OP37 Impact On Uncertainty Of Disaggregating Cost Data

2019 ◽  
Vol 35 (S1) ◽  
pp. 8-9
Author(s):  
Conor Teljeur ◽  
Paul Carty ◽  
Máirín Ryan
Keyword(s):  
Cost Utility ◽  
Cost Data ◽  
Model Parameters ◽  
Robot Assisted ◽  
Total Cost ◽  
Uncertainty Set ◽  
The Cost ◽  
The Impact ◽  
Cost Components

IntroductionEconomic models contain several parameters ordinarily subject to uncertainty. Unlike most other model parameters, costs can constitute numerous distinct components. For example, a surgical intervention can require a variety of disposables and reusable equipment. A micro-costing output may be disaggregated or presented as a total cost. Uncertainty could be applied to individual cost components or to total cost. We aimed to explore how disaggregation of cost data may impact on uncertainty using a case study.MethodsA set of simulations using hypothetical scenarios were developed with uncertainty set at ± 20 percent. The simulations investigated the impact of number of cost components, balance between components, and correlation between them. A cost-utility model from an assessment of robot-assisted radical prostatectomy was analyzed; procedure cost was divided into 32 individual cost components or treated as a total cost.ResultsBased on five equal cost components, uncertainty reduces from ± 20 percent for correlated variables to ± 9 percent for uncorrelated variables. With increasing numbers of uncorrelated cost components, the uncertainty in the total cost decreases markedly. The uncertainty around total robot-assisted surgery procedure equipment costs was ± 19.7 percent when components were correlated and ± 9.4 percent when uncorrelated. The impact on uncertainty in the incremental cost effectiveness ratio (ICER) was negligible but the ranking of parameters in the univariate sensitivity analysis changed.ConclusionsAnalyzing uncertainty by aggregated or disaggregated costs can have implications for presenting uncertainty in costs to decision makers. Applying uncertainty to aggregated costs essentially implies that variation in the cost of individual components is perfectly correlated. By disaggregating cost components they are being treated as uncorrelated, which can substantially reduce uncertainty in the total cost. In this case study we found that although the reduction in uncertainty could be clearly seen in the cost parameter, it had a negligible impact on uncertainty in the ICER.

scholarly journals The Development of Patient Scheduling Groups for an Effective Appointment System

2016 ◽  
Vol 07 (01) ◽  
pp. 43-58 ◽  
Author(s):  
Yu Li Huang
Keyword(s):  
Access To Care ◽  
Treatment Time ◽  
Optimization Technique ◽  
Urgent Care ◽  
Patient Scheduling ◽  
Total Cost ◽  
Patient Type ◽  
Clinic Efficiency ◽  
The Cost ◽  
The Impact

SummaryPatient access to care and long wait times has been identified as major problems in outpatient delivery systems. These aspects impact medical staff productivity, service quality, clinic efficiency, and health-care cost.This study proposed to redesign existing patient types into scheduling groups so that the total cost of clinic flow and scheduling flexibility was minimized. The optimal scheduling group aimed to improve clinic efficiency and accessibility.The proposed approach used the simulation optimization technique and was demonstrated in a Primary Care physician clinic. Patient type included, emergency/urgent care (ER/UC), follow-up (FU), new patient (NP), office visit (OV), physical exam (PE), and well child care (WCC). One scheduling group was designed for this physician. The approach steps were to collect physician treatment time data for each patient type, form the possible scheduling groups, simulate daily clinic flow and patient appointment requests, calculate costs of clinic flow as well as appointment flexibility, and find the scheduling group that minimized the total cost.The cost of clinic flow was minimized at the scheduling group of four, an 8.3% reduction from the group of one. The four groups were: 1. WCC, 2. OV, 3. FU and ER/UC, and 4. PE and NP. The cost of flexibility was always minimized at the group of one. The total cost was minimized at the group of two. WCC was considered separate and the others were grouped together. The total cost reduction was 1.3% from the group of one.This study provided an alternative method of redesigning patient scheduling groups to address the impact on both clinic flow and appointment accessibility. Balance between them ensured the feasibility to the recognized issues of patient service and access to care. The robustness of the proposed method on the changes of clinic conditions was also discussed.

