Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

Abstract Background Previous systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions. Method A systematic literature review was conducted which screened the following databases: Pubmed, Medline, Embase, Cochrane and Econlit. An inclusion and exclusion criteria were developed following PRISMA guidelines. A narrative review methodology was adopted due to the heterogeneity of the reporting of the costs across the studies. Results One thousand three hundred eighty-nine papers were found and 16 were included in the review. All of the interventions were variations of a case management approach. Apart from one study which had mixed results, all of the papers reported a decrease in ED use and costs. There were no cost effectiveness studies. Conclusion The majority of interventions for frequent presenters to the ED were found to decrease ED use and cost. Future research should be undertaken to examine the cost effectiveness of these interventions.

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The Socioeconomic Welfare of Urban Green Areas and Parks; A Literature Review of Available Evidence

Sustainability ◽

10.3390/su13147863 ◽

2021 ◽

Vol 13 (14) ◽

pp. 7863

Author(s):

Antonios Kolimenakis ◽

Alexandra D. Solomou ◽

Nikolaos Proutsos ◽

Evangelia V. Avramidou ◽

Evangelia Korakaki ◽

...

Keyword(s):

Literature Review ◽

Urban Policy ◽

Green Spaces ◽

Future Research ◽

Natural Environments ◽

Exclusion Criteria ◽

Urban Green ◽

Urban Green Spaces ◽

Urban Green Areas ◽

Green Areas

Urban green areas present a lucid example for the harmonious co-existence of the artificial and natural environments best illustrated by their interdependence and interconnection in urban spaces. Urban green areas are essential for the health and wellbeing of citizens. The present study aimed to investigate those multiple benefits for citizens that arise through the existence of urban green areas, as well as important policy dimensions that should be considered when designing the expansion of urban green spaces in urban development. The study was based on a literature review to examine for available evidence on the benefit levels derived by the existence of urban green areas. An extended literature review was followed by a structured review, based on specific inclusion and exclusion criteria, which partly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in two databases, and a total of 1674 articles and abstracts were identified through the database searches. After removing 114 duplicates, 1560 records were initially screened based on title and abstract. Following inclusion and exclusion criteria, 14 articles were incorporated in the structured review and a total of 47 in the extended review. The extended literature review identified 33 additional articles examining aspects of benefits that did not fall under the pre-established inclusion and exclusion criteria used in the structured review, such as health benefits and other social parameters associated with urban green spaces. The selected studies were allocated in five principal groups according to study types: three of the them consisted of studies employing “willingness to pay” (WTP) methods, five were based on property values, two studies assigned monetary values, while another two assigned CO2 values, and, finally, two studies were based on qualitative criteria. The results indicated benefits to citizens and increased welfare levels gained by the existence of urban green areas. The conducted review revealed a number of findings and recommendations that could direct future research and urban policy. Those hints could assist local authorities as well as stakeholders in order to measure and assess the benefits of green spaces and urban parks and promote measures and programs to assist their further deployment.

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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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Cost Needed to Treat (CNT) and Number Needed to Treat (NNT) analysis of drugs for treatment of heart failure in India

European Heart Journal ◽

10.1093/ehjci/ehaa946.3539 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Mullavelil ◽

V George ◽

A Thannikkal ◽

R Aravindakshan ◽

D John ◽

...

Keyword(s):

Heart Failure ◽

Cost Effectiveness ◽

Treatment Strategies ◽

Future Research ◽

Number Needed To Treat ◽

Neprilysin Inhibitor ◽

Long Term Treatment ◽

The Cost ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

Abstract Background Only little attention has been paid to treatment strategies of chronic disease conditions that require long term treatment and repeated hospitalizations Purpose Our aim was to review cost-effectiveness of guideline directed medical therapy of heart failure in India and identify drugs that can be made available free of cost or at subsidized rates to the patient population. Methods Data extracted from ten landmark trials in heart failure was used to compute Number Needed to Treat (NNT) and Cost Needed to Treat (CNT) of drugs used in heart failure, to prevent cardiovascular mortality and heart failure re-hospitalization using HDS Plotter- Incremental Cost Effectiveness Calculator. Since various brands (i.e. trade names) with wide cost range are available in Indian market, the average retail price in Indian Rupees for year 2019 was considered and converted to US dollars and used for the analysis.NNT and CNT of each drug was computed and the cost-effectiveness was analyzed. WHO recommendation of three times per capita GDP was used as the cost effectiveness threshold. Results Medications that were labeled as class I for the treatment of heart failure, were included in our analysis. Ivabradine, Valsartan and Angiotensin Receptor Neprilysin inhibitor (ARNi) did not meet the cost effectiveness criteria for preventing cardio-vascular mortality. For prevention of heart failure re-hospitalization, all drugs except ARNi, met the cost effectiveness threshold. Conclusion Any future research would need to consider compliance factor along with Willingness to Pay (WTP) to understand the real acceptance of these drugs on the ground in India. Log prices (in US$) of various HF drugs Funding Acknowledgement Type of funding source: None

