scholarly journals A Comparative Analysis of Risk and Cost-effectiveness of Outpatient versus Inpatient Hindfoot Fusion

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035
Author(s):  
Andrew Moon ◽  
Andrew McGee ◽  
Harshadkumar Patel ◽  
Samuel Huntley ◽  
Martim Pinto ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Outpatient Surgery ◽  
Outpatient Setting ◽  
Emergency Department Visits ◽  
Average Total Cost ◽  
Fusion Surgery ◽  
Total Cost ◽  
Ed Visits ◽  
Hindfoot Fusion ◽  
The Cost

Category: Hindfoot Introduction/Purpose: Hindfoot fusion procedures are increasingly being performed in the outpatient setting. However, the cost-effectiveness of hindfoot fusion procedures compared with risk and benefit have not been clearly investigated. The primary objective of this study was to investigate the cost-effectiveness of outpatient versus inpatient hindfoot arthrodesis. Secondary objectives were to compare patient characteristics and short-term complications of patients in each cohort. Methods: This was a retrospective review of all patients who underwent inpatient and outpatient hindfoot fusion procedures at a single institution from 2013-2017. Data collected for each patient included demographic information, operative variables, comorbidities, complications, and any subsequent emergency department visits, readmissions or reoperations. Cost data was collected for each inpatient or outpatient encounter, as well as any subsequent encounters related to the index procedure. Results: Of 151 total hindfoot procedures performed over the study period, 37 were inpatient and 114 were performed in the outpatient setting. There were 3 more readmissions, 22 more ED visits, and 0 more reoperations after outpatient surgery vs inpatient surgery. The average total cost for an outpatient hindfoot fusion procedure was significantly lower than the average total cost for inpatient hindfoot fusion, without a significant increase in complication rate. We are currently in the process of performing the total cost analysis, and will have the completed cost and risk/benefit information within the next two weeks. Conclusion: Outpatient hindfoot fusion surgery may be more cost-effective when compared to inpatient fusion surgery without a significant increase in complications, ED visits, or readmissions.

Cost-effectiveness analysis of first-line treatment for metastatic renal cell carcinoma (mRCC) in Colombia (ONCOLGroup study)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16150-e16150
Author(s):  
J. Godoy ◽  
A. F. Cardona ◽  
H. Cáceres ◽  
J. M. Otero ◽  
M. Lujan ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Renal Cell ◽  
Cost Effective ◽  
Average Total Cost ◽  
Line Treatment ◽  
First Line ◽  
Total Cost ◽  
The Cost ◽  
First Line Treatment

e16150 Background: Renal cell carcinoma has increased its incidence by 126% since 1950. A local study developed a complete economic evaluation of sunitinib versus IFN in first-line treatment of mRCC in Colombia, finding that sunitinib was more cost-useful and cost-effective. Methods: A Markov model was developed using 6-week cycles for evaluating the cost-effectiveness of four interventions (IFN, sunitinib, bevacizumab+IFN, sorafenib) approved as first-line treatment for mRCC in Colombia. The model used the third-party payer perspective and a 5-year time-line; it also presumed that all the patients (pts) continued with active treatment until progression when it became acceptable to continue with a second-line treatment or BSC. Overall survival (OS) and progression-free survival (PFS) curves of IFN were used as reference framework; they were obtained form a published clinical trial. The hazard ratios (HR) for PFS and OS were estimated for comparing new generation medicaments with IFN. The information about frequency of use and health service cost units consumed in Colombia was taken from a series of 24 pts treated in Manizales, Pereira, Medellín and Bogotá. Service costs were requested from an external consultant and corresponded to the average value billed by the EPSs, calculated from 33 sources of information which were representative of the country's market. The cost of the medicaments was obtained from LCLC. The costs and benefits were discounted annually at 3%. (all cost are presented in Colombian pesos Col$ 2008 with an exchange rate 1 USD = 1836.20 Col$). Results: Incremental analysis indicated a difference of 41.1 million Col$ in the average total cost of treatment when Sunitinib was compared to IFN; in contrast, comparing sorafenib and Bevacizumab+INF to sunitinib demonstrated that the average total cost was less for the sunitinib by 8.3 and 104.2 million Col$, respectively. Additionally, the ratios of incremental cost-effectiveness by life years (LY) gained demonstrated sunitinib's simple dominance over sorafenib and the combination of bevacizumab+IFN, and an average by LY gained of 100.5 million Col$ compared to IFN. Conclusions: Sunitinib is the most cost-effective option as first-line treatment for mRCC pts in Colombia. [Table: see text]

scholarly journals Cost analysis of breast cancer diagnostic assessment programs

2017 ◽  
Vol 24 (5) ◽  
pp. 354 ◽  
Author(s):  
G.N. Honein-AbouHaidar ◽  
J.S. Hoch ◽  
M.J. Dobrow ◽  
T. Stuart-McEwan ◽  
D.R. McCready ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Medical Records ◽  
Diagnostic Tests ◽  
Estimation Method ◽  
Financial Data ◽  
Diagnostic Assessment ◽  
Future Cost ◽  
Total Cost ◽  
The Cost