Penetapan Tarif Ambulans Untuk Evakuasi Medis Berbasis Unit Cost

2021 ◽  
Vol 7 (1) ◽  
pp. 167-173
Author(s):  
Kelvin Riupassa ◽  
Narizma Nova ◽  
Endah Lestari ◽  
Sri Juniarti Azis ◽  
Wahyu Sulistiadi
Keyword(s):  
Recovery Rate ◽  
Unit Cost ◽  
Cost Recovery ◽  
Maintenance Costs ◽  
Total Cost ◽  
Medical Evacuation ◽  
Operational Costs ◽  
Emergency Ambulance ◽  
The Cost ◽  
Cost Components

Background: An ambulance is a vehicle designed to be able to handle emergency patients, provide first aid and carry out intensive care while on the way to a referral hospital. Ambulance operations require a large amount of funds obtained from APBD funds through tariffs that were passed through the DKI Jakarta Governor Regulation five years ago. For this reason, a new tariff is required to adjust to current conditions. Objectives: The purpose of this study is to calculate the unit cost of ambulance services in DKI Jakarta to be a consideration in the tariff setting policy in DKI Jakarta province. Research Metodes: This study uses a quantitative descriptive approach to obtain information about the unit cost of the Jakarta ambulance production unit. The method used is the calculation of real cost using the basis of the causes of costs. This research was conducted at the DKI Jakarta Emergency Ambulance using secondary data on investment costs, operational costs and maintenance costs in 2018. Results: The total cost of emergency ambulance in 2018 is known that the proportion of three cost components, namely operational costs, is 76%, followed by investment costs of 20% and maintenance costs of 3%. The calculation of the total cost of medical evacuation using the double distribution method is Rp. 98,915,016,805.00 divided by the number of medical evacuations in 2018 of 37,564 activities, the unit cost of medical evacuation for the AGD of DKI Jakarta Health Office is Rp. 2,633,215.00 without subsidies. APBD costs, while if the subsidy component is included in the calculation, the unit cost for one trip to the AGD of the Health Office is Rp. 604,071.00. This is still far above the current tariff of Rp. 450.00, so the cost recovery rate (CRR) is still below. 100%. Conclusion: From the three cost components consisting of investment, operational and maintenance costs,the largest proportion was operational costs at 76%. The Cost Recovery Rate has not reached 100% so that the existing rates have not covered the costs incurred.   Keywords: ambulance; price fixing; unit cost

Cost Comparison of Panel Level and Wafer Level Fan-out Packaging

2019 ◽  
Vol 2019 (DPC) ◽  
pp. 000141-000164
Author(s):  
Amy Lujan
Keyword(s):  
Cost Reduction ◽  
Cost Comparison ◽  
Cost Modeling ◽  
Cost Models ◽  
Wafer Level ◽  
Process Flow ◽  
Total Cost ◽  
Large Panels ◽  
The Cost ◽  
The Impact

In recent years, the possibility of panels replacing wafers in some fan-out applications has been a topic of interest. Questions of cost and yield continue to arise even as the industry appears to be full steam ahead. While large panels allow for more packages to be produced at once, the cost does not scale simply based on how many more packages can be generated from a panel over a wafer. This analysis begins by breaking down the types of cost and will discuss how those types of cost are impacted (or not) by the shift from wafer to panel. Activity based cost modeling is used; this is a detailed, bottom-up approach that takes into account each type of cost for each activity in a process flow. Two complete cost models were constructed for this analysis. A variety of package sizes are analyzed, and multiple panel sizes are included as well. For each set of activities in the fan-out process flow, there is an explanation of how the process changes with the move to panel, including assumptions related to throughput, equipment price, and materials. The cost reduction that may be achieved at each package and panel size will be presented for each processing segment. The focus of this analysis is on the details of each segment of the process flow, but results for the total cost of various packages will also be presented. There is also a section of analysis related to the impact of yield on the competitiveness of panel processing.

scholarly journals Direct Cost of Reprocessing Cotton-woven Surgical Drapes: a Case Study

