scholarly journals Mobile robotic systems in patient-facing functions: national acceptability survey, single site feasibility study and cost-effectiveness analysis

2020 ◽  
Author(s):  
Peter R Chai ◽  
Farah Z Dadabhoy ◽  
Hen-Wei Huang ◽  
Jacqueline N Chu ◽  
Annie Feng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Feasibility Study ◽  
National Survey ◽  
Cost Savings ◽  
Robotic System ◽  
Single Site ◽  
Robotic Systems ◽  
Decision Analytic Model ◽  
Analytic Model ◽  
Online Sampling

Objective: To understand the acceptability of patient-facing mobile robotic systems on a national scale, conduct a pilot feasibility study to deploy and measure satisfaction associated with clinical evaluation using a mobile telehealth robot in the emergency department (ED) and to build a decision analytic model to gauge the potential of a robotic system to prevent COVID-19 infections and conserve personal protective equipment in the ED. Design: Mixed study comprising an online sampling-based survey, single-site observational clinical trial and development of a decision analytic model. Setting: A quaternary care, urban, academic, emergency department in Boston, Massachusetts, USA. Participants: For the acceptability survey, we recruited N=1000 individuals living in the United States participating in an online sampling from the survey provider YouGov. In the ED study, we enrolled 40 individuals over 18 years old presenting to the ED for evaluation. Interventions: In the pilot ED study, consenting participants were exposed to a mobile robotic system facilitated triage interview controlled by an emergency medicine clinician. Afterwards, participants completed a survey to measure their satisfaction with the robotic system. Main outcome measures: Acceptability of mobile robot facilitated tasks in healthcare (national survey), satisfaction with interaction of a robotic system (ED study), number of potential SARS-CoV-2 infections avoided and cost savings (US dollars) per year per ED (decision analytic model). Results: In the national survey, participants rated the use of robotics for a variety of patient-facing healthcare functions useful or very useful. The perceived usefulness increased when asked to consider these functions in the context of the COVID-19 pandemic. In the ED, 40 patients completed study procedures; 92.5% (N=37) reported satisfaction with the robotic system. Most participants (82.5%, N=33) reported their experience being evaluated by a robotic system was as good as an in-person encounter. Our decision analytic model estimated that robotic evaluations could prevent 2.68 infections per ED yearly and save $1 million annually per ED by decreasing PPE and additional staffing in a triage space. Conclusions: Robotic systems were broadly acceptable across the US and their acceptance increased in the setting of COVID-19. Mobile robotic-enabled teleheath facilitated contactless evaluation of ED patients and was highly acceptable and equivalent to an in-person history. Robotic platforms may prevent healthcare-associated COVID-19 transmission to healthcare workers and have a significant cost savings if widely implemented among healthcare systems.

scholarly journals Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model

2015 ◽  
Vol 25 (9) ◽  
pp. 1559-1568 ◽  
Author(s):  
Oleg Borisenko ◽  
Daniel Adam ◽  
Peter Funch-Jensen ◽  
Ahmed R. Ahmed ◽  
Rongrong Zhang ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Health Care Systems ◽  
Cost Savings ◽  
Decision Analytic Model ◽  
Analytic Model ◽  
Care Systems

scholarly journals Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Jordana K Schmier ◽  
Paige E Miller ◽  
Jessica A Levine ◽  
Vanessa Perez ◽  
Kevin C Maki ◽  
...  
Keyword(s):  
Dietary Fiber ◽  
Cost Savings ◽  
Decision Analytic Model ◽  
Analytic Model

scholarly journals Response to the Comment on “Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model”

2015 ◽  
Vol 25 (7) ◽  
pp. 1256-1257 ◽  
Author(s):  
Oleg Borisenko ◽  
Daniel Adam ◽  
Peter Funch-Jensen ◽  
Ahmed R. Ahmed ◽  
Rongrong Zhang ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Health Care Systems ◽  
Cost Savings ◽  
Decision Analytic Model ◽  
Analytic Model ◽  
Care Systems

scholarly journals Potential Cost Savings Associated with Targeted Substitution of Current Guideline-Concordant Inpatient Agents with Omadacycline for the Treatment of Adult Hospitalized Patients with Community-Acquired Bacterial Pneumonia at High Risk for Clostridioides difficile Infections: Results of Healthcare-Decision Analytic Model from the United States Hospital Perspective

