Evaluation of Tonsillectomy and Lymphoma Workup -Who Should Get a Lymphoma Workup? Is It Cost Effective?.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3128-3128
Author(s):  
Cecilia C. Yeung ◽  
Maggie A. Gama ◽  
Rodriguez Rafael ◽  
Edward C. Larkin ◽  
Kim Janatpour
Keyword(s):  
Squamous Cell ◽  
Literature Search ◽  
Medical Center ◽  
Pediatric Population ◽  
Adult Population ◽  
Cost Effective ◽  
Clinical Findings ◽  
Follicular Hyperplasia ◽  
Common Diagnosis ◽  
The Cost

Abstract Intro: Tonsillectomy is a common surgery for both adults and children. In children (under 18 years) the most common diagnosis is follicular hyperplasia. In adults (18 years and older) the most common neoplastic diagnosis is squamous cell carcinoma. Although a common fear of lymphoma involving the tonsils persist, the literature indicates non-Hodgkin lymphoma as the least common diagnosis among tonsillectomy specimens. The purpose of this study was to provide indications and guidelines to delineate a cost effective approach for selection of tonsils for lymphoma workup. At UC Davis Medical Center, if lymphoma is considered in the differential, the tonsil is processed through a lymphoma workup protocol; touch preps, flow cytometry, cytogenetics, electron microscopy, B5-fixed, and formalin-fixed tissue in paraffin. Tissue is frozen in liquid nitrogen and stored for possible future studies. This approach diminishes the possibility of a missed lymphoma diagnosis, however it is costly and labor intensive. The initial phase of our investigation involved the identification of worrisome clinical findings for comparison with our patient population. Next, we address the incidence of tonsillar lymphoma in children versus adults in our hospital because the two populations historically exhibit drastically different diagnoses. In the final phase of our investigation we address the cost effectiveness of our approach. Method: To define what clinical findings are worrisome, we performed a literature search of “tonsillectomy and lymphoma” on pubmed and revealed 60 articles dating back to 1980 with 22 articles selected for review. Next, we reviewed over 900 tonsillar specimens collected over five years at the Medical Center. This data was stratified with respect to age, diagnoses, and whether a lymphoma workup was performed. Data: Prominent worrisome clinical findings included: unilateral enlargement, rapidly growing tonsillar mass, and grossly asymmetric tonsils. The results of our specimen (UC Davis) review is included in the chart below. In 5 years lymphoma workups were performed in19 children and 42 adults. The cost of each workup was $4063.00 and Medicare reimburses $1180. Conclusion: The incidence of lymphoma in our pediatric population is 0 and in our adult population is less than 1%. The cost per lymphoma diagnosis in our pediatric population exceeds $77,197.00. In contrast, the cost per lymphoma diagnosis in our adult population is $21,330.00. This data in conjunction with our literature search leads us to recommend selecting specimens for lymphoma work up in both adults and pediatric patients with the clinical findings of unilateral growth, rapidly enlarging tonsillar mass, and grossly asymmetric tonsils as a criteria. Special consideration in the pediatric population should also include strong clinical suspicion for lymphoma prior to ordering a lymphoma workup due to an extremely low incidence. Tonsillar diagnoses in Children versus Adults Benign Lymphoma Other Neoplasm Children (n=372) 372 0 0 Adults (n=654) 572 8 82 Total (n=1034) 944 (91%) 8 (<1%) 82 (8%) Benign diagnoses include: follicular hyperplasia, benign mucosa and tonsillar tissue, amyloidosis, acute and chronic tonsillitis.Lymphoma diagnoses include: large B-cell , follicle center cell , and lymphoblastic lymphoma. Other Neoplasm diagnoses include: squamous cell and basal cell and metastatic adenocarcinoma, malignant spindle cell sarcoma.

scholarly journals Cost-effectiveness of pembrolizumab for treatment of platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma in China: an economic analysis based on a randomised, open-label, phase III trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038867 ◽  
Author(s):  
Wenxiu Xin ◽  
Haiying Ding ◽  
Qilu Fang ◽  
Xiaowei Zheng ◽  
Yinghui Tong ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Squamous Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Platinum Resistant ◽  
The Cost