2015 ◽  
Vol 49 (3) ◽  
pp. 488-494 ◽  
Author(s):  
Mariana Fexina Tomé ◽  
Antônio Fernandes Costa Lima
Keyword(s):  
Human Resources ◽  
Direct Cost ◽  
Financial Resources ◽  
Average Total Cost ◽  
Descriptive Case Study ◽  
Total Cost ◽  
Advantages And Disadvantages ◽  
Cost Of Materials ◽  
The Cost

OBJECTIVE Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$) originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%). It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%). CONCLUSION The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources.

scholarly journals Cost–utility of sofosbuvir/velpatasvir versus other direct-acting antivirals for chronic hepatitis C genotype 1b infection in China

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e035224
Author(s):  
Haoya Yun ◽  
Guoqiang Zhao ◽  
Xiaojie Sun ◽  
Lizheng Shi
Keyword(s):  
Sensitivity Analysis ◽  
Hepatitis C ◽  
Cost Effective ◽  
Cost Utility ◽  
Direct Acting Antivirals ◽  
Lifetime Horizon ◽  
System Perspective ◽  
Direct Acting ◽  
The Cost ◽  
The Impact

ObjectiveThis study aimed to estimate the cost–utility of sofosbuvir/velpatasvir (SOF/VEL) compared with other direct-acting antivirals (DAAs) in Chinese patients with hepatitis C virus (HCV).DesignA Markov model was developed to estimate the disease progression of patients with HCV over a lifetime horizon from the healthcare system perspective. Efficacy, clinical inputs and utilities were derived from the published literature. Drug costs were from the market price survey, and health costs for Markov health states were sourced from a Chinese study. Costs and utilities were discounted at an annual rate of 5%. One-way and probabilistic sensitivity analyses were conducted to test the impact of input parameters on the results.InterventionsSOF/VEL was compared with sofosbuvir+ribavirin (SR), sofosbuvir+dasabuvir (SD), daclatasvir+asunaprevir (DCV/ASV), ombitasvir/paritaprevir/ritonavir+dasabuvir (3D) and elbasvir/grazoprevir (EBR/GZR).Primary and secondary outcomesCosts, quality-adjusted life years (QALYs) and incremental cost–utility ratios (ICURs).ResultsSOF/VEL was economically dominant over SR and SD. However, 3D was economically dominant compared with SOF/VEL. Compared with DCV/ASV, SOF/VEL was cost-effective with the ICUR of US$1522 per QALY. Compared with EBR/GZR, it was not cost-effective with the ICUR of US$369 627 per QALY. One-way sensitivity analysis demonstrated that reducing the cost of SOF/VEL to the lower value of CI resulted in dominance over EBR/GZR and 3D. Probabilistic sensitivity analysis demonstrated that 3D was cost-effective in 100% of iterations in patients with genotype (GT) 1b and SOF/VEL was not cost-effective.ConclusionsCompared with other oral DAA agents, SOF/VEL treatment was not the most cost-effectiveness option for patients with chronic HCV GT1b in China. Lower the price of SOF/VEL will make it cost-effective while simplifying treatment and achieving the goal of HCV elimination.

Cost-effectiveness studies in ovarian cancer

2003 ◽  
Vol 13 (Suppl 2) ◽  
pp. 212-219
Author(s):  
T. D. Szucs ◽  
P. Wyss ◽  
K. J. Dedes
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Clinical Decision ◽  
Cost Utility ◽  
Chemotherapy Drugs ◽  
Pain And Suffering ◽  
Acquisition Costs ◽  
The Cost ◽  
Effectiveness Studies ◽  
The Impact

