scholarly journals Cost-effectiveness analysis of a hospital electronic medication management system

2015 ◽  
Vol 22 (4) ◽  
pp. 784-793 ◽  
Author(s):  
Johanna I Westbrook ◽  
Elena Gospodarevskaya ◽  
Ling Li ◽  
Katrina L Richardson ◽  
David Roffe ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Management System ◽  
Medication Management ◽  
Cost Effectiveness Analysis ◽  
Operating Costs ◽  
Sensitivity Analyses ◽  
Economic Evaluations ◽  
System Perspective ◽  
Effectiveness Analysis ◽  
Potential Ades

Abstract Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS). Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs. Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially. Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.

scholarly journals Bayesian Regression Model for a Cost-Utility and Cost-Effectiveness Analysis Comparing Punch Grafting Versus Usual Care for the Treatment of Chronic Wounds

2020 ◽  
Vol 17 (11) ◽  
pp. 3823 ◽  
Author(s):  
Carmen Selva-Sevilla ◽  
Elena Conde-Montero ◽  
Manuel Gerónimo-Pardo
Keyword(s):  
Cost Effectiveness ◽  
Usual Care ◽  
Chronic Wounds ◽  
Cost Utility ◽  
Cost Effectiveness Analysis ◽  
Bayesian Regression ◽  
Sensitivity Analyses ◽  
System Perspective ◽  
Effectiveness Analysis ◽  
Life Years

Punch grafting is a traditional technique used to promote epithelialization of hard-to-heal wounds. The main purpose of this observational study was to conduct a cost-utility analysis (CUA) and a cost-effectiveness analysis (CEA) comparing punch grafting (n = 46) with usual care (n = 34) for the treatment of chronic wounds in an outpatient specialized wound clinic from a public healthcare system perspective (Spanish National Health system) with a three-month time horizon. CUA outcome was quality-adjusted life years (QALYs) calculated from EuroQoL-5D, whereas CEA outcome was wound-free period. One-way sensitivity analyses, extreme scenario analysis, and re-analysis by subgroups were conducted to fight against uncertainty. Bayesian regression models were built to explore whether differences between groups in costs, wound-free period, and QALYs could be explained by other variables different to treatment. As main results, punch grafting was associated with a reduction of 37% in costs compared to usual care, whereas mean incremental utility (0.02 ± 0.03 QALYs) and mean incremental effectiveness (7.18 ± 5.30 days free of wound) were favorable to punch grafting. All sensitivity analyses proved the robustness of our models. To conclude, punch grafting is the dominant alternative over usual care because it is cheaper and its utility and effectiveness are greater.

Cost-Effectiveness Analysis of the Use of Probiotics for the Prevention of Clostridium difficile–Associated Diarrhea in a Provincial Healthcare System

2016 ◽  
Vol 37 (9) ◽  
pp. 1079-1086 ◽  
Author(s):  
Jenine R. Leal ◽  
Steven J. Heitman ◽  
John M. Conly ◽  
Elizabeth A. Henderson ◽  
Braden J. Manns
Keyword(s):  
Cost Effectiveness ◽  
Primary Prevention ◽  
Clostridium Difficile ◽  
Healthcare System ◽  
Cost Savings ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Preventive Strategy ◽  
System Perspective ◽  
Effectiveness Analysis

OBJECTIVETo conduct a full economic evaluation assessing the costs and consequences related to probiotic use for the primary prevention of Clostridium difficile–associated diarrhea (CDAD).DESIGNCost-effectiveness analysis using decision analytic modeling.METHODSA cost-effectiveness analysis was used to evaluate the risk of CDAD and the costs of receiving oral probiotics versus not over a time horizon of 30 days. The target population modeled was all adult inpatients receiving any therapeutic course of antibiotics from a publicly funded healthcare system perspective. Effectiveness estimates were based on a recent systematic review of probiotics for the primary prevention of CDAD. Additional estimates came from local data and the literature. Sensitivity analyses were conducted to assess how plausible changes in variables impacted the results.RESULTSTreatment with oral probiotics led to direct costs of CDN $24 per course of treatment per patient. On average, patients treated with oral probiotics had a lower overall cost compared with usual care (CDN $327 vs $845). The risk of CDAD was reduced from 5.5% in those not receiving oral probiotics to 2% in those receiving oral probiotics. These results were robust to plausible variation in all estimates.CONCLUSIONSOral probiotics as a preventive strategy for CDAD resulted in a lower risk of CDAD as well as cost-savings. The cost-savings may be greater in other healthcare systems that experience a higher incidence and cost associated with CDAD.Infect Control Hosp Epidemiol 2016;37:1079–1086

Ixazomib (IXA), carfilzomib (CAR), elotuzumab (ELO) or daratumumab (DAR) with lenalidomide and dexamethasone (LEN+DEX) versus LEN+DEX only in relapsed/refractory multiple myeloma (R/R MM): A comparative cost-effectiveness analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8043-8043
Author(s):  
Mavis Obeng-Kusi ◽  
Daniel Arku ◽  
Neda Alrawashdh ◽  
Briana Choi ◽  
Nimer S. Alkhatib ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Effectiveness Analysis ◽  
The Other ◽  
Sensitivity Analyses ◽  
Treatment Comparison ◽  
Comparative Cost ◽  
Effectiveness Analysis ◽  
Life Years

