scholarly journals Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Sheena Xin Liu ◽  
Rui Xiang ◽  
Charles Lagor ◽  
Nan Liu ◽  
Kathleen Sullivan
Keyword(s):  
Heart Failure ◽  
Cost Saving ◽  
Hospital Admissions ◽  
Clinical Performance ◽  
Cost Savings ◽  
Time Frame ◽  
Economic Modeling ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Year Gain

Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from$2832 to$5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in$2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.

scholarly journals Implications of Achieving TICI 2b Versus TICI 3 Reperfusion in Patients With Ischemic Stroke: A Cost-Effectiveness Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Xiao Wu ◽  
Dheeraj Gandhi ◽  
Charles C Matouk ◽  
Joseph Schindler ◽  
Danny Hughes ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cost Saving ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Old Patients ◽  
Life Years ◽  
Outcome Differences

Abstract INTRODUCTION The degree of successful reperfusion of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) is one of the critical and potentially modifiable determinants of clinical outcome. Differences in outcomes between patients with TICI 2b vs TICI 3 reperfusion have recently been highlighted. This study examines the public health and cost implications of achieving TICI 2b vs TICI 3 reperfusion. METHODS A decision-analytic study was performed to estimate the lifetime quality-adjusted life years (QALY) and associated costs based on the degree of reperfusion achieved. The base case calculations and multiple one-way sensitivity analyses were performed for AIS patients with LVO undergoing MT in 3 age groups: 55, 65, and 75 yr old, respectively. RESULTS Within 90 d, achieving TICI 3 results in a cost-saving of $5,258 per patient and health benefit of 7.3 d in perfect health as compared to TICI 2b. In the long-term, for the 3 ages groups (55, 65, and 75 yr old), achieving TICI 3 results in cost savings of $82,965, $51,155, and $31,034 respectively, and health benefits of 2.42 QALYs, 1.92 QALYs, and 1.36 QALYs. Every 1% increase in TICI 3 in 55-yr-old patients at a nation-wide level results in a cost saving of nearly $6.1 million and a health benefit of 176 QALYs. Among 65-yr-old patients, the corresponding cost savings and health benefit are $3.7 million and 176 QALYs, and $2.3 million and 99 QALYS for 75-yr-old patients. CONCLUSION There are substantial cost and health implications of achieving complete vs incomplete reperfusion after EVT. Our study reinforces the need for a more conservative definition of therapy success and treatment approaches to achieve TICI 3 reperfusion.

scholarly journals Association Between PM2.5 and Daily Hospital Admissions for Heart Failure: A Time-Series Analysis in Beijing

2018 ◽  
Vol 15 (10) ◽  
pp. 2217 ◽  
Author(s):  
Man Li ◽  
Yao Wu ◽  
Yao-Hua Tian ◽  
Ya-Ying Cao ◽  
Jing Song ◽  
...  
Keyword(s):  
Heart Failure ◽  
Time Series ◽  
Degrees Of Freedom ◽  
Hospital Admissions ◽  
Scientific Evidence ◽  
Poisson Model ◽  
Sensitivity Analyses ◽  
Calendar Time ◽  
Medical Claim ◽  
Increased Risk

There is little evidence that acute exposure to fine particulate matter (PM2.5) impacts the rate of hospitalization for congestive heart failure (CHF) in developing countries. The primary purpose of the present retrospective study was to evaluate the short-term association between ambient PM2.5 and hospitalization for CHF in Beijing, China. A total of 15,256 hospital admissions for CHF from January 2010 to June 2012 were identified from Beijing Medical Claim Data for Employees and a time-series design with generalized additive Poisson model was used to assess the obtained data. We found a clear significant exposure response association between PM2.5 and the number of hospitalizations for CHF. Increasing PM2.5 daily concentrations by 10 μg/m3 caused a 0.35% (95% CI, 0.06–0.64%) increase in the number of CHF admissions on the same day. We also found that female and older patients were more susceptible to PM2.5. These associations remained significant in sensitivity analyses involving changing the degrees of freedom of calendar time, temperature, and relative humidity. PM2.5 was associated with significantly increased risk of hospitalization for CHF in this citywide study. These findings may contribute to the limited scientific evidence about the acute impacts of PM2.5 on CHF in China.

