The Influence of Dose Frequency and Agent Toxicity on the Cost of Parenteral Antibiotic Therapy

1982 ◽  
Vol 16 (12) ◽  
pp. 935-938 ◽  
Author(s):  
Robert P. Rapp ◽  
Catherine L. Bannon ◽  
Brack A. Bivins
Keyword(s):  
Combination Therapy ◽  
Antibiotic Therapy ◽  
First Generation ◽  
Single Agent ◽  
Cost Effective ◽  
Generation Cephalosporin ◽  
Dose Frequency ◽  
Surgery Patient ◽  
Time Required ◽  
The Cost

The influence of the number of daily doses on the overall cost of antibiotic therapy is examined in a general surgery patient population. Patients receiving a single first-generation cephalosporin are compared with patients receiving two or three antibiotics (including an aminoglycoside) in terms of (1) the cost of the drug and the supplies, (2) time required for nursing and pharmacy personnel to prepare and administer the doses, and (3) the influence of agent toxicity (renal function) on physician-ordered laboratory tests. On the whole, combination therapy including an aminoglycoside was four times as expensive as single-agent (first-generation cephalosporin) therapy. If future studies demonstrate that single-agent antibiotic therapy is as effective as traditional combination therapy for specific infectious diseases, the influence of the number of daily doses of drug and agent toxicity may support the cost-effective use of the newer agents.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

scholarly journals Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline

2006 ◽  
Vol 189 (6) ◽  
pp. 494-501 ◽  
Author(s):  
Judit Simon ◽  
Stephen Pilling ◽  
Rachel Burbeck ◽  
David Goldberg
Keyword(s):  
Combination Therapy ◽  
Decision Analysis ◽  
Secondary Care ◽  
Treatment Options ◽  
Severe Depression ◽  
Cost Effective ◽  
Current Evidence ◽  
Resource Utilisation ◽  
Moderate Depression ◽  
The Cost

BackgroundTreatment options for depression include antidepressants, psychological therapy and a combination of the two.AimsTo develop cost-effective clinical guidelines.MethodSystematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.ResultsOver the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400–18 300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression.ConclusionsCombination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.

scholarly journals The Cost-effectiveness of Biological Therapy Cycles in the Management of Crohn’s Disease

2019 ◽  
Vol 13 (10) ◽  
pp. 1323-1333 ◽  
Author(s):  
Kristian Bolin ◽  
Erik Hertervig ◽  
Edouard Louis
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Willingness To Pay ◽  
Cost Effective ◽  
Treatment Intensification ◽  
Tree Model ◽  
Necrosis Factor Alpha ◽  
The Cost

Abstract Objectives To examine the cost-effectiveness of continued treatment for patients with moderate-severe Crohn’s disease in clinical remission, with a combination of anti-tumour necrosis factor alpha [anti-TNFα] [infliximab] and immunomodulator therapy compared with two different withdrawal strategies: [1] withdrawal of the anti-TNFα therapy; and [2] withdrawal of the immunomodulator therapy, respectively. Methods A decision-tree model was constructed mimicking three treatment arms: [1] continued combination therapy with infliximab and immunomodulator; [2] withdrawal of infliximab; or [3] withdrawal of the immunomodulator. Relapses in each arm are managed with treatment intensification and re-institution of the de-escalated drug according to a prespecified algorithm. State-dependent relapse risks, remission probabilities, and quality of life weights were collected from previous published studies. Results Combination therapy was less costly and more efficient than the withdrawal of the immunomodulator, and more costly and more efficient than withdrawal of infliximab. Whether or not combination therapy is cost-effective, compared with the alternatives, depends primarily on current pharmaceutical prices and the willingness-to-pay per additional quality-adjusted life-year [QALY]. Conclusions Combination therapy using a combination of anti-TNFα [infliximab] and an immunomodulator is cost-effective in the treatment of Crohn’s disease compared with treatment cycles in which the immunomodulator is withdrawn. Combination treatment is cost-effective compared with treatment cycles in which infliximab is withdrawn, at prices of infliximab below€192/100 mg, given a willingness-to-pay threshold at€49 020 [Sweden] per additional QALY.