BackgroundPembrolizumab was recently demonstrated to have survival benefit in patients with recurrent or metastatic head and neck squamous cell carcinoma (r/mHNSCC). However, the cost-effectiveness of pembrolizumab versus chemotherapy in China remains uncertain.ObjectiveThis analysis aimed to describe the cost-effectiveness of pembrolizumab versus standard-of-care (SOC) therapy in r/mHNSCC in China.DesignA Markov model consisting of three health states (stable, progressive and dead) was developed to compare the cost and effectiveness of pembrolizumab with SOC in platinum-resistant r/mHNSCC. Model inputs for transition probabilities and toxicity were collected from the KEYNOTE-040 trial, while health utilities were estimated from a literature review. Cost data were acquired for the payer’s perspective in China. Costs and outcomes were discounted at an annual rate of 3.0%. Sensitivity analyses were conducted to test the uncertainties surrounding model parameters.Outcome measuresThe primary outcome was incremental cost-effectiveness ratios (ICERs), which were calculated as the cost per quality-adjusted life years (QALYs).ResultsThe total mean cost of pembrolizumab and SOC was US$45 861 and US$41 950, respectively. As for effectiveness, pembrolizumab yielded 0.31 QALYs compared with 0.25 QALYs for SOC therapy. The ICER for pembrolizumab versus SOC was US$65 186/QALY, which was higher than the willingness-to-pay threshold (WTP) of US$28 130/QALY in China. The univariate sensitivity analysis indicated that utility values for progressive state, probability from stable to progressive in the SOC group, as well as cost of pembrolizumab were the three most influential variables on ICER. The probabilistic sensitivity analysis demonstrated that standard therapy was more likely to be cost-effective compared with pembrolizumab at a WTP value of US$28 130/QALY. Results were robust across both univariate analysis and probabilistic sensitivity analysis.ConclusionsPembrolizumab is not likely to be a cost-effective strategy compared with SOC therapy in patients with platinum-resistant r/mHNSCC in China.Trial registration numberNCT02252042; Post-results.

Cost-Effectiveness of the Pneumococcal Vaccine in Healthy Younger Adults

2002 ◽  
Vol 22 (1_suppl) ◽  
pp. 45-57 ◽  
Author(s):  
Patricia Vold Pepper ◽  
Douglas K. Owens
Keyword(s):  
Young Adults ◽  
Cost Effectiveness ◽  
Pneumococcal Vaccine ◽  
Adult Population ◽  
Vaccination Strategy ◽  
Cost Effective ◽  
Incidence Rates ◽  
Younger Adults ◽  
Effective Measure ◽  
The Cost

Objectives Routine vaccination for Streptococcus pneumoniae has been recommended as a cost-effective measure for elderly and immunocompromised patients, yet no analysis has been performed for healthy younger adults in America. The authors evaluated the cost-effectiveness of the pneumococcal vaccine and determined the net health benefits conferred for the healthy young adult population. Methods The authors developed a decision model to compare the health and economic outcomes of vaccinate versus do not vaccinate for S. pneumoniae. Results Vaccinating patients for S. pneumoniae generates benefits that are dependent on incidence rates and the efficacy of the vaccine. In the 22-year-old patient with a pneumonia incidence of 0.3/1000, the vaccine would need to be >71 percent effective for the vaccination strategy to cost less than $50,000/QALY gained. At an incidence of 0.4/1000, the threshold efficacy is 53 percent, whereas at 0.5/1000 it is 43 percent. In the 35-year-old patient where the incidence of pneumococcal pneumonia is higher (0.85/1000), the vaccine would be cost-effective with an efficacy as low as 30 percent. Conclusions Use of the S. pneumoniae vaccine in young adults would provide modest reductions in pneumonia-associated morbidity and mortality. Vaccination of young adults is moderately expensive unless vaccine efficacy is above 50% to 60%. In 35-year-old adults, use of the vaccine is cost-effective even with moderate efficacy.

