A Cost-Benefit Analysis of Reducing Surgical Site Infections

2018 ◽  
Vol 84 (2) ◽  
pp. 254-261
Author(s):  
Alexander Rosemurgy ◽  
Jacqueline Whitaker ◽  
Kenneth Luberice ◽  
Christian Rodriguez ◽  
Darrell Downs ◽  
...  
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Surgical Site Infections ◽  
Potential Cost ◽  
Pancreatic Resections ◽  
Before And After ◽  
Abdominal Operations ◽  
The Cost ◽  
The Impact

Surgical Site Infections (SSI) represent an onerous burden on our health-care system. This study was undertaken to determine the impact of a protocol aimed at reducing SSIs on the frequency and cost of SSIs after abdominal surgery. Beginning in 2013, 811 patients undergoing gastrointestinal operations were prospectively followed. In 2014, we initiated a protocol to reduce SSIs. SSIs were monitored before and after protocol implementation, and differences in SSI incidence and associated costs were determined. Before protocol initiation, standardized operative preparation cost was $40.85 to $126.94 per patient depending on the results of methicillin-resistant Staphylococcus aureus screen; after protocol initiation, the cost was $43.85 per patient, saving up to $83.09 per patient. With the protocol in place, SSI rate was reduced from 4.9 to 3.4 per cent (13 of 379) representing a potential prevention of eight infections that would have cost payers $166,280 ($20,785 per infection). Notably, the SSI rate after pancreatectomy was reduced by 63 per cent ( P = 0.04). With preparation and diligence, SSI rate can be meaningfully reduced and potential cost savings can be achieved. In particular, SSI rate reduction for major abdominal operations and especially pancreatic resections can be achieved. A protocol to reduce SSI is a “win-win” for all stakeholders and should be encouraged with thoughtful and active participation from all hospital disciplines.

A Comparative Analysis of the Costs and Benefits of Outsourcing Vs. Insourcing Cleaning Services in a Rural Hospital in Uganda

2018 ◽  
Vol 06 (1) ◽  
pp. 9-20 ◽  
Author(s):  
Paschal N Mujasi ◽  
Zerish Z Nkosi
Keyword(s):  
Service Quality ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Quality Data ◽  
Total Cost ◽  
Before And After ◽  
Quality Rating ◽  
One Year ◽  
The Cost ◽  
The Impact

Background:This study estimates the net cost benefit of outsourcing cleaning services in a hospital in Uganda. The aim is to demonstrate an approach that can be applied by hospital managers using readily available data to conduct a cost benefit analysis as part of pre-sourcing evaluation.Methods:A before and after design was used to analyze, from the hospital manager’s perspective, the impact of outsourcing cleaning services on the hospital’s costs. Cost and service quality data was collected for the pre- and post- outsourcing period. Net costs of outsourcing were determined using a total cost pre- and post-out-sourcing approach. Benefits were monetized by comparing the costs of outsourcing with the theoretical in-sourcing costs that would be required to achieve the same quality as outsourced cleaning services. The theoretical in-sourcing costs were estimated by weighting the actual insourcing costs by a quality factor based on the hospital manager’s rating of service quality pre- and post-outsourcing. The outcome measures were the net total cost and cost per square meter cleaned for a one-year period.Results:Before adjusting for quality, outsourcing cleaning services were more costly than insourcing, with an annual cost of UGX 644.35 ($ 0.25) and UGX 568.07 ($ 0.22) per square meter cleaned, respectively. After adjusting for quality, outsourcing is cost-beneficial, providing a cost saving of UGX 372.20 ($ 0.14) per square meter cleaned. Sensitivity analysis indicates that cost of the outsourcing contract and manager’s quality rating of outsourced services have the greatest impact on value for money from outsourcing. An annual contract cost above UGX 1000 ($ 0.38) per square meter cleaned makes outsourcing less beneficial, keeping all other factors constant. An average quality rating below 5 for the outsourced service makes outsourcing less beneficial cost wise.Conclusion:Outsourcing resulted in additional hospital expenditure compared to in-sourcing, but also resulted in better quality service. Adjusting for quality makes outsourcing more cost beneficial. The magnitude of the cost benefit is sensitive to the contract value and the managers’ quality rating of the outsourced services.

scholarly journals Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

2021 ◽  
Author(s):  
Kit N Simpson ◽  
Michael J Fossler ◽  
Linda Wase ◽  
Mark A Demitrack
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
Protein Signaling ◽  
Opioid Receptor Agonist ◽  
Cost Effective Alternative ◽  
Μ Opioid Receptor ◽  
The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

