scholarly journals Estimating the broader fiscal consequences of acute hepatic porphyria (AHP) with recurrent attacks in Belgium using a public economic analytic framework

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mark P. Connolly ◽  
Nikos Kotsopoulos ◽  
Sebastian Vermeersch ◽  
Julien Patris ◽  
David Cassiman
Keyword(s):  
Healthcare Costs ◽  
Clinical Pathways ◽  
Cost Savings ◽  
Social Benefit ◽  
Work Activity ◽  
Public Economic ◽  
Economic Framework ◽  
Lifetime Costs ◽  
Lifetime Earnings ◽  
Public Costs

Abstract Background Acute hepatic porphyria (AHP) is a rare, debilitating disease characterized by potentially life-threatening attacks often resulting in chronic symptoms that negatively impact daily functioning and quality of life. Symptoms of AHP prevent many individuals from working and achieving lifetime work averages. The aim of this study was to apply a public economic framework to evaluate AHP in Belgium, taking into consideration a broad range of costs that are relevant to government in relation to social benefit payments and lifetime taxes paid. Methodology A public economic framework was developed exploring lifetime costs for government attributed to an individual with AHP and recurrent attacks in Belgium. Work-activity and lifetime direct taxes paid, indirect consumption taxes and requirements for public benefits were estimated based on established clinical pathways for AHP and compared to the general population (GP). The model includes AHP-related healthcare costs and non-AHP healthcare costs for the GP. Results Lifetime earnings are reduced in an individual with AHP by €347,802 per person (p.p.), translating to reduced lifetime taxes paid of €183,187 for an AHP individual compared to the GP. We estimate increased lifetime disability benefit support of €247,242 for an AHP individual compared to GP. Lifetime healthcare costs for a person with AHP were estimated to be €3,030,316 due to frequent hospitalisations associated with porphyria attacks compared to the GP. The lifetime costs for a person with 12 attacks per annum factoring in transfers, taxes and healthcare costs are estimated to be €3,460,745 p.p. Eliminating AHP attacks after 10 years of active disease, thus, enabling a person to return to work increases lifetime earnings by €224,575 p.p. Increased work activity in such individuals would generate an estimated €118,284 p.p. over their lifetime. The elimination of AHP attacks could also lead to reductions in disability payments of €179,184 p.p. and healthcare cost savings of €1,511,027 p.p. Conclusions Due to severe disability resulting from constant attacks, AHP patients with recurrent attacks incur significant public costs. Lifetime taxes paid are reduced as these attacks occur during peak earning and working years. In those patients, reducing AHP attacks can confer significant fiscal benefits for government, including reduced healthcare costs, reduced disability payments and improved tax revenue.

scholarly journals Estimating the Broader Fiscal Consequences of Acute Hepatic Porphyria (AHP) in Belgium Using a Public Economic Analytic Framework

2021 ◽  
Author(s):  
Mark Connolly ◽  
Nikos Kotsopoulos ◽  
Sebastian Vermeersch ◽  
Julien Patris ◽  
David Cassiman
Keyword(s):  
Healthcare Costs ◽  
Clinical Pathways ◽  
Cost Savings ◽  
Social Benefit ◽  
Work Activity ◽  
Public Economic ◽  
Economic Framework ◽  
Lifetime Costs ◽  
Lifetime Earnings ◽  
Public Costs