Ovarian cancer is the fifth leading cause of cancer-related deaths. The costs associated with this cancer impact both on the affected individual and on the health system. Screening is currently unproven as a strategy for improving outcomes for women with ovarian cancer. Randomized controlled trials, however, are underway, estimating any impact of screening with ultrasound and CA125 on ovarian cancer mortality. Paclitaxel and carboplatin combination, the standard first-line chemotherapy regimen for ovarian cancer, has not been compared with cisplatin and cyclophosphamide regarding the cost-effectiveness and cost-utility, but for paclitaxel and cisplatin, numerous studies have addressed these issues. The estimated incremental costs resulting from these studies fall well within the generally accepted range for new therapies. Although acquisition costs of new chemotherapy drugs exceed those of older drugs, the impact of costly drugs on total costs may be cost saving due to less costs related to supportive and palliative care. The most important costs for the patient, the pain and suffering associated with ovarian cancer and its treatment, are hard to quantify. Nevertheless, patients' quality of life must be considered when making a clinical decision to treat this disease. A review of available cost-effectiveness studies is presented and discussed.

scholarly journals Estimating the Impact of Medical Innovation: A Case Study of HIV Antiretroviral Treatments

2008 ◽  
Vol 11 (2) ◽  
Author(s):  
Mark G Duggan ◽  
William N Evans
Keyword(s):  
Health Care ◽  
Good Alternative ◽  
Care Utilization ◽  
Short Term ◽  
Fda Approval ◽  
New Treatments ◽  
The Cost ◽  
The Impact ◽  
Average Health

As health care consumes a growing share of GDP, the demand for better evidence regarding the effects of health care treatments and how these vary across individuals is increasing. Estimating this with observational data is difficult given the endogeneity of treatment decisions. But because the random assignment clinical trials (RACTs) used in the FDA approval process only estimate average health effects and do not consider spending, there is no good alternative. In this study we use administrative data from California's Medicaid program to estimate the impact of HIV antiretroviral treatments (ARVs). We use data on health care utilization to proxy for health status and exploit the rapid takeup of ARVs following their FDA approval. Our estimate of a 68 percent average mortality rate reduction is in line with the results from RACTs. We also find that the ARVs lowered short-term health care spending by reducing expenditures on other categories of medical care. Combining these two effects we estimate the cost per life year saved at $19,000. Our results suggest an alternative method for estimating the real-world effects of new treatments that is especially well-suited to those treatments that diffuse rapidly following their approval.

Estimating the Total Cost of Infused Iron Chelation Therapy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5576-5576 ◽  
Author(s):  
Marie-Pierre Desrosiers ◽  
Krista A. Payne ◽  
Jean-Francois Baladi
Keyword(s):  
Cohort Study ◽  
Resource Use ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Cost Data ◽  
Iron Chelation Therapy ◽  
Cell Disease ◽  
Total Cost ◽  
Unit Costs ◽  
The Cost

Abstract Background: Patients suffering from β-thalassemia or sickle cell disease require on-going blood transfusions. Chronic transfusion, however, results in iron overload, which if not removed by iron chelation therapy (ICT), causes organ damage. Deferoxamine (DFO) is currently the standard of care for ICT, but many patients do not adhere to therapy possibly because of the need for almost daily infusions lasting 8 to 10 hours each. Rationale: While the impact of current care on clinical and patient outcomes is generally understood, less is known about the total cost of DFO therapy. Objectives: To identify a complete set of cost items to inform the development of an ICT related Resource Use Questionnaire (RUQ) for administration in an international cohort study of the actual cost of ICT in practice; and to obtain a preliminary, literature-based estimate of total annual per patient costs of ICT. Methods: A search of the literature (EMB Reviews; Scirus and Ovid Medline (1996+); PubMed (1995+) was performed using the following key words: thalassemia, sickle cell disease, myelodysplastic syndrome, cost, iron chelation, Desferal, deferoxamine, resource use, reimbursement and compliance. Cost items were extracted from eligible studies to create an aggregated, composite set of ICT-related variables to which unit costs (2004/2005 USD) were applied. Results: Of 396 abstracts obtained, all but 96 were excluded because ICT cost data were lacking. Of those retained, only 4 studies (1 Israël;1 US;2 UK) reported ICT-related costs (1 lifetime;3 annual). Cost variables differed markedly among studies each focusing on some specific aspect. The application of unit costs to the composite list of ICT-related variables and associated resource use profiles reveal that total annual per patient ICT costs may be as high as $7,487 to $15,836 (£4,191 to £8,865) depending on age. The cost of DFO accounts for only 16%–31% of these estimated total costs, with the balance accounted for by other annual ancillary expenditures such as equipment and supplies, monitoring, and home health care services. Total costs could well be underestimated given that component lifetime costs such as DFO treatment complications, the clinical sequelae of poor adherence to DFO, and the indirect costs of lost productivity were not included. Cost estimates will be supplemented and validated at the time of abstract presentation by the resource use and unit cost data generated by the RUQ employed in the aforementioned international cohort study. Conclusions: Estimated total costs of ICT are substantial and well exceed the cost of DFO alone. A paucity of published data related to the total costs of ICT underscores the need for additional ICT cost data from actual practice to better understand the economic impact of novel ICT agents.