Objectives Diagnostic assessment programs (daps) appear to improve the diagnosis of cancer, but evidence of their cost-effectiveness is lacking. Given that no earlier study used secondary financial data to estimate the cost of diagnostic tests in the province of Ontario, we explored how to use secondary financial data to retrieve the cost of key diagnostic test services in daps, and we tested the reliability of that cost-retrieving method with hospital-reported costs in preparation for future cost-effectiveness studies.Methods We powered our sample at an alpha of 0.05, a power of 80%, and a margin of error of ±5%, and randomly selected a sample of eligible patients referred to a dap for suspected breast cancer during 1 January–31 December 2012. Confirmatory diagnostic tests received by each patient were identified in medical records. Canadian Classification of Health Intervention procedure codes were used to search the secondary financial data Web portal at the Ontario Case Costing Initiative for an estimate of the direct, indirect, and total costs of each test. The hospital-reported cost of each test received was obtained from the host-hospital’s finance department. Descriptive statistics were used to calculate the cost of individual or group confirmatory diagnostic tests, and the Wilcoxon signed-rank test or the paired t-test was used to compare the Ontario Case Costing Initiative and hospital-reported costs.Results For the 191 identified patients with suspected breast cancer, the estimated total cost of $72,195.50 was not significantly different from the hospital-reported total cost of $72,035.52 (p = 0.24). Costs differed significantly when multiple tests to confirm the diagnosis were completed during one patient visit and when confirmatory tests reported in hospital data and in medical records were discrepant. The additional estimated cost for non-salaried physicians delivering diagnostic services was $28,387.50.Conclusions It was feasible to use secondary financial data to retrieve the cost of key diagnostic tests in a breast cancer dap and to compare the reliability of the costs obtained by that estimation method with hospital-reported costs. We identified the strengths and challenges of each approach. Lessons learned from this study have to be taken into consideration in future cost-effectiveness studies.

The planning, rationing and organization of work on technical maintenance of machinery and equipment in animal husbandry

2021 ◽  
pp. 58-67
Author(s):  
L. I. Kovalyev ◽  
I. L. Kovalyev ◽  
M. N. Kostomakhin
Keyword(s):  
Animal Husbandry ◽  
Dairy Farms ◽  
Technical Service ◽  
Average Total Cost ◽  
Highly Qualified ◽  
Maintenance And Repair ◽  
Total Cost ◽  
Service Contracts ◽  
Technical Maintenance ◽  
The Cost

Maintenance and repair of livestock machinery and equipment is carried out as a rule by specialized repair and service enterprises on the basis of service contracts in accordance with the procedure established by law. However, with the renewal of the park’s farms with machines and equipment with automated and computerized process control, as well as the reconstruction of dairy farms and complexes, it became necessary to have a production base and highly qualified specialists for the maintenance of equipment. The most important and key provisions of the improved methodology of planning and accounting of work in the technical service of animal husbandry with the use of a number of standards are given, some features of accounting and planning of these types of work have been noted. The concepts of “repair unit” and “category of complexity of technical service” have been defined. The general provisions of the methodology for calculating costs and determining the cost of carrying out maintenance and repair of livestock equipment have been considered. On the base of calculations, the average total cost standards for carrying out maintenance and repair of livestock equipment have been established. These standards greatly simplify the planning of costs during the operation of equipment, and also allow us to determine the cost of maintenance and repair at different stages of the creation of new machines.

scholarly journals Effect of the scale of production on the cost-effectiveness of milk production systems belonging to the “Balde Cheio” program

2018 ◽  
Vol 39 (3) ◽  
pp. 1211
Author(s):  
Flávio De Moraes ◽  
Marcos Aurélio Lopes ◽  
Francisval De Melo Carvalho ◽  
Afonso Aurélio de Carvalho Peres ◽  
Fábio Raphael Pascoti Bruhn ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Labor Force ◽  
Milk Production ◽  
Large Scale ◽  
Unit Cost ◽  
Small Scale ◽  
Total Cost ◽  
Medium Scale ◽  
Return On Capital ◽  
The Cost