scholarly journals THE COST-EFFECTIVENESS OF DEPRESSION SCREENING FOR THE GENERAL ADULT POPULATION

2021 ◽  
Author(s):  
Melike Yildirim ◽  
Bradley Gaynes ◽  
Pinar Keskinocak ◽  
Brian Pence ◽  
Julie L Swann
Keyword(s):  
Cost Effectiveness ◽  
Transition Probabilities ◽  
Adult Population ◽  
Cost Effective ◽  
Routine Screening ◽  
Screening Tools ◽  
Male Population ◽  
Life Years ◽  
Annual Screening ◽  
The Cost

Objective. Screening has an essential role in preventive medicine. Ideally, screening tools detect patients early enough to manage the disease and reduce symptoms. We aimed to determine the cost-effectiveness of routine screening schedules. Methods. We used a discrete-time nonstationary Markov model to simulate the progression of depression. We adopted annual transition probabilities, which were dependent on patient histories, such as the number of previous episodes, treatment status, and time spent without treatment state based on the available data. We used Monte Carlo techniques to simulate the stochastic model for 20 years or during the lifetime of individuals. Baseline and screening scenario models with screening frequencies of annual, 2-year, and 5-year were compared based on incremental cost-effectiveness ratios (ICER). Results. In the general population, all screening strategies were cost-effective compared to the baseline. However, male and female populations differed based on cost over quality-adjusted life years (QALY). Females had lower ICERs, and annual screening had the highest ICER for females, with 11,134 $/QALY gained. In contrast, males had around three times higher ICER, with annual screening costs of 34,065$/QALY gained. Conclusions. Considering the high lifetime prevalence and recurrence rates of depression, detection and prevention efforts can be one critical cornerstone to support required care. Our analysis combined the expected benefits and costs of screening and assessed the effectiveness of screening scenarios. We conclude that routine screening is cost-effective for all age groups of females and young, middle-aged males. Male population results are sensitive to the higher costs of screening.

A guide to cost-effective management of leg ulcers

2021 ◽  
Vol 27 (5) ◽  
pp. 136-144
Author(s):  
Matthew Taylor ◽  
Leanne Atkin
Keyword(s):  
Chronic Wounds ◽  
Adult Population ◽  
Cost Effective ◽  
Health Impact ◽  
Leg Ulcers ◽  
Evidence Based Practices ◽  
Obesity And Diabetes ◽  
Prevalence Of Obesity ◽  
The Cost

Chronic wounds have a substantial economic impact on the NHS, with leg ulcers alone costing almost £4.6 billion per year. Approximately 2% of the adult population is affected by lower limb ulceration, and this is rising as a result of demographics, including longer life expectancy and the increasing prevalence of obesity and diabetes. Even after healing, the recurrence rate of leg ulcers is high, meaning that the cost and health impact is a long-term problem. There appears to be a large variation in treatment methods, possibly as a result of a lack of evidence-based practices. The variation in practice means that, in many areas, healing times are far from optimal, leading to increased costs and health burden for the patient. This article outlines a number of previously published recommendations, including the leg ulcer treatment pathway. The article also provides an overview of the considerations when undertaking an economic evaluation of pathways, and provides recommendations about the type of data that should be routinely collected in clinical trials.

A review of techniques for difficult catheterisation and their costs

2021 ◽  
pp. 205141582110391
Author(s):  
Rion Healy ◽  
James Edward Dyer
Keyword(s):  
Supply Chain ◽  
Cost Analysis ◽  
Literature Search ◽  
Cost Effective ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Flexible Cystoscopy ◽  
Cost Implications ◽  
The Cost

Objective: Awareness of departmental expenditure gives surgeons the ability to make cost-effective decisions. We reviewed the available techniques for difficult catheterisation and assessed the cost of each method. Methods: A literature search was undertaken using EMBASE and Medline databases. Seven techniques for difficult catheterisation were identified, and a cost analysis was performed. All items required for a technique were costed per unit, including VAT, and can be referenced to the NHS supply chain. Results: Techniques were divided into three broad categories: simple urethral techniques – increased lubrication with different catheter sizes (£5.05) or types (£8.83 Tiemann tip, £10.65 Coude tip); complex urethral techniques – blind hydrophilic guidewire (£27.31), S-dilators (£244.62) and flexible cystoscopy (£38.78); and percutaneous techniques – suprapubic catheterisation (£117.38). Conclusion: This paper demonstrates a progression in cost and specialist input required when moving from simple urethral techniques to complex and percutaneous techniques. It is clear that clinicians should consider these cost implications and exhaust all simple techniques before moving to the more complex options. We would advocate the use of a national evidence-based difficult catheter algorithm to guide management based on both effectiveness and cost. Level of evidence: Not applicable.