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1195
Author(s):  
Thomas Lodise ◽  
Mauricio Rodriguez ◽  
Surya Chitra ◽  
Kelly Wright ◽  
Nimish Patel
Keyword(s):  
Bacterial Pneumonia ◽  
Cost Savings ◽  
The United States ◽  
Hospitalized Patients ◽  
Decision Analytic Model ◽  
Current Guideline ◽  
Analytic Model ◽  
Healthcare Decision ◽  
Model Population ◽  
Clostridioides Difficile

Introduction: Approximately 3% of hospitalized patients with community-acquired bacterial pneumonia (CABP) develop healthcare-associated Clostridioides difficile infection (HCA-CDI). The validated Davis risk score (DRS) indicates that patients with a DRS ≥ 6 are at an increased risk of 30-day HCA-CDI. In the phase 3 OPTIC CABP study, 14% of CABP patients with DRS ≥ 6 who received moxifloxacin developed CDI vs. 0% for omadacycline. This study assessed the potential economic impact of substituting current guideline-concordant CABP inpatient treatments with omadacycline in hospitalized CABP patients with a DRS ≥ 6 across US hospitals. Methods: A deterministic healthcare-decision analytic model was developed. The model population was hospitalized adult CABP patients with a DRS ≥ 6 across US hospitals (100,000 patients). In the guideline-concordant arm, 14% of CABP patients with DRS ≥ 6 were assumed to develop an HCA-CDI, each costing USD 20,100. In the omadacycline arm, 5 days of therapy was calculated for the entire model population. Results: The use of omadacycline in place of guideline-concordant CABP inpatient treatments for CABP patients with DRS ≥ 6 was estimated to result in cost savings of USD 55.4 million annually across US hospitals. Conclusion: The findings of this simulated model suggest that prioritizing the use of omadacycline over current CABP treatments in hospitalized CABP with a DRS ≥ 6 may potentially reduce attributable HCA-CDI costs. The findings are not unique to omadacycline and could be applied to any antibiotic that confers a lower risk of HCA-CDI relative to current CABP inpatient treatments.

scholarly journals Tranexamic acid for the prevention of postpartum hemorrhage: a cost-effectiveness analysis

2020 ◽  
Author(s):  
Wayde Dazelle ◽  
Megan Ebner ◽  
Jamil Kazma ◽  
Homa Ahmadzia
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Status Quo ◽  
Decision Analytic Model ◽  
Maternal Outcomes ◽  
Analytic Model ◽  
Costs And Benefits ◽  
The Status ◽  
Markov Decision ◽  
The Cost

Objectives: To estimate the cost-effectiveness of alternative risk-dictated strategies utilizing prophylactic tranexamic acid (TXA) for the prevention of postpartum hemorrhage. Design: Cost-utility analysis using a Markov decision-analytic model. Setting: All US labor and delivery units. Population: A cohort of 3.8 million women delivering in the US. Methods: We constructed a microsimulation-based Markov decision-analytic model estimating the lifetime costs and benefits of three alternative risk-dictated strategies for TXA prophylaxis versus the status quo (no TXA). Each strategy differentially modified risk-specific hemorrhage probabilities by preliminary estimates of TXA’s prophylactic efficacy. Costs and benefits were considered from the healthcare system and societal perspectives. Main outcome measures: Incremental costs, quality-adjusted life-years (QALYs), and adverse maternal outcomes averted. Results: All TXA strategies were dominant versus the status quo, implying that they were more effective while also being cost-saving. Providing TXA to all delivering women irrespective of hemorrhage risk assignment produced the most favorable results overall, with estimated cost savings greater than $670 million and approximately 149,505 hemorrhage cases, 2,933 hysterectomies, and 70 maternal deaths averted, per annual cohort. Threshold analysis suggested that TXA is likely to be cost-saving for health systems at costs below $184 per gram. Conclusions: Our findings suggest that routine prophylaxis with TXA would likely result in substantial cost-savings and reductions in adverse maternal outcomes in this context. The integrity of this conclusion is maintained across all risk-dictated strategies, even when the cost of TXA is significantly higher than what is supported in the literature.