Inspection Manpower Planning for X & S Control Charts

2012 ◽  
Vol 488-489 ◽  
pp. 1624-1630
Author(s):  
Wen An Yang ◽  
Wen He Liao ◽  
Yu Guo
Keyword(s):  
Control Charts ◽  
Cost Effective ◽  
Manpower Planning ◽  
Sampling Interval ◽  
Optimal Number ◽  
Optimization Strategy ◽  
Effective Manner ◽  
Time Required ◽  
The Cost ◽  
And Control

A method of determining the optimal number of inspectors and/or working time required on a specific SPC activity is presented in the study. The issue of inspection manpower planning is handled as a constrained optimization problem. The optimization strategy is not only to minimize the avoidable surplus quality loss due to failure of detecting the out-of-control states but to determine the cost of inspection manpower from the perspective of deploying an appropriate amount of inspection manpower in a cost-effective manner, and meanwhile the values of sample size, sampling interval and control limits of control charts are also determined. The result obtained indicates that the total cost (or loss) can be substantially reduced if implementing control charts was equipped with adequate inspection manpower.

Is There Cost Reduction Potential for Extended Half-Life Cephalosporins?

1986 ◽  
Vol 20 (12) ◽  
pp. 975-980 ◽  
Author(s):  
Robert D. Scalley ◽  
Clifford C. Stuart
Keyword(s):  
Half Life ◽  
Cost Reduction ◽  
Drug Acquisition ◽  
Cost Effective ◽  
Generation Cephalosporin ◽  
Nursing Time ◽  
Personnel Costs ◽  
Acquisition Costs ◽  
The Cost ◽  
The Impact

Two new second-generation cephalosporin derivatives with extended half-lives, ceforanide and cefonicid, have recently entered the U.S. marketplace. Because longer dosing intervals require fewer daily doses, potential exists for overall cost reduction if pharmacy and nursing time can be effectively saved. Reduction in personnel costs, however, must be sufficient for these more expensive products to be truly cost effective. We studied the impact of substituting these newer agents for older, less expensive products with formulary status at our 200-bed community hospital. Results show that no nursing expenses could be recovered, and there is little chance of consistently reducing pharmacy compounding expenses. Within the constraints of these studies, particularly physician prescribing habits, the GRASP (Grace Reynolds Application and Study of PETO) system of determining nurse staffing, and our drug acquisition costs, we find that the newer extended half-life products have very limited usefulness and may only increase the cost of antibiotic utilization.

Development of an Economic and Efficient Installation Vessel for Tidal Stream Energy Converter Arrays

2013 ◽  
Author(s):  
Rachel Nicholls-Lee ◽  
Simon Hindley ◽  
Richard Parkinson
Keyword(s):  
Oil And Gas ◽  
Cost Effective ◽  
Concept Design ◽  
Market Place ◽  
Operations And Maintenance ◽  
Tidal Turbine ◽  
Tidal Stream ◽  
Tidal Stream Energy ◽  
Time Required ◽  
The Cost

In order for tidal stream technology to develop into a viable and cost effective energy solution, the overall cost of tidal array installation, operations and maintenance must be driven down. The key issues which drive the cost are the time required to conduct operations and susceptibility to weather risk coupled with the expense of marine assets. Current vessels have limited operational windows due to weather and tidal constraints, which result in considerable cumulative costs due to high charges for such vessels. The marine renewable industry is currently reliant on vessels of opportunity from the offshore oil and gas sector; which, while sufficient for single device demonstration deployments, are not viable for array installations. De-coupling the tidal sector from this market place offers the opportunity to reduce the volatility of vessel day rates. This paper presents the concept design of an efficient and economic, fit for purpose installation vessel for tidal stream energy converters. The vessel has good dynamic positioning capabilities for operation in strong tidal currents thus broadening the operational window. The environmental impact of the vessel is reduced when compared to existing vessels. A key criterion throughout the design process is minimizing the cost of the vessel to tidal turbine site developers.

