Comparing Expenditures in Depressed Patients Treated with Venlafaxine ER and SSRIs

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S13) ◽  
pp. 1-7
Author(s):  
Diane M. Sloan ◽  
Jacques LeLorier
Keyword(s):  
Cost Effectiveness ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Cost Savings ◽  
Indirect Costs ◽  
Patient Characteristics ◽  
Medical Costs ◽  
Direct Medical Costs ◽  
Medical Visits ◽  
Study Results ◽  
The Cost

AbstractDepression is a chronic illness whose true costs to society are unclear. The costs associated with depression are direct (drugs and treatment), indirect (absenteeism and loss of productivity), and intangible (quality of life). Direct costs are usually easy to quantify. Indirect costs often test the ingenuity of researchers whose results are, at best, crude approximations. Intangible costs are elusive and may never be measured with any degree of accuracy. To compound matters further, many patients with depression have never been diagnosed, which complicates the cost accounting analysis of depression from a societal perspective. What is clear is that the worldwide costs of depression are climbing The overall costs of treating depression attributable to drug therapy are modest. The appropriate choice of antidepressant therapy is likely to be the product that provides the highest effectiveness in terms of overall costs. As a result, it is important that prescribers have an idea of the benefit derived from the cost of drugs, and how the cost effectiveness of different drugs compare.Previous studies of antidepressant cost effectiveness have suggested that the use of venlafaxine, which costs more than generic selective serotonin reuptake inhibitors (SSRIs), may be no more costly when total costs (eg, how many drugs were prescribed, how many medical or emergency room visits patients had, and how often they were hospitalized) are calculated. The objectives of this retrospective, populationbased, database study were to identify patient characteristics and factors associated with the choice of antidepressant in order to assess differences in persistence, healthcare utilization, and direct medical costs associated with venlafaxine and SSRI pharmacotherapy.Study results indicated that in this real-world setting, medical costs were similar among depressive patients treated with venlafaxine and SSRIs. The higher purchase price of venlafaxine was balanced by cost savings due to fewer hospitalizations and fewer outpatient medical visits. Differences in drug treatment may also partially explicate the observed differences in average direct medical costs between venlafaxine and SSRIs.

The Direct and Indirect Costs of Treating the Victims of the 2016 Nice Terror Attacks in a Single Pediatric Hospital

2021 ◽  
pp. 1-4
Author(s):  
Federico Solla ◽  
Eytan Ellenberg ◽  
Virginie Rampal ◽  
Julien Margaine ◽  
Charles Musoff ◽  
...  
Keyword(s):  
Indirect Costs ◽  
Medical Costs ◽  
Pediatric Hospital ◽  
Terror Attack ◽  
Direct And Indirect Costs ◽  
Terror Attacks ◽  
Direct Medical Costs ◽  
Annual Budget ◽  
The Difference ◽  
The Cost

Abstract Objective: To analyze the cost of the terror attack in Nice in a single pediatric institution. Methods: We carried out descriptive analyses of the data coming from the Lenval University Children’s Hospital of Nice database after the July 14, 2016 terror attack. The medical cost for each patient was estimated from the invoice that the hospital sent to public insurance. The indirect costs were calculated from the hospital’s accounting, as the items that were previously absent or the difference between costs in 2016 versus the previous year. Results: The costs total 1.56 million USD, corresponding to 2% of Lenval Hospital’s 2016 annual budget. Direct medical costs represented 9% of the total cost. The indirect costs were related to human resources (overtime, sick leave), revenue shortfall, and security and psychiatric reinforcement. Conclusion: Indirect costs had a greater impact than did direct medical costs. Examining the level and variety of direct and indirect costs will lead to a better understanding of the consequences of terror acts and to improved preparation for future attacks.

scholarly journals 992. Rethinking the 28-day HIV nPEP Dispensing Practice: A Pediatric ID Clinic Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
David Zhang ◽  
Julia Rosebush ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
Veena Ramaiah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Wholesale Price ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Post Exposure Prophylaxis ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
The University ◽  
Lost To Follow Up