Abstract P257: Cost-Effectiveness of Advanced Neuroimaging for Transient & Minor Neurological Events in the Emergency Department

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ava L Liberman ◽  
Hui Zhang ◽  
sara rostanski ◽  
Natalie Cheng ◽  
charles esenwa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Standard Of Care ◽  
Neurological Symptoms ◽  
Low Risk ◽  
Diagnostic Evaluation ◽  
Decision Analytic Model ◽  
Analytic Model ◽  
Total Cost

Background: Accurate diagnosis of patients with transient or minor neurological events is challenging with non-trivial rates of Emergency Department (ED) misdiagnosis reported. Recent studies suggest that advanced neuroimaging can improve diagnostic accuracy in presumed low-risk patients, but a cost-effective ED diagnostic evaluation strategy remains uncertain. We therefore evaluate two strategies designed to determine which patients with low-risk transient and minor neurological symptoms can be directly discharged from the ED. Methods: We constructed a decision-analytic model to evaluate two ED-based diagnostic evaluation strategies for patients with presumed low-risk transient or minor neurological symptoms: (1) obtain advanced neuroimaging (MRI brain and MRA head and neck) in the ED on every patient or (2) current ED standard of care of clinical evaluation and basic neuroimaging. The main probability variables were: proportion of patients with true ischemic events, specificity and sensitivity of each evaluation strategy, recurrent stroke rate, and direct healthcare costs. We calculated incremental cost-effectiveness ratios (ICER) and performed threshold analyses to evaluate diagnostic test parameters. Cost-effectiveness was defined as willingness to pay (WTP) <$100,000 USD per quality adjusted life year (QALY) gained. Results: Our primary and sensitivity analyses found that the advanced neuroimaging strategy more cost-effective than ED standard of care, the latter of which has an ICER exceeding the WTP threshold. The total cost of the advanced neuroimaging strategy was $3,210 with an effectiveness of 0.9397 whereas the total cost of the standard ED strategy was $4,338 with an effectiveness of 0.9399 in the primary model. Using threshold analyses, we found that potential superior diagnostic approaches to the advanced neuroimaging strategy would have to be >92% specific, >70% sensitive, and cost less than or equal to the standard of care strategy. Conclusion: In our decision-analytic model, obtaining advanced neuroimaging on all patients presenting with low-risk transient and minor neurological symptoms was the more cost-effective strategy as compared to current practice.

scholarly journals Cost Savings of Reduced Constipation Rates Attributed to Increased Dietary Fibre Intakes in Europe: A Decision-Analytic Model

2015 ◽  
Vol 5 (1) ◽  
pp. 14-23 ◽  
Author(s):  
Kathryn O’Sullivan ◽  
Jordana Schmier ◽  
Vanessa Perez ◽  
Susan Cloran ◽  
Carolyn Hulme-Lowe
Keyword(s):  
Dietary Fibre ◽  
Cost Savings ◽  
Decision Analytic Model ◽  
Analytic Model

scholarly journals Costs and Cost-Effectiveness of User-Testing of Health Professionals’ Guidelines to Reduce the Frequency of Intravenous Medicines Administration Errors by Nurses in the United Kingdom: A Probabilistic Model Based on Voriconazole Administration

2021 ◽  
Author(s):  
Matthew D. Jones ◽  
Bryony Dean Franklin ◽  
D. K. Raynor ◽  
Howard Thom ◽  
Margaret C. Watson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Medication Error ◽  
Low Cost ◽  
Cost Savings ◽  
Credible Interval ◽  
Probability Of Detection ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Published Data ◽  
User Testing

Abstract Aim In the UK, injectable medicines are often prepared and administered by nurses following the Injectable Medicines Guide (IMG). Our earlier study confirmed a higher frequency of correct administration with user-tested versus standard IMG guidelines. This current study aimed to model the cost-effectiveness of user-testing. Methods The costs and cost-effectiveness of user-testing were explored by modifying an existing probabilistic decision-analytic model. The adapted model considered administration of intravenous voriconazole to hospital inpatients by nurses. It included 11 error types, their probability of detection and level of harm. Model inputs (including costs) were derived from our previous study and other published data. Monte Carlo simulation using 20,000 samples (sufficient for convergence) was performed with a 5-year time horizon from the perspective of the 121 NHS trusts and health boards that use the IMG. Sensitivity analyses were undertaken for the risk of a medication error and other sources of uncertainty. Results The net monetary benefit at £20,000/quality-adjusted life year was £3,190,064 (95% credible interval (CrI): −346,709 to 8,480,665), favouring user-testing with a 96% chance of cost-effectiveness. Incremental cost-savings were £240,943 (95% CrI 43,527–491,576), also favouring user-tested guidelines with a 99% chance of cost-saving. The total user testing cost was £6317 (95% CrI 6012–6627). These findings were robust to assumptions about a range of input parameters, but greater uncertainty was seen with a lower medication error risk. Conclusions User-testing of injectable medicines guidelines is a low-cost intervention that is highly likely to be cost-effective, especially for high-risk medicines.

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