PP428 Rechargeable Versus Recharge-Free Sacral Neurostimulation: An Australian Health Economics Analysis

2021 ◽  
Vol 37 (S1) ◽  
pp. 36-37
Author(s):  
Rashmi Joglekar ◽  
Alexandra Cordato
Keyword(s):  
Cost Minimization ◽  
Symptom Control ◽  
Economic Value ◽  
Cost Savings ◽  
Dropout Rates ◽  
Battery Life ◽  
Hospital Data ◽  
Real World Data ◽  
Sensitivity Testing ◽  
Australian Health

IntroductionSacral neuromodulation is a well-established therapy for urinary and fecal incontinence. Currently available sacral neurostimulators require replacement every three to five years due to battery depletion. New rechargeable sacral neurostimulators with a potential 15-year battery life now have regulatory approval in Australia. However, the initial outlay for the device is higher than for the predicate devices. Our objective was to assess the economic value of rechargeable devices, compared with recharge-free implants, and to identify the patients most likely to benefit from the introduction of this novel technology in Australia.MethodsThe Medicare database was reviewed to quantify populations likely to derive benefits from rechargeable technology. Cost minimization and budget impact analyses were conducted from a payer perspective. Cost inputs were derived from Medicare and the Private Hospital Data Bureau. Two scenarios were modeled comparing the three and five-year battery life of the recharge-free devices with 15 years for a rechargeable device. Sensitivity testing was conducted based on potential uptake and dropout rates (due to death, dementia, etc.).ResultsRechargeable neurostimulators were found to be dominant (cost-saving) in all modeled scenarios, facilitated by a reduction in the frequency of battery replacement procedures and their associated risks for patients. Rechargeability also facilitated higher power settings for optimal symptom control, without trading off device longevity. Younger patients are expected to derive the greatest benefit from the extended battery life as data showed that 40 percent of the implantations were for patients younger than 65 years. The key uncertainty in this analysis was the limited real-world data on patient selection and preferences, which may influence uptake and dropout rates.ConclusionsRechargeable sacral neurostimulators deliver cost savings to the healthcare system due to their extended battery life. Fewer replacement surgeries are an important patient-relevant outcome, especially for younger populations. This finding is important because it demonstrates the economic value of rechargeability to payers and provides robust evidence supporting therapy access for privately insured patients in Australia.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

An Economic Evaluation of the Highlands and Islands Teledentistry Project

2002 ◽  
Vol 8 (3) ◽  
pp. 165-177 ◽  
Author(s):  
P A Scuffham ◽  
M Steed
Keyword(s):  
Cost Minimization ◽  
Cost Savings ◽  
Remote Communities ◽  
Scottish Highlands ◽  
Orkney Islands ◽  
General Dental Practitioner ◽  
Dental Practices ◽  
Hospital Visits ◽  
The Cost ◽  
Outreach Visits

A 12-month trial of teledentistry was conducted in two general dental practices (one in the Orkney Islands and one in the Scottish Highlands at Kingussie). The dental practices had a PC-based videoconferencing link, connected by ISDN at 128 kbit/s, to a restorative specialist at a hospital in Aberdeen. Twenty-five patients were recruited into the trial. A cost-minimization analysis was undertaken by comparing the costs of teledentistry with two alternatives: outreach visits, where the specialist regularly visited the remote communities, and hospital visits, where patients in remote communities travelled to hospital for consultation. For Orkney patients, dental teleconsultations cost the National Health Service (NHS) an additional £36 per patient compared with outreach visits, but cost-savings of £270 per patient could be achieved compared with hospital visits. For Kingussie patients, teleconsultations cost the NHS an additional £44 and there were cost-savings of £1.54 compared with outreach visits and hospitals visits, respectively. However, patients incurred additional costs for radiographs and photographs, and the general dental practitioner incurred additional preparation time costs. When the value of patient time was included, there were cost-savings of around £900 per Orkney patient compared with hospital visits, but compared with outreach visits teledentistry cost an additional £180 per patient. Based on the trial data, there were no cost-savings from teledentistry for Kingussie patients, even when the value of time was included. These results were relatively robust in a sensitivity analysis. However, we estimated that the cost-effectiveness of teledentistry would improve with greater familiarity and use of equipment. Benefits and cost-savings would be greatest in island or remote communities, where patients have to travel long distances to hospital for specialist consultations.

