scholarly journals Cerebrospinal fluid leakage costs after craniotomy and health economic assessment of incidence reduction from a hospital perspective in the Netherlands

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052553
Author(s):  
Chris van Lieshout ◽  
Emma M H Slot ◽  
Ahmet Kinaci ◽  
Mare H Kollen ◽  
Eelco W Hoving ◽  
...  
Keyword(s):  
Health Economic ◽  
Cost Savings ◽  
Economic Assessment ◽  
Cost Difference ◽  
Potential Cost ◽  
Hospital Perspective ◽  
Cranial Surgery ◽  
Preventative Measures ◽  
The Cost ◽  
Mean Cost

ObjectivesWe aim to quantify the cost difference between patients with incisional cerebrospinal fluid (iCSF) leakage and those without after intradural cranial surgery. Second, the potential cost savings per patient when a decrease in iCSF leakage rate would be achieved with and without added costs for preventative measures of various price and efficacy are modelled.DesignHealth economic assessment from a hospital perspective based on a retrospective cohort study.SettingDutch tertiary referral centre.ParticipantsWe included 616 consecutive patients who underwent intradural cranial surgery between 1 September 2017 and 1 September 2018. Patients undergoing burr hole surgery or transsphenoidal surgery, or who died within 1 month after surgery or were lost to follow-up were excluded.Primary and secondary outcome measuresOutcomes of the cost analysis include a detailed breakdown of mean costs per patient for patients with postoperative iCSF leakage and patients without, and the mean cost difference. For the scenario analyses the outcomes are the potential cost savings per 1000 patients when a decrease in iCSF leakage would be achieved.ResultsMean cost difference between patients with and without iCSF leakage was €9665 (95%CI, €5125 to €14 205). The main cost driver was hospital stay with a difference of 8.5 days. A 25% incidence reduction would result in a mean cost saving of −€94 039 (95% CI, −€218 258 to −€7077) per 1000 patients. A maximum cost reduction of −€653 025 (95% CI, −€1 204 243 to −€169 120) per 1000 patients could be achieved if iCSF leakage would be reduced with 75% in all patients, with 72 cases of iCSF leakage avoided.ConclusionsPostoperative iCSF leakage after intradural cranial surgery increases healthcare costs significantly and substantially. From a health economic perspective preventative measures to avoid iCSF leakage should be pursued.

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.

scholarly journals Technology-enabled remote management of diabetes foot disease and potential for reduction in associated health costs: a pilot study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Fiona Main ◽  
Ania Zubala ◽  
Jane Gorman ◽  
Sandra Jones ◽  
Jenny Hall ◽  
...  
Keyword(s):  
Health Economic ◽  
Pilot Study ◽  
Cost Savings ◽  
Economic Assessment ◽  
Remote Access ◽  
Limb Amputation ◽  
Health Economic Analysis ◽  
Remote Management ◽  
Integrated Pathway ◽  
Foot Disease

AbstractDiabetes-related foot disease, particularly when associated with amputation, affects quality of life and has a significant impact on health care costs. A pilot study using enhanced technology to facilitate remote access and video conferencing from rural locations to the diabetes MDT through a new service pathway confirmed high levels of patient satisfaction with 89% of foot ulcers improved or stable and only two minor amputations. A health economic analysis suggested potential for significant cost savings if this was scaled up regionally. Further evaluation of an integrated pathway, impact on lower limb amputation rates and full health economic assessment is recommended.

Evaluation of the dosing strategies of biologic agents and the theoretical impact of dose rounding

2016 ◽  
Vol 24 (1) ◽  
pp. 47-55
Author(s):  
Savannah Lindsey ◽  
Laura Beth Parsons ◽  
Lindsay Rosenbeck Figg ◽  
Jill Rhodes
Keyword(s):  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Medical Center ◽  
Academic Medical Center ◽  
Wholesale Price ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Potential Cost ◽  
Cost Avoidance ◽  
The Cost

Introduction Monoclonal antibodies possess unique pharmacokinetic properties that permit flexible dosing. Increased use and high costs of these medications have led to the development of cost-containing strategies. This study aims to quantify the cost savings and clinical impact associated with dose rounding monoclonal antibodies to the nearest vial size. Methods This study was a single-arm, retrospective chart review assessing all monoclonal antibody doses dispensed at an outpatient community infusion center associated with an academic medical center between August 2014 and August 2015. All monoclonal antibody doses were reviewed to determine the cost of drug wasted using two methods. The waste-cost analysis described the amount of drug disposed of due to the use of partial vials. The theoretical dose savings described potential cost avoidance based on rounding the ordered dose to the nearest vial size. The theoretical rounded dose was compared to the actual ordered dose to explore clinical implications. Results A total of 436 doses were included. Of these, 237 were not rounded to the nearest vial size and included in the analysis. The cost of waste associated with these doses was $108,013.64 using actual wholesale price. The potential cost avoidance associated with the theoretical dose calculation was $83,595.53. Rounding these doses to the nearest vial size resulted in a median 6.7% (range, 1.4–20%) deviation from ordered dose. Conclusions Rounding monoclonal antibodies to the nearest vial size could lead to significant cost and waste savings with minimal deviation from the actual ordered dose.

