Oral Antibiotic Management of Acute Osteomyelitis of the Hand: Outcomes and Cost Comparison to Standard Intravenous Regimen

Hand ◽  
2019 ◽  
pp. 155894471987314
Author(s):  
Mark Henry ◽  
Forrest H. Lundy
Keyword(s):  
Bone Loss ◽  
Direct Cost ◽  
Cost Model ◽  
Cost Savings ◽  
Cost Of Care ◽  
Cost Comparison ◽  
Study Cohort ◽  
Oral Antibiotic ◽  
Direct Inoculation ◽  
The Cost

Background: Acute, direct inoculation osteomyelitis of the hand has traditionally been managed by intravenous antibiotics. With proven high levels of bone and joint penetration, specific oral antimicrobials may deliver clinical efficacy but at substantially lower cost. Methods: Sixty-nine adult patients with surgically proven acute, direct inoculation osteomyelitis of the hand were evaluated for clinical response on a 6-week postdebridement regimen of susceptibility-matched oral antibiotics. Inclusion required gross purulence and bone loss demonstrated at the initial debridement and radiographic evidence of bone loss. Excluded were 2 patients with extreme medical comorbidities. There were 53 men and 16 women with a mean age of 46 years. Mean follow-up was 16 weeks (±10). The cost model for the outpatient oral antibiotic treatment was intentionally maximized using Walgreen’s undiscounted cash price. The cost model for the traditional intravenous treatment regimen was intentionally minimized using the fully discounted Medicare fee schedule. Results: All patients achieved resolution of osteomyelitis by clinical and radiographic criteria. In addition, 7 patients underwent successful subsequent osteosynthesis procedures at the previously affected site without reactivation. The mean postdebridement direct cost of care per patient in the study cohort was $482.85, the cost of the antibiotic alone. The postdebridement direct cost of care per patient on a regimen of vancomycin 1.5 g every 12 hours via peripherally inserted central catheter line was $21 646.90. Conclusions: Acute, direct inoculation osteomyelitis of the hand can be successfully managed on oral antibiotic agents with substantial direct and indirect cost savings.

scholarly journals Cost and consequences of using 7.1% chlorhexidine gel for newborn umbilical cord care in Kenya

2021 ◽  
Author(s):  
Lecia Brown ◽  
Alan Martin ◽  
Christopher Were ◽  
Nandita Biswas ◽  
Alexander Liakos ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Direct Cost ◽  
Cost Savings ◽  
Cost Of Care ◽  
World Health ◽  
Healthcare Sector ◽  
Cord Care ◽  
Outpatient Visits ◽  
Umbilical Cord Care ◽  
Bed Days

Abstract Background: Umbilical-cord infection (omphalitis) is a major cause of neonatal mortality in Kenya. Chlorhexidine 7.1% digluconate gel, (CHX), delivering 4% chlorhexidine was identified as a life-saving commodity for newborn cord care by the United Nations and is included on the World Health Organization and Kenyan Essential Medicines Lists. Methods: We employed a cost-consequence model to assess resource saving and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Economic outcomes associated with omphalitis cases avoided were then determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Costs and other inputs were sourced from the literature and supplemented by expert clinical opinion/informed inputs, making assumptions as necessary. Reports: The model estimated that, over 1 year, ~23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~13,000 outpatient visits, ~43,000 bed days and preserving ~114,000 workdays. CHX was associated with annual direct cost savings of ~590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and of 5.43 USD/course when also including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of the impacts of upscaling CHX use more robust.

Cost Comparison of Fan-Out WLP vs. Embedded Die

2011 ◽  
Vol 2011 (DPC) ◽  
pp. 001003-001018
Author(s):  
Alan Palesko ◽  
Jan Vardaman
Keyword(s):  
Cost Model ◽  
Form Factors ◽  
Cost Effective ◽  
Cost Comparison ◽  
Package Design ◽  
Supply Chain Logistics ◽  
Cost Effective Approach ◽  
Large Production ◽  
The Cost ◽  
Cost Differences

Fabricating the package after the die is placed can result in smaller form factors, increased performance, and improved supply chain logistics for OEMs. There are many different approaches for this packaging technique, but two of the most prominent are Fan-Out WLP and Embedded Die. Fan-Out WLP leverages existing semiconductor technology for a cost effective approach to achieve relatively tight package design rules. The Embedded Die strategy leverages existing PCB lamination technology for cost-reduction through scale: fabricating many small packages on large production panels. We will examine the cost differences and similarities between Fan-Out WLP and Embedded Die strategies by developing a comprehensive cost model for each technology. We will then analyze the manufacturing costs (labor, material, depreciation, yield loss, and tooling) and yield impacts across a variety of designs to demonstrate the cost differences and similarities in each packaging technology.