This study investigates the cost-effectiveness of 20 demonstration units (DUs) belonging to the "Balde Cheio" program. The units in question are from the state of Rio de Janeiro, Brazil, dating from January to December 2011, and are sorted according to the scale of production (small, medium and large). The data were analyzed using Predictive Analytical software (PASW) 18.0. The scale of production influenced the total cost of milk production, and therefore profitability and cost-effectiveness. The large-scale stratum showed the lowest total unit cost. The positive results in medium and large scales in milk production lead to optimal conditions for long-term production, with the capitalization of cowmen. The items regarding the effective operating cost (EOC) with the biggest influence on the costs of dairy activity in the small scale stratum were food, energy and miscellaneous expenses. In the medium scale, these were food, labor force, and miscellaneous expenses. Finally, in the large scale, they were food, labor force and energy. In the small and large scale, the items regarding the total cost with the biggest influence on the costs of dairy activity were food, labor force, and return on capital, while in the medium scale, they were food, return on capital, and labor force. The average break-even point of 14 of the DUs was higher than the average daily production.

scholarly journals Direct Cost of Reprocessing Cotton-woven Surgical Drapes: a Case Study

2015 ◽  
Vol 49 (3) ◽  
pp. 488-494 ◽  
Author(s):  
Mariana Fexina Tomé ◽  
Antônio Fernandes Costa Lima
Keyword(s):  
Human Resources ◽  
Direct Cost ◽  
Financial Resources ◽  
Average Total Cost ◽  
Descriptive Case Study ◽  
Total Cost ◽  
Advantages And Disadvantages ◽  
Cost Of Materials ◽  
The Cost

OBJECTIVE Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$) originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%). It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%). CONCLUSION The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources.

scholarly journals Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda

2018 ◽  
Vol 3 (2) ◽  
pp. e000526 ◽  
Author(s):  
Giulia Greco ◽  
Louise Knight ◽  
Willington Ssekadde ◽  
Sophie Namy ◽  
Dipak Naker ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Schools ◽  
Physical Violence ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cluster Randomised Controlled Trial ◽  
Total Cost ◽  
Good School ◽  
Randomised Controlled ◽  
The Cost

IntroductionThis paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda.MethodsThe effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider’s perspective to estimate total and unit costs.ResultsThe total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US$397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US$7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial.ConclusionsThe GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region.

scholarly journals Economic analysis of tilapia farming in some selected area of Dinajpur District: A comparison between monoculture and polyculture

2019 ◽  
Vol 17 (1) ◽  
pp. 117-121
Author(s):  
Zannatul Ferdoushi ◽  
Zubaida Parveen Patwary ◽  
Yeasmin Ara ◽  
Masud Rana
Keyword(s):  
Study Data ◽  
Cost Ratio ◽  
Average Total Cost ◽  
Total Cost ◽  
Face To Face ◽  
Benefit Cost Ratio ◽  
The Cost ◽  
Benefit Cost ◽  
Production Period ◽  
Structured Questionnaire

The study was conducted to assess the cost and return from tilapia farming. Fifty homestead aquaculture ponds practicing monoculture and polyculture of tilapia (25 farmers from each category) were selected for this study. Data had been collected through face to face interview by using a structured questionnaire during April to September 2015 from the selected farmers of Dinajpur districts. The results from the survey revealed that both the tilapia monoculture and polyculture farming were profitable. However, the average total cost per hectare per production period was found higher (Tk. 332,712.08) in tilapia monoculture than tilapia culture with carps (Tk. 241,722.34). Moreover, the net margin was also found higher in tilapia monoculture with benefit cost ratio 1.51. Whereas, the benefit cost ratio in polyculture farming was 1.34. J. Bangladesh Agril. Univ. 17(1): 117–121, March 2019

Pharmacoeconomic Analysis of Using Sinemet CR over Standard Sinemet in Parkinsonian Patients with Motor Fluctuations

1998 ◽  
Vol 32 (9) ◽  
pp. 878-883 ◽  
Author(s):  
Alan G Hempel ◽  
Mary L Wagner ◽  
Mohamed A Maaty ◽  
Jacob I Sage
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Tertiary Care ◽  
Motor Fluctuations ◽  
University Teaching ◽  
Total Cost ◽  
Medication Costs ◽  
The Cost

