scholarly journals Administration of indwelling urinary catheters in four Australian Hospitals: cost-effectiveness analysis of a multifaceted nurse-led intervention

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rod Ling ◽  
Michelle Giles ◽  
Andrew Searles
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
New South ◽  
New South Wales ◽  
Cost Effectiveness Analysis ◽  
Urinary Catheters ◽  
Short Term ◽  
Post Intervention ◽  
Effectiveness Analysis ◽  
South Wales

Abstract Background Urinary catheters are useful among hospital patients for allowing urinary flows and preparing patients for surgery. However, urinary infections associated with catheters cause significant patient discomfort and burden hospital resources. A nurse led intervention aiming to reduce inpatient catheterisation rates was recently trialled among adult overnight patients in four New South Wales hospitals. It included: ‘train-the trainer’ workshops, site champions, compliance audits and promotional materials. This study is the ‘in-trial’ cost-effectiveness analysis, conducted from the perspective of the New South Wales Ministry of Health. Methods The primary outcome variable was catheterisation rates. Catheterisation and procedure/treatment data were collected in three point prevalence patient surveys: pre-intervention (n = 1630), 4-months (n = 1677), and 9-months post-intervention (n = 1551). Intervention costs were based on trial records while labour costs were gathered from wage awards. Incremental cost effectiveness ratios were calculated for 4- and 9-months post-intervention and tested with non-parametric bootstrapping. Sensitivity scenarios recalculated results after adjusting costs and parameters. Results The trial found reductions in catheterisations across the four hospitals between preintervention (12.0 % (10.4 − 13.5 %), n = 195) and the 4- (9.9 % (8.5 − 11.3 %), n = 166 ) and 9- months (10.2 % (8.7 − 11.7 %) n = 158) post-intervention points. The trend was statistically non-significant (p = 0.1). Only one diagnosed CAUTI case was observed across the surveys. However, statistically and clinically significant decreases in catheterisation rates occurred for medical and critical care wards, and among female patients and short-term catheterisations. Incremental cost effectiveness ratios at 4-months and 9-months post-intervention were $188 and $264. Bootstrapping found reductions in catheterisations at positive costs over at least 72 % of iterations. Sensitivity scenarios showed that cost effectiveness was most responsive to changes in catheterisation rates. Conclusions Analysis showed that the association between the intervention and changes in catheterisation rates was not statistically significant. However, the intervention resulted in statistically significant reductions for subgroups including among short-term catheterisations and female patients. Cost-effectiveness analysis showed that reductions in catheterisations were most likely achieved at positive cost. Trial Registration Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000090314). First hospital enrolment, 15/11/2016; last hospital enrolment, 8/12/2016.

scholarly journals Cost-Effectiveness Analysis of the New South Wales Adult Drug Court Program

2004 ◽  
Vol 28 (1) ◽  
pp. 3-27 ◽  
Author(s):  
Marian Shanahan ◽  
Emily Lancsar ◽  
Marion Haas ◽  
Bronwyn Lind ◽  
Don Weatherburn ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Drug Court ◽  
New South ◽  
New South Wales ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
South Wales

Incremental Cost-Effectiveness Analysis

1999 ◽  
Vol 52 (6) ◽  
pp. 517-522 ◽  
Author(s):  
Scott B. Cantor ◽  
Theodore G. Ganiats
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis

Cost-effectiveness analysis of neoadjuvant immune checkpoint inhibition (ICI) versus cisplatin-based chemotherapy (CBC) in muscle-invasive bladder cancer (MIBC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 419-419
Author(s):  
Ali Raza Khaki ◽  
Yong Shan ◽  
Richard Nelson ◽  
Sapna Kaul ◽  
John L. Gore ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Randomized Clinical Trials ◽  
Pathologic Complete Response ◽  
Weighted Average ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Effectiveness Analysis

419 Background: Multiple single-arm clinical trials have shown promising pathologic complete response (pCR) rates with neoadjuvant ICIs in MIBC. However, ICIs remain costly. We conducted a cost-effectiveness analysis comparing neoadjuvant ICIs with CBC. Methods: We applied a decision analytic simulation model with a health care payer perspective and two-year time horizon to compare neoadjuvant ICIs vs CBC. For the primary analysis we compared pembrolizumab with dose dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC). We performed a secondary analysis with gemcitabine/cisplatin (GC) as CBC and exploratory analyses with atezolizumab or nivolumab/ipilimumab as ICIs (vs both ddMVAC and GC). We input pCR rates from trials (ICIs) or a weighted average of prior studies (CBC) and costs from average sales price. Outcomes of interest included costs, 2-year recurrence-free survival (RFS), and incremental cost-effectiveness ratio (ICER) of cost per 2-year RFS. A threshold analysis estimated a pCR rate or price reduction for ICI to be cost-effective and one-way and probabilistic sensitivity analyses were performed. Results: Results of the cost effectiveness analysis are shown in the table. The incremental cost of pembrolizumab compared with ddMVAC was $8,042 resulting in an incremental improvement of 0.66% in 2-year RFS for an ICER of $1,218,485 per 2-year RFS. A pCR of 71% or a 26% reduction in cost of pembrolizumab would render it more cost-effective with an ICER of $100,000 per 2-year RFS. GC required a 96% pembrolizumab cost reduction to achieve an ICER of $100,000 per 2-year RFS. Atezolizumab appeared to be more cost-effective than ddMVAC, even though the 2yr RFS was 0.66% worse. Conclusions: ICIs were not cost-effective as neoadjuvant therapies, except when atezolizumab was compared with ddMVAC. Pembrolizumab would approach cost-effective thresholds with 26% or 96% reduction in cost when compared to ddMVAC and GC, respectively. Randomized clinical trials, larger sample sizes and longer follow-up are required to better understand the value of ICIs as neoadjuvant treatments. [Table: see text]

