PP048 Quality Of Health Care Through Integration: Experience Of Cochlear Implantation

2017 ◽  
Vol 33 (S1) ◽  
pp. 93-94
Author(s):  
Lyazzat Kosherbayeva ◽  
Aigul Medeulova ◽  
Abdulla Alzhanov
Keyword(s):  
Health Care ◽  
Healthcare System ◽  
Cochlear Implantation ◽  
Cost Utility ◽  
Economic Research ◽  
Rehabilitation Programs ◽  
Life Years ◽  
The Republic ◽  
The Cost

INTRODUCTION:The State Program for Health Development of the Republic of Kazakhstan (RK) “Densaulyk” for 2016–2019 initiated the modernization of primary health care with the introduction of family practice in order to ensure the availability, completeness and quality of health services on the basis of an integrated healthcare system focused on the needs of the population. The aim of this study was to determine the effectiveness of the cochlear implantation (CI) programs.METHODS:A literature search was conducted for all clinical trials, randomized controlled trials, and reviews in the PubMed, Cochrane, and Center for Reviews and Dissemination databases. Two reviewers independently evaluated all publications for selection. The analysis included the cost-effectiveness and benefit from the CI program.RESULTS:We analyzed the effectiveness of the services for CI in the RK and other countries (1). In our analysis, we identified that there is no research on Quality-adjusted Life Years (QALYs) and Cost-Utility Analysis (CUA) in RK. We found that, in general, the cost of CI and pre-surgical procedures are comparable with other countries. The length of stay in Kazakhstan was much higher (an average of 8 days) compared with other countries (3 days). Also in RK, there were significantly lower prices per hospital day and cost of various consultations. Postoperative costs of other countries consisted of one-third to two-thirds of the total costs for preoperative and implantation stages (2, 3). There was a little information on the effectiveness of rehabilitation programs in RK.CONCLUSIONS:Economic research like QALYs and CUA are new directions in the healthcare system in the RK. Lack of integration between primary care, rehabilitation and other services leads to difficulties in assessing the effectiveness of CI programs (for example, in our case, there was the restriction of assessment in only postoperative costs).

Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

2002 ◽  
Vol 22 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Karin Sennfält ◽  
Martin Magnusson ◽  
Per Carlsson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Peritoneal Dialysis ◽  
Kidney Failure ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Age Group ◽  
The Cost ◽  
Quality Adjusted Life

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

scholarly journals A Systematic Review of Economic Analyses Studying Rituximab in R-CHOP Therapy in Patients with Non-Hodgkin Lymphoma

2009 ◽  
Vol 2 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Jenna L. Yoder ◽  
Khalid M. Kamal
Keyword(s):  
Cost Effectiveness ◽  
Hodgkin Lymphoma ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Non Hodgkin Lymphoma ◽  
Life Years ◽  
The Cost ◽  
Economic Studies ◽  
Chop Therapy

Objectives: To explore the use of pharmacoeconomic principles through examination of economic evaluations pertaining to the combination of the monoclonal antibody rituximab with conventional CHOP (cyclophosphamide/doxorubicin/ vincristine/ prednisone) or CHOP-like chemotherapy regimens in patients with non-Hodgkin lymphoma. Methods: A literature search was conducted using Evidence-Based Medical Reviews (EBMR), International Pharmaceutical Abstracts (IPA), and Medline databases to identify all economic studies relating to rituximab in combination with CHOP or CHOP-like regimens. The systematic evaluation also utilized the Quality of Health Economic Studies instrument to assess the quality of each study that was included in the final review. Results: Initially, eight studies were retrieved which included the use of rituximab in non-Hodgkin lymphoma treatment. Of these, four studies were excluded as rituximab was used as a stand-alone treatment option. The remaining four studies involved conventional CHOP therapy versus the combination with rituximab (R-CHOP) in patients with non-Hodgkin lymphoma. One study employed a cost-effectiveness analysis while the remaining three studies used a cost-utility analysis and reported the outcomes in terms of quality-adjusted life years (QALYs). Conclusions: The cost-effectiveness evaluation illustrated the dominance of R-CHOP over CHOP-alone in terms of both lower costs and increased life years gained. The cost-utility of R-CHOP in terms of costs/QALYs were below the accepted threshold of 50,000 in international monetary units. Through examination of evaluation principles employed, it is found that valid results are highly dependent on the input data, assumptions, and sensitivity analyses. Clinical decisionmakers must take into account specific inclusions of costs relevant to their own practice setting.

scholarly journals PARE0008 MOBILE APPLICATION “MOJRA” FOR MONITORING PATIENTS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1290.1-1290 ◽  
Author(s):  
N. Teodorovic ◽  
S. Djordjevic ◽  
L. Vranic
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Best Practice ◽  
Mobile Apps ◽  
Digital Health ◽  
Work Capacity ◽  
Learning Center ◽  
Approval Procedure ◽  
The Republic