Abstract Background In July 2017, The University of Chicago Comer Children’s Hospital Emergency Department (ED) transitioned from a 5-day to a 28-day HIV nPEP (non-occupational post-exposure prophylaxis) dispensation model in an effort to increase adherence. Anecdotal reports of patients lost to follow-up after ED discharge called into question the utility and cost-effectiveness of this practice. We analyzed HIV nPEP follow-up rates in our clinic, explored reasons for nonadherence, and performed basic cost-savings analyses to inform potential changes to our dispensation model. Methods A retrospective review of both electronic health and pharmacy records was conducted for patients prescribed 28-days of HIV nPEP in the ED and scheduled for outpatient follow-up in Pediatric ID clinic from July 2017-June 2019. Clinic provider documentation of nPEP adherence and reasons for nonadherence were examined. Patients were given an initial dose of nPEP regimen in the ED and provided all subsequent doses to complete at home. Using average wholesale price (AWP), we calculated the total cost of each regimen and potential savings if a shorter duration of HIV nPEP supply was dispensed. Results 50 patients received a 28-day supply of HIV nPEP. Please refer to Table 1 regarding baseline patient characteristics. Of these, only 19 (38%) patients had documented outpatient follow-up after nPEP initiation. Median time to follow-up was 6 days (IQR: 3.0-9.0 days). Of the 19 patients with follow-up, 3 admitted to medication non-adherence. Although side effects were elicited in a total of 9 patients (18%), only 1 cited medication intolerance as the reason for discontinuing their nPEP. Given the relatively short time to follow-up, a potential savings of $1720-2211/patient could be achieved if a 10-14 day supply was dispensed. Conclusion Outpatient follow-up after 28-day HIV nPEP dispensation in our ED was < 40%, calling into question the cost-effectiveness of this dispensation model. While our current practice alleviates nPEP interruption due to potential insurance issues and pick-up delays, follow-up and adherence are not assured. The significant cost-savings with a shorter supply at the outset may encourage more robust follow-up and adherence. Disclosures All Authors: No reported disclosures

Abstract 19839: Clinical and Economic Burden of Rheumatic Heart Disease in Low-Income Nations: Estimating the Cost-of-Illness in India and Uganda

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Alexander T Sandhu ◽  
Kathikeyan G ◽  
Ann Bolger ◽  
Emmy Okello ◽  
Dhruv S Kazi
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Cost Of Illness ◽  
Economic Burden ◽  
Indirect Costs ◽  
Medical Costs ◽  
Discrete State ◽  
Direct Medical Costs ◽  
The Cost ◽  
Rheumatic Heart

Introduction: Rheumatic heart disease (RHD) strikes young adults at their peak economic productivity. Defining the global economic burden of RHD may motivate investments in research and prevention, yet prior approaches considering only medical costs may have underestimated the cost of illness. Objectives: To estimate the clinical and economic burden of RHD in India and Uganda. Outcomes were disability-adjusted life years (DALYs), direct medical costs, and indirect costs due to disability and premature mortality (2012 USD). Methods: We used a discrete-state Markov model to simulate the natural history of RHD using country-, age-, and gender-specific estimates from the literature and census data. We estimated direct medical costs from WHO-CHOICE and Disease Control and Prevention 3 publications. We conservatively estimated indirect costs (lost earnings and imputed caregiver costs) from World Bank data using novel economic methods. Results: In 2012, RHD generated 6.1 million DALYs in India and cost USD 10.7 billion (Table 1), including 1.8 billion in direct medical costs and 8.9 billion in indirect costs. During the same period, RHD produced 216,000 DALYs in Uganda, and cost USD 414 million, and, as in India, indirect costs represented the majority (88%) of the cost of illness. In both countries, women accounted for the majority (71-80%) of the DALYs; in Uganda, women bore 75% of the total cost. In sensitivity analyses, higher progression rates for subclinical disease doubled direct costs and DALYs. Conclusion: RHD exacts an enormous toll on the populations of India and Uganda, and its economic burden may be grossly underestimated if indirect costs are not systematically included. Women bear a disproportionate clinical burden from pregnancy-related complications. These results suggest that effective prevention and screening of RHD may represent a sound public health investment, particularly if targeted at high-risk subgroups such as young women.