Cost-Effectiveness Analysis of Short-Term Clopidogrel Therapy for ST Elevation Myocardial Infarction

2010 ◽  
Vol 9 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Kyle B. Gibler ◽  
Haiden A. Huskamp ◽  
Marc S. Sabatine ◽  
Sabina A. Murphy ◽  
David J. Cohen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Cost Effectiveness Analysis ◽  
St Elevation Myocardial Infarction ◽  
Short Term ◽  
Effectiveness Analysis ◽  
Clopidogrel Therapy ◽  
St Elevation

scholarly journals Short-Term Spatio-Temporal Drought Forecasting Using Random Forests Model at New South Wales, Australia

2020 ◽  
Vol 10 (12) ◽  
pp. 4254 ◽  
Author(s):  
Abhirup Dikshit ◽  
Biswajeet Pradhan ◽  
Abdullah M. Alamri
Keyword(s):  
Random Forest ◽  
Time Scales ◽  
New South ◽  
New South Wales ◽  
Second Phase ◽  
Drought Forecasting ◽  
Short Term ◽  
South Wales ◽  
Drought Classes ◽  
Statistical Metrics

Droughts can cause significant damage to agriculture and water resources, leading to severe economic losses and loss of life. One of the most important aspect is to develop effective tools to forecast drought events that could be helpful in mitigation strategies. The understanding of droughts has become more challenging because of the effect of climate change, urbanization and water management; therefore, the present study aims to forecast droughts by determining an appropriate index and analyzing its changes, using climate variables. The work was conducted in three different phases, first being the determination of Standard Precipitation Evaporation Index (SPEI), using global climatic dataset of Climate Research Unit (CRU) from 1901–2018. The indices are calculated at different monthly intervals which could depict short-term or long-term changes, and the index value represents different drought classes, ranging from extremely dry to extremely wet. However, the present study was focused only on forecasting at short-term scales for New South Wales (NSW) region of Australia and was conducted at two different time scales, one month and three months. The second phase involved dividing the data into three sample sizes, training (1901–2010), testing (2011–2015) and validation (2016–2018). Finally, a machine learning approach, Random Forest (RF), was used to train and test the data, using various climatic variables, e.g., rainfall, potential evapotranspiration, cloud cover, vapor pressure and temperature (maximum, minimum and mean). The final phase was to analyze the performance of the model based on statistical metrics and drought classes. Regarding this, the performance of the testing period was conducted by using statistical metrics, Coefficient of Determination (R2) and Root-Mean-Square-Error (RMSE) method. The performance of the model showed a considerably higher value of R2 for both the time scales. However, statistical metrics analyzes the variation between the predicted and observed index values, and it does not consider the drought classes. Therefore, the variation in predicted and observed SPEI values were analyzed based on different drought classes, which were validated by using the Receiver Operating Characteristic (ROC)-based Area under the Curve (AUC) approach. The results reveal that the classification of drought classes during the validation period had an AUC of 0.82 for SPEI 1 case and 0.84 for SPEI 3 case. The study depicts that the Random Forest model can perform both regression and classification analysis for drought studies in NSW. The work also suggests that the performance of any model for drought forecasting should not be limited only through statistical metrics, but also by examining the variation in terms of drought characteristics.

scholarly journals Patient-Controlled Intravenous Morphine Analgesia Combined with Transcranial Direct Current Stimulation for Post-Thoracotomy Pain: A Cost-Effectiveness Study and A Feasibility for Its Future Implementation

2020 ◽  
Vol 17 (3) ◽  
pp. 816 ◽  
Author(s):  
Nemanja Rancic ◽  
Katarina Mladenovic ◽  
Nela V. Ilic ◽  
Viktorija Dragojevic-Simic ◽  
Menelaos Karanikolas ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Cost Effectiveness Analysis ◽  
Control Group ◽  
Morphine Analgesia ◽  
Direct Current Stimulation ◽  
Effectiveness Analysis ◽  
Intravenous Morphine

This prospective randomized study aims to evaluate the feasibility and cost-effectiveness of combining transcranial direct current stimulation (tDCS) with patient controlled intravenous morphine analgesia (PCA-IV) as part of multimodal analgesia after thoracotomy. Patients assigned to the active treatment group (a-tDCS, n = 27) received tDCS over the left primary motor cortex for five days, whereas patients assigned to the control group (sham-tDCS, n = 28) received sham tDCS stimulations. All patients received postoperative PCA-IV morphine. For cost-effectiveness analysis we used data about total amount of PCA-IV morphine and maximum visual analog pain scale with cough (VASP-Cmax). Direct costs of hospitalization were assumed as equal for both groups. Cost-effectiveness analysis was performed with the incremental cost-effectiveness ratio (ICER), expressed as the incremental cost (RSD or US$) per incremental gain in mm of VASP-Cmax reduction. Calculated ICER was 510.87 RSD per VASP-Cmax 1 mm reduction. Conversion on USA market (USA data 1.325 US$ for 1 mg of morphine) revealed ICER of 189.08 US$ or 18960.39 RSD/1 VASP-Cmax 1 mm reduction. Cost-effectiveness expressed through ICER showed significant reduction of PCA-IV morphine costs in the tDCS group. Further investigation of tDCS benefits with regards to reduction of postoperative pain treatment costs should also include the long-term benefits of reduced morphine use.

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