Cost-effectiveness of nivolumab for treatment of platinum-resistant recurrent or metastatic squamous cell carcinoma of the head and neck.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6026-6026 ◽  
Author(s):  
Kate Carroll ◽  
Kathryn Ries Tringale ◽  
Kaveh Zakeri ◽  
Assuntina Gesualda Sacco ◽  
Linda Barnachea ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Single Agent ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Single Agent Therapy ◽  
The Cost

6026 Background: The Checkmate 141 randomized trial found that patients with platinum-refractory, recurrent or metastatic (R/M) squamous-cell carcinoma of the head and neck (SCCHN) treated with nivolumab had significantly longer overall survival than those treated with standard, single-agent therapy. However, nivolumab is more expensive than standard treatment. We conducted a cost-effectiveness analysis of nivolumab for the treatment of R/M SCCHN. Methods: We constructed a Markov model to simulate treatment with nivolumab or other single-agent therapy (docetaxel, cetuximab, or methotrexate) for patients with R/M SCCHN. Transition probabilities including disease progression, survival, and toxicity were derived from clinical trial data, while costs (in 2016 US dollars) and health utilities were estimated from the literature. Incremental cost-effectiveness ratios (ICERs), expressed as dollar per quality-adjusted life-year (QALY), were calculated with values less than $100,000/QALY considered cost-effective from a healthcare payer perspective. We conducted one-way and probabilistic sensitivity analyses to examine model uncertainty. Results: Our base-case model found that treatment with nivolumab increased overall cost by $59,000 and improved effectiveness by 0.2443 QALYs compared to single-agent therapy, leading to an ICER of $241,100/QALY. In sensitivity analyses, the model was most sensitive to the cost of nivolumab and assumptions about survival. Nivolumab would become cost-effective if the cost per cycle decreased from $13,432 to $5,716. If we assumed that all patients alive at the end of the Checkmate 141 trial were cured of their disease then nivolumab was still not considered cost-effective (ICER $160,000/QALY). Probabilistic sensitivity analysis also demonstrated relative stability of the cost-effectiveness model and found that treatment with nivolumab was cost-effective 0% of the time at a willingness-to-pay threshold of $100,000/QALY. Conclusions: While nivolumab significantly improves overall survival, at the current cost it would not be considered a cost-effective treatment option for patients with R/M SCCHN.

scholarly journals The Cost-effectiveness of Initial Immunomodulators or Infliximab Using Modern Optimization Strategies for Crohn’s Disease in the Biosimilar Era

2019 ◽  
Author(s):  
Abhinav Vasudevan ◽  
Francis Ip ◽  
Danny Liew ◽  
Daniel R Van Langenberg
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Cost Effective ◽  
Extended Model ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Therapy Costs ◽  
The Cost

Abstract Background Treatment cost, efficacy, and safety are integral considerations when optimizing management of Crohn’s disease (CD). This study assessed the cost-effectiveness of initial immunomodulator and anti–tumor necrosis factor (anti-TNF) agents for the treatment of CD from a US third-party perspective, incorporating current treatment algorithms, optimization strategies, and reduced costs availed by biosimilars. Method A 1-year Markov model was developed to simulate the cost and quality-adjusted life-years (QALYs) of initial azathioprine, infliximab, and combination therapy for moderate to severe CD. Treatment was changed based on tolerability and clinical disease activity at 3-monthly intervals. Efficacy data were based on published literature. Results Initial azathioprine had the lowest cost and utility ($35,337 and 0.63 QALYs), whereas combination therapy was the costliest yet conferred the highest health benefits ($57,638 and 0.67 QALYs). The incremental cost-effectiveness of infliximab and combination therapy compared with azathioprine were both in excess of $500,000 per QALY gained. Initial azathioprine remained the most cost-effective treatment on sensitivity analysis compared with infliximab and combination therapy, with 90% reductions in anti-TNF therapy costs and a 5-year time horizon, although combination therapy had an acceptable cost-effectiveness when costs were reduced in the extended model. Initial infliximab, ustekinumab, and vedolizumab were dominated by combination therapy. Conclusions In the biosimilar era, initial azathioprine with escalation to infliximab appeared more cost-effective in the short term compared with infliximab or combination therapy, although initial combination therapy yields acceptable ICERs in the long term with continued reductions in anti-TNF therapy costs and will likely be the preferred treatment strategy in the future.