Abstract Background Acute hepatic porphyria (AHP) is a rare, debilitating disease characterized by potentially life-threatening attacks often resulting in chronic symptoms that negatively impact daily functioning and quality of life. Symptoms of AHP prevent many individuals from working and achieving lifetime work averages. The aim of this study was to apply a public economic framework to evaluate AHP in Belgium, taking into consideration a broad range of costs that are relevant to government in relation to social benefit payments and lifetime taxes paid. Methodology A public economic framework was developed exploring lifetime costs for government attributed to an individual with AHP in Belgium. Work-activity and lifetime direct taxes paid, indirect consumption taxes and requirements for public benefits were estimated based on established clinical pathways for AHP and compared to the general population (GP). The model includes AHP-related healthcare costs and non-AHP healthcare costs for the GP. Results Lifetime earnings are reduced in an individual with AHP by €347,802 per person (p.p.), translating to reduced lifetime taxes paid of €183,187 for an AHP individual compared to the GP. We estimate increased lifetime disability benefit support of €247,242 for an AHP individual compared to GP. Lifetime healthcare costs for a person with AHP were estimated to be €3,030,316 due to frequent hospitalisations associated with porphyria attacks compared to the GP. The lifetime costs for a person with 12 attacks per annum factoring in transfers, taxes and healthcare costs are estimated to be €3,460,745 p.p. Eliminating AHP attacks after 10 years of active disease, thus, enabling a person to return to work increases lifetime earnings by €224,575. Increased work activity in this cohort would generate an estimated €118,284 p.p. over their lifetime. The elimination of AHP attacks could also lead to reductions in disability payments of €179,184 p.p. and healthcare cost savings of €1,511,027. Conclusions Due to severe disability resulting from constant attacks, AHP patients incur significant public costs. Lifetime taxes paid are reduced as these attacks occur during peak earning and working years. Reducing AHP attacks can confer significant fiscal benefits for government, including reduced healthcare costs, reduced disability payments and improved tax revenue.

scholarly journals Estimating the fiscal impact of rare diseases using a public economic framework: a case study applied to hereditary transthyretin-mediated (hATTR) amyloidosis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Mark P. Connolly ◽  
Saswat Panda ◽  
Julien Patris ◽  
Bouke P. C. Hazenberg
Keyword(s):  
Rare Diseases ◽  
Early Death ◽  
Health Conditions ◽  
Health Costs ◽  
Work Activity ◽  
Public Economic ◽  
Economic Framework ◽  
Wide Range ◽  
The Government

Abstract Background A wide range of rare diseases can have fiscal impacts on government finances that extend beyond expected healthcare costs. Conditions preventing people from achieving national lifetime work averages will influence lifetime taxes paid and increase the likelihood of dependence on public income support. Consequently, interventions that influence projected lifetime work activity, morbidity and mortality can have positive and negative fiscal consequences for government. The aim of this study was to apply a public economic framework to a rare disease that takes into consideration a broad range of costs that are relevant to government in relation to transfers received and taxes paid. As a case study we constructed a simulation model to calculate the fiscal life course of an individual with hereditary transthyretin-mediated (hATTR) amyloidosis in The Netherlands. In this lethal disease different progressive disease scenarios occur, including polyneuropathy and/or cardiomyopathy. Results Due to progressive disability, health care resource use, and early death, hATTR amyloidosis with polyneuropathy receives more transfers from government compared to the general population. In a scenario where a patient is diagnoses with hATTR at age 45, an individual pays €180,812 less in lifetime taxes and receives incrementally €111,695 in transfers from the government, compared to a person without hATTR. Patients suffering from cardiomyopathy die after median 4 years. The health costs of this scenario are therefore lower than that of the other polyneuropathy-based scenarios. Conclusions The fiscal analysis illustrates how health conditions influence not only health costs, but also the cross-sectorial public economic burden attributed to lost tax revenues and public disability allowances. Due to the progressive nature of hATTR amyloidosis used in this study, public costs including disability increase as the disease progresses with reduced lifetime taxes paid. The results indicate that halting disease progression early in the disease course would generate fiscal benefits beyond health benefits for patients. This analysis highlights the fiscal consequences of diseases and the need for broader perspectives applied to evaluate health conditions. Conventional cost-effectiveness framework used by many health technology assessment agencies have well-documented limitations in the field of rare diseases and fiscal modeling should be a complementary approach to consider.

Documenting the Benefits and Cost Savings of a Large Multistate Cancer Pathway Program From a Payer's Perspective

2013 ◽  
Vol 9 (5) ◽  
pp. e241-e247 ◽  
Author(s):  
Eugene D. Kreys ◽  
Jim M. Koeller
Keyword(s):  
Clinical Pathways ◽  
Cost Savings ◽  
Substantial Cost ◽  
Physician Compliance

Broadly implemented clinical pathways can achieve reasonable physician compliance, resulting in substantial cost savings.