Measures to Relieve the Stress of Water

2013 ◽  
Vol 361-363 ◽  
pp. 636-639 ◽  
Author(s):  
Shi Kai Duan ◽  
Guo Shi Shen ◽  
Zhen Dong Shan ◽  
Yan Dong ◽  
Kai Zheng ◽  
...  
Keyword(s):  
Water Resources ◽  
Water Shortage ◽  
The United States ◽  
Three Solutions ◽  
Total Cost ◽  
Pros And Cons ◽  
Water Strategy ◽  
The Cost ◽  
Significant Regional Difference

In order to develop realistic water resources strategy, we initially analyze the situation of water resources in the United States which present a significant regional difference. Then on the basis of previous studies, we propose the cost formulas of water storage, movement and desalinization. By analyzing the practical application, along with pros and cons of the above three solutions accordingly, we consider that a comprehensive utilization of these measures will be the best water strategy for America to solve the water shortage problem. Later we apply the conclusion to a case study of Southern California, we propose an optimization model which aims to minimize the total cost of the water strategy, and then use Lingo to solve the problem. Results show that 5.946 billion cubic meters of water by transferring is the best way to make up for the water use gap in 2025 and the total cost is 2.94 billion dollars. Finally, we summarize the strengths and weaknesses of our paper. What needs to be emphasized is that our model can also be adapted into the analysis of other states, which shows great flexibility.

scholarly journals Self-report versus care provider registration of healthcare utilization: Impact on cost and cost-utility

2009 ◽  
Vol 25 (4) ◽  
pp. 588-595 ◽  
Author(s):  
Martine Hoogendoorn ◽  
Carel R. van Wetering ◽  
Annemie M. Schols ◽  
Maureen P. M. H. Rutten-van Mölken
Keyword(s):  
Resource Use ◽  
Care Provider ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Cost Utility ◽  
Self Report ◽  
Chronic Obstructive ◽  
Cost Difference ◽  
The Cost ◽  
The Impact

Objectives: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility.Methods: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evaluating the effect of an INTERdisciplinary COMmunity-based management program (INTERCOM) for patients with chronic obstructive pulmonary disease (COPD). The program was offered by physiotherapists, dieticians and respiratory nurses. During the 2-year period, patients reported all resource use in a cost booklet. In addition, data on hospital admissions and outpatient visits, visits to the physiotherapist, dietician or respiratory nurse, diet nutrition, and outpatient medication were obtained from administrative records. The cost per quality-adjusted life-year (QALY) was calculated in two ways, using data from the cost booklet or registrations.Results: In total, 175 patients were included in the study. Agreement between self-report and registrations was almost perfect for hospitalizations (rho = 0.93) and physiotherapist visits (rho = 0.86), but above 0.55, moderate, for all other types of care. The total cost difference between the registrations and the cost booklet was 464 euros with the highest difference for hospitalizations 386 euro. Based on the cost booklet the cost difference between the treatment group and usual care was 2,444 euros (95 percent confidence interval [CI], −819 to 5,950), which resulted in a cost-utility of 29,100 euro/QALY. For the registrations, the results were 2,498 euros (95 percent CI, −88 to 6,084) and 29,390 euro/QALY, respectively.Conclusions: This study showed that the use of self-reported data or data from registrations effected within-group costs, but not between-group costs or the cost utility.

Sign in / Sign up

Export Citation Format

Share Document