Comparison of cost-effectiveness and postoperative outcomes following integration of a stiff shaft glidewire into percutaneous nephrolithotripsy

Aims: To analyze the cost effectiveness of integrating a stiff shaft glidewire (SSGW) in percutaneous nephrolithotripsy (PCNL) relative to standard technique (ST). This is prudent because healthcare providers are experiencing increased pressure to improve procedure-related cost containment. Methods: ST for PCNL at our institution involves a hydrophilic glidewire during initial percutaneous access and then two new stiff shaft wires. The SSGW is a hydrophilic wire used for initial access and the remainder of the procedure. We collected operating room (OR) costs for all primary, unilateral PCNL cases over a 5-month period during which ST for PCNL was used at a single institution with a single surgeon and compared with a 6-month period during which a SSGW was used. Mean costs for each period were then compared along with stone-free rates and complications. Results: We included 17 total cases in the ST group and 22 in the SSGW group. The average operating room supply cost for the ST group was $1937.32 and $1559.39 in the SSGW group. The net difference of $377.93 represents a nearly 20% decrease in cost. This difference was statistically significant ( p = 0.031). There was no difference in postoperative stone-free rates (82.4% versus 86.4%, p = 1.0, respectively) or complications (23.5% versus 13.6%, p = 0.677, respectively) between ST and SSGW groups. Conclusion: Transitioning to a SSGW has reduced OR supply cost by reducing the number of supplies required. The change in wire did not affect stone-free rates or complications.

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Cost-Effectiveness of Initial Revision Digit Amputation Performed in the Emergency Department Versus the Operating Room

Hand ◽

10.1177/1558944718790577 ◽

2018 ◽

Vol 15 (2) ◽

pp. 208-214 ◽

Cited By ~ 1

Author(s):

Joseph A. Gil ◽

Avi D. Goodman ◽

Andrew P. Harris ◽

Neill Y. Li ◽

Arnold-Peter C. Weiss

Keyword(s):

Emergency Department ◽

Cost Effectiveness ◽

Operating Room ◽

Cost Effective ◽

Initial Management ◽

Fingertip Amputation ◽

Significant Difference ◽

Initial Procedure ◽

The Cost ◽

Cost Effectiveness Threshold

Background: The objective of this study was to determine the comparative cost-effectiveness of performing initial revision finger amputation in the emergency department (ED) versus in the operating room (OR) accounting for need for unplanned secondary revision in the OR. Methods: We retrospectively examined patients presenting to the ED with traumatic finger and thumb amputations from January 2010 to December 2015. Only those treated with primarily revision amputation were included. Following initial management, the need for unplanned reoperation was assessed and associated with setting of initial management. A sensitivity analysis was used to determine the cost-effectiveness threshold for initial management in the ED versus the OR. Results: Five hundred thirty-seven patients had 677 fingertip amputations, of whom 91 digits were initially primarily revised in the OR, and 586 digits were primarily revised in the ED. Following initial revision, 91 digits required unplanned secondary revision. The unplanned secondary revision rates were similar between settings: 13.7% digits from the ED and 12.1% of digits from the OR ( P = .57). When accounting for direct costs, an incidence of unplanned revision above 77.0% after initial revision fingertip amputation in the ED would make initial revision fingertip amputation in the OR cost-effective. Therefore, based on the unplanned secondary revision rate, initial management in the ED is more cost-effective than in the OR. Conclusions: There is no significant difference in the incidence of unplanned/secondary revision of fingertip amputation rate after the initial procedure was performed in the ED versus the OR.

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Clinical Utility and Cost Effectiveness of Complement 3 and Complement 4 in different Clinical Subspecialties in Hamad Medical Corporation

University of the Future: Re-Imagining Research and Higher Education ◽

10.29117/quarfe.2020.0161 ◽

2020 ◽

Author(s):

Foziyeh Esmaiel Naji ◽

Mohammed Ehlayel ◽

Nader Al-Dewik ◽

Ahmed Malki

Keyword(s):