8043 Background: IXA, CAR, ELO and DARin combination with LEN+DEXhave been found superior in efficacy compared to LEN+DEX in the management of R/R MM. Applying indirect treatment comparisons from a network meta-analysis (NMA), this economic evaluation aimed to estimate the comparative cost-effectiveness and cost-utility of these four triplet regimens in terms of progression-free survival (PFS). Methods: In the absence of direct treatment comparison from a single clinical trial, NMA was used to indirectly estimate the comparative PFS benefit of each regimen. A 2-state Markov model simulating the health outcomes and costs was used to evaluate PFS life years (LY) and quality-adjusted life years (QALY) with the triplet regimens over LEN+DEX and expressed as the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). Probability sensitivity analyses were conducted to assess the influence of parameter uncertainty on the model. Results: The NMA revealed that DAR+LEN+DEX was superior to the other triplet therapies, which did not differ statistically amongst them. As detailed in the Table, in our cost-effectiveness analysis, all 4 triplet regimens were associated with increased PFSLY and PFSQALY gained (g) over LEN+DEX at an additional cost. DAR+LEN+DEX emerged the most cost-effective with ICER and ICUR of $667,652/PFSLYg and $813,322/PFSQALYg, respectively. The highest probability of cost-effectiveness occurred at a willingness-to-pay threshold of $1,040,000/QALYg. Conclusions: Our economic analysis shows that all the triplet regimens were more expensive than LEN +DEX only but were also more effective with respect to PFSLY and PFSQALY gained. Relative to the other regimens, the daratumumab regimen was the most cost-effective.[Table: see text]

Cost-effectiveness analysis of neoadjuvant immune checkpoint inhibition (ICI) versus cisplatin-based chemotherapy (CBC) in muscle-invasive bladder cancer (MIBC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 419-419
Author(s):  
Ali Raza Khaki ◽  
Yong Shan ◽  
Richard Nelson ◽  
Sapna Kaul ◽  
John L. Gore ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Randomized Clinical Trials ◽  
Pathologic Complete Response ◽  
Weighted Average ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Effectiveness Analysis

419 Background: Multiple single-arm clinical trials have shown promising pathologic complete response (pCR) rates with neoadjuvant ICIs in MIBC. However, ICIs remain costly. We conducted a cost-effectiveness analysis comparing neoadjuvant ICIs with CBC. Methods: We applied a decision analytic simulation model with a health care payer perspective and two-year time horizon to compare neoadjuvant ICIs vs CBC. For the primary analysis we compared pembrolizumab with dose dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC). We performed a secondary analysis with gemcitabine/cisplatin (GC) as CBC and exploratory analyses with atezolizumab or nivolumab/ipilimumab as ICIs (vs both ddMVAC and GC). We input pCR rates from trials (ICIs) or a weighted average of prior studies (CBC) and costs from average sales price. Outcomes of interest included costs, 2-year recurrence-free survival (RFS), and incremental cost-effectiveness ratio (ICER) of cost per 2-year RFS. A threshold analysis estimated a pCR rate or price reduction for ICI to be cost-effective and one-way and probabilistic sensitivity analyses were performed. Results: Results of the cost effectiveness analysis are shown in the table. The incremental cost of pembrolizumab compared with ddMVAC was $8,042 resulting in an incremental improvement of 0.66% in 2-year RFS for an ICER of $1,218,485 per 2-year RFS. A pCR of 71% or a 26% reduction in cost of pembrolizumab would render it more cost-effective with an ICER of $100,000 per 2-year RFS. GC required a 96% pembrolizumab cost reduction to achieve an ICER of $100,000 per 2-year RFS. Atezolizumab appeared to be more cost-effective than ddMVAC, even though the 2yr RFS was 0.66% worse. Conclusions: ICIs were not cost-effective as neoadjuvant therapies, except when atezolizumab was compared with ddMVAC. Pembrolizumab would approach cost-effective thresholds with 26% or 96% reduction in cost when compared to ddMVAC and GC, respectively. Randomized clinical trials, larger sample sizes and longer follow-up are required to better understand the value of ICIs as neoadjuvant treatments. [Table: see text]

COST-EFFECTIVENESS ANALYSIS: CAN WE REDUCE VARIABILITY IN COSTING METHODS?

