Cost-Effective Approach to the Laparoscopic Appendectomy

2020 ◽  
Vol 86 (6) ◽  
pp. 715-720
Author(s):  
Alexander M. DeMare ◽  
Natalie C. Luehmann ◽  
Samer Kawak ◽  
Emily E. Abbott ◽  
Jordan Long ◽  
...  
Keyword(s):  
Health Care ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Health Care Cost ◽  
Perforated Appendicitis ◽  
Cost Effective ◽  
Cost Effective Approach ◽  
Disposable Instruments ◽  
Improving Health Care ◽  
Median Operative Time

Background Surgeons can help reduce health care spending by selecting affordable and efficient instruments. The laparoscopic appendectomy (LA) is commonly performed and can serve as a model for improving health care cost. Methods We retrospectively reviewed all adult patients who underwent LA for non-perforated appendicitis from March 2015 to November 2017. Our objective was to determine which combination of disposable instruments afforded the lowest total operative cost without compromising postoperative outcomes. Results In total, 1857 consecutive patients were reviewed from 2 hospitals. After determining the 8 most commonly utilized combinations of disposable instruments, 846 patients were ultimately analyzed. The combination of a LigaSure, Endoloop, and an EndoBag (LEB) had the shortest median operative time (25 minutes, P < .001) and lowest median total operative cost ($1893, P < .001). Conclusions The LEB instrument combination rendered the shortest operative time, lowest total operative cost, and can be used to maximize surgical value during LA.

Teleconsultations: who uses them and how?

2002 ◽  
Vol 8 (6) ◽  
pp. 319-324 ◽  
Author(s):  
Pekka T Jaatinen ◽  
Jari Forsström ◽  
Pekka Loula
Keyword(s):  
Health Care ◽  
Data Protection ◽  
Health Care Professionals ◽  
Cost Effective ◽  
Asynchronous Communication ◽  
Literature Survey ◽  
Patient Confidentiality ◽  
Cost Effective Approach ◽  
User Groups ◽  
Primary Focus

A literature survey was carried out to identify papers describing teleconsulting applications. From 1259 potentially relevant articles identified through Medline, 128 articles were selected for review. The majority of these had been published in the Journal of Telemedicine and Telecare (50 articles, or 39%). We analysed different user groups, equipment and implementation issues, and the type of connections. In 101 studies (79%) the teleconsultations were between doctors, in 11 they were between patient and doctor, in seven between patient and nurse, and in nine between nurse and doctor. Studies of consultations between patients and health-care professionals were thus quite rare. Surgery was the most common specialty in which teleconsultation was described. The teleconsultations were realtime or mainly realtime in 72% of articles. In 39% of studies the primary focus was on videoconferencing. The most common means of connection was by ISDN digital lines (38%). There were very few mentions of how to ensure data protection or to maintain patient confidentiality. We conclude that, for the majority of teleconsultation needs, asynchronous communication is the most flexible and cost-effective approach. Realtime videoconferencing can be justified only in particular circumstances.

scholarly journals Cost-Effectiveness Analysis Of Text Messaging To Support Health Advice For Smoking Cessation 

2020 ◽  
Author(s):  
Raquel Cobos-Campos ◽  
Javier Mar ◽  
Antxon Apiñaniz ◽  
Arantza Sáez de Lafuente ◽  
Naiara Parraza ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Text Messaging ◽  
Health Care Cost ◽  
Cost Effective ◽  
Text Messages ◽  
Health Advice

Abstract Background: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide.Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. Methods: We performed a Markov model-based cost-effectiveness analysiscomparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers’mobile phones. A Markov model was used in which smokerstransitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costsfor lost productivity, respectively.Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. Results: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of €7.4 and €1,327 per QALY gained (ICER)for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. Conclusions: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres.

scholarly journals Laparoscopic appendectomy in children - new fashion or privilege

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 90-92
Author(s):  
Zoran Golubovic ◽  
Nenad Janic ◽  
Branislav Jovanovic
Keyword(s):  
Length Of Stay ◽  
Laparoscopic Appendectomy ◽  
Pediatric Surgery ◽  
Operative Time ◽  
Operating Time ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Surgical Experience ◽  
Single Institution ◽  
One Year

Whether laparoscopic appendectomy is superior to open appendectomy for simple and perforated appendicitis in children is still debatable. To answer this question, surgical experience of three experienced pediatric surgeons in a single institution was studied during one year in all cases of laparoscopic appendectomy. From January 2003 to January 2004, all laparoscopic appendectomies were reviewed for operative technique, advantages, disadvantages, operative time and length of stay. There were 44 laparoscopic appendectomies in children aged 4 to 19 years. Operating time dropped from 52 minutes at the beginning to less than 25 minutes at the end of year. Operating time in perforated appendicitis was slightly longer, from 58-65 minutes. Length of stay was 1-2 days for simple cases, and maximum 5 days for perforated ones. There were no postoperative complications such as abscess, bowel obstruction, bleeding, wound infection or mortality. Laparoscopic appendectomy is at least as safe and effective, if not superior to, as open appendectomy for both, simple and perforated appendicitis. Postoperative pain is less, and recovery is faster. Laparoscopic appendectomy is our procedure of choice in pediatric surgery.

scholarly journals Promoting Health and Improving Health Care in a Cost-Effective Manner through a Military Digital Library

2006 ◽  
Vol 171 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Peter H. Stoloff ◽  
Michael P. D'Alessandro ◽  
Donna M. D'Alessandro ◽  
Richard S. Bakalar
Keyword(s):  
Health Care ◽  
Digital Library ◽  
Cost Effective ◽  
Effective Manner ◽  
Improving Health Care

Cost-Effectiveness of Early-Initiated Treatment for Advanced-Stage Epithelial Ovarian Cancer Patients: A Modeling Study

2014 ◽  
Vol 24 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Tom Hoyer ◽  
Ruud Bekkers ◽  
Hein Gooszen ◽  
Leon Massuger ◽  
Maroeska Rovers ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Health Care ◽  
Cost Effectiveness ◽  
Epithelial Ovarian Cancer ◽  
Health Care Cost ◽  
Cost Effective ◽  
Current Treatment ◽  
Current Evidence ◽  
Advanced Stage ◽  
Life Years

ObjectiveBetween diagnosis and primary treatment of patients with epithelial ovarian cancer (EOC), gaps of several weeks exist. Reducing these time intervals may benefit the patient and may lead to a reduction of costs. We explored the cost-effectiveness of early-initiated treatment of patients with suspected advanced-stage EOC compared with that of current treatment.MethodsA discrete event simulation was used to synthesize all available evidences and to evaluate the health care costs and effects (quality-adjusted life years [QALYs]) of the 2 treatment strategies over lifetime. Overall survival, progression-free survival, health-related quality of life, and costs of the separate events were assumed to remain equal. Other uncertainties were addressed using deterministic and probabilistic sensitivity analyses.ResultsThe treatment times of current and early-initiated treatment were 27 and 24 weeks, respectively. Early-initiated treatment yielded 3.42 QALYs per patient, for a total expected health care cost of €25,654. Current treatment yielded 3.40 QALYs per patient, for a total expected health care cost of €25,607. This resulted in an incremental cost-effectiveness ratio of €2592 per QALY gained for early-initiated treatment compared with that for current treatment. For the willingness to pay for €30,000 or more per QALY, early-initiated treatment had a 100% probability of being cost-effective compared with current treatment under the previously mentioned assumptions.ConclusionsGiven the current evidence, early-initiated treatment of patients with suspected advanced-stage EOC leads to additional QALYs and seems to be cost-effective compared with current treatment.

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