scholarly journals Measles CEA

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S64-S65
Author(s):  
Emily Hyle
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Economic Value ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
International Travel ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Cost Effectiveness Ratio ◽  
The Impact

Abstract Background Most measles importations are due to returning US travelers infected during international travel. We projected clinical outcomes and assessed cost-effectiveness of pretravel evaluation for measles immunity and MMR vaccination among eligible adult US international travelers. Methods We designed a decision tree to investigate pretravel evaluation compared with no evaluation from the societal perspective. Data from the Global TravEpiNet Consortium and published literature informed input parameters (Figure 1). Outcomes included measles cases averted per 10 million travelers, costs, and the incremental cost-effectiveness ratio (ICER, Δcosts/Δmeasles cases averted); we considered ICERs < $100,000/measles case averted to be cost-effective. We performed sensitivity analyses to assess the impact of varying the probability of exposure based on travel destination, and the percentage of travelers with pre-existing measles immunity. Results In the base case, departure after pretravel evaluation resulted in 16 measles importations and 46 transmissions per 10 million travelers and cost $132 million, vs without pretravel evaluation (26 importations and 87 transmissions per 10 million travelers, costing $22 million). Pretravel evaluation averted 51 measles cases per 10 million travelers with an ICER of $2.2 million per case averted. Results were most sensitive to the probability of measles exposure and the traveler’s pre-existing immunity (Figure 2). Pretravel evaluation was cost-effective for travelers to Asia if pre-existing measles immunity was <80%. Evaluation was always cost-effective for travelers to Africa when pre-existing immunity was less than 100% and became cost saving when the percentage of immune travelers was lower (<70%). Travelers who were more likely to be non-immune and were visiting destinations with higher probabilities of exposure were most likely to benefit from pretravel evaluation for measles immunity at excellent economic value. Conclusion As risk of measles exposure increases and likelihood of travelers’ pre-existing immunity decreases, it can be cost-effective or cost saving to assess US international travelers’ measles immunity status and vaccinate with MMR prior to departure. Disclosures All authors: No reported disclosures.

scholarly journals Modelling the dynamic effects of elective hospital admissions on emergency levels in England

2019 ◽  
Vol 59 (4) ◽  
pp. 1933-1957
Author(s):  
Sergi Jimenez-Martin ◽  
Catia Nicodemo ◽  
Stuart Redding
Keyword(s):  
Cost Saving ◽  
Fixed Effects ◽  
Hospital Admissions ◽  
Primary Care Trust ◽  
Cost Savings ◽  
Unintended Consequences ◽  
Policy Makers ◽  
Elective Treatment ◽  
Life Threatening ◽  
The Cost

Abstract In England as elsewhere, policy makers are trying to reduce the pressure on costs due to rising hospital admissions by encouraging GPs to refer fewer patients to hospital specialists. This could have an impact on elective treatment levels, particularly procedures for conditions which are not life-threatening and can be delayed or perhaps withheld entirely. This study attempts to determine whether cost savings in one area of publicly funded health care may lead to the increases in cost in another and therefore have unintended consequences by offsetting the cost-saving benefits anticipated by policy makers. Using administrative data from Hospital Episode Statistics in England, we estimate dynamic fixed effects panel data models for emergency admissions at Primary Care Trust and Hospital Trust levels for the years 2004–2013, controlling for a group of area-specific characteristics and other secondary care variables. We find a negative link between current levels of elective care and future levels of emergency treatment. This observation comes from a time of growing admissions, and there is no guarantee that the link between emergency and elective activity will persist if policy is effective in reducing levels of elective treatment, but our results suggest that the cost-saving benefits to the NHS from reducing elective treatment are reduced by between 5.6 and 15.5% in aggregate as a consequence of increased emergency activity.