Cost Effectiveness ◽

Autoimmune Diseases ◽

Complement System ◽

Clinical Utility ◽

Healthcare Providers ◽

Diagnostic Tools ◽

Complement 3 ◽

Hamad Medical Corporation ◽

Complement 4 ◽

The Cost

Background: Complement system is one of ancient innate immune systems in our body fighting against pathogens and foreign bodies. Either one of its three pathways, classical, alternative or lectin activates it. Because of its role and importance in combating against different pathological conditions, it works through defined proteins including regulators and inhibitors. However, over or under stimulation of complement system can lead to various diseases. A number of analytical assays are used to measure complement proteins and its activation states considering complement 3 (C3), complement 4 (C4) as the most common test used. Objectives: Our aims are to study the clinical utility and cost effectiveness of C3 and C4 among different clinical subspecialties in Hamad Medical Corporation (HMC), Doha-Qatar. Design and methods: A retrospective study was conducted using electronic medical records to generate patient’s list from clinical immunology laboratory at HMC. Data on 326 patients were collected from 1st January till 31st March, 2017 and used as pilot study after omitting duplications. The data was studied for its demographical, disease categories, C3 and C4 test results. C3 and C4 test cost were calculated inside HMC and compared to other healthcare providers in country and abroad. Results: A total of 326 patients, 148 males and 178 females (M/F ratio:0.8:1), of age (mean age ±SD) of 36 ± 17.6 years. 289(86%) were >15 years and 47(14%) were 15 or less. Kidney diseases (34%), autoimmune diseases (25%), and allergic diseases (18%) were the top 3 diseases, and constituted 77% of all diseases. 45/336 (13.4%) showed low C3, C4, or both. Mean levels of C3 (±SD) was 120.8 ±36.3 mg/dl, and C4 was27.85±11.9 mg/dl. High C3 and C4 levels were observed in 53 (15.7%) of patients. The cost of performing one test either C3 or C4 in HMC is 22 QR ($6), while other healthcare providers inside the country costed 150-300 QR ($41.2-$82.4). Conclusion: Autoimmune diseases, renal diseases and joist diseases were the most common diseases with low C3 and C4 levels. Although the cost of a single test of C3 or C4 is low, the total annual cost is huge. The treating physician is recommended to exercise judicious clinical wisdom when ordering C3 or C4 tests as diagnostic tools

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Economic Impact of Home-Use versus Office-Use Diphenylcyclopropenone in Extensive Alopecia Areata

Skin Appendage Disorders ◽

10.1159/000520568 ◽

2021 ◽

pp. 1-10

Author(s):

Chinmanat Lekhavat ◽

Pinyo Rattanaumpawan ◽

Isree Juengsamranphong

Keyword(s):

Cost Effectiveness ◽

Side Effects ◽

Alopecia Areata ◽

Treatment Guidelines ◽

Healthcare Providers ◽

Cost Effective ◽

Real World Data ◽

Alternative Treatment Option ◽

Significant Difference ◽

The Cost

Introduction: Diphenylcyclopropenone (DPCP) is the medication of choice for the treatment of severe alopecia areata (AA) according to AA treatment guidelines. Precise initiation and application are important factors for successful treatment. However, it is difficult for patients who live far away to visit their doctor weekly. Methods: We conducted a retrospective cohort study to assess the cost, effectiveness, and side effects of DPCP treatment between office-use DPCP (O-DPCP) and home-use DPCP (H-DPCP) in severe AA patients. A cost-effectiveness analysis was performed from the perspective of healthcare providers and patients using real-world data and the national cost statistics for hospital services comparing O-DPCP and H-DPCP in patients with severe AA at 24, 36, and 48 weeks. Results: Two groups of 41 patients treated with O-DPCP and H-DPCP were enrolled. There was no significant difference in the proportion of patients who showed a favorable outcome (≥50% improvement) with minimal side effects between both groups at 24 (O-DPCP 43.9% vs. H-DPCP 26.8%, p = 0.11), 36 (O-DPCP 58.5% vs. H-DPCP 43.9%, p = 0.19), or 48 weeks (O-DPCP 63.4% vs. H-DPCP 56.1%, p = 0.49). The cost of H-DPCP was half of the cost of O-DPCP. Discussion/Conclusion: H-DPCP is a cost-effective and time-efficient alternative treatment option for severe AA patients.

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Managing Operating Room Cost in Cardiac Surgery with Three Process Interventions

Encyclopedia of Healthcare Information Systems ◽

10.4018/978-1-59904-889-5.ch104 ◽

2008 ◽

pp. 830-837

Author(s):

Antti Peltokorpi ◽

Juha-Matti Lehtonen ◽

Jaakko Kujala ◽

Juhani Kouri

Keyword(s):

Operating Room ◽

Operations Management ◽

Healthcare Providers ◽

Anesthesia Induction ◽

Open Heart ◽

Time Duration ◽

Public And Private ◽

Block Time ◽

Average Operating ◽

Efficiency And Productivity

Healthcare providers in both public and private sectors are facing increasing pressure to improve their cost efficiency and productivity. The increasing cost of new technological solutions has enforced to apply operations management techniques developed for industrial and service processes. Meyer’s (2004) review of existing research shows that, on average, operating rooms (ORs) operate only at 68% of capacity. Using OR time efficiently is especially challenging when long operations are scheduled to fixed OR block time. This situation is typical in open heart surgeries, where a high variability in the length of required OR time combined with four and a half hour average OR time duration makes scheduling two operations during a normal eight hour workday difficult. The objective of this paper is to analyze the effect that three different process interventions have on the OR cost in OR performing open heart surgeries. The investigated process interventions are 4 days OR week (4D), the better accuracy of operating room time forecast (F) and doing anesthesia induction outside the OR (I). These interventions were emerged from practical organization context. This paper is organized as follows. First we provide a review of the existing literature on measures of OR utilization and investigated three interventions. Based on existing literature we construct a simulation model to test the interventions’ effect on OR utilization. Conclusions of results are presented and practical implications and new contribution to existed theory of operating room management is discussed.

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