Costs of unicompartmental compared with total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 23-31
Author(s):  
Robert A. Burnett III ◽  
JaeWon Yang ◽  
P. Maxwell Courtney ◽  
E. Bailey Terhune ◽  
Charles P. Hannon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Healthcare Costs ◽  
Cost Savings ◽  
Vein Thrombosis ◽  
Total Knee ◽  
The Mean ◽  
One Year ◽  
Surgery Rates

Aims The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. Results Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). Conclusion Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.

scholarly journals Health Impact and Cost-Effectiveness of Financing Fruit and Vegetable Subsidies with a Sugar-Sweetened Beverage Tax in the US: A Micro-Simulation Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1721-1721
Author(s):  
Matti Marklund ◽  
Yujin Lee ◽  
Junxiu Liu ◽  
Stephen Sy ◽  
Shafika Abrahams-Gessel ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Cost Savings ◽  
Tax Revenue ◽  
Fruit And Vegetable ◽  
Sugar Sweetened Beverage ◽  
Excise Tax ◽  
Sweetened Beverage ◽  
Life Years ◽  
The Us

Abstract Objectives Financial incentives and disincentives are effective tools for improving food purchases and health. Healthy food subsidies have only been considered for vulnerable populations and can be costly, while sugar-sweetened beverage (SSB) taxes can be considered financially regressive and punitive. The potential joint health and economic impacts of combining these approaches at a national scale have not been evaluated. Methods A validated microsimulation model, CVD PREDICT, was used to estimate reductions in CVD events, diabetes cases, gains in quality-adjusted life-years (QALYs), costs, and cost-effectiveness of a national U.S. fruit and vegetable subsidy fully or partly financed by SSB excise tax revenue ($0.01/tsp of added sugar). For the fully financed subsidy, cost could not exceed net tax revenue; while for the partly financed subsidy, costs were greater and ensured that taxes paid did not exceed subsidies received in either low or high income subgroups. Model inputs included national demographic and dietary data from NHANES 2009–2014; policy effects on consumer intakes, industry responses, and diet-disease effects from meta-analyses; and policy costs (tax and subsidy implementation, subsidy costs, industry reformulation), and health-related costs (formal/informal healthcare costs, productivity costs) from published sources. Findings were evaluated over 10 years and lifetime, with costs (in constant 2019 USD) and QALYs discounted at 3% annually. Results Both the fully and partly financed joint intervention was estimated to be cost-saving, compared to a base-case scenario accounting for gradual voluntary SSB industry reformulation. At 10 years, the fully financed intervention would prevent approximately 1.11M CVD events, 0.14M CVD deaths, and 0.34M diabetes cases, gain 0.87M QALYs, generate 1.49B net revenue, and save $56B in formal healthcare costs. Corresponding values for the partially financed intervention were 1.42M, 0.17M, 0.34M, 1.18M, −13.9B, and $65B. Estimated benefits and cost-savings were approximately 4–15 fold higher over a lifetime. Conclusions A joint national strategy combining revenue from an SSB excise tax to fully or partially finance fruit and vegetable subsidies could generate substantial health gains and cost-savings for the US, while minimizing government spending. Funding Sources NIH, NHLBI.

Emerging development and use of clinical pathways to improve quality and standardize care in oncology.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 139-139
Author(s):  
Colin Nash ◽  
Ken Williams ◽  
Francesca Pirog ◽  
Kristi Mitchell
Keyword(s):  
Patient Outcomes ◽  
Clinical Pathways ◽  
Grey Literature ◽  
Cost Savings ◽  
Independent Evidence ◽  
Provider Networks ◽  
Reduced Toxicity ◽  
Oncology Practice ◽  
Evidence Based Care ◽  
The Impact

