prevalence of diabetes mellitus in Africa, and there is paucity of evidences on the determinants of early detection and treatment program. Operational studies and community-based interventions aiming to community sensation and screening for diabetes mellitus are highly recommended.

scholarly journals Contrasting effects of reduced incubation cost on clutch attendance by male and female European starlings

Behaviour ◽  
2005 ◽  
Vol 142 (11-12) ◽  
pp. 1479-1493 ◽  
Author(s):  
Thijs van Overveld ◽  
Michael J.L. Magrath ◽  
Jan Komdeur
Keyword(s):  
Cost Of Care ◽  
Nest Attendance ◽  
European Starlings ◽  
Relative Contribution ◽  
Fat Reserves ◽  
Functional Differences ◽  
Thermal Status ◽  
Incubating Birds ◽  
The Cost ◽  
And Control

AbstractIn biparental birds, the relative contribution of the sexes to parental care can be viewed as a co-operative equilibrium that reflects the relative costs and benefits to each parent. If there are asymmetries in these costs or benefits, then any changes to the cost of care could result in a corresponding adjustment to their relative contribution. Incubation is a parental activity, shared in many species, which is costly both in terms of energy expenditure and time. In this study we manipulated the cost of incubation for pairs of European starlings (Sturnus vulgaris) by experimentally warming selected clutches to examine how this affected attendance by each parent. We found that total nest attendance did not differ between heated and control nests, although there was some evidence among heated nests that attendance declined with increasing effectiveness of the heater. Furthermore, relative male contribution was greater at heated than control nests resulting from the net effect of females tending to reduce, and males increase, attendance. We suggest that this shift in relative attendance may have been observed because females have a more developed brood patch and are more sensitive and responsive to clutch temperature than males. Consequently, females tended to reduce attendance at heated nests while males, with less reliable information on the clutch's thermal status, increased attendance to compensate for the reduction by the female. We also found that females at heated nests were lighter than at control nests, possibly because they were able to shed the additional fat reserves, a characteristic of incubating birds, earlier than females at control nests. We suggest that adjustment of clutch temperature in biparental species provides a valuable approach to investigating factors, including functional differences, asymmetries in brood value, and parental negotiation rules, that shape the roles of the sexes in incubation.

Modelling food safety and economic consequences of surveillance and control strategies for Salmonella in pigs and pork

2010 ◽  
Vol 139 (5) ◽  
pp. 754-764 ◽  
Author(s):  
F. M. BAPTISTA ◽  
T. HALASA ◽  
L. ALBAN ◽  
L. R. NIELSEN
Keyword(s):  
Cost Effectiveness ◽  
Food Safety ◽  
Control Strategies ◽  
Cost Effective ◽  
Economic Consequences ◽  
Informed Decision Making ◽  
Effectiveness Analysis ◽  
Stochastic Simulation Model ◽  
The Cost ◽  
And Control

SUMMARYTargets for maximum acceptable levels of Salmonella in pigs and pork are to be decided. A stochastic simulation model accounting for herd and abattoir information was used to evaluate food safety and economic consequences of different surveillance and control strategies, based among others on Danish surveillance data. An epidemiological module simulated the Salmonella carcass prevalence for different scenarios. Cost-effectiveness analysis was used to compare the costs of the different scenarios with their expected effectiveness. Herd interventions were not found sufficient to attain Salmonella carcass prevalence <1%. The cost-effectiveness of abattoir interventions changed with abattoir size. The most cost-effective strategy included the use of steam vacuum and steam ultrasound. Given uncertainty of the effect of steam vacuum and steam ultrasound, model results should be updated as more information becomes available. This framework contributes to informed decision-making for a more cost-effective surveillance and control of Salmonella in pigs and pork.

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