Outpatient Cervical Ripening: A Cost-Minimization and Threshold Analysis

2019 ◽  
Vol 37 (03) ◽  
pp. 245-251 ◽  
Author(s):  
Shannon L. Son ◽  
Ashley E. Benson ◽  
Emily Hart Hayes ◽  
Akila Subramaniam ◽  
Erin A. S. Clark ◽  
...  
Keyword(s):  
Cost Saving ◽  
Incremental Cost ◽  
Cost Minimization ◽  
Sensitivity Analyses ◽  
Cervical Ripening ◽  
Base Case ◽  
System Perspective ◽  
Hospital Perspective ◽  
Wide Range ◽  
Unfavorable Cervix

Objective To evaluate cost of outpatient (OP) versus inpatient (IP) ripening with transcervical balloons, and determine circumstances in which each strategy would be cost saving. Study Design We created a decision model comparing OP and IP balloon ripening in term (≥37 weeks) singleton pregnancies with unfavorable cervix. We performed a cost-minimization analysis and threshold analyses comparing two OP ripening strategies (broad and limited use) to IP ripening from a health system perspective. Base case estimates of probability, utilization, and cost were derived from the literature. The primary outcome was incremental cost of OP versus IP ripening from a hospital perspective. One- and two-way sensitivity analyses explored uncertainty in the model. Results Both OP ripening strategies were cost saving compared with IP ripening: incremental cost −$228.40/patient with broad use and −$73.48/patient with limited use. OP ripening was no longer cost saving if hours saved on labor and delivery (L&D) were <3.5, insertion visit cost >$714, or facility cost/hour on L&D <$61. Two-way sensitivity analyses showed that OP ripening was cost saving under the most plausible clinical circumstances. Conclusion In patients with unfavorable cervix, OP transcervical balloon ripening was cost saving under a wide range of circumstances, particularly if OP ripening can shorten time spent on L&D by 3.5 hours.

scholarly journals Cost–consequence analysis of fluticasone furoate/vilanterol for asthma management in Spain: an analysis based on the Salford Lung Study in asthma

2019 ◽  
Vol 21 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Laura Amanda Vallejo-Aparicio ◽  
Jesús Molina ◽  
Iñigo Ojanguren ◽  
Ana Viejo Casas ◽  
Alicia Huerta ◽  
...  
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
National Health System ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Fluticasone Furoate ◽  
Potential Cost ◽  
Asthmatic Patients ◽  
Cost Consequence

Abstract Objectives The Salford Lung Study in asthma (SLS asthma) is a 12-month, open-label randomised clinical trial comparing clinical effectiveness of initiating once-daily inhaled combination of fluticasone furoate/vilanterol (FF/VI) 184/22 mcg or 92/22 mcg, with continuing optimized usual care (UC) with inhaled corticosteroids (ICS) alone, or in combination with a long-acting β2-agonist (ICS/LABA), in asthmatic patients followed in primary care in the UK. The objective of the analysis is to estimate the economic impact of these results when applied in Spain. Methods A 1-year cost–consequence model was populated with SLS asthma, adopting the Spanish National Health System (NHS) perspective. 775,900 of diagnosed asthmatic patients ≥ 18 years old currently managed with UC in Spain were included in the analysis. Effectiveness data included the percentage of patients per Asthma Control Test (ACT) category at 24 and 52 weeks from SLS asthma. Direct costs (pharmacological and per ACT category) were estimated from Spanish public sources and literature (€, 2018). Base case analysis assumed an increased use of FF/VI from 10 to 20% within 1 year. One-way sensitivity analyses were performed. Results Within the 775,900 asthmatic patients analysed, substitution of UC with FF/VI was associated with reduced costs due to ACT improvement, leading to potential total annual savings of €4,927,672. Sensitivity analyses ranged from €6,012,975 to €14,783,015 cost savings associated with FF/VI. An analysis considering patients only on ICS/LABA showed potential cost savings of €8,207,448. Conclusions The improved asthma control for FF/VI compared with UC observed in SLS asthma could be translated into potential savings for the Spanish NHS. These results may be useful for decision makers.