Cost of lung cancer in East Azerbaijan province, in Iran, in 2017

2020 ◽  
Vol 14 (3) ◽  
pp. 461-470
Author(s):  
Habibeh Mir ◽  
Farshad Seyednejad ◽  
Habib Jalilian ◽  
Shirin Nosratnejad ◽  
Mahmood Yousefi
Keyword(s):  
Lung Cancer ◽  
Length Of Hospital Stay ◽  
Indirect Costs ◽  
Medical Costs ◽  
Content Type ◽  
Direct Medical Costs ◽  
Hospitalization Costs ◽  
Illness Study ◽  
East Azerbaijan ◽  
The Cost

Purpose Costs estimation is essential and important to resource allocation and prioritizing different interventions in the health system. The purpose of this paper is to estimate the costs of lung cancer in Iran, in 2017. Design/methodology/approach This was a prevalence-based cost of illness study with a bottom-up approach costing conducted from October 2016 to April 2017. The sample included 645 patients who referred to Imam Reza hospital, Tabriz, Iran, in 2017. Follow-up interviews were every two months. Hospitalization costs extracted from the patient’s record and outpatient costs, nondirect medical costs and indirect costs collected using questionnaire. SPSS software version 22 was used for the data analysis. Findings Mean direct medical costs, nondirect medical costs and indirect costs amounted to 36,637.02 ± 23,515.13 PPP (2016) (251,313,217.83 Rials), 2,025.25 ± 3,303.72 PPP (2016) (16,613,202.53 Rials) and 48,348.55 ± 34,371.84 PPP (2016) (396,599,494.56 Rials), respectively. There was a significant and negative correlation between direct medical costs, direct nonmedical costs, indirect costs and age at diagnosis, and there was a significant and positive correlation between the length of hospital stay and direct medical cost. Originality/value As the cost of lung cancer is substantial and there have been little studies in this area, the objective of this study is to investigate the cost of lung cancer and present ways to tackle this.

scholarly journals Cost Comparisons between Home- and Clinic-Based Testing for Sexually Transmitted Diseases in High-Risk Young Women

2007 ◽  
Vol 2007 ◽  
pp. 1-5 ◽  
Author(s):  
Kenneth J. Smith ◽  
Robert L. Cook ◽  
Roberta B. Ness
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Controlled Trial ◽  
Cost Savings ◽  
Indirect Costs ◽  
Sexually Transmitted ◽  
Home Based ◽  
Home Testing ◽  
Testing Cost ◽  
The Cost

Home testing for chlamydia and gonorrhea increases screening rates, but the cost consequences of this intervention are unclear. We examined the cost differences between home-based and clinic-based testing and the cost-effectiveness of home testing based on the DAISY study, a randomized controlled trial. Direct and indirect costs were estimated for home and clinic testing, and cost-effectiveness was calculated as cost per additional test performed. In the clinic testing group, direct costs were $49/test and indirect costs (the costs of seeking or receiving care) were $62/test. Home testing cost was $25/test. We found that home testing was cost saving when all testing for all patients was considered. However cost savings were not seen when only asymptomatic tests or when patient subgroups were considered. A home testing program could be cost saving, depending on whether changes in clinic testing frequency occur when home testing is available.

Cost effectiveness of whole breast IMRT for reduction of moist desquamation

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17004-17004 ◽  
Author(s):  
J. B. Strauss ◽  
S. S. Chen ◽  
A. T. Dickler ◽  
K. L. Griem
Keyword(s):  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Marginal Cost ◽  
Cost Minimization ◽  
Medical Costs ◽  
Breast Size ◽  
Direct Medical Costs ◽  
Moist Desquamation ◽  
Breast Imrt ◽  
The Cost