139 Background: Clinical pathways have emerged as a tool for payers to encourage provider adherence to evidence-based care. Avalere sought to understand how oncology pathway developers consider different types of evidence and physician input in designing pathways, and how the experiences of early programs may serve as an indicator for future implementation. Methods: Avalere conducted targeted white and grey literature searches to identify and analyze pathways used by oncology practice groups, provider networks, and major commercial payers. The research was augmented by informant interviews with representatives from leading organizations that have developed or implemented pathways. Results: Current pathways programs differ in their origins and objectives. Across these programs, Avalere identified findings in three key areas: Development: Developers consider efficacy of treatments first, followed by toxicity, and then cost. Many developers conduct an independent evidence review, while others leverage clinical practice guidelines. All developers solicit physician input on pathway design and updates; Use: Independent pathway developers partner with commercial insurers and large provider networks to design pathways with cost-saving components. Physicians are evaluated based on their adherence to the pathways, but are not held accountable for reporting or performance on NQF-endorsed quality measures; Impact: Cost savings in early programs are largely due to reduced toxicity-related medical costs, use of less expensive drugs, and lower total drug use. However, there is limited evidence on the impact of pathways on patient outcomes. Conclusions: There is variability across oncology pathway developers regarding their scope, granularity, and processes related to evaluating and incorporating evidence. If clinical programs demonstrate early cost reductions while improving patient outcomes, payers will likely attempt to expand pathways programs to new geographies and therapeutic areas. Existing practice patterns and previously implemented pathways programs will likely play heavily in determining which pathways are adopted in a given region, but national standardization is highly unlikely.

scholarly journals Ocular foreign bodies: evolution of professional roles and public costs in Quebec

2021 ◽  
Vol 83 (2) ◽  
pp. 9-15
Author(s):  
Benoit Tousignant ◽  
Drissa Moriba Coulibaly ◽  
Julie Brûlé ◽  
Jacques Gresset
Keyword(s):  
Health Insurance ◽  
Healthcare Costs ◽  
Foreign Bodies ◽  
Family Physicians ◽  
Significant Trend ◽  
Public Healthcare ◽  
Regression Slopes ◽  
Apparent Shift ◽  
Public Costs ◽  
Almost All

Purpose In 2003, Quebec optometrists were legally enabled to extract superficial ocular foreign bodies, with part of this service covered by the universal health insurance. This study analyses the evolution of roles for professionals managing this condition (optometrists, ophthalmologists, emergency physicians and family physicians) and the related public healthcare costs. Methods Data from the provincial health insurance were combined to demographic and annual healthcare workforce statistics. Across professions and sociosanitary regions, variations in annual rates of conditions treated were calculated, as well as variations in public healthcare costs. Linear regression slopes of these variations were used as indicators of linear trends. Results Between 2010 and 2016, the proportion of cases managed by optometrists increases from 32% to 44%, following a significant trend (p < 0.007). For family physicians, the proportion of cases managed decreases from 49% to 33%, following a significant trend (p < 0.0001). The increase in optometrists managing cases is visible in almost all sociosanitary regions, reaching +19%. A significant trend was observed for increasing healthcare costs for optometrists (p < 0.008) and ophthalmologists (p < 0.004) and for decreasing healthcare costs for family physicians (p < 0.001). In 2016, optometrists managed 44% of cases, representing 13% of related healthcare costs. Conclusion In Quebec, optometrists are now the professionals managing the largest proportion of superficial ocular foreign bodies, across the province. There is an apparent shift from the proportion of cases managed by family physicians, which have similarly decreased.

scholarly journals 1232. Potential Health and Cost Outcomes of Optimized Statistical Process Control Use for Surgical Site Infection Surveillance

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S443-S444
Author(s):  
Nicole Nehls ◽  
Iulian Ilieş ◽  
James C Benneyan ◽  
Arthur W Baker ◽  
Deverick J Anderson
Keyword(s):  
United States ◽  
Pilot Study ◽  
Process Control ◽  
Statistical Process Control ◽  
Healthcare Costs ◽  
Cost Savings ◽  
The United States ◽  
Outbreak Detection ◽  
Statistical Process ◽  
Traditional Surveillance