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Abstract TP286: A Literature Review of Cost-effectiveness of Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke

Stroke ◽

10.1161/str.47.suppl_1.tp286 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Guijing Wang ◽

Heesoo Joo ◽

Mary G George

Keyword(s):

Ischemic Stroke ◽

Cost Effectiveness ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Cost Effective ◽

Recombinant Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

The Cost ◽

Effectiveness Studies

Introduction: Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed. Objectives: We conducted a literature review of the cost-effectiveness studies about IV rtPA. Methods: A literature search was conducted using PubMed, MEDLINE, and EconLit, with the key words stroke, cost, economic benefit, saving, cost-effectiveness, tissue plasminogen activator, and rtPA. The review is limited to original research articles published during 1995–2014 in English-language peer-reviewed journals. Results: We found 15 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 1 study within 0-6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective. Conclusions: The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.

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Variations in cost calculations in spine surgery cost-effectiveness research

Neurosurgical FOCUS ◽

10.3171/2014.3.focus1447 ◽

2014 ◽

Vol 36 (6) ◽

pp. E1 ◽

Cited By ~ 40

Author(s):

Matthew D. Alvin ◽

Jacob A. Miller ◽

Daniel Lubelski ◽

Benjamin P. Rosenbaum ◽

Kalil G. Abdullah ◽

...

Keyword(s):

United Kingdom ◽

Cost Effectiveness ◽

Spine Surgery ◽

Indirect Costs ◽

Cost Calculation ◽

Effectiveness Research ◽

Reimbursement System ◽

The United Kingdom ◽

The Cost ◽

Effectiveness Studies

Object Cost-effectiveness research in spine surgery has been a prominent focus over the last decade. However, there has yet to be a standardized method developed for calculation of costs in such studies. This lack of a standardized costing methodology may lead to conflicting conclusions on the cost-effectiveness of an intervention for a specific diagnosis. The primary objective of this study was to systematically review all cost-effectiveness studies published on spine surgery and compare and contrast various costing methodologies used. Methods The authors performed a systematic review of the cost-effectiveness literature related to spine surgery. All cost-effectiveness analyses pertaining to spine surgery were identified using the cost-effectiveness analysis registry database of the Tufts Medical Center Institute for Clinical Research and Health Policy, and the MEDLINE database. Each article was reviewed to determine the study subject, methodology, and results. Data were collected from each study, including costs, interventions, cost calculation method, perspective of cost calculation, and definitions of direct and indirect costs if available. Results Thirty-seven cost-effectiveness studies on spine surgery were included in the present study. Twenty-seven (73%) of the studies involved the lumbar spine and the remaining 10 (27%) involved the cervical spine. Of the 37 studies, 13 (35%) used Medicare reimbursements, 12 (32%) used a case-costing database, 3 (8%) used cost-to-charge ratios (CCRs), 2 (5%) used a combination of Medicare reimbursements and CCRs, 3 (8%) used the United Kingdom National Health Service reimbursement system, 2 (5%) used a Dutch reimbursement system, 1 (3%) used the United Kingdom Department of Health data, and 1 (3%) used the Tricare Military Reimbursement system. Nineteen (51%) studies completed their cost analysis from the societal perspective, 11 (30%) from the hospital perspective, and 7 (19%) from the payer perspective. Of those studies with a societal perspective, 14 (38%) reported actual indirect costs. Conclusions Changes in cost have a direct impact on the value equation for concluding whether an intervention is cost-effective. It is essential to develop a standardized, accurate means of calculating costs. Comparability and transparency are essential, such that studies can be compared properly and policy makers can be appropriately informed when making decisions for our health care system based on the results of these studies.

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Are SSRIs a Cost-Effective Alternative to Tricyclics?

The British Journal of Psychiatry ◽

10.1192/bjp.168.4.404 ◽

1996 ◽

Vol 168 (4) ◽

pp. 404-409 ◽

Cited By ~ 64

Author(s):

Matthew Hotopf ◽

Glyn Lewis ◽

Charles Normand

Keyword(s):

Cost Effectiveness ◽

Selective Serotonin Reuptake Inhibitors ◽

Cost Effective ◽

Drop Out ◽

Attrition Rates ◽

The Difference ◽

Randomised Controlled ◽

Meta Analyses ◽

The Cost ◽

Effectiveness Studies

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are more expensive than tricyclics. Reports have suggested that SSRIs are cost-effective because they are better tolerated and safer in overdose.MethodA systematic review of all randomised controlled trials (RCTs), meta-analyses, and cost-effectiveness studies comparing SSRIs and tricyclic antidepressants (TCAs).ResultsNone of the RCTs provided an economic analysis and there were methodological problems in the majority which would preclude this approach. Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRIs drop out of RCTs. Cost-effectiveness studies have been based on crude ‘modelling’ approaches and over-estimate the difference in attrition rates and the cost of treatment failure. It appears impossible to evaluate the economic aspects of suicide because of its rarity.ConclusionsThere is no evidence to suggest that SSRIs are more cost-effective than TCAs. The debate will only be concluded when a prospective cost-effectiveness study is done in the setting of a large primary care based RCT.