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.

scholarly journals Cost Comparison of Suture Anchor Modified Broström Repair and Augmentation of the Modified Broström with FiberTape Device

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0047
Author(s):  
Emily Vannatta ◽  
Chris M. Stauch ◽  
Jesse King ◽  
Morgan S. Kim ◽  
Laura R. Luick ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Return To Work ◽  
Ankle Instability ◽  
Group Versus ◽  
Cost Savings ◽  
Chronic Ankle Instability ◽  
Cost Comparison ◽  
Suture Anchors ◽  
Ligament Repair ◽  
The Cost

Category: Ankle; Sports Introduction/Purpose: Augmentation of the Broström procedure with FiberTape device has been described for the treatment of chronic ankle instability. However, it has yet to be determined if the cost of the implant is negated by the benefits to the patient. The purpose of this study was to perform a comprehensive cost analysis by comparing the cost of surgical procedure, physical therapy visits, time off work, and any costs related to revision surgery between the Broström reconstruction with suture anchors alone versus augmentation with a FiberTape device. Methods: 166 patients undergoing lateral ankle ligament repair were analyzed retrospectively. Patients underwent either a modified Broström ligament repair with two suture anchors or Broström ligament repair with FiberTape augmentation. All patients followed the same post-operative protocol for early weight bearing and initiation of physical therapy once the wound was healed. Timing of return to work and the total number of visits of physical therapy before discharge were recorded. Implant costs, facility charges and professional fees were obtained from billing records. Lost income for missed days of work was based on the Pennsylvania Bureau of Labor Statistics. Complications requiring return to the operating room were recorded. Patients were followed out to one year. Results: Aggregate cost in the modified Broström group was $2,219 more expensive than when augmenting with FiberTape ($20,970 vs. $18,751) despite an increased implant cost of $900. This difference was the result of a greater number of therapy visits and days out of work in the modified Broström group versus the augmentation group (14.9 vs 12.4) as well as a significantly higher amount of days out of work in the modified Broström group versus augmentation (63.3 vs. 53.8 days respectively). No statistically significant difference was found for operation time between groups, and failure rates were similar; 2.0% (1/49) for FiberTape and 3.4% (4/117) for modified Broström. Conclusion: The aim of this study was to explore the cost comparison of the modified Broström procedure for chronic ankle instability versus the FiberTape augmentation. Despite an upfront increase in implant costs, the average cost per procedure was lower for the augmentation group. The majority of cost savings occurred in decreases in the number of physical therapy visits and faster return to work times. The results of this study suggest that the use of FiberTape to augment modified Broström repair may have a financial benefit and cost savings to patients and the healthcare system.

scholarly journals Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lecia Brown ◽  
Alan Martin ◽  
Christopher Were ◽  
Nandita Biswas ◽  
Alexander Liakos ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Direct Cost ◽  
Cost Savings ◽  
Cost Of Care ◽  
World Health ◽  
Healthcare Sector ◽  
Cord Care ◽  
Outpatient Visits ◽  
Umbilical Cord Care ◽  
Bed Days

Abstract Background Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. Methods We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. Results The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.

Benefit Evaluation for Manufacturing of Marine Propellers

2008 ◽  
Author(s):  
Der-Min Tsay ◽  
Hsin-Pao Chen ◽  
Sa´ndor Vajna ◽  
Michael Schabacker
Keyword(s):  
Cost Model ◽  
Cost Savings ◽  
Machining Efficiency ◽  
Machining Time ◽  
Marine Propellers ◽  
Tool Paths ◽  
Benefit Evaluation ◽  
Cad Cam ◽  
Increase Productivity ◽  
The Cost

To increase productivity of marine propellers by raising machining efficiency, this paper presents the zigzag/spiral tool paths generation algorithm based on the arc base curve approach for three-axis machining of curved surfaces of propellers. By considering the shapes of selected cutters with different types of tool paths generated by the proposed procedure, machining efficiency can be calculated and simulated. To verify the accuracy and effectiveness of the developed approach, numerical and experimental results of machining of propeller surfaces are compared. It was proved that the machining time can be cut down up to 19% by using zigzag tool paths with a toroidal cutter. In addition, the machining knowledge revealed here can be accumulated for benefit evaluation in the manufacturing process with existing CAD/CAM systems. From the cost model, design, and process views, the overall cost savings after 5 years are investigated, and the expected benefit yield is about 45%.