Cost-benefit analysis of AR-V7 testing in patients (Pts) with metastatic castration resistant prostate cancer (mCRPC) eligible for abiraterone (Abi) or enzalutamide (Enza).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 283-283
Author(s):  
Mark Christopher Markowski ◽  
Kevin D. Frick ◽  
James R. Eshleman ◽  
Jun Luo ◽  
Emmanuel S. Antonarakis
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Castration Resistant Prostate Cancer ◽  
The Us ◽  
Effective Option ◽  
Current Price ◽  
Societal Challenge ◽  
The Cost

283 Background: The rising cost of oncology care in the US is an ongoing societal challenge, and identifying biomarkers that inform clinical decisions and reduce the use of ineffective therapies remains elusive. A splice variant of the androgen receptor, AR-V7, was found to confer resistance to Abi and Enza in men with mCRPC, but did not negatively affect responses to taxanes, suggesting that early use of chemotherapy may be a more effective option for AR-V7(+) pts. With the recent development of a CLIA-certified clinical assay for AR-V7 at Johns Hopkins, we hypothesized that AR-V7 testing in mCRPC pts may result in cost savings by avoiding futile treatment with Abi/Enza in men with AR-V7(+) disease. Methods: We calculated the cost savings of performing AR-V7 testing in mCRPC pts prior to starting Abi/Enza (and avoiding these drugs in AR-V7(+) men) versus treating all mCRPC pts with Abi/Enza (without use of the biomarker). We have set the cost of the AR-V7 assay at $1000. The cost of 3 months of Abi/Enza (the minimum time it would take to determine resistance, clinically) was approximated at $20,000. We estimated that 30,000 mCRPC pts per year are eligible for Abi/Enza in the US. Results: In our prior studies, about 30% of mCRPC pts previously treated with Abi/Enza had detectable AR-V7 in CTCs. Assuming an AR-V7 prevalence of 30%, about 9,000 AR-V7(+) mCRPC pts per year would receive ineffective treatment with Abi/Enza, at an estimated cost of $180 Million. The upfront cost of testing all mCRPC pts who are Abi/Enza-eligible for AR-V7 is $30 Million, resulting in a net cost savings of $150 Million. When performing a continuous cost-benefit analysis after assuming other prevalences of AR-V7 (ranging from 4% to 50%) and a range of costs for Abi/Enza ($2000 to $24,000 per 3 months), we determined that AR-V7 testing would result in a cost savings as long as the prevalence of AR-V7 is > 5% (if the cost of 3 months of Abi/Enza remains at $20,000). Conclusions: AR-V7 testing in mCRPC pts (at $1000/test) is cost-beneficial when considering the current price of Abi/Enza, and may reduce the ineffective use of Abi/Enza leading to a net cost savings to the healthcare system.

scholarly journals Estimation of Damage Cost to Building Façades per kilo Emission of Air Pollution in Norway

Atmosphere ◽  
2020 ◽  
Vol 11 (7) ◽  
pp. 686 ◽  
Author(s):  
Terje Grøntoft
Keyword(s):  
Air Pollution ◽  
Marginal Cost ◽  
18Th Century ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Damage Cost ◽  
Damage Costs ◽  
Marginal Damage ◽  
The Cost ◽  
The Impact

This work reports marginal damage costs to façades due to air pollution exposure estimated “bottom up,” for Norway and Oslo (Norway) by the use of exposure response functions (ERFs) and impact pathway analysis from the emission to the deteriorating impact. The aim of the work was to supply cost estimates that could be compared with reported damage costs to health, agriculture, and ecosystems, and that could be used in cost-benefit analysis by environmental authorities. The marginal damage costs for cleaning, repair, and in total (cleaning + repair) were found to be, in Norway: eight, two, and 10, respectively, and for a traffic situation in Oslo: 50 (77), 50 (28), and 100 (105), (×/÷ 2.5) Euro/kg emission of PM10, SO2, and NO2 in total. For Oslo, the values represent a recorded façade materials inventory for 17–18th century buildings, and in the brackets the same façade inventory as for Norway. In total, 5–10% of the marginal damage cost was found to be due to NO2. The total marginal cost was found to be shared about equally between the impact of PM10 and SO2 in Norway (50 and 42% of the impact) and for the 17–18th century buildings in Oslo (45% and 49% of the impact), but for a similar façade materials inventory in Oslo as Norway, the total marginal cost due to PM10 was about two-thirds and that due to SO2 about one-third of the total, with about 5% of the cost still being due to NO2. The division of the costs between the separate pollutant influences on the cleaning and repair was, however, found to be significantly different in Norway and Oslo. In Norway, about 60% of the marginal cleaning cost was found to be due to PM10, 30% due to SO2, and 10% due to NO2. In Oslo, about 85% of the marginal cleaning costs were found to be due to PM10, 10% due to SO2, and 5% due to NO2. For the marginal repair cost, the opposite situation was found, in both Norway and Oslo, with 80–90% of the cost being due to SO2, 5–10% being due to PM10, and 5–10% due to NO2. As other factors than air pollution deteriorates façades and influences maintenance decisions, the expenses that can be attributed to the air pollution could be significantly lower.