scholarly journals 2694. Incidence of Pneumocytis jiroveci (PJP) Infection with 3-Month Prophylaxis of Aerosolized Pentamidine (AP) in Autologous Hematopoietic Stem Cell Transplantation (HSCT)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S947-S947
Author(s):  
Sarah Perreault ◽  
Dayna McManus ◽  
Rebecca Pulk ◽  
Jeffrey E Topal ◽  
Francine Foss ◽  
...  
Keyword(s):  
Cost Savings ◽  
Cost Comparison ◽  
High Dose ◽  
Potential Cost ◽  
Hematopoietic Stem ◽  
Increased Risk ◽  
One Year ◽  
Relapsed Disease ◽  
The Cost ◽  
Autologous Hsct

Abstract Background HSCT patients are at an increased risk of developing PJP after transplant due to treatment induced immunosuppression. Given the risk of cytopenias with co-trimoxazole, AP is utilized as an alternative for PJP prophylaxis. A prior study revealed a 0% (0/19 patients) incidence when AP prophylaxis was given for one year post autologous HSCT. Current guidelines recommend a duration of 3 – 6 months for PJP prophylaxis in autologous HSCT. The primary endpoint of this study was to assess the incidence of PJP infection within one year post autologous HSCT in patients who received 3 months of AP. Secondary endpoint was a cost comparison of 3 months compared with 6 months of AP. Methods A single-center, retrospective study of adult autologous HSCT patients at Yale New Haven Hospital between February 2013 and December 2017 was performed. Patients were excluded if: <18 years of age, received < or >3 months of AP, changed to alternative PJP prophylactic agent or received no PJP prophylaxis, received tandem HSCT, deceased prior to one year post-transplant from a non PJP-related infection, HIV positive, or lost to follow-up. Pentamidine was given as a 300 mg inhalation monthly for 3 months starting Day +15 after autologous HSCT. Results A total of 288 patients were analyzed, no PJP infections occurred within one year post HSCT. Additionally, 187 (65%) patients received treatment post HSCT with 135/215 (63%) receiving maintenance immunomodulatory drugs for myeloma and 40/288 (14%) patients developing relapsed disease. 43% of the chemotherapy regimens for relapsed disease included high dose corticosteroids. The cost difference of using 3 months vs. 6 months of AP is $790, reflecting the cost of drug and its administration. Applying our incidence of 0%, potential cost savings of 3 months vs. 6 months of AP would be $330,000 over 5 years or $66,000 per year. Conclusion Three months of AP for PJP prophylaxis in autologous HSCT patients is safe and effective as well as cost-effective compared with a 6 month regimen. Disclosures All authors: No reported disclosures.