Improved Acoustic Quick-Disconnect Technology for Mooring Operations

2021 ◽  
Author(s):  
Jonathan Kent Longridge ◽  
Johnny Shield ◽  
Sarah Finn ◽  
Tom Fulton
Keyword(s):  
Shallow Water ◽  
Oil And Gas ◽  
Signal Transmission ◽  
Cost Savings ◽  
Oil And Gas Industry ◽  
Lessons Learned ◽  
Battery Life ◽  
User Friendliness ◽  
Mooring Lines ◽  
Reduced Risk

Objectives/Scope As the offshore oil and gas industry has changed, deep water Mobile Offshore Drilling Units (MODU) are commonly outfitted with dynamic positioning (DP) systems and on-vessel mooring equipment to facilitate drilling operations at ultra-deep and shallow water well locations. However, since many shallow water locations can experience harsh conditions and may require moorings for station-keeping performance, it is beneficial to enable a DP rig to quickly disconnect from its mooring system and avoid hazardous conditions without support vessel assistance. Providing this capability, acoustically releasable subsea mooring connectors allow a rig's mooring lines to be released remotely and almost immediately. Additionally, the ability to disconnect without Anchor Handler Vessel (AHV) assistance for mooring operations and rig transit support offers reduced risk and cost savings. Methods, Procedures, Process A brief review of existing quick-disconnect mooring devices will be presented. It will highlight how the technology has evolved and is being used, particularly in recent years. Successes, problems, and lessons learned from past InterMoor and SRP product development will be summarized and focused attention will be given to a significant number of more recent improvements to increase the product's reliability, availability, serviceability, and robustness. Improvements to ensure reliable long-term battery life and power supply, enhance on-vessel accessibility and user-friendliness for rig personnel, and employ advanced acoustic signal transmission, reception, and device status analytics will be discussed. External modifications to reinforce its robustness during deployment and internal electromechanical changes to facilitate its serviceability will also be described. Results, Observations, Conclusions A substantially lighter and smaller acoustically releasable mooring connector was developed two years ago, tested thereafter, recently deployed on several offshore mooring campaigns, and has now been upgraded to incorporate high-fidelity electronics with the ability to release under tension loads as high as 900 tonnes. As such, this second-generation device's reliability, accessibility, and serviceability are significantly enhanced. Results from offshore deployments from recent MODU and barge mooring operations will be summarized. This technology provides a safer way to quickly disconnect mooring lines and offers cost efficiency by allowing faster rig moves from one location to the next with reduced risk. Novel/Additive Information The paper will cover the work, challenges, trials, and tribulations required to bring a new product to market with cutting edge capabilities. Novel highlights will include the integration of a networked data transmission and communication system, the system's fundamental change from pneumatic to electromechanical actuation, and additional enhancements and improvements that are unique to mooring quick-disconnect devices and at the forefront of subsea technology.

scholarly journals Impact assessment of the incorporation of the rotavirus vaccine in the province of San Luis – Argentina

2019 ◽  
Vol 147 ◽  
Author(s):  
S. García Martí ◽  
F. Augustovski ◽  
L. Gibbons ◽  
V. Loggia ◽  
A. Lepetic ◽  
...  
Keyword(s):  
Economic Value ◽  
Interrupted Time Series ◽  
Medical Costs ◽  
Control Group ◽  
Rotavirus Vaccine ◽  
Age Group ◽  
Real World Data ◽  
San Luis ◽  
Age Related ◽  
Vaccine Impact