scholarly journals 567. Does Universal Nasal Decolonization with an Alcohol-Based Nasal Antiseptic Reduce Infection Risk and Cost?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S268-S268
Author(s):  
Scott Arden
Keyword(s):  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Infection Risk ◽  
Practice Change ◽  
Screening Tests ◽  
Contact Precautions ◽  
Chlorhexidine Bathing ◽  
Before And After ◽  
The Cost ◽  
The Impact

Abstract Background Nasal decolonization with mupirocin to reduce infection risk, has been associated with mupirocin-resistant Staphylococcus aureus (SA). A community hospital identified two patients colonized with methicillin and mupirocin-resistant SA (MRSA), one scheduled for surgery, one for inpatient IV antibiotic therapy. Instead of mupirocin, an alcohol based nasal antiseptic was applied to these patients twice daily for 5 days, resulting in a negative MRSA nasal screening test in both patients. Neither patient developed an infection during or after treatment. Building on this success, a plan was made to assess the impact of universal nasal decolonization to replace screening and contact precautions for MRSA colonized patients, and to reduce surgical site infections (SSI). Methods A 12-month project using a before and after design, was initiated in April 2018. The project involved twice daily application of alcohol-based nasal antiseptic for all inpatients, and preoperatively for all surgical patients in addition to existing preoperative chlorhexidine bathing. No other practice change was made during this period. Assessment of impact was planned by comparing the incidence of MRSA bacteremia and SSI at baseline (2017) and after project implementation, in addition to costs avoided with reduction of nasal screening and CP. Results Compared with baseline, between April 2018 and March 2019, there was a decrease in MRSA bacteremia from 3/1,000 patient-days to 0/1,000 patient-days, a reduction in CP from 3.78 to 1.53/1,000 patient-days, a reduction in nasal screens from 3,874 to 605, and a reduction of all-cause (Gram-negative and Gram-positive) SSI after all surgical procedures from 3/4,313 procedures to 0/4,872 procedures. After accounting for the cost of the nasal antiseptic, the reduction in gowns, gloves and nasal screening tests resulted in $104,099.91costs avoided. Conclusion House-wide application of alcohol-based nasal antiseptic in place of screening and contact precautions, resulted in a reduced incidence of both MRSA bacteremia and SSI for all types of surgical procedures, in addition to significant costs avoided. Disclosures All authors: No reported disclosures.

The Cost-Benefit Analysis for the Evaluation of Public Infrastructure Projects - The Case of the Subway of Potenza

2014 ◽  
Vol 1073-1076 ◽  
pp. 1362-1367
Author(s):  
Benedetto Manganelli
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Economic Feasibility ◽  
Transport Infrastructure ◽  
Benefit Analysis ◽  
Public Infrastructure ◽  
New Public ◽  
The Cost ◽  
The City

In the present work the economic feasibility of a project of public infrastructure, the expansion of the subway of the city Potenza, is estimated. The assessment has been developed through the application of the Cost-Benefit Analysis. As is known the advantage of this technique is the ability to express in monetary terms the externalities (positive and negative) generated by the project. In this case, the external cost savings related to the improvement of the mobility in the city have been internalized. The research has shown that the valuation of the externalities can be an effective way to manage the planning of new public transport infrastructure.

scholarly journals Cost–benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals

2015 ◽  
Vol 47 (2) ◽  
pp. 575-587 ◽  
Author(s):  
Roland Diel ◽  
Albert Nienhaus ◽  
Doris Hillemann ◽  
Elvira Richter
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Drug Susceptibility Testing ◽  
Sputum Smear ◽  
Test Accuracy ◽  
Potential Cost ◽  
Hospital Perspective ◽  
Mdr Tb ◽  
Smear Negative