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Literature review on effect of microfinance institutions on poverty in South Asian countries and their sustainability

International Journal of Emerging Markets ◽

10.1108/ijoem-07-2020-0861 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Prashant Kumar Gupta ◽

Seema Sharma

Keyword(s):

Literature Review ◽

South Asian ◽

Systematic Literature Review ◽

Future Research ◽

Microfinance Institutions ◽

Asian Countries ◽

Exclusion Criteria ◽

Trade Off ◽

Content Type ◽

Positive Effect

PurposeThe authors present a systematic literature review on microfinance institutions’ (MFIs) effect on poverty and how they can ensure their sustainability. The purpose of this article is to review the effect of MFIs on poverty in South Asian countries. The analysis and review of the selected corpus of literature also provide avenues for future research.Design/methodology/approachA total of 95 papers from 49 journals in 4 academic libraries and publishers were systematically studied and classified. The authors define the keywords and the inclusion/exclusion criteria for the identification of papers. The review includes an analysis of the selected papers that give insights about publications with respect to themes, number of themes covered in individual publications, nations, scope, methodology, number of methods used and publication trend.FindingsThe literature indicates the positive effect of microfinance on poverty but with a varying degree on various categories of poor. The relation between poverty and microfinance is, however, dependent on the nation under the scanner. While sustainability and outreach co-exist, their trade-off is still a matter of debate.Originality/valueThis is the first systematic literature review on MFIs’ effect on poverty in South Asian nations. Additionally, the authors discuss the literature on the trade-off between sustainability and outreach for MFIs.

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TECHNIQUES FOR DIAGNOSING OSTEOPOROSIS: A SYSTEMATIC REVIEW OF COST-EFFECTIVENESS STUDIES

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462314000257 ◽

2014 ◽

Vol 30 (3) ◽

pp. 273-281 ◽

Cited By ~ 2

Author(s):

Davide Minniti ◽

Ottavio Davini ◽

Maria Rosaria Gualano ◽

Maria Michela Gianino

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Postmenopausal Women ◽

Cost Effective ◽

Economic Evaluations ◽

Clear Cut ◽

Step Procedure ◽

Database Research ◽

The Cost ◽

Effectiveness Studies

Objectives:The study question was whether dual-energy X-ray absorptiometry (DXA) alone is more cost-effective for identifying postmenopausal women with osteoporosis than a two-step procedure with quantitative ultrasound sonography (QUS) plus DXA. To answer this question, a systematic review was performed.Methods:Electronic databases (PubMed, INAHTA, Health Evidence Network, NIHR, the Health Technology Assessment program, the NHS Economic Evaluation Database, Research Papers in Economics, Web of Science, Scopus, and EconLit) were searched for cost-effectiveness publications. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using the Drummond checklist.Results:Seven journal articles and four reports were reviewed. The cost per true positive case diagnosed by DXA was found to be higher than that for diagnosis by QUS+DXA in two articles. In one article it was found to be lower. In three studies, the results were not conclusive. These articles were characterized by the differences in the types of devices, parameters and thresholds on the QUS and DXA tests and the unit costs of the DXA and QUS tests as well as by variability in the sensitivity and specificity of the techniques and the prevalence of osteoporosis.Conclusions:The publications reviewed did not provide clear-cut evidence for drawing conclusions about which screening test may be more cost-effective for identifying postmenopausal women with osteoporosis.

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Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department ‘near miss’ for breathlessness: a strengths-based qualitative study

BMJ Open ◽

10.1136/bmjopen-2017-017536 ◽

2017 ◽

Vol 7 (12) ◽

pp. e017536 ◽

Cited By ~ 11

Author(s):

Tim Luckett ◽

Jane Phillips ◽

Miriam Johnson ◽

Maja Garcia ◽

Priyanka Bhattarai ◽

...

Keyword(s):

Emergency Department ◽

Self Efficacy ◽

Near Miss ◽

Self Management ◽

Integrative Approach ◽

Future Research ◽

Management Approach ◽

Chronic Obstructive ◽

Pharmacological Management ◽

Near Misses

ObjectivesBreathlessness ‘crises’ in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED ‘near misses’ where they considered going to the ED but successfully self-managed instead.Design and methodsA qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen’s Transactional Model of Stress and Coping informed interpretive themes.ResultsInterviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.ConclusionsIn addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients’ generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.

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