Abstract Rotavirus (RV) is the main cause of acute gastroenteritis (AGE) in young children. The San Luis province of Argentina introduced RV vaccination in May 2013. We estimate vaccine impact (RVI) using real-world data. Data on all-cause AGE cases and AGE-related hospitalisations for San Luis and the adjacent Mendoza province (control group) were obtained and analysed by interrupted time-series methods. Regardless of the model used for counterfactual predictions, we estimated a reduction in the number of all-cause AGE cases of 20–25% and a reduction in AGE-related hospitalisations of 55–60%. The vaccine impact was similar for each age group considered (<1 year, <2 years and <5 years). RV vaccination was estimated to have reduced direct medical costs in the province by about 4.5 million pesos from May 2013 to December 2014. Similar to previous studies, we found a higher impact of RV vaccination in preventing severe all-cause AGE cases requiring hospitalisation than in preventing all-cases AGE cases presenting for medical care. An assessment of the economic value of RV vaccination could take other benefits into account in addition to the avoided medical costs and the costs of vaccination.

Data-Driven Design of Control Strategies for Distributed Energy Systems

2019 ◽  
Vol 141 (11) ◽  
Author(s):  
Philip Odonkor ◽  
Kemper Lewis
Keyword(s):  
Energy Cost ◽  
Cost Minimization ◽  
Computational Cost ◽  
Cost Savings ◽  
Price Volatility ◽  
Energy Resources ◽  
Data Driven ◽  
Distributed Energy Resources ◽  
Maximization Problem ◽  
Distributed Energy

Abstract The flexibility afforded by distributed energy resources in terms of energy generation and storage has the potential to disrupt the way we currently access and manage electricity. But as the energy grid moves to fully embrace this technology, grid designers and operators are having to come to terms with managing its adverse effects, exhibited through electricity price volatility, caused in part by the intermittency of renewable energy. With this concern however comes interest in exploiting this price volatility using arbitrage—the buying and selling of electricity to profit from a price imbalance—for energy cost savings for consumers. To this end, this paper aims to maximize arbitrage value through the data-driven design of optimal operational strategies for distributed energy resources (DERs). Formulated as an arbitrage maximization problem using design optimization principles and solved using reinforcement learning, the proposed approach is applied toward shared DERs within multi-building residential clusters. We demonstrate its feasibility across three unique building clusters, observing notable energy cost reductions over baseline values. This highlights a capability for generalized learning across multiple building clusters and the ability to design efficient arbitrage policies for energy cost minimization. The scalability of this approach is studied using two test cases, with results demonstrating an ability to scale with relatively minimal additional computational cost, and an ability to leverage system flexibility toward cost savings.

Designing Optimal Arbitrage Policies for Distributed Energy Systems in Building Clusters Using Reinforcement Learning

2019 ◽  
Author(s):  
Philip Odonkor ◽  
Kemper Lewis
Keyword(s):  
Renewable Energy ◽  
Reinforcement Learning ◽  
Electricity Markets ◽  
Energy Cost ◽  
Cost Minimization ◽  
Control Strategies ◽  
Cost Savings ◽  
Price Volatility ◽  
Maximization Problem ◽  
Distributed Energy

Abstract In the wake of increasing proliferation of renewable energy and distributed energy resources (DERs), grid designers and operators alike are faced with several emerging challenges in curbing allocative grid inefficiencies and maintaining operational stability. One such challenge relates to the increased price volatility within real-time electricity markets, a result of the inherent intermittency of renewable energy. With this challenge, however, comes heightened economic interest in exploiting the arbitrage potential of price volatility towards demand-side energy cost savings. To this end, this paper aims to maximize the arbitrage value of electricity through the optimal design of control strategies for DERs. Formulated as an arbitrage maximization problem using design optimization, and solved using reinforcement learning, the proposed approach is applied towards shared DERs within multi-building residential clusters. We demonstrate its feasibility across three unique building cluster demand profiles, observing notable energy cost reductions over baseline values. This highlights a capability for generalized learning across multiple building clusters and the ability to design efficient arbitrage policies towards energy cost minimization. Finally, the approach is shown to be computationally tractable, designing efficient strategies in approximately 5 hours of training over a simulation time horizon of 1 month.

