EXPLORING PATENT ACTIVITY AND ITS POTENTIAL ASSOCIATION WITH HEALTHCARE OUTCOMES: A CASE STUDY OF OSTOMY PRODUCTS IN SWEDEN

Objectives:The aim of this study was to evaluate whether ostomy industry patent activity (PA) is associated with patient outcomes and healthcare costs.Methods:Two groups of ostomy pouch users based on manufacturer PA (low or high) were compared in terms of ostomy-related wear patterns, adverse events, and healthcare expenditure. Using Swedish registry data, all patients with newly formed stomas were divided between each group and were followed during a 2-year period (2011–12). Propensity score matching and parametric duration analysis were used to compare outcomes between patients of similar characteristics such as sex, age, and ostomy surgery type.Results:In both one- and two-piece systems, the high PA group had significantly lower monthly ostomy-related expenditure than the low PA group (one-piece: 197.47 EUR versus 233.34 EUR; two-piece: 164.00 EUR versus 278.98 EUR). Fewer pouch and skin wafer purchases per month were an important driver of cost differences. Both groups had similar likelihood of purchasing dermatological products for skin complications over time.Conclusions:PA in the ostomy care industry was associated with reduced healthcare costs, but not necessarily with fewer skin complications. It suggests that there is a health economic benefit from products made by patent intensive companies which may differentiate them from generic comparators, but more research is needed to understand the impact of activities conducive to medical innovation on health outcomes.

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Medical Malpractice

The Oxford Handbook of Law and Economics ◽

10.1093/oxfordhb/9780199684205.013.006 ◽

2017 ◽

pp. 119-147

Author(s):

Ronen Avraham ◽

Max M. Schanzenbach

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Medical Malpractice ◽

Healthcare Costs ◽

Standards Of Care ◽

Healthcare Outcomes ◽

Malpractice Liability ◽

The Impact

This chapter assesses theory and evidence on the efficacy of medical malpractice liability and limitations to it in improving healthcare outcomes, and identifies unresolved issues that merit further attention from scholars. First, it explores the theoretical and legal background on medical malpractice. It then turns to the available evidence by focusing on three basic areas of study: the impact of malpractice limitations on payouts and litigation, the effect of malpractice limitations on overall healthcare costs, and the effect of malpractice on two major cost drivers in the healthcare system: cardiac and obstetrics practice. It argues that limitations on liability did not and likely cannot significantly reduce healthcare costs. Finally, the chapter discusses new and important trends in the literature regarding reforms to standards of care and the role of clinical practice guidelines and communication and disclosure programs.

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Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120986800 ◽

2021 ◽

pp. 104990912098680

Author(s):

Paige E. Sheridan ◽

Wendi G. LeBrett ◽

Daniel P. Triplett ◽

Eric J. Roeland ◽

Andrew R. Bruggeman ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Healthcare Costs ◽

Healthcare Expenditure ◽

Advanced Cancer Patients ◽

Palliative Care Consultation ◽

Care Consultation ◽

The Impact

Background: There is inconsistent evidence that palliative care intervention decreases total healthcare expenditure at end-of-life for oncology patients. This inconsistent evidence may result from small sample sizes at single institution studies and disparate characterization of costs across studies. Comprehensive studies in population-based datasets are needed to fully understand the impact of palliative care on total healthcare costs. This study analyzed the impact of palliative care on total healthcare costs in a nationally representative sample of advanced cancer patients. Methods: We conducted a matched cohort study among Medicare patients with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation on factors related to both the receipt of palliative care and end of life costs. We compared direct costs between matched patients to determine the per-patient economic impact of a palliative care consultation. Results: Patients who received a palliative care consultation experienced an average per patient cost of $5,834 compared to $7,784 for usual care patients (25% decrease; p < 0.0001). Palliative care consultation within 7 days of death decreased healthcare costs by $451, while palliative care consultation more than 4 weeks from death decreased costs by $4,643. Conclusion: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditure among advanced cancer patients. Earlier palliative care consultation results in greater cost reductions than consultation in the last week of life.

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Digital transformation of the emergency department-inpatient interface (EDii): integration for future innovation

Australian Health Review ◽

10.1071/ah18176 ◽

2020 ◽

Vol 44 (5) ◽

pp. 666

Author(s):

Andrew Staib ◽

Clair Sullivan ◽

Cara Joyce Cabilan ◽

Rohan Cattell ◽

Rob Eley

Keyword(s):