P1383ECONOMIC BENEFITS OF SWITCHING FROM INTRAVENOUS TO SUBCUTANEOUS ERTHROPOIESIS-SIMULATING AGENTS THERAPY FOR MANAGEMENT OF ANEMIA IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Bhanu Prasad ◽  
Maryam Jafari ◽  
Joanne Kappel ◽  
Julie Toppings ◽  
Linda Gross
Keyword(s):  
Transferrin Saturation ◽  
Cost Savings ◽  
Hemodialysis Patients ◽  
T Test ◽  
Epoetin Alfa ◽  
Epoetin Alpha ◽  
Iv Iron ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Abstract Background and Aims Erythropoiesis stimulating agents (ESA’s) were introduced in the treatment of anemia in 1989 and it immediately led to a marked decline in the number of blood transfusions and improved quality of life in patients across the spectrum of chronic kidney disease. Several studies from the mid 1990s have shown that the required doses of Epoetin alpha were lower when administered subcutaneously (SQ). These studies led to guidelines by NKF (1997) and KDOQI (2001) recommending the use of SQ over intravenous (IV) as considerable cost savings could be achieved without compromising care. The rise in the reported cases of pure red cell aplasia (PRCA) led to a change in guidelines in 2006 and led to units changing exclusively to IV route. It was subsequently identified that polysorbate 80 from uncoated rubber stoppers in pre-filled syringes rather than the route of administration was the most plausible cause of PRCA. However, higher doses of ESAs, have been associated with adverse health outcomes across all hematocrit categories in hemodialysis patients. While the current practice is to administer ESAs to patients through IV route, SQ ESAs achieve the same target hemoglobin level at a reduced dose and cost. Given the dose -sparing advantages of SQ Epoetin alpha administration, we decided to gradually transition our patients to SQ and examined the cost of IV versus SQ treatment. The objective of our study was to determine the economic benefit of the change in the route of administration from IV to SQ ESA in hemodialysis patients. Method We conducted a retrospective cohort study in 215 hemodialysis patients who transitioned from IV Epoetin alfa to SQ at four hemodialysis sites in the province of Saskatchewan, Canada from September 2014 to July 2017. The dose and cost of different routes of Epoetin alfa administration per patient per month was calculated. Also, blood hemoglobin, markers of erythropoiesis (transferrin saturation and Ferritin), IV iron dose and cost were determined in relation to route of Epoetin alfa administration. The dependent t-test was used to compare mean variables between pre-switch and post-switch period. Differences in variables across three serum hemoglobin ranges (&lt;95, 95-115, &gt;115 gram/liter) were assessed using the independent t-test. Results The mean Epoetin alfa doses per patient per month (47,327.9±33,133.0 international unit) during pre-switch (IV) period were greater than of post-switch (SQ) period (34,253±24,858.1), a decrease of 27.62% (p&lt;0.001). The mean hemoglobin concentration for patients in both periods remained stable (103.3±9.2 versus 104.3±13.3, p=0.34) and within the target range. The reduction in the dose of Epoetin alfa per patient per month (IU± standard deviation) upon conversion remained similar (IV versus SQ) in all the subcategories: hemoglobin &lt;95 g/L (65,941 versus 52,717), hemoglobin 95-115g/L (42,120 versus 29,619) and (35,289 versus 17,651) for hemoglobin &gt;115 g/L. There were no significant differences in transferrin saturation, Ferritin and IV iron dose and cost between the two study periods. The mean cost (CAD± SD) of Epoetin alfa per patient per month decreased from 674.4±477.4 pre-switch to 484.8±354.3 post-switch (p&lt;0.001), a decrease of 28.11%; whereas, the cost of IV iron remained similar in pre- and post-switch period. Conclusion The (mean) cost of Epoetin alfa per patient per year in our study when given IV was $ 8,088 (CAD) and once converted to SQ was $ 5,817 (CAD) while achieving equivalent hemoglobin levels, a saving of $ 2271 (CAD) per year. Based on these values, if we extrapolate our savings to 900 prevalent patients to SQ Epoetin alfa we can realize a cost saving of $2,043,900 per year. Conversion of Epoetin alfa from IV to SQ led to substantial cost savings at our hemodialysis units.

scholarly journals Cry for health: a quantitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse

2019 ◽  
Author(s):  
Gemma Halliwell ◽  
Sandi Dheensa ◽  
Elisabetta Fenu ◽  
Sue K Jones ◽  
Jessica Asato ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Health Service ◽  
Health Services ◽  
Service Use ◽  
Cost Savings ◽  
Health Service Use ◽  
Potential Cost ◽  
Safety Outcomes ◽  
The Cost ◽  
Domestic Violence And Abuse

Abstract Background Domestic violence and abuse damages the health of survivors and increases use of healthcare services. We report findings from a multi-site evaluation of hospital-based advocacy services, designed to support survivors attending emergency departments and maternity services. Methods Independent Domestic Violence Advisors (IDVA) were co-located in five UK hospitals. Case-level data were collected at T1 (initial referral) and T2 (case closure) from survivors accessing hospital (T1 N = 692; T2 N = 476) and community IDVA services (T1 N = 3,544; T2 N = 2,780), used as a comparator. Measures included indicators of sociodemographic characteristics, experience of abuse, health service use, health and safety outcomes. Multivariate analyses tested for differences in changes in abuse, health and factors influencing safety outcomes. Health service use data in the six months pre-and post- intervention were compared to generate potential cost savings by hospital IDVA services. Results Hospital IDVAs worked with survivors less visible to community IDVA services and facilitated intervention at an earlier point. Hospital IDVAs received higher referrals from health services and enabled access to a greater number of health resources. Hospital survivors were more likely to report greater reductions in and cessation of abuse. No differences were observed in health outcomes for hospital survivors. The odds of safety increased two-fold if hospital survivors received over five contacts with an IDVA or accessed six or more resources / programmes over a longer period of time. Six months preceding IDVA intervention, hospital survivors cost on average £2,463 each in use of health services; community survivors cost £533 each. The cost savings observed among hospital survivors amounted to a total of £2,050 per patient per year. This offset the average cost of providing hospital IDVA services. Conclusions Hospital IDVAs can identify survivors not visible to other services and promote safety through intensive support and access to resources. The co-location of IDVAs within the hospital encouraged referrals to other health services and wider community agencies. Further research is required to establish the cost-effectiveness of hospital IDVA services, however our findings suggest these services could be an efficient use of health service resources.