Our objective was to assess the cost–benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects.

scholarly journals Cost and Benefit Analysis of Contract Farming

2019 ◽  
Vol 8 (1) ◽  
pp. 37-46
Author(s):  
N Harish
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Fixed Cost ◽  
Benefit Analysis ◽  
Total Income ◽  
Contract Farming ◽  
Total Cost ◽  
Before And After ◽  
Cost And Benefit Analysis ◽  
The Cost

This article focused on cost-benefit analysis of contract farming. The cost benefit analysis includes total cost, total income and profit before and after contract farming of respondents. Total cost calculated without fixed cost and with fixed cost, profit also calculated with fixed cost and without fixed cost. Contract farming is beneficial to farmers after contract farming. The total cost should be considered without fixed cost.

The use of animals in research: counting the costs and the benefits

2004 ◽  
Vol 44 (11) ◽  
pp. 1079 ◽  
Author(s):  
M. D. Rickard
Keyword(s):  
Animal Welfare ◽  
Animal Ethics ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Ethics Committees ◽  
Benefit Analysis ◽  
Economic Gain ◽  
Animal Ethics Committees ◽  
The Cost ◽  
The Impact

The Australian Code of Practice for the Care and Use of Animals for Scientific Purposes requires Animal Ethics Committees to assess the merits of any research proposal involving the use of sentient animals. As part of that assessment they should make a judgment as to whether or not the costs to the welfare of the experimental animals are outweighed by the benefits of the predicted experimental outcome (i.e. conduct a cost–benefit analysis). This paper describes one approach that has been proposed to assist Animal Ethics Committees to take all factors into account when making this judgment. When agricultural animals are used in research the potential benefits are usually measured in terms of improved health and welfare or increased productivity when the research outcomes are applied to other animals reared in agricultural enterprises. When the aim of a project is to improve the health and welfare of the animals (i.e. ‘animal benefit’), the benefits are usually obvious and counting the cost is straightforward even if the impact on the animals under experimentation is quite extreme (e.g. death as an unavoidable endpoint in a vaccination experiment). Where the benefits accrue solely in terms of increased productivity or economic gain (i.e. ‘human benefit’), then balancing the costs and the benefits can be more problematical because people’s personal beliefs and their orientation towards animal welfare influence their assessment. Economists indicate that it is not increased productivity per se that generates value but consumption. Therefore, consumer perceptions of any adverse impact that gains in productivity have on the welfare of farmed animals can play a significant role in determining the ultimate benefit (value) of a particular piece of research with the sole aim to increase production and economic gain. This paper will explore some postulated relationships between productivity and animal welfare which could influence consumer preferences and hence the cost–benefit analysis.

Reducing the Cost of Ship Maintenance and Repair

2014 ◽  
Author(s):  
Victoria Dlugokecki ◽  
Dennis Fanguy ◽  
Lisa Hepinstall ◽  
Matthew Tedesco
Keyword(s):  
Cost Reduction ◽  
Cost Benefit Analysis ◽  
Good Practice ◽  
Cost Benefit ◽  
Maintenance Cost ◽  
Potential Cost ◽  
Design Rules ◽  
Deck Plate ◽  
General Dynamics ◽  
The Cost

In July 2011, the National Shipbuilding Research Program (NSRP)awarded the project entitled “Reduction of Total Ownership Costs Through Application of Design For Maintenance (DFM) and Repair Methodologies Project” a collaborative shipyard-led research project, supported by Bollinger Shipyards(Prime), BAE Systems Southeast Shipyards, Vigor Shipyards, the Trident Refit Facility in Kingsbay, GA, General Dynamics Electric Boat, General Dynamics NASSCO, and the Naval Center for Cost Analysis at NSWC-Carderock. Through this customer-centric project, nearly 40 DFM workshops were held with the deck-plate repairers at public and private shipyards across the US to identify major maintenance cost drivers, maintenance cost reduction opportunities, and deliver design rules to reduce total ownership costs to ship owners based on Design for Maintainability (DFM) principles. This paper will provide an understanding of the process used to develop the DFM information and will discuss the DFM principles applied and highlight the “good practice” design rules that resulted from this effort. The paper will also describe the Cost Benefit Analysis process and templates developed through the project, along with provide an appreciation of the potential cost benefits associated with the implementation of DFM principles. The DFM database, also developed through the project, with over 1000+ repair-based cost reduction strategies will also be highlighted.

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