OBJECTIVE: To compare the costs of pharmacotherapy in patients with Parkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR. DESIGN: Investigators retrospectively reviewed records of patients converting from Sinemet to Sinemet CR for efficacy and total drug costs. Cost-effectiveness was evaluated retrospectively from data collected in prospective Sinemet CR efficacy trials. SETTING: Parkinson's disease clinic at a tertiary care university teaching hospital. PATIENTS: 100 patients with motor fluctuations who had undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME MEASURES: Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre- and postconversion costs were compared by using the paired, two-tailed Student's t-test. A substudy of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours “on” without chorea. RESULTS: While total daily medication costs after conversion increased by 21%, patients experienced either a comparable or an improved degree of disease control with Sinemet CR. Patients who were also taking selegiline were able to decrease selegiline expense by 20%. The costs of other adjunctive medications did not differ significantly after conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2.85 decrease in total cost per hour on without chorea (p = 0.11). CONCLUSIONS: Although Sinemet CR is more costly, it may be more cost-effective in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.

The association between hospitals’ risk-adjusted emergency department visits and survival and costs in kidney cancer patients.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 609-609
Author(s):  
Joel E Segel ◽  
Eric W. Schaefer ◽  
Jay D. Raman ◽  
Christopher S. Hollenbeak
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Kidney Cancer ◽  
Mortality Rates ◽  
Emergency Department Visits ◽  
Medicare Data ◽  
Initial Surgery ◽  
Oncology Care ◽  
Ed Visits ◽  
The Cost

609 Background: As payers turn to alternative payment models, including the CMS Oncology Care Model, risk-adjusted emergency department (ED) visits are being incorporated as a quality. Yet little is know about this metric compares to existing metrics such as risk-adjusted mortality rates and costs. Methods: Using 2007-2012 SEER-Medicare data, we used logistic regression to model occurrence of an ED visit within 30 and 365 days for all kidney cancer patients receiving initial surgery. Our model controlled for demographics, stage, histology, systemic targeted therapy, and comorbidities. Based on model predictions, we created a ratio of actual versus predicted ED visits for hospitals to identify hospitals with higher and lower than predicted ED visit rates. We estimated the association between the hospitals’ ED visit ratio and hospitals’ risk-adjusted 365-day mortality rates, and 6- and 12-month total costs and total costs (less ED visits). Results: In our sample of 6,078 patients, 15.5% had an ED visit within 30 days of surgery and 43.5% within 365 days. For hospitals with ≥10 patients, we found no statistically significant association between 30-day or 365-day risk-adjusted ED visit rate and their 365-day risk-adjusted mortality rate. While hospitals’ 30-day ED visit rates were significantly associated with 6- and 12-month costs, the association was largely driven by the cost of the ED visit itself. Conversely, hospitals’ 365-day ED visit rates were significantly associated with 12-month costs after excluding the cost of the ED visit. Conclusions: Our results suggest hospitals’ risk-adjusted ED visit rates capture a qualitatively different measure of quality than the more commonly reported mortality rates and is significantly associated with patient cost.

scholarly journals The cost‑effectiveness of hypertonic saline inhalations for infant bronchiolitis.

2020 ◽  
Author(s):  
jefferson buendia ◽  
Ranniery Acuña-Cordero
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Decision Makers ◽  
Hypertonic Solution ◽  
Cost Effectiveness Ratio ◽  
Tropical Country ◽  
Total Cost ◽  
Use Of Resources ◽  
Lower Total Cost ◽  
The Cost

Abstract BackgroundPharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% hypertonic solution is useful for infants with bronchiolitis. This study aims to evaluate the cost-effectiveness of the HS inhalations in infant bronchiolitis in a tropical country Methods Decision tree analysis was used to calculate the expected costs and QALYs. All cost and use of resources were collected directly from medical invoices of 193 patient hospitalized with diagnosis of bronchiolitis in tertiary centers, of Rionegro, Colombia. The utility values applied to QALYs calculations were collected from the literature. The economic analysis was carried out from a societal perspective.ResultsThe model showed that nebulized 3% hypertonic solution, was associated with lower total cost than controls (US $200vs US $240 average cost per patient), and higher QALYs ( 0.92 vs 0.91 average per patient); showing dominance. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio.Conclusion The nebulized 3% hypertonic solution was cost-effective in the inpatient treatment of infant bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries.

Sign in / Sign up

Export Citation Format

Share Document