Electronic Medical Records ◽

Patient Outcomes ◽

Medical Records ◽

Emergency Admission ◽

Tertiary Hospital ◽

Digital Transformation ◽

Relative Reduction ◽

Process Measures ◽

The Impact

As the focus of clinicians and government shifts from speciality-based care to system-based key performance indicators such as the National Emergency Access Target (NEAT) or the 4-h rule, integration between emergency department (ED) and inpatient clinical workflows and information systems is becoming increasingly necessary. Such system measures drive the implementation of integrated electronic medical records (ieMR) to digitally integrate these workflows. The objective of this case study was to describe the impact of digital transformation of the ED–in-patient interface (EDii) of a large tertiary hospital on process measures and clinical outcomes for patients requiring emergency admission to hospital. Data were collected from routine clinical and administrative information systems to measure process and clinical outcome measures, including ED length of stay, compliance with the 4-h rule and in-patient mortality between 28 November 2014 and 28 February 2017. The 4-h rule compliance for all patients, as well as for the EDii group (admitted to hospital excluding short stay ward), declined after digitisation. There were 55 fewer deaths in the postintervention group (15% relative reduction; P = 0.02) and a 10% relative reduction in adjusted mortality as measured by the Hospital Standardised Mortality Ratio for emergency patients (eHSMR), which did not reach statistical significance. Digital deceleration in ED performance did occur with an ieMR rollout, but worsening of key patient outcomes was not observed. What is known about this topic? Much has been written about the introduction of electronic medical records (EMRs) in emergency departments. This work sits alongside a substantial body of evidence outlining the relationship between process measures of ED performance and important patient outcomes. However, much less is known about the impact of digital transformation on the complex adaptive system that is the EDii and the impact of digitisation on the vulnerable group of patients who require emergency admission to hospital. What does this paper add? The objective of this case study was to describe the effect of a rapid rollout of an integrated EMR. This EMR simultaneously transformed care delivery both in the ED and the inpatient space and impacted on the politically and clinically sensitive performance and outcome measures of the EDii in a large tertiary hospital. The present study is the first that specifically examined the effect of digitisation at the EDii. What are the implications for practitioners? The understanding that digital deceleration will occur, but that with good patient outcome monitoring worsening of key patient outcomes is not likely to occur, now holds a key place in digital transformation planning. The measures of the EDii examined in this case study provide a foundation for this montoring.

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MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and cancer: an old debate revisited

Acta Endocrinologica ◽

10.1530/eje-16-0178 ◽

2016 ◽

Vol 175 (4) ◽

pp. R147-R156 ◽

Cited By ~ 39

Author(s):

Cesar Luiz Boguszewski ◽

John Ayuk

Keyword(s):

Patient Outcomes ◽

Epidemiological Data ◽

Cross Sectional ◽

Endocrine Disease ◽

Potential Association ◽

Increased Risk ◽

Incidence And Mortality ◽

Prostate Cancers ◽

Study Designs ◽

The Impact

Based on experimental and animal models, epidemiological data from non-acromegaly populations, and longitudinal and cross-sectional cohorts of patients with acromegaly, a potential association between acromegaly and cancer has long been hypothesized, in particular colorectal cancer, and, to a lesser extent, breast, thyroid and prostate cancers. The exact mechanisms underlying this potential association have not been fully elucidated. Results from studies examining cancer incidence and mortality in acromegaly have been inconsistent, with some demonstrating increased risk, whereas others show no increase. This article reviews the existing data relating to cancer risk and mortality in acromegaly, exploring the limitations of study designs and the impact of changes in disease control and patient outcomes over time.

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P805 Patients with Crohn’s disease treated with ustekinumab vs. vedolizumab in real-world settings

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.933 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S630-S630

Author(s):

M Chiorean ◽

J Jiang ◽

N Candela ◽

G Chen ◽

H Romdhani ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Real World ◽

Healthcare Costs ◽

Index Date ◽

Drug Costs ◽

Healthcare Outcomes ◽

Coding System ◽

Cost Differences

Abstract Background Ustekinumab (UST) and vedolizumab (VDZ) are approved biologic therapies for moderate to severe Crohn’s disease (CD). Comparative data on real-world patient characteristics and healthcare costs for these drugs are scarce. Methods We examined healthcare costs associated with UST (healthcare common procedure coding system [HCPCS]: J3357, J3358, C9261, C9487, Q9989) and VDZ (HCPCS: C9026, J3380) in a retrospective cohort study of Truven commercial claims data (2009–2018) for adults with CD (international classification of diseases-9/10 codes: 555/K50). Eligible patients (18–89 years old) initiated UST or VDZ (index drug) on/after Sept 26, 2016, had CD as the latest relevant autoimmune disease on or before index drug initiation (index) date, ≥6 months of data available both before and after the index date, completed induction, and initiated maintenance therapy. Entropy balancing was used to address confounding factors (baseline characteristics). Primary outcome was healthcare costs assessed from a US payer perspective from index date to treatment discontinuation or end of follow-up (time on treatment). Cost were reported in 2018 US$ per patient per month and compared between treatment groups overall, and for biologic-naïve and -experienced (≥1 pre-index biologic therapy for CD) subgroups, using mean cost differences (MCD) obtained from weighted two-part models. Results The 599 (117 biologic-naive) UST- and 589 (172 biologic-naive) VDZ-treated patients who met eligibility criteria were similar in sex (54% and 57% female), mean age (41 ± 14 and 44 ± 14 years), time since diagnosis (42 ± 33 and 46 ± 35 months) and Charlson comorbidity index (0.4 ± 1.0 and 0.6 ± 1.1). Disease location, follow-up duration, and prior therapies and surgeries were also comparable. Characteristics were similar in biologic-naïve and -experienced patients. Mean weighted time on treatment was 11.4 and 12.1 months in UST- and VDZ-treated patients. Mean weighted total healthcare costs per patient per month was higher with UST vs. VDZ (MCD=$5051) driven by total index drug costs (MCD=$4946; Table). Cost differences were consistent in biologic-naïve and -experienced patients (total cost MCD=$4466 and $4836, both p < 0.01). Conclusion Characteristics of UST- and VDZ-treated patients in real-world settings were comparable. In this population of patients receiving maintenance treatment for CD, index drug costs make UST treatment substantially more costly than VDZ. Further comparison of healthcare outcomes in patients treated with UST vs. VDZ is warranted.

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