scholarly journals Yield and Cost of Individual Common Diagnostic Tests in New Primary Care Outpatients in Japan

2002 ◽  
Vol 48 (1) ◽  
pp. 42-54 ◽  
Author(s):  
Yuzuru Takemura ◽  
Haku Ishida ◽  
Yuji Inoue ◽  
J Robert Beck
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
Cost Savings ◽  
Clinical Pathology ◽  
Panel Testing ◽  
Occult Disease ◽  
Definition Of ◽  
The Cost

Abstract Background:Appropriate diagnostic testing involves considerations of cost-effectiveness. We examined the cost-effectiveness of individual tests in a panel of tests defined by the Japan Society of Clinical Pathology. Methods: We studied 540 new, symptomatic primary care outpatients with a set of 30 common diagnostic tests [the Essential Laboratory Tests (2); ELT(2) panel] for clinical evaluation and identification of occult disease. A useful result (UR) of testing was defined as a finding that contributed to a change in a physician’s diagnosis or decision-making relating to a “tentative initial diagnosis” obtained from history and physical examination alone. Results: The ELT(2) panel testing yielded 398 URs and uncovered 261 occult diseases among 540 patients. In total, 1592 tests contributed to either UR-generation or discovery of occult disease. The cost per effective test (cost required per test that contributed to either definition of effectiveness) ranged from ¥108 (∼US$0.92) for total cholesterol to ¥6200 (∼$52.50) for chest x-ray. Contribution rates and the cost per effective test varied among disease categories. We restructured panel components considering the effectiveness of each test. Subsets of the ELT(2) would have improved cost-effectiveness and achieved cost savings in five of eight disease categories. Conclusions: Assembly of tests based on cost-effectiveness can improve clinical efficiency and decrease total cost of panel testing for selected patient groups.

scholarly journals Opportunistic Discovery of Occult Disease by Use of Test Panels in New, Symptomatic Primary Care Outpatients: Yield and Cost of Case Finding

2000 ◽  
Vol 46 (8) ◽  
pp. 1091-1098 ◽  
Author(s):  
Yuzuru Takemura ◽  
Haku Ishida ◽  
Yuji Inoue ◽  
Hiroyuki Kobayashi ◽  
J Robert Beck
Keyword(s):  
Primary Care ◽  
Uric Acid ◽  
Cost Effectiveness ◽  
Disease Patient ◽  
Fecal Occult Blood ◽  
X Rays ◽  
Clinical Efficiency ◽  
National Defense Medical College ◽  
Occult Disease ◽  
The Cost

Abstract Background: Diagnostic test panels have been advocated by the Japan Society of Clinical Pathology for evaluation of presenting complaints of new outpatients in primary care medicine. The tests have additional potential utility for opportunistic finding of asymptomatic diseases, but data are lacking on the number of new conditions identified by the test panels and on the cost per identified case. Methods: We studied 540 new, symptomatic patients at the Comprehensive Medicine Clinics of National Defense Medical College during 1991–1997. All underwent testing with the “Essential Laboratory Tests” panel (2) [ELT(2) panel]. This panel includes hematologic tests, urinalysis, total protein, C-reactive protein, albumin, cholesterol, triglycerides, glucose, urea nitrogen, creatinine, uric acid, serum protein fractionation, six enzymes, and optional tests, including x-rays, electrocardiogram, and fecal occult blood. Results: The ELT(2) panel uncovered 276 additional diagnoses of asymptomatic disease or abnormal health status. The most frequent occult condition was hyperlipidemia (100 cases) followed by liver dysfunction (53 cases). Clinical efficiency of the panel (occult diseases/patient) varied depending on the category of tentative initial diagnosis, with the highest efficiency in patients with cardiovascular disease. We created smaller panels by combining 11 basic tests [called the ELT(1) baseline panel] with one or more additional tests from the ELT(2) and analyzed their cost-effectiveness. Addition of four tests (total cholesterol, alanine aminotransferase, glucose, and uric acid) improved both clinical efficiency (0.41 occult disease/patient) and economic efficiency [¥2372 (∼$22.50 US)/occult disease] at a cost-effectiveness of ¥177 per incremental case of occult disease. Addition of further tests decreased cost-effectiveness. Conclusions: Although the ELT(2) panel has supplemental utility for opportunistic screening of some significant, occult diseases and conditions, universal utilization of the full panel is not supported by the cost-effectiveness found in this study.