scholarly journals One year outcomes of heart failure multispecialty multidisciplinary team virtual meetings

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Essa ◽  
E Oguguo ◽  
H Douglas ◽  
A Foster ◽  
L Walker ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Saving ◽  
Outpatient Clinic ◽  
Multidisciplinary Team ◽  
Tertiary Care ◽  
Cost Savings ◽  
Seamless Integration ◽  
Morbidity Score ◽  
Co Morbidity ◽  
The Mean

Abstract   Heart Failure is frequently associated with several comorbidities such as ischaemic heard disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease and frailty. This level of complexity is best dealt with by a multispecialty multidisciplinary team (MDT) model. This was a single centre observational study (January 2020-December 2020) that was undertaken in a British university hospital looking at effect of HF multispecialty virtual MDT meetings on HF outcomes. Patients acted as their own controls outcomes compared for equal period pre versus post MDT meeting. The multi-specialty meeting was conducted once monthly via video-conferencing. It consisted of heart failure cardiologists (from primary secondary and tertiary care), heart failure specialist nurses (hospital and community), nephrologist, endocrinologist, palliative care specialists, chest physician, pharmacist, pharmacologist and geriatrician. Recommendations were made as consensus from the multispecialty meeting. The main outcome measures were 1) number of hospitalisations and 2) outpatient clinic attendances 3) cost savings. A total of 189 patients were discussed from January-December 2020. This was uninterrupted during the COVID-19 pandemic. The mean age was 70.3±18.1 years and median follow-up 6 months (range 1–13 months). The mean Charlson Co-morbidity score was 5.3±1.2 and Rockwood Frailty Score was 4.9±1. The mean number of outpatient clinic attendances avoided was 1.7±0.4. This reduced inconvenience to patients, saved patients money (transport and parking costs) and led to carbon footprint reduction. The MDT meeting total costs were £15,400 and the 31 clinic appointments they generated cost an estimated £3720. However, the MDT meetings prevented 277 clinic appointments (cost saving £33,352). Finally, the mean number of hospitalisations pre-MDT was 0.7 Vs 0.2 post MDT (p&lt;0.01) with a saving of around 730 bed days (estimated cost-saving £260,000). The HF multispecialty virtual MDT approach provides seamless integration of primary care community services with secondary and tertiary care. Consensus decision from MDT meetings provides holistic approach for HF patients with comorbidities and frailty, and reduces inconvenience to patients by preventing the need to attend multiple specialty clinics. This approach can also lead to significant cost-savings to the healthcare system. FUNDunding Acknowledgement Type of funding sources: None.

Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system

2015 ◽  
Vol 39 (1) ◽  
pp. 12 ◽  
Author(s):  
Joshua M. Byrnes ◽  
Tracy A. Comans
Keyword(s):  
Cost Saving ◽  
Cost Savings ◽  
Medical Practitioner ◽  
Sensitivity Analyses ◽  
Medical Practitioners ◽  
Medical Specialists ◽  
The Government ◽  
The Impact ◽  
Direct Referral ◽  
Out Of Pocket Costs

Objective To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. Methods A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Results Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government of up to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. Conclusions The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving. What is known about the topic? Extending Medicare rebates payable to patients when physiotherapists directly refer patients to specialist medical practitioners is a contentious topic. Physiotherapy groups have argued that direct referral with a rebate would allow faster access to consultant advice resulting in better patient care. However, it has also been argued that widening criteria for rebates would increase overall costs to Medicare Australia. What does this paper add? This analysis finds that allowing direct referral with a rebate would result in a cost saving to both the government funder and patient out-of-pocket costs. What are the implications for practitioners? Policymakers should consider widening the criteria for rebates payable for referral to medical specialists to include physiotherapists, as this could result in faster management of patients and cost savings for both patients and Medicare Australia.