scholarly journals Hydrophone VSP surveys in hard rock

Geophysics ◽  
2012 ◽  
Vol 77 (5) ◽  
pp. WC223-WC234 ◽  
Author(s):  
Andrew Greenwood ◽  
Christian J. Dupuis ◽  
Milovan Urosevic ◽  
Anton Kepic
Keyword(s):  
Hard Rock ◽  
Cost Effective ◽  
Mine Planning ◽  
Data Sets ◽  
Successful Case ◽  
Seismic Acquisition ◽  
Deployment Time ◽  
Time Required ◽  
Operational Issues ◽  
The Cost

Seismic imaging in hard rock environments is gaining wider acceptance as an exploration technique and as a mine-planning tool. To date, 13 successful case studies have been acquired in Australia. The images generated from hard rock targets exhibit large levels of complexity and their interpretations remain an active area of study. To assist the imaging and better understand the source of the reflections observed, vertical seismic profiling (VSP) can be employed. This technique is not readily applied to hard rock environments because cost and operational issues often prove prohibitive. We propose the use of hydrophone arrays as a cost effective solution to VSP acquisition. We highlight the key challenges in using these receivers and propose solutions to overcome them. By careful acquisition methodologies and refined signal processing techniques, the tube waves that have up to now compromised the use of hydrophones for VSP acquisition can be effectively mitigated. We show that the data acquired with hydrophones compare favorably to that acquired with conventional 3C geophones. The data acquired with hydrophones come at a fraction of the cost and deployment time required for conventional acquisition procedures. Our results show that hydrophone vertical seismic acquisition is a viable, cost effective, and efficient solution that should be employed more routinely in hard rock environments to enhance the value of the surface data sets being acquired.

The effect of collector size on forest litter-fall collection and analysis

1983 ◽  
Vol 13 (6) ◽  
pp. 1037-1042 ◽  
Author(s):  
M. C. McShane ◽  
D. W. Carlile ◽  
W. T. Hinds
Keyword(s):  
Cost Effective ◽  
Forest Litter ◽  
Litter Fall ◽  
Laboratory Sample ◽  
Large Numbers ◽  
The Mean ◽  
Definition Of ◽  
Time Required ◽  
The Cost ◽  
Sample Sorting

Litter fall is commonly collected for a variety of ecological studies. This study was designed to test the effect of collector size on the precision of forest litter-fall estimates and on the time involved in laboratory sample sorting. Collectors varied in size from 0.010 to 0.933 m2 and were physically nested, the smaller units within larger units. Ten of these collector combinations were randomly placed on a 1-ha plot in a Douglas-fir/western hemlock (Pseudotsugamenziesii (Mirb.) Franco/Tsugaheterophylla (Raf.) Sarg.) stand in H. J. Andrews Experimental Forest. Collections were made monthly and records were kept of the time required to sort the litter into needles, epiphytes, and miscellaneous categories. Based on a definition of precision as ±10% of the mean, 90% of the time, results indicate (i) that the cost of obtaining precise estimates of needle fall decreases with decreasing collector size to 0.010 m2, (ii) that collectors of any size can be used to obtain estimates of total litter fall if the number of collectors required to obtain precise results is determined, and (iii) that precise estimates of epiphyte biomass require large numbers of samplers and are not cost effective.

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