P5669Clinical management of syncope patients guided by insertable cardiac monitors in Europe

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Moyson ◽  
A Verma ◽  
A Natale ◽  
A Amin ◽  
S Beinart ◽  
...  
Keyword(s):  
Real World ◽  
Recurrent Event ◽  
Battery Life ◽  
Real World Data ◽  
European Guidelines ◽  
Kaplan Meier ◽  
Clinical Action ◽  
Unexplained Syncope ◽  
Multi Center Study

Abstract Introduction Current European guidelines recommend the use of insertable cardiac monitors (ICMs) in the early phase of evaluation for patients with recurrent, unexplained syncope and a likelihood of recurrence during the device battery life. The ongoing Reveal LINQ Registry collects real-world data on clinical actions guided by the insertable cardiac monitor (ICM) in these patients. Purpose To characterize ICM-guided diagnosis and treatment of syncope patients in Europe. Methods The Reveal LINQ Registry is a prospective, observational, multi-center study evaluating real-world performance of the ICM. Patients from European centres who had syncope indicated as the reason for ICM implant were included in the analysis. Kaplan-Meier methods were used to determine the percentage of patients receiving treatment. Results In total, 139 patients from 12 centres [Portugal (78); The Netherlands (30); Belgium (12); Italy (10); Germany (5); United Kingdom (4)] received an ICM to monitor for unexplained syncope and had at least one follow-up visit. The mean age was 61.2 and 51.1% were female. During a mean follow-up time of 11.2 months, 31 patients experienced at least one recurrent syncope event classified as: cardiac (9), vasovagal (4), idiopathic (8) and unknown (10). An arrhythmia was diagnosed in 14 (45.2%) patients with a recurrent event and clinical actions were taken in 12 (38.7%) patients (10 IPGs, and 2 AF ablations). Among patients without a recurrence, 25 (23.1%) had an arrhythmia diagnosed and 20 (18.5%) had a clinical action taken (13 therapeutic device implants, 4 ablations, and 3 medication changes). Overall, the rate of clinical actions was 32.6% after 18 months of ICM follow-up in the unexplained syncope population (Figure). Time to treatment Conclusion Clinical actions are taken in approximately one third of unexplained syncope patients monitored with an ICM after 18 months of follow up. Acknowledgement/Funding Medtronic

Economic analysis of alternative pembrolizumab and nivolumab dosing strategies at an academic cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6504-6504
Author(s):  
Evan Thomas Hall ◽  
Jenny Zhang ◽  
Eun-Jeong Kim ◽  
Grace Hwang ◽  
Shailender Bhatia ◽  
...  
Keyword(s):  
Cost Minimization ◽  
Pharmaceutical Expenditure ◽  
Cost Savings ◽  
Fixed Dose ◽  
Cancer Center ◽  
Data Repository ◽  
Cancer Therapies ◽  
Medicine Research ◽  
Dosing Strategies ◽  
The Impact