Implications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis

2020 ◽  
pp. neurintsurg-2020-015873 ◽  
Author(s):  
Xiao Wu ◽  
Mihir Khunte ◽  
Dheeraj Gandhi ◽  
Charles Matouk ◽  
Danny R Hughes ◽  
...  
Keyword(s):  
Cost Saving ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
The United States ◽  
Base Case ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Old Patients ◽  
Life Years

BackgroundThe benefit of endovascular thrombectomy (EVT) in stroke patients with large-vessel occlusion (LVO) depends on the degree of recanalization achieved. We aimed to determine the health outcomes and cost implications of achieving TICI 2b vs TICI 3 reperfusion in acute stroke patients with LVO.MethodsA decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years (QALY) of EVT-treated patients, and costs based on the degree of reperfusion achieved. The study was performed with a societal perspective in the United States' setting. The base case calculations were performed in three age groups: 55-, 65-, and 75-year-old patients.ResultsWithin 90 days, achieving TICI 3 resulted in a cost saving of $3676 per patient and health benefit of 11 days in perfect health as compared with TICI 2b. In the long term, for the three age groups, achieving TICI 3 resulted in cost savings of $46,498, $25,832, and $15 719 respectively, and health benefits of 2.14 QALYs, 1.71 QALYs, and 1.23 QALYs. Every 1% increase in TICI 3 in 55-year-old patients nationwide resulted in a cost saving of $3.4 million and a health benefit of 156 QALYs. Among 65-year-old patients, the corresponding cost savings and health benefit were $1.9 million and 125 QALYs.ConclusionThere are substantial cost and health implications in achieving complete vs incomplete reperfusion after EVT. Our study provides a framework to assess the cost-benefit analysis of emerging diagnostic and therapeutic techniques that might improve patient selection, and increase the chances of achieving complete reperfusion.

scholarly journals Varenicline treatment for smoking cessation in high risk patients: a budget impact analysis

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Federico Spandonaro ◽  
Letizia Mancusi ◽  
Barbara Polistena
Keyword(s):  
Smoking Cessation ◽  
High Risk ◽  
Cost Saving ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
High Risk Patients ◽  
Italian National Health Service ◽  
Risk Patients

INTRODUCTION: The promotion of smoking cessation is a worldwide Public Health priority.OBJECTIVE: To estimate the budget impact on the Italian National Health Service (NHS) of the access to reimbursement of varenicline for the treatment of high risk patients with bronchopulmonary, diabetic and cardiovascular diseases.METHODS: A closed-group Markov model was developed in order to compare the costs incurred by the NHS to promote smoking cessation with cessation-related savings, using an alternative scenario in which aids to cessation are not reimbursed by the NHS. The analysis was conducted over a 5-year time horizon, in the perspective of the Italian NHS. Efficacy was expressed in terms of smoke abstinence for at least one year, and data was derived from clinical trials; the savings associated with smoking cessation were derived from cost-of-illness studies.RESULTS: The results show how costs would concentrate in the first year: they are estimated at € 200.6 million, of which € 162.4 million for drug therapy and € 38.2 million for counseling. Average annual savings over the first five years are estimated at € 77.7 million, with a cumulative net impact at 5 years of € -188.0 million (cost-saving). The analysis appears to be robust: sensitivity analyses show that the covering of initial costs occurs in any case between the third and fourth year, and that the treatment remains cost-saving at 5 years.CONCLUSIONS: The financial impact on the Italian NHS of the reimbursement of varenicline for the treatment of high risk smoking population would be a sustainable healthcare policy, resulting in cost savings starting from the fourth year.

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