Background:In Serbia, regular examinations with a rheumatologist are scheduled on average every 3 to 4 months. With this in mind, there is a real possibility that many patient data during this period may not be presented to the doctor during the examination, either because the patient forgets them or because they may focus on other issues and may not highlight key factsObjectives:To overcome this problem, the Association of Patients with Rheumatic Diseases of Serbia-ORS in cooperation with an IT firm developed the application “MojRA”, which was presented at the annual rheumatology congress of Serbia held in September 2019. The application “MojRA” is intended for patients suffering from rheumatoid arthritis - RA. The application enables efficient storage and systematization of data, allows doctors to monitor the condition of their patients between two examinations and have a medical history. “MojRA” is available for now from smartphones running the android operating system on the google play store. The privacy of patient information is guaranteed.Methods:Patients with RA will be able to record and store information about important moments during treatment in a simple and transparent way. At each subsequent visit they will be able to describe what happened to their illness in the meantime. The application can create different types of reports and views.At the same time, the doctor can use the app to inform the patient about her/his condition in real time, which will contribute to better and more meaningful communication. All this would improve the quality of health care, preserving work capacity and improving the quality of life.Results:In order to simplify biotherapy committee approval procedure for patients of RA, the “Charger” has been developed in association with ORS and URes. The “Charger” will connect data collected by MojRa to the registry of RA patients, making the whole approval procedure more efficient and transparent.Testing of the second version of this application is underway, meetings are held between the patients using the application and the IT company that created it.Plans are to expand the app to other types of arthritis in the near future, too, and will soon be completed for devices running Apple operating systems.Conclusion:In addition to being of great benefit to patients and doctors, it can in the future be of immeasurable importance for the savings in the overall health care system of the Republic of Serbia.References:[1]Mobile Apps for Rheumatoid Arthritis: Opportunities and Challenges, Mollard E, Michaud K, Rheum Dis Clin, May 2019, Volume 45, Issue 2, Pages 197–209[2]Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality, Rebecca Grainger, Hutt Hospital, JMIR Publications, Advancing Digital Health Research, Feb 27, 2017.[3]ACR Mobile Apps,https://www.rheumatology.org/Learning-Center/Apps,American College of Reumatology.Disclosure of Interests:None declared

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

Who is a “Senior”? Looking for a definition in the healthcare system

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Monica Consolandi
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Healthcare System ◽  
Health Care System ◽  
Design Methodology ◽  
Social Role ◽  
Content Type ◽  
The Core ◽  
Starting Point

Purpose Seniors are nowadays at the core of important reflections to understand both how to ensure them a proper quality of life and better recognize their social role, providing them services and proper health care to value them as persons and resources. This paper aims to find a through definition about who is a senior, in the author’s opinion the starting point to help them flourishing. Design/methodology/approach As an example of definitions, an online dictionary and two geriatric text-books are quoted, highlighting qualities and rights referred to seniors especially in the delicate context of the health-care system. Findings The lack of a commonly shared perspective on this delicate kind of patient entails the difficulty to reach a coherent and satisfying definition about who a senior is. Originality/value The lack of a commonly shared definition leads to inevitable misunderstandings and could explain the arduousness of considering seniors in all their aspects. Further investigations are suggested.

scholarly journals Funding the New Biologics – CCOHTA Report on the Cost Effectiveness of Infliximab for Crohn’s Disease: Pearls and Pitfalls

2002 ◽  
Vol 16 (12) ◽  
pp. 877-879 ◽  
Author(s):  
John K Marshall
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Economic Analysis ◽  
Safety Data ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
State Transitions ◽  
Health State ◽  
Life Years ◽  
The Cost

The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) published an economic analysis, using a Markov model, of infliximab therapy for Crohn’s disease that is refractory to other treatments. This was the first fully published economic analysis that addresses this treatment option. Health state transitions were based on data from Olmsted County, Minnesota, health state resource profiles were created using expert opinion and a number of assumptions were made when designing the model. The analysis was rigorous, the best available efficacy and safety data were used, state-of-the art sensitivity analyses were undertaken and an ‘acceptability curve‘ was constructed. The model found that infliximab was effective in increasing quality-adjusted life years when offered in a variety of protocols, but it was associated with high incremental cost utility ratios compared with usual care. The results should be interpreted, however, in view of a number of limitations. The time horizon for the analysis was short (one year), because of a lack of longer-term efficacy data, and might have led to an underestimation of the benefits from averting surgery. Because the analysis was performed from the perspective of a Canadian provincial ministry of health, only direct medical costs were considered. Patients with active Crohn’s disease are likely to incur significant indirect costs, which could be mitigated by this medication. The analysis should be updated as new data become available. Moreover, small changes in the cost of the medication could make the treatment cost effective, according to this model. Economic analyses, such as the one undertaken by the CCOHTA, cannot by themselves solve dilemmas in the allocation of limited health care resources, and other considerations must be included when formulating policy. This is especially important for patients with severe Crohn’s disease, who have significant disability and for whom few therapeutic options exist.