scholarly journals Common Diagnostic Test Panels for Clinical Evaluation of New Primary Care Outpatients in Japan: A Cost-Effectiveness Evaluation

1999 ◽  
Vol 45 (10) ◽  
pp. 1752-1761 ◽  
Author(s):  
Yuzuru Takemura ◽  
Haku Ishida ◽  
Yuji Inoue ◽  
J Robert Beck
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Diagnostic Test ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Pathology ◽  
Clinical Effectiveness ◽  
Panel Testing ◽  
Efficiency Cost ◽  
Patient Groups

Abstract Background: The Japan Society of Clinical Pathology (JSCP) has developed a guideline for common diagnostic test utilization in new primary care outpatients. To determine the scientific and economic validity of the JSCP panel testing system, we analyzed cost-effectiveness parameters of test panels advocated. Methods: The “Essential Laboratory Tests” panel (2) [ELT(2) panel], a package of common diagnostic tests added to the ELT(1) baseline health-status screening panel, was applied to 540 new outpatients who visited the Comprehensive Medicine Clinics in an academic medical center during 1991 to 1997. A “useful result” (UR) of testing was defined as a finding that contributed to a change in a physician’s diagnosis- or decision-making, relating to a “tentative initial diagnosis” (TID) obtained from history and physical examination alone. Results: Clinical usefulness was demonstrated in 259 patients with ELT(2), in whom 398 URs were generated. Clinical effectiveness (UR/TID) ranged from 1.65 (hematological) to 0.088 (neurological disease), with a cost disparity from ¥1251 (∼$10) to ¥23 037 (∼$200) per UR. A total of 1137 tests generated URs. We further assessed the clinical effectiveness and economic efficiency (cost/UR) of ELT(1) and restructured panels. Use of the ELT(1) alone generated 244 URs in 167 patients. The poor efficiency of the ELT(1) panel was markedly improved with the addition of certain ELT(2)-specific tests in liver/pancreatobiliary, metabolic/endocrine, and cardiovascular disease groups. Conclusions: A wide disparity in the utility of ELT panels in different patient groups does not support the JSCP recommendation of their routine use for new outpatients. Selective test combinations should be used in selected patient groups.

scholarly journals 2015. Minimal Impact of Blood Culture Contaminants on Patient Care Decisions May Limit Cost-Effectiveness of Interventions to Reduce Contamination Rates

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S676-S676 ◽  
Author(s):  
David Augusto. Terrero Salcedo ◽  
Margaret Powers-Fletcher ◽  
Alan G Smulian
Keyword(s):  
Cost Effectiveness ◽  
Blood Culture ◽  
Patient Care ◽  
Antimicrobial Therapy ◽  
Hospital Admissions ◽  
Cost Savings ◽  
Minimal Impact ◽  
Admission Status ◽  
Definition Of ◽  
The Cost

Abstract Background High blood culture (BC) contamination rates have been associated with increased healthcare cost, antimicrobial use, and extended length of stay. Interventions using blood culture diversion devices (BCDD) reduce contamination rates, but often increase equipment costs compared with traditional collection techniques. Cost savings will only be achieved, therefore, if contaminated BCs do in fact lead to expensive care decision. The purpose of this study was to define the actual impact of contaminated BCs on patient care as a means of determining the cost-effectiveness of implementing BCDD at our institution. Methods A retrospective review of all contaminated BCs collected in our Emergency Department (ED) from July 2018 to December 2018 was completed. Data including antimicrobial therapy, admission status, laboratory orders, and co-morbidities for patients with contaminated cultures, as defined by the College of American Pathologist (CAP), were recorded. Laboratory costs included rapid molecular assays performed for patients admitted from the ED, as well as technologist effort and media costs for BC work-up. Results During this study period, out of a total of 4,176 blood draws, there were 118 BCs (2.8%) that met the CAP definition of contamination. Of all contaminated cultures, only 12.7% (n = 15) of patients were treated because of a positive BC, while 68.6% were given antibiotics due to other comorbidities; A total of 22 patients (18.6%) did not receive any antibiotics during the encounter. The most common therapy for treated contaminants was vancomycin (14/15, 93.34%) for an average of 5.2 days. No patients with contaminated BCs were admitted to the hospital because of a positive result; 92.3% of patients with contaminated BCs were admitted, however, for a different diagnosis. Based on average treatment and laboratory costs, the total costs per contaminant were estimated at $170 USD. Conclusion Contamination of BCs collected in the ED does not routinely lead to antimicrobial therapy or hospital admissions at our institution. This minimal impact of BC contaminants on patient care decisions and healthcare costs limits the cost-effectiveness of interventions such as BCDD at our institution. These findings may be specific to our institution based on our clinical practice and unique patient population. Disclosures All authors: No reported disclosures.