17004 Background: Cost minimization studies have compared conventional whole breast radiation therapy (C-WBRT) to whole breast intensity modulated radiation therapy (IMRT). Consistently, IMRT has proved to be far more expensive. The weakness of cost minimization studies is that they assume the outcomes and toxicities of the treatment modalities in question are identical. Data from a case- control trial and a recent randomized controlled trial show that IMRT reduces the incidence of moist desquamation. We performed an analysis to estimate the cost effectiveness of breast IMRT to prevent moist desquamation. Methods: The direct medical costs of C-WBRT and IMRT were estimated using the 2006 Medicare Fee Schedule. We assumed rates of moist desquamation of 48 to 31% in accordance with Pignol, et al., ASTRO 2006. The cost effectiveness ratio (additional dollars spent per case of desquamation avoided) was calculated under two circumstances: 1) every patient received IMRT, or 2) only those patients destined to desquamate were treated with IMRT. Results: The direct medical costs of C-WBRT are $7,948 vs. $29,790 for IMRT. Thus, the marginal cost of IMRT is $22,142. In circumstance 1, the marginal cost to avoid one case of desquamation is $130,247. In circumstance 2, this cost is $62,518. Conclusions: The two circumstances described above are extremes that bound the range of cost estimates. Patient risk factors for desquamation, such as large breast size, can be used to identify high risk patients, obviating the need to treat all patients with IMRT. However, perfect prospective identification of all patients destined to desquamate is unlikely. Instead, the true marginal cost to avoid one case of moist desquamation will lie between $62,518 and $130,247. This cost may be too high to justify the benefit of reduced acute skin toxicity, but it is likely that the benefits of IMRT have been underestimated. IMRT may shorten the duration of moist desquamation. Late effects such as breast fibrosis and color variegation of the skin caused by desquamation as well as dose to the heart and lungs may be decreased by IMRT. If new data support these benefits, then IMRT may become a more cost effective option. No significant financial relationships to disclose.

scholarly journals Cost consequences analysis of hypertensive outpatients: a study in a private hospital in Yogyakarta special province

2021 ◽  
Vol 17 (2) ◽  
pp. 116-126
Author(s):  
Dinasari Bekti Pratidina ◽  
Fithria Dyah Ayu Suryanegara ◽  
Diesty Anita Nugraheni
Keyword(s):  
Clinical Outcome ◽  
Antihypertensive Therapy ◽  
Private Hospital ◽  
Indirect Costs ◽  
Medical Costs ◽  
Patient’S Perspective ◽  
Direct Medical Costs ◽  
Significant Difference ◽  
The Cost ◽  
Real Costs

Background: Hypertension is a chronic disease that requires long-term treatment and has an impact on the cost of treatment. The costs will be greater given the loss of productivity, family burden, and social life impacted by hypertension based on patient’s perspective. Objective: The purpose of the study was to determine the costs and clinical outcome of antihypertensive therapy from the patient's perspective and to identify the discrepancies between the costs and the INA-CBGs (Indonesia Case Based Groups) tariff. Methods: The research was an observational study with a cross-sectional design. The targeted population was outpatients who had received antihypertensive therapy for at least 1 month at a private hospital in Yogyakarta. The costs included direct medical costs, direct non-medical costs, and indirect costs, while the clinical outcomes were patient’s blood pressure. The descriptive analysis was carried out to describe the characteristics of the research subjects, the clinical outcome, and the cost. Analysis of the discrepancies between the costs and the INA-CBGs tariff used the Mann-Whitney test and One-Sample t-test. Results: The results showed that the average direct medical costs, direct non-medical costs, and indirect costs from the patient’s perspective were IDR359,408.00, IDR24,617.00, and IDR 40,583.00, respectively. There was a significant difference between the real costs and the rate of INA-CBGs based on the results of statistical tests, while the cost discrepancy was IDR5,287,045.00. Conclusion: The direct non-medical costs and indirect costs of hypertensive outpatients were less than the direct medical costs. A significant difference occurred between the real costs and INA CBG’s tariff. Keywords: hypertension, cost consequences, pharmacoeconomics, patient’s perspective

Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus

2015 ◽  
Vol 81 (8) ◽  
pp. 807-811 ◽  
Author(s):  
Jeremy A. Warren ◽  
Joseph A. Ewing ◽  
Allyson L. Hale ◽  
Dawn W. Blackhurst ◽  
Eric S. Bour ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Bariatric Surgery ◽  
Cost Effectiveness ◽  
Type Ii Diabetes ◽  
Cost Savings ◽  
Medical Costs ◽  
Type Ii Diabetes Mellitus ◽  
Morbidly Obese ◽  
Type Ii ◽  
The Cost

There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM). We propose a model that demonstrates the cost-effectiveness of increasing the number of bariatric surgical operations performed on patients with T2DM in the United States. We applied published population cost estimates (2012) for medical care of T2DM to a retrospective cohort of morbidly obese patients in South Carolina. We compared differences in 10-year medical costs between those having bariatric surgery and controls. Resolution of T2DM in the bariatric cohort was assumed to be 40 per cent. Considering only the direct medical costs of T2DM, the 10-year aggregate cost savings compared with a control group is $2.7 million/1000 patients; the total (direct and indirect) cost savings is $5.4 million/1000 patients. When considering resolution of T2DM alone, increasing the number of bariatric operations for a given population leads to a substantial cost savings over a 10-year period. This study adds to the growing body of evidence suggesting that bariatric surgery is a cost-effective means of caring for the obese patient.