scholarly journals Cost-effectiveness of treatment optimisation with biomarkers for immunotherapy in solid tumours: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048141
Author(s):  
Sara Mucherino ◽  
Valentina Lorenzoni ◽  
Valentina Orlando ◽  
Isotta Triulzi ◽  
Marzia Del Re ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Immune Checkpoint ◽  
Cost Utility ◽  
Solid Tumours ◽  
Economic Evaluations ◽  
Monetary Benefit ◽  
The Cost ◽  
Net Monetary Benefit

IntroductionThe combination of biomarkers and drugs is the subject of growing interest both from regulators, physicians and companies. This study protocol of a systematic review is aimed to describe available literature evidences about the cost-effectiveness, cost-utility or net-monetary benefit of the use of biomarkers in solid tumour as tools for customising immunotherapy to identify what further research needs.Methods and analysisA systematic review of the literature will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed and Embase will be queried from June 2010 to June 2021. The PICOS model will be applied: target population (P) will be patients with solid tumours treated with immune checkpoint inhibitors (ICIs); the interventions (I) will be test of the immune checkpoint predictive biomarkers; the comparator (C) will be any other targeted or non-targeted therapy; outcomes (O) evaluated will be health economic and clinical implications assessed in terms of incremental cost-effectiveness ratio, net health benefit, net monetary benefit, life years gained, quality of life, etc; study (S) considered will be economic evaluations reporting cost-effectiveness analysis, cost-utility analysis, net-monetary benefit. The quality of the evidence will be graded according to Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review will assess the cost-effectiveness implications of using biomarkers in the immunotherapy with ICIs, which may help to understand whether this approach is widespread in real clinical practice. This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.PROSPERO registration numberCRD42020201549.

scholarly journals Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Health Scope ◽  
2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Maryam Khoramrooz ◽  
Asra Asgharzadeh ◽  
Saeide Alidoost ◽  
Zeynab Foroughi ◽  
Saber Azami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Home Care ◽  
Hospital Care ◽  
Cost Effective ◽  
Stroke Patients ◽  
Life Years ◽  
Effective Option ◽  
The Cost

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

scholarly journals Priority problems of the work of Ukrainian customs authorities in the terms of European and Euro-Atlantic integration

2021 ◽  
Vol 2021 (1) ◽  
pp. 96-103
Author(s):  
Oksana Yurynets ◽  
Keyword(s):  
Economic Research ◽  
Customs Union ◽  
The European Union ◽  
Low Level ◽  
Existing Problems ◽  
Single European Market ◽  
Permanent Improvement ◽  
The Cost ◽  
Research And Policy

Today, more and more companies focus on problems in customs clearance of products crossing the border during the implementation of export-import activities. In the context of European and Euro- Atlantic integration, which promote the accession of Ukrainian enterprises to the single European market, one of the priority tasks is the urgent solution of existing problems in the customs sphere. After all, one of the integral stages of Ukraine’s economic integration into the European Union is the successful accession of customs authorities to the Customs Union through harmonization of customs procedures with European norms, introduction of common customs principles and permanent improvement of customs activities on the basis of progressive customs instruments. The results of the survey of domestic exporters and importers that was conducted by the Institute for Economic Research and Policy Consulting indicated the following key problems in the work of Ukrainian customs authorities: insufficient quality of customs legislation; low level of transparency and openness of customs authorities; corruption and bribery among customs officers; intentional overstatement of the customs value of goods; low level of quality of technical support of customs authorities; low level of qualification of customs officers; frequent changes in the organizational management structure of customs authorities and their management; burdensome fiscal function of customs authorities. The identified problems in the work of customs authorities of Ukraine in the context of European and Euro-Atlantic integration made it possible to identify priority directions for improving customs procedures: increasing efficiency, transparency and non-discrimination of customs procedures for export-import operations, reducing the cost of customs clearance for export-import, absolute harmonization of domestic customs legislation with European norms, unification of customs procedures with European customs practices in export-import operations, reduction of bureaucracy of customs procedures in export-import operations, optimization of customs payments in export-import operations, etc. The implementation of these directions of improvement of customs procedures in the export-import operations should take place with the use of specific urgent customs instruments, which will promptly solve the existing urgent problems in the work of customs authorities.

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