scholarly journals Cost Effectiveness Analysis of Fecal Transplant Delivery Methods for Recurrent Clostridium difficile Infections in Outpatients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S386-S386 ◽  
Author(s):  
Jeremey Walker ◽  
Nathan Gundacker ◽  
Martin Rodriguez ◽  
Ellen Eaton
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Clostridium Difficile ◽  
Medical Center ◽  
Cost Effective ◽  
Third Party ◽  
Base Case ◽  
Delivery Methods ◽  
The Cost ◽  
Cure Rates

Abstract Background Clostridium difficile infection (CDI) accounts for more than $1 billion annually in US health care costs. Recurrent CDI (RCDI, recurrence within 8 weeks of initial treatment) contributes substantially to this cost. The objective of the study was to compare the cost effectiveness of FMT delivered via colonoscopy vs. blind nasogastric tube (NGT) in outpatients. We hypothesized that FMT by NGT would be cost-effective given its low risk and simplicity. Methods A decision-analytic simulation model compared the cost effectiveness of FMT by colonoscopy vs. NGT from a third-party payer perspective. Our base case cure rates were derived from a cohort receiving outpatient RCDI treatment at our institution. Cure was defined as resolution of symptoms for ≥ 90 days. Procedural cost and consultation was defined by average reimbursement to a large southeastern medical center in 2016 USD based on current procedural terminology (CPT) codes, and cost of disease states were derived from published literature. Health utilities were defined by quality of life year (QALY) based on published literature. Incremental Cost Effectiveness ratio (ICER) was defined as the cost per additional QALY gained. We assumed a 90 day time horizon. One-way sensitivity analysis was performed on all variables using ranges defined by published literature. We used TreeAge Software (Williamstown, MA). Results In the base case, FMT by colonoscopy was dominant (more effective and less costly) than NGT, with cost of $1,568/QALY vs. $1,910/QALY respectively. Cure rates of FMT by colonoscopy vs. NGT (100% vs. 87%) had the largest impact on ICER based on one-way sensitivity analysis. Therefore, a subsequent two-way sensitivity analysis was conducted to compare cure rates of both delivery methods and found that NGT delivery is cost effective as cure rates approach colonoscopy delivery cure rates within 5 percentage points. Conclusion Contrary to our hypothesis, our decision model supports FMT by colonoscopy as the preferred delivery method in outpatients with RCDI relative to NGT delivery. Additional costs of colonoscopy delivery are off-set by the improved cure rate leading to lower overall costs. As cure rates from NGT delivery are optimized, NGT may become the preferred method for FMT delivery. Disclosures All authors: No reported disclosures.

scholarly journals Angiotensin II for the treatment of distributive shock in the intensive care unit: A US cost-effectiveness analysis

2020 ◽  
Vol 36 (2) ◽  
pp. 145-151
Author(s):  
Laurence W. Busse ◽  
Gina Nicholson ◽  
Robert J. Nordyke ◽  
Cho-Han Lee ◽  
Feng Zeng ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Angiotensin Ii ◽  
Adult Population ◽  
Survival Rates ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Life Years ◽  
The Us ◽  
Distributive Shock ◽  
The Cost