scholarly journals Financial Impact of Cancer Drug Wastage and Potential Cost Savings From Mitigation Strategies

2017 ◽  
Vol 13 (7) ◽  
pp. e646-e652 ◽  
Author(s):  
Caitlyn Y.W. Leung ◽  
Matthew C. Cheung ◽  
Lauren F. Charbonneau ◽  
Anca Prica ◽  
Pamela Ng ◽  
...  
Keyword(s):  
Cost Savings ◽  
Mitigation Strategies ◽  
Drug Costs ◽  
Financial Impact ◽  
Cancer Drug ◽  
Total Drug ◽  
Potential Cost ◽  
Cross Sectional ◽  
Drug Wastage ◽  
The Cost

Purpose: Cancer drug wastage occurs when a parenteral drug within a fixed vial is not administered fully to a patient. This study investigated the extent of drug wastage, the financial impact on the hospital budget, and the cost savings associated with current mitigation strategies. Methods: We conducted a cross-sectional study in three University of Toronto–affiliated hospitals of various sizes. We recorded the actual amount of drug wasted over a 2-week period while using current mitigation strategies. Single-dose vial cancer drugs with the highest wastage potentials were identified (14 drugs). To calculate the hypothetical drug wastage with no mitigation strategies, we determined how many vials of drugs would be needed to fill a single prescription. Results: The total drug costs over the 2 weeks ranged from $50,257 to $716,983 in the three institutions. With existing mitigation strategies, the actual drug wastage over the 2 weeks ranged from $928 to $5,472, which was approximately 1% to 2% of the total drug costs. In the hypothetical model with no mitigation strategies implemented, the projected drug cost wastage would have been $11,232 to $149,131, which accounted for 16% to 18% of the total drug costs. As a result, the potential annual savings while using current mitigation strategies range from 15% to 17%. Conclusion: The financial impact of drug wastage is substantial. Mitigation strategies lead to substantial cost savings, with the opportunity to reinvest those savings. More research is needed to determine the appropriate methods to minimize risk to patients while using the cost-saving mitigation strategies.

Plastic Liners for Offshore Production Lines: A Cost Effective Alternative Solution to Corrosion Resistant Alloys?

2021 ◽  
Author(s):  
Thomas Delaplace ◽  
Morgan Gouriou ◽  
Denis Melot
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Sensitivity Study ◽  
Cost Comparison ◽  
Production Lines ◽  
Potential Cost ◽  
Corrosion Resistant ◽  
Offshore Production ◽  
Design Requirements ◽  
The Cost

Abstract This paper presents the investigations performed by TotalEnergies and Saipem on the cost effectiveness potential of internal plastic lining for corrosion protection of offshore production lines. Objective was to better understand for a complete EPCI cost comparison the various parameters that could have a significant impact on the potential savings associated with the use of plastic lining instead of CRAs (Corrosion Resistant Alloys) for very corrosive production fluids such as sour gases. An extensive cost comparison study between CRA lining and plastic lining for offshore production lines was performed considering sensitivity on several parameters: 3 pipe diameters, S-Lay, Reel-Lay and J-Lay installation, sensitivity to external thermal insulation requirements, mechanical and design requirements, to pipe length and fixed costs (technologies and vessels). A dedicated calculation tool for system design and cost assessment was built on purpose for this sensitivity study. Costs were assessed for the various cases, starting from pipe design, then assessing procurement costs, fabrication costs then installation costs with preliminary cycle time assessment. Project management and engineering costs have been considered to obtain comparative EPCI (as installed) cost assessments for the various study cases. Plastic lining appears to be a cost-effective solution installed in J-Lay or S-Lay in addition to reeling (up to 45% of potential cost savings on installed line compared to CRA lining). The main driver for the cost savings is associated to the procurement of the pipes and associated lining, including pipe manufacturing. Some smaller savings can also be obtained from the offshore cycle times in J-Lay and S-Lay as the CRA welding add a significant operation time in comparison with standard CS welds. The fixed additional costs associated to the plastic lining (specific tooling for example) can be quickly amortized after a few kilometers thanks to the material cost savings. Integrating them as a company investment allows to unlock costs savings even for shorter lines. The thermal contribution of the plastic liner is also interesting regarding the overall pipe insulation design. This study completes the works already performed by the industry on the offshore costs of plastic lining as it considers the whole EPCI CAPEX costs from the Contractor and Operator points of view and offshore experience. The study integrates the S-Lay and J-Lay installation methods (while previous studies mainly focused on Reel-Lay) and includes an extensive sensitivity study with various key parameters such as pipe sizes, pipe design requirements, material costs and offshore operation times to get a general overview of potential benefits associated with plastic linings for offshore production lines transporting corrosive fluids such as sour gases.