Cost assessment of multi-tenancy for a 5G broadband network in a dense urban area

2020 ◽  
Vol 22 (2) ◽  
pp. 53-70
Author(s):  
Juan Rendon Schneir ◽  
Konstantinos Konstantinou ◽  
Julie Bradford ◽  
Gerd Zimmermann ◽  
Heinz Droste ◽  
...  
Keyword(s):  
Cost Model ◽  
Access Network ◽  
Cost Savings ◽  
Economic Benefits ◽  
Mobile Service ◽  
Content Type ◽  
Broadband Network ◽  
Cost Implications ◽  
The Cost ◽  
Network Sharing

Purpose 5G systems will enable an improved transmission performance and the delivery of advanced communication services. To meet the expected requirements, operators will need to invest in network modernisation, with the radio access network being the most expensive network component. One possible way for operators to reduce this investment would be via sharing of resources by means of a multi-tenancy concept. This implies that a mobile service provider may use the common infrastructure of one or various infrastructure providers, whereby it provides services to multiple tenants. This paper aims to study the expected cost savings in terms of capital expenditures (CAPEX) and operational expenditures (OPEX) that can be achieved when using a cloudified 5G multi-tenant network. Design/methodology/approach A cost model was used. The study period is 2020-2030 and the study area consists of three local districts in central London, UK. Findings This paper describes that the total cost reduction achieved when using multi-tenancy for a 5G broadband network in comparison with the case where operators make the investment independently ranges from 5.2% to 15.5%. Research limitations/implications Further research is needed to assess the cost implications of network sharing for 5G on a regional or nationwide basis. Originality/value Very little quantitative research about the cost implications of network sharing under 5G networks has been published so far. This paper sheds light on the economic benefits of multi-tenancy in a 5G broadband network.

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 Cost savings to hospital of rituximab use in severe autoimmune acquired thrombotic thrombocytopenic purpura

2020 ◽  
Vol 4 (3) ◽  
pp. 539-545
Author(s):  
George Goshua ◽  
Amit Gokhale ◽  
Jeanne E. Hendrickson ◽  
Christopher Tormey ◽  
Alfred Ian Lee
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Cost Savings ◽  
Cost Of Care ◽  
Inpatient Admission ◽  
Inpatient Cost ◽  
Inpatient Setting ◽  
Thrombocytopenic Purpura ◽  
Academic Center ◽  
The Cost ◽  
Barrier To Care

Abstract Patients with severe autoimmune thrombotic thrombocytopenic purpura (TTP) experience acute hematologic emergencies during disease flares and a lifelong threat for relapse. Rituximab, in addition to steroids and therapeutic plasma exchange (TPE), has been shown to mitigate relapse risk. A barrier to care in initiating rituximab in the inpatient setting has been the presumed excessive cost of medication to the hospital. Retrospectively reviewing TTP admissions from 2004 to 2018 at our academic center, we calculated the actual inpatient cost of care. We then calculated the theoretical cost to the hospital of initiating rituximab in the inpatient setting for both initial TTP and relapse TTP cohorts, with the hypothesis that preventing sufficient future TTP admissions offsets the cost of initiating rituximab in all patients with TTP. At a median follow-up of 55 months in the initial TTP cohort, rituximab use produced a projected cost savings of $905 906 and would have prevented 185 inpatient admission days and saved 137 TPE procedures. In the relapse TTP setting, rituximab use produced a projected cost savings of $425 736 and would have prevented 86 inpatient admission days and saved 64 TPE procedures. From a hospital cost standpoint, cost of rituximab should no longer be a barrier to initiating inpatient rituximab in both initial and relapse TTP settings.

A cost comparison of two strategies for treating stage IB2 cervical cancer

2008 ◽  
Vol 18 (2) ◽  
pp. 274-278 ◽  
Author(s):  
J. A. Lachance ◽  
C. J. Darus ◽  
G. J. Stukenborg ◽  
B. F. Schneider ◽  
L. W. Rice ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Operating Room ◽  
Cost Of Care ◽  
Cost Comparison ◽  
External Beam Radiation ◽  
Tumor Diameter ◽  
Beam Radiation ◽  
Definitive Chemoradiation ◽  
Adjuvant Hysterectomy ◽  
The Cost

Patients with stage IB2 cervical cancer at our institution are treated primarily with definitive chemoradiation, or chemoradiation followed by adjuvant hysterectomy. We sought to compare the cost differences associated with these two strategies. We identified all patients with stage IB2 cervical cancer who received their entire treatment regimen at our institution between 1995 and 2004. All patients received a combination of chemotherapy, external beam radiation, and one brachytherapy procedure, followed by either a second brachytherapy procedure or a simple hysterectomy. We retrieved cost data associated with hospitalization for the completion of respective treatment, including pharmacy, laboratory and pathology, radiation, and operating room services, as well as the costs of supplies and room and board. We identified 46 patients with stage IB2 cervical cancer, 23 who received a second brachytherapy procedure and 23 who underwent simple hysterectomy. Patients displayed similar demographics and similar disease characteristics including initial tumor diameter and histology. The cost of care for adjuvant hysterectomy group was greater ($8,316.70 vs 5,508.70, P< 0.0001). Specific differences included higher operating room costs ($1520 vs 414, P< 0.0001), pharmacy costs ($675 vs 342, P< 0.0001), and laboratory/pathology costs ($597 vs 89, P< 0.0001). We conclude that definitive chemoradiation appears to be associated with lower costs for management of stage IB2 cervical cancer when compared to simple adjuvant hysterectomy.

Sign in / Sign up

Export Citation Format

Share Document