BackgroundPatients with distributive shock who are unresponsive to traditional vasopressors are commonly considered to have severe distributive shock and are at high mortality risk. Here, we assess the cost-effectiveness of adding angiotensin II to the standard of care (SOC) for severe distributive shock in the US critical care setting from a US payer perspective.MethodsShort-term mortality outcomes were based on 28-day survival rates from the ATHOS-3 study. Long-term outcomes were extrapolated to lifetime survival using individually estimated life expectancies for survivors. Resource use and adverse event costs were drawn from the published literature. Health outcomes evaluated were lives saved, life-years gained, and quality-adjusted life-years (QALYs) gained using utility estimates for the US adult population weighted for sepsis mortality. Deterministic and probabilistic sensitivity analyses assessed uncertainty around results. We analyzed patients with severe distributive shock from the ATHOS-3 clinical trial.ResultsThe addition of angiotensin II to the SOC saved .08 lives at Day 28 compared to SOC alone. The cost per life saved was estimated to be $108,884. The addition of angiotensin II to the SOC was projected to result in a gain of .96 life-years and .66 QALYs. This resulted in an incremental cost-effectiveness ratio of $12,843 per QALY. The probability of angiotensin II being cost-effective at a threshold of $50,000 per QALY was 86 percent.ConclusionsFor treatment of severe distributive shock, angiotensin II is cost-effective at acceptable thresholds.

scholarly journals CYSTIC FIBROSIS IN AN ADULT – A RARE CASE – DIAGNOSED AND CONFIRMED BY A NEW, NOVEL, INDIGENOUS TECHNIQUE

2012 ◽  
Vol 02 (04) ◽  
pp. 65-70
Author(s):  
Raghava Sharma ◽  
Raghu Raj ◽  
Sukanya Shetty
Keyword(s):  
Cystic Fibrosis ◽  
Standardized Test ◽  
Pediatric Population ◽  
Adult Population ◽  
Autosomal Recessive Disorder ◽  
Cost Effective ◽  
Genetic Mutation ◽  
Test Technique ◽  
Sweat Chloride ◽  
New Novel

AbstractCystic fibrosis (CF) is an important autosomal recessive disorder caused due to genetic mutation thus affecting the chloride channel. It involves multiple systems particularly lungs, respiratory tract and gastro intestinal tract. It is mainly considered as a disease of pediatric population. However it is being reported from adult population, more frequently from the western countries due to better survival.CF is reported very rarely from India and report of adult CF is much more rarer. Conformation of CF is by HRCT (High resolution computerized tomography), gene mutation analysis and sweat chloride estimation. However sweat chloride test presently being employed (called pilocarpine iontophoresis ) is costly, very complicated and is not available even in most advanced centers in India.Our case highlights the need for a high index of suspicion for suspecting CF in adults with chronic respiratory symptoms, and the need for a cost effective, easily available, reproducible, standardized test technique for sweat chloride estimation.Here with we present a case of CF (cystic fibrosis) in an adult male of 23 years whose diagnosis was confirmed by a new novel indigenous technique of Sweat chloride estimation.

The IBM-PC in electron microscopy

1996 ◽  
Vol 54 ◽  
pp. 612-613
Author(s):  
James F. Mancuso
Keyword(s):  
Head Start ◽  
Image Acquisition ◽  
Cost Effective ◽  
Financial Applications ◽  
Number Of Factors ◽  
Instrument Control ◽  
The Cost ◽  
Training And Support ◽  
Control Image ◽  
Ibm Pc

IBM PC compatible computers are widely used in microscopy for applications ranging from control to image acquisition and analysis. The choice of IBM-PC based systems over competing computer platforms can be based on technical merit alone or on a number of factors relating to economics, availability of peripherals, management dictum, or simple personal preference.IBM-PC got a strong “head start” by first dominating clerical, document processing and financial applications. The use of these computers spilled into the laboratory where the DOS based IBM-PC replaced mini-computers. Compared to minicomputer, the PC provided a more for cost-effective platform for applications in numerical analysis, engineering and design, instrument control, image acquisition and image processing. In addition, the sitewide use of a common PC platform could reduce the cost of training and support services relative to cases where many different computer platforms were used. This could be especially true for the microscopists who must use computers in both the laboratory and the office.

Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽  
2007 ◽  
Vol 36 (06) ◽  
pp. 309-312 ◽  
Author(s):  
T. Schulz ◽  
M. Jünger ◽  
M. Hahn
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Stage ◽  
Clinical Signs ◽  
Cost Effective ◽  
Duplex Sonography ◽  
Foam Sclerotherapy ◽  
Average Loss ◽  
One Year ◽  
The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

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