scholarly journals Costs of paying higher prices for equivalent effects on the Pharmaceutical Benefits Scheme

2017 ◽  
Vol 41 (1) ◽  
pp. 1 ◽  
Author(s):  
Jonathan Karnon ◽  
Laura Edney ◽  
Michael Sorich
Keyword(s):  
Service Use ◽  
Cost Savings ◽  
Therapeutic Group ◽  
Value For Money ◽  
Potential Cost ◽  
Cost Minimisation ◽  
Policy Frameworks ◽  
The Cost ◽  
Equal Effectiveness ◽  
Pharmaceutical Benefits Scheme

Objective The aims of the present study were to illustrate and discuss the effects of the non-maintenance of equivalent prices when the comparators of pharmaceuticals listed on the Pharmaceutical Benefits Schedule (PBS) on a cost-minimisation basis come off-patent and are subject to statutory price reductions, as well as further potential price reductions because of the effects of price disclosure. Methods Service use, benefits paid, and price data were analysed for a selected sample of pharmaceuticals recommended for listing on a cost-minimisation basis between 2008 and 2011, and their comparators, to estimate the cost savings to the PBS of maintaining equivalent prices. Results Potential cost savings for 12 pharmaceuticals, including alternative compounds and combination products across nine therapeutic groups, ranged from A$570 000 to A$40 million to April 2015. Potential savings increased significantly following recent amendments to the price disclosure process. Conclusions Potential savings from maintaining equivalent prices for all pharmaceuticals listed on the PBS on a cost-minimisation basis could be over A$500 million per year. Actions to reduce these costs can be taken within existing policy frameworks, but legislative and political barriers may need to be addressed to minimise these costs, which are incurred by the taxpayer for no additional benefit. What is known about the topic? Pharmaceuticals listed on the PBS must provide value for money. Many pharmaceuticals achieve this by demonstrating equal effectiveness to an already listed pharmaceutical and requesting the same price as this comparator; that is, listing on a cost-minimisation basis. When the comparator moves off-patent, the price of the still-patented pharmaceutical is protected, whereas the off-patent drug is subject to price disclosure and often steep price reductions. What does this paper add? This paper adds to recent evidence on the costs to government of paying different prices for two or more pharmaceuticals that are equally effective. Between 2008 and 2011, the direct comparators for 68 pharmaceuticals listed on a cost-minimisation basis have moved onto the price disclosure list. Across 12 of these listings, the potential cost savings in the 10 months to April 2015 were A$73 million. What are the implications for practitioners? The PBS costs the Australian government over A$9 billion per year. Annual savings over A$500 million per year could be achieved by maintaining cost-minimisation across equally effective pharmaceuticals. This would improve the efficiency of the PBS at no risk to patients. Legislation is required to remove the existing F1 and F2 categorisation of listed pharmaceuticals, but the proposed changes would remove the need for therapeutic group premiums and simplify the pricing of PBS items.

scholarly journals Community-based continuity of midwifery care versus standard hospital care: a cost analysis

2001 ◽  
Vol 24 (1) ◽  
pp. 85 ◽  
Author(s):  
Caroline S Homer ◽  
Deborah V Matha ◽  
Lesley G Jordan ◽  
Jo Wills ◽  
Gregory K Davis
Keyword(s):  
Standard Care ◽  
Caesarean Section Rate ◽  
Cost Savings ◽  
Model Of Care ◽  
Community Based ◽  
Midwifery Care ◽  
New Model ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

This paper reports the costs of providing a new model of maternity care compared to standard care in anAustralian public hospital. The mean cost of providing care per woman was lower in the group who had the newmodel of care compared with standard care ($2 579 versus $3 483). Cost savings associated with new model of carewere maintained even after costs associated with admission to special care nursery were excluded. The cost saving wasalso sustained even when the caesarean section rate in the new model of care increased to beyond that of the standardcare group.

Sign in / Sign up

Export Citation Format

Share Document