scholarly journals Cost analysis of breast cancer diagnostic assessment programs

2017 ◽  
Vol 24 (5) ◽  
pp. 354 ◽  
Author(s):  
G.N. Honein-AbouHaidar ◽  
J.S. Hoch ◽  
M.J. Dobrow ◽  
T. Stuart-McEwan ◽  
D.R. McCready ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Medical Records ◽  
Diagnostic Tests ◽  
Estimation Method ◽  
Financial Data ◽  
Diagnostic Assessment ◽  
Future Cost ◽  
Total Cost ◽  
The Cost

Objectives Diagnostic assessment programs (daps) appear to improve the diagnosis of cancer, but evidence of their cost-effectiveness is lacking. Given that no earlier study used secondary financial data to estimate the cost of diagnostic tests in the province of Ontario, we explored how to use secondary financial data to retrieve the cost of key diagnostic test services in daps, and we tested the reliability of that cost-retrieving method with hospital-reported costs in preparation for future cost-effectiveness studies.Methods We powered our sample at an alpha of 0.05, a power of 80%, and a margin of error of ±5%, and randomly selected a sample of eligible patients referred to a dap for suspected breast cancer during 1 January–31 December 2012. Confirmatory diagnostic tests received by each patient were identified in medical records. Canadian Classification of Health Intervention procedure codes were used to search the secondary financial data Web portal at the Ontario Case Costing Initiative for an estimate of the direct, indirect, and total costs of each test. The hospital-reported cost of each test received was obtained from the host-hospital’s finance department. Descriptive statistics were used to calculate the cost of individual or group confirmatory diagnostic tests, and the Wilcoxon signed-rank test or the paired t-test was used to compare the Ontario Case Costing Initiative and hospital-reported costs.Results For the 191 identified patients with suspected breast cancer, the estimated total cost of $72,195.50 was not significantly different from the hospital-reported total cost of $72,035.52 (p = 0.24). Costs differed significantly when multiple tests to confirm the diagnosis were completed during one patient visit and when confirmatory tests reported in hospital data and in medical records were discrepant. The additional estimated cost for non-salaried physicians delivering diagnostic services was $28,387.50.Conclusions It was feasible to use secondary financial data to retrieve the cost of key diagnostic tests in a breast cancer dap and to compare the reliability of the costs obtained by that estimation method with hospital-reported costs. We identified the strengths and challenges of each approach. Lessons learned from this study have to be taken into consideration in future cost-effectiveness studies.

The cost-effectiveness of diagnostic testing strategies for Helicobacter pylori

2000 ◽  
Vol 95 (7) ◽  
pp. 1691-1698 ◽  
Author(s):  
Nimish Vakil ◽  
David Rhew ◽  
Andrew Soll ◽  
Joshua J. Ofman
Keyword(s):  
Helicobacter Pylori ◽  
Cost Effectiveness ◽  
Diagnostic Testing ◽  
Testing Strategies ◽  
The Cost

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

scholarly journals Economic evaluations of health care interventions in Oropharyngeal Dysphagia after Stroke: Protocol for a Systematic Review.

2021 ◽  
Author(s):  
Sergio Marin ◽  
Mateu Serra-Prat ◽  
Omar Ortega ◽  
Pere Clavé
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Oropharyngeal Dysphagia ◽  
Cost Savings ◽  
Economic Evaluations ◽  
Stroke Patients ◽  
Post Stroke ◽  
Healthcare Interventions ◽  
The Cost

Abstract Background and purpose: Oropharyngeal Dysphagia (OD) affects 40-81% of patients after stroke. A recent systematic review on the costs of OD and it’s main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could lead to reduction of clinical complications and significant cost savings. The purpose of this systematic review is to assess the available literature exploring the efficiency or cost-effectiveness of available healthcare interventions on the appropriate management of OD. Methods: A systematic review on economic evaluations of health care interventions on post-stroke patients with OD following PRISMA recommendations will be performed. MEDLINE, Embase, the National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry Database will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or studies in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetized with a narrative method and using tables. Quality evaluation will be done using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement. Discussion: The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarize the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. Systematic review registration: PROSPERO CRD42020136245

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