2003 ◽  
Vol 19 (2) ◽  
pp. 407-420 ◽  
Author(s):  
Taghreed Adam ◽  
David B. Evans ◽  
Marc A. Koopmanschap
Keyword(s):  
Cost Effectiveness ◽  
Systematic Approach ◽  
Methodological Issue ◽  
Cost Effectiveness Analysis ◽  
Economic Evaluations ◽  
Policy Makers ◽  
The Third ◽  
Effectiveness Analysis ◽  
Sources Of Variation ◽  
Made In

Objectives: The need for consistency and standardization of methods for economic appraisals has been recognized for some time and has led to the development of several sets of guidelines for economic evaluations and for costs. Despite this, considerable diversity is still apparent in applied studies. Some of these diversities might be defensible, and some might not. The objectives of this study are to explore sources of variations in the methods used in applied studies and to discuss the nature of these variations and the possibility of reducing some of them.Methods: We first use a systematic approach to identify the major sources of variation in costing methods used in applied economic evaluations. We then compare the methods used with the recommendations made in available guidelines.Results: Four possible sources of variation are identified. The first is where guidelines do not agree in their recommendations; therefore, it is not surprising that applied studies use different methods. The second is where guidelines agree in principle but provide little detail on how to comply with their recommendations; and the third is where a particular methodological issue is not discussed in guidelines. The fourth reason is simply lack of compliance with accepted guidelines.Conclusions: Variability in costing methods used in applied studies raises questions about the validity of their results and makes it difficult to compare the results of different studies. We discuss the implications for the transferability and generalizability of results and suggest ways to minimize the variability in the methods so that the results of costing studies and economic evaluations can be of more value to policy-makers.

scholarly journals Development Of An Excel-Based Cost Effectiveness Analysis Tool For Ascertaining Value For Money In Implementation Of Hiv And Other Health Interventions At Bomu Hospital, Kenya

2020 ◽  
Author(s):  
NANCY MUCOGO NJERU ◽  
Elizabeth Owiti ◽  
Aabid Ahmed
Keyword(s):  
Cost Effectiveness ◽  
Health Sector ◽  
Data Entry ◽  
Cost Effectiveness Analysis ◽  
Economic Evaluations ◽  
Analysis Tool ◽  
Governmental Organizations ◽  
Effectiveness Analysis ◽  
Non Governmental Organizations ◽  
The University

Abstract An Organization Capacity Assessment done in Bomu hospital in April 2015 with an aim to strengthen the local institution’s capacity for sustainable fight against HIV Aids pandemic led to the development of this excel-based cost effectiveness analysis tool. Objective: The specific objectives were to develop a cost-effectiveness analysis excel tool complete with instruction manual for use in costing, determining prices of services and carrying out economic evaluations. Method: A technical working team (TWG) comprising of senior management of the hospital and the University of Nairobi Fellow was formed. The TWG identified program where cost indicators would be derived, developed cost indicators collection tools, collected costing data and build necessary consensus and assumptions. The data was used to design the tool complete with working instructions. Results: The tool comprises of processes, instructions, excel data entry provisions and inbuilt formulae in excel sheets. The unique tool features include; simple to use instructions, systematic listing of cost elements with a drop down option to allow selection as required, allows additional cost elements to be added thus increasing scope of use . The tool also separates costs and sub-costs in a manner that allows cost drivers to be known precisely as well as avoid double costing among others. Conclusion: The tool is transferable to other facilities and can be replicated in all hospitals within the country, in private, public and non – governmental organizations. Its regular review, improvements and utilization will be important for the health sector to fully benefit from its use. It will be necessary to sensitize health facilities to address information gaps and also ensure that data is available in form and detail necessary for costing purposes. Key words: Economic evaluation, Costing, Resources, Treatment outcomes

scholarly journals Evaluating the Cost-effectiveness Analysis of Rehabilitation Methods for Patients with Stroke

2021 ◽  
Author(s):  
Farzaneh Miri ◽  
Nader Jahanmehr ◽  
Reza Goudarzi
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Rehabilitation Service ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Rehabilitation Strategy ◽  
At Home

Abstract Aims: This study evaluated and compared the cost-effectiveness of rehabilitation interventions in patients with stroke in the three alternatives of hospitals, units and homes due to the fact that one of the stroke management challenges is how to provide a rehabilitation service to these patients in Iran. Methods: This is a cost-effectiveness analysis from the perspective of a health system. A Markov model with a 20-year time horizon in 3-month cycles was used to analyze the costs and outcomes. Cost data were collected from the 210 patients undergoing rehabilitation in the hospital, home and unit. Utility data were extracted from previously published literature with the same setting. The cost-effectiveness analysis was conducted by calculating ICER using TreeAge Software. Basic and probabilistic sensitivity analyses were also conducted at the end. Results: The average cost of rehabilitation in home strategy ($ 2306) was less than hospital ($2955) and unit ($3485) strategies. Furthermore, the utility of home strategy (26.03) was 8 units higher than hospital utility (17.99) and 19 units higher than utility of the stroke unit (7.03). The Acer values of hospital, stroke unit and home groups were $11424, $33159 and $7233 per utility, respectively. According to the results, the home-based rehabilitation strategy is cost effective compared to hospital and unit rehabilitation strategy. The results of the probabilistic sensitivity analysis also showed that the ICER of home strategy is always cost-effective than the other strategies. Limitation: : limitation of the present study was the reliance on utility values of other studies. Conclusion: Rehabilitation at home is the most cost-effective strategy for stroke patients. Given the high rates of this disease in Iran and the high cost of it, it is suggested that policy makers lay the groundwork for providing these services at home.

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