Abstract Background Surgical site infections (SSIs) are common (160,000–300,000 per year in the United States) and costly ($6,000–$25,500 per event) healthcare-associated infections with potentially lethal outcomes (2.1%–6.7% mortality rate). A prior analysis by our group suggested that statistical process control (SPC) can detect SSI outbreaks earlier than traditional epidemiological surveillance methods. This study aimed to quantify the potential impact of SPC surveillance on patient outcomes (prevented SSIs and deaths) and healthcare costs. Methods We retrospectively analyzed 30 SSI outbreaks occurring over a period of 8 years in a network of 50 community hospitals from the Southeastern United States. We applied 24 control chart variations, including 2 optimized for SSI surveillance, 6 with expert-defined pre-outbreak baselines (used in our pilot study), 4 with lagged rolling baselines (idem), and 12 common practice ones (using rolling baselines with no lag or fixed baselines). The charts used procedure-specific data from either the outbreak hospital or the entire network to compute baseline SSI rates. We calculated the average SSI rates during, before and after the outbreaks, and the months elapsed between SPC and traditional detection. We then used these values to estimate the number of SSIs that could have been prevented by SPC, and corresponding deaths avoided and cost savings (Figure 1). Results Optimized charts detected 96% of the outbreaks earlier than traditional surveillance, while pilot study and common practice charts did so only 65% (58%) of the time (Figure 2). Optimized charts could potentially prevent 15.2 SSIs, 0.64 deaths, and save $226,000 in excess care costs per outbreak. Overall, charts using network baselines performed better than those relying on local hospital data. Commonly used variations were the least effective, but were still able to improve on traditional surveillance (Figure 3). Conclusion SPC methods provide a great opportunity to prevent infections and deaths and generate cost savings, ultimately improving patient safety and care quality. While common practice SPC charts can also speed up outbreak detection, optimized SPC methods have a significantly higher potential to prevent SSIs and reduce healthcare costs. Disclosures All authors: No reported disclosures.

Abstract 16853: Dietary Improvements and the Preventable Cost of Cardiovascular Disease: Evidence From the Literature

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Donglan Zhang ◽  
Mary E Cogswell ◽  
Guijing Wang
Keyword(s):  
United States ◽  
Healthcare Cost ◽  
Healthcare Costs ◽  
Fruits And Vegetables ◽  
Sodium Intake ◽  
Saturated Fat ◽  
Cost Savings ◽  
The United States ◽  
Dietary Component ◽  
Dietary Components

Introduction: Cardiovascular diseases (CVD) risk has been linked to dietary components in many studies, but the associated reduction in CVD healthcare costs with dietary improvements has not been systematically evaluated. Hypothesis: CVD healthcare cost savings associated with an improvement in dietary metrics are substantial. Methods: We searched PubMed, Embase, CINAHL and ABI/Inform to identify population-based studies published between January 1990 and December 2014 on CVD healthcare costs related to a dietary component. The selected dietary components, in accordance with those identified by the American Heart Association in their 2010 Strategic Impact goals, included salt/sodium, sugar-sweetened beverages, fruits and vegetables, fish/omega-3 fatty acids, whole grains/fiber. Other selected dietary components, based on AHA’s secondary dietary metrics, were nuts, processed meat and saturated fat. For each dietary component, we evaluated the CVD healthcare cost savings if the current consumption level were to be changed. Results: In 329 articles obtained, 15 studies evaluated the healthcare costs associated with one or more of dietary components: salt/sodium (n=12); fruit and vegetables (n=1); meat (n=1); saturated fat (n=3). The majority of studies (n=11) used an incidence-based approach, and the remaining were prevalence-based analyses. Adjusting the costs to 2013 US dollar values using consumer price index and purchasing power parity exchange rate, reducing average sodium intake by 1.2 g/day could save $1794 per person per year in the United Kingdom. Reducing individual sodium intake to 2.3 g/day could save $1955 per person in the United States. Increasing consumption of fruits and vegetables from <0.5 cup / day to more than 1.5 cups / day could save $1481 per person in the United States. Conclusions: In conclusion, reducing sodium intake and increasing consumption of fruits and vegetables could substantially reduce CVD costs. Few studies were available on the cost savings associated with dietary components for cardiovascular health. These results suggest a need for economic studies using high-quality cost information and the most recent evidence to predict long-term cost savings.

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