6504 Background: Pembrolizumab (P) and nivolumab (N) were initially investigated and FDA-approved with weight-based dosing strategies, but later the approval label was amended to a fixed dose administration. Given increasing concerns about financial toxicity of cancer therapies, we hypothesize that weight-based dosing of P and N and allowing vial sharing among patients will result in substantial cost savings. Methods: We obtained IRB approval to retrospectively examine all outpatient doses of P and N given at three Stanford Medicine infusion centers between July 1, 2018 and Oct 31, 2018 using the Stanford Medicine Research Data Repository (STARR) database. We performed cost-minimization analysis modeling the impact of dosing strategies based upon patient weight versus fixed dosing (2 mg/kg vs 200 mg q3wks for P; 3 mg/kg vs 240 mg q2wks or 6 mg/kg vs 480 q4wks for N). “Dose-minimization” (DM) was defined as whichever dose was lower (weight-based or fixed dose). The impact of allowing vial sharing (considering commercially available vial sizes) between patients treated at the same site and on the same date was assessed. Average sales price (ASP) from Center for Medicare and Medicaid Services for Part B drugs was used for cost estimates. Results: A total of 1,029 doses of P or N were administered across a variety of cancer types. For most doses (N = 789, 77%), the calculated weight-based dose was less than the fixed dose. DM resulted in decreased usage and expenditures of both P and N, and a further decrease was observed with vial sharing. Total savings estimated with DM and vial sharing strategy were > $1.4 million (Table). This amounted to savings of > 22,000 mg of P (112 fixed doses) and > 11000 mg of N (47 fixed doses). Savings were greatest at the highest volume infusion center. Conclusions: Alternative dosing strategies of P and N would result in significantly less drug utilization and pharmaceutical expenditure without anticipated impact on efficacy. Potential barriers to this approach include existing policies regarding vial sharing and drug vial sizes. [Table: see text]

scholarly journals P592 Costs savings associated with ferric maltol and the reduced use of intravenous iron based on real world data

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S541-S542
Author(s):  
S Howaldt ◽  
C K Becker ◽  
J A Becker ◽  
A C Poinas
Keyword(s):  
Real World ◽  
Productivity Loss ◽  
Drug Acquisition ◽  
Cost Savings ◽  
Intravenous Iron ◽  
Ferric Carboxymaltose ◽  
Real World Data ◽  
Iv Iron ◽  
Acquisition Costs ◽  
The Mean

Abstract Background Intravenous (IV) iron is frequently used in patients with iron deficiency (ID) when conventional oral ferrous products are ineffective or cannot be used (e.g. due to poor tolerability). Oral ferric maltol is a new iron ferric product registered in Europe and US. The aim of this study was to quantify the use of IV iron before and after the introduction of the new oral ferric maltol in real world settings and extrapolate the overall costs involved. Methods Data were collected from a single centre German clinical practice, MVZ für Immunologie, in inflammatory bowel disease (IBD) patients treated with iron therapy for ID with or without anaemia between 2013 and 2019 through the systematic CEDUR IBD registry and local medical records. The first cohort was formed of patients treated between 2013 and 2015, receiving only IV iron as ferric carboxymaltose (FCM). The second cohort was formed of patients treated between 2017 and 2019, receiving either oral ferric maltol only or ferric maltol in combination with FCM. Costs involved in each cohort were extrapolated using a societal perspective. Results Following the introduction of oral ferric maltol, the actual total number of FCM infusions observed was 138, showing a decrease of 70% compared to the first cohort in which oral ferric maltol was not available. This decreased number of infusions between the two cohorts was associated with total costs-savings of €56,933. In the first cohort, the administration costs were €44,536, the drug acquisition costs were €59,536 and the productivity loss were €30,944. In the second cohort, the administration costs were €13,597 the drug acquisition costs were €55,028 and the productivity loss were €9,447. A secondary scenario strictly applying the doses taken from respective SmPCs was tested and resulted in greater costs-savings. Noteworthy, the mean (SD) haemoglobin (Hb) level at baseline in the first cohort was lower with 11.5g/dl (1.19) vs. 12.2g/dl (1.18) in the second cohort. Three to six months after the treatment had been stopped, the mean (SD) Hb level was 13g/dl in both the first and second cohort with a SD of 1.31 and 1.37 respectively, showing that Hb levels were maintained in both cohorts. Conclusion The introduction of the new oral ferric maltol resulted in a decrease of 70% in terms of number of FCM infusions which was associated with costs-savings of €56,933 in terms of administration, drug acquisition and productivity loss costs. Considering that Hb levels were maintained in both cohorts, these results indicate that ID patients with or without anaemia previously treated with IV iron can also be managed effectively with oral ferric maltol resulting in overall societal cost-savings.

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