Abstract P90: Cardiovascular and Economic Outcomes Following Initiation of Atorvastatin versus Simvastatin in an Employed Population Stratified by Cardiovascular Risk

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Ross Simpson ◽  
James Signorovitch ◽  
Karthik Ramakrishnan ◽  
Jasmina Ivanova ◽  
Howard Birnbaum ◽  
...  
Keyword(s):  
High Risk ◽  
Cost Savings ◽  
Indirect Costs ◽  
Medical Costs ◽  
Matched Pairs ◽  
Intermediate Risk ◽  
Direct Medical Costs ◽  
Significant Difference ◽  
Risk Patients ◽  
Employer Perspective

OBJECTIVE: To compare initiation with atorvastatin versus simvastatin among higher- and lower-risk employees in terms of subsequent risk of cardiovascular (CV) events and direct and indirect costs from the employer perspective. METHODS: Employees initiating atorvastatin or simvastatin were identified from a claims database (1999-2006) spanning 23 large, self-insured employers and stratified as 1) high-risk employees with prior CV events, diabetes or renal disorders and 2) low-to-intermediate-risk employees without these conditions. Propensity score matching was used to adjust for baseline differences between the atorvastatin and simvastatin cohorts, and two-year outcomes were compared between matched cohorts. Indirect costs included disability payments and medically-related absenteeism. Atorvastatin and simvastatin drug costs were imputed with recent prices to account for availability of generic simvastatin. RESULTS: Among 4,167 matched pairs of high-risk employees, initiation with atorvastatin vs. simvastatin was associated with similar rates of subsequent CV events (17.6 vs. 18.4%, P=0.37), higher direct medical costs ($17,590 vs. $17,377, P=0.002), similar indirect costs ($4,830 vs. $4,989, P=0.29) and higher total costs by $54 ($22,420 vs. $22,366, P=0.034). The majority of high-risk employees (62%) received low initial statin doses (atorvastatin ≤ 10 mg or simvastatin ≤ 20 mg). Among 9,326 matched pairs of low-to-intermediate risk employees, initiation with atorvastatin vs. simvastatin was associated with a lower rate of CV events (3.1 vs. 3.7%, p=0.030), lower direct medical costs ($8,400 vs. $8,436, P<0.001), similar indirect costs ($2,781 vs. $2,807; P=0.12) and lower total costs by $61 ($11,181 vs. $11,243, P<0.001). CONCLUSIONS: Among high-risk patients, initiation with atorvastatin vs. simvastatin was associated with no significant difference in CV events and higher total costs to employers. Among low-to-intermediate risk patients, initiation with atorvastatin vs. simvastatin was associated with fewer CV events and net cost savings to employers. Formulary policies reserving atorvastatin for higher-risk patients may not be beneficial from the employer perspective.

A Cost-Effectiveness Comparison of Surgical Treatments for Mitral Valve Disease

1988 ◽  
Vol 4 (3) ◽  
pp. 447-461
Author(s):  
Basil N. Papageorge ◽  
Stuart O. Schweitzer
Keyword(s):  
Cost Effectiveness ◽  
Mitral Valve ◽  
Cost Savings ◽  
Indirect Costs ◽  
Direct And Indirect Costs ◽  
Mitral Valve Reconstruction ◽  
Valve Reconstruction ◽  
Early Reconstruction ◽  
Surgical Treatments ◽  
The Cost

AbstractThis study compares the cost-effectiveness of mitral valve reconstruction and replacement. Published clinical data were used to determine the effectiveness of each procedure. Both direct and indirect costs were calculated. The findings indicate that reconstruction has lower costs per year of life extended than replacement due to better outcomes. Changing outcome probabilities and discount rates did not alter these results. Cost savings in excess of 40% may be achieved by early reconstruction for suitable patients. These results suggest that the prevailing practice of delaying surgery until replacement is needed should be reconsidered, especially for patients who could benefit from reconstruction.

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