Technology-enabled remote management of diabetes foot disease and potential for reduction in associated health costs: a pilot study

AbstractDiabetes-related foot disease, particularly when associated with amputation, affects quality of life and has a significant impact on health care costs. A pilot study using enhanced technology to facilitate remote access and video conferencing from rural locations to the diabetes MDT through a new service pathway confirmed high levels of patient satisfaction with 89% of foot ulcers improved or stable and only two minor amputations. A health economic analysis suggested potential for significant cost savings if this was scaled up regionally. Further evaluation of an integrated pathway, impact on lower limb amputation rates and full health economic assessment is recommended.

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Health economic evaluation of a clinical pharmacist's intervention on the appropriate use of devices and cost savings: A pilot study

International Journal of Surgery ◽

10.1016/j.ijsu.2020.08.021 ◽

2020 ◽

Vol 82 ◽

pp. 143-148 ◽

Cited By ~ 1

Author(s):

Virginie Chasseigne ◽

Sophie Bouvet ◽

Sihame Chkair ◽

Marlène Buisson ◽

Marie Richard ◽

...

Keyword(s):

Health Economic ◽

Economic Evaluation ◽

Pilot Study ◽

Health Economic Evaluation ◽

Cost Savings ◽

Appropriate Use

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Including Health Economic Analysis in Pilot Studies: Lessons Learned from a Cost-Utility Analysis within the PROSPECTIV Pilot Study

Global & Regional Health Technology Assessment Italian Northern Europe and Spanish ◽

10.5301/grhta.5000269 ◽

2017 ◽

Vol 4 (1) ◽

pp. grhta.5000269

Author(s):

Richéal M. Burns ◽

Jane Wolstenholme ◽

Bethany Shinkins ◽

Emma Frith ◽

Lauren Matheson ◽

...

Keyword(s):

Health Economic ◽

Pilot Study ◽

Economic Analysis ◽

Cost Utility ◽

Cost Utility Analysis ◽

Lessons Learned ◽

Utility Analysis ◽

Health Economic Analysis ◽

Pilot Studies

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Cerebrospinal fluid leakage costs after craniotomy and health economic assessment of incidence reduction from a hospital perspective in the Netherlands

BMJ Open ◽

10.1136/bmjopen-2021-052553 ◽

2021 ◽

Vol 11 (12) ◽

pp. e052553

Author(s):

Chris van Lieshout ◽

Emma M H Slot ◽

Ahmet Kinaci ◽

Mare H Kollen ◽

Eelco W Hoving ◽

...

Keyword(s):

Health Economic ◽

Cost Savings ◽

Economic Assessment ◽

Cost Difference ◽

Potential Cost ◽

Hospital Perspective ◽

Cranial Surgery ◽

Preventative Measures ◽

The Cost ◽

Mean Cost

ObjectivesWe aim to quantify the cost difference between patients with incisional cerebrospinal fluid (iCSF) leakage and those without after intradural cranial surgery. Second, the potential cost savings per patient when a decrease in iCSF leakage rate would be achieved with and without added costs for preventative measures of various price and efficacy are modelled.DesignHealth economic assessment from a hospital perspective based on a retrospective cohort study.SettingDutch tertiary referral centre.ParticipantsWe included 616 consecutive patients who underwent intradural cranial surgery between 1 September 2017 and 1 September 2018. Patients undergoing burr hole surgery or transsphenoidal surgery, or who died within 1 month after surgery or were lost to follow-up were excluded.Primary and secondary outcome measuresOutcomes of the cost analysis include a detailed breakdown of mean costs per patient for patients with postoperative iCSF leakage and patients without, and the mean cost difference. For the scenario analyses the outcomes are the potential cost savings per 1000 patients when a decrease in iCSF leakage would be achieved.ResultsMean cost difference between patients with and without iCSF leakage was €9665 (95%CI, €5125 to €14 205). The main cost driver was hospital stay with a difference of 8.5 days. A 25% incidence reduction would result in a mean cost saving of −€94 039 (95% CI, −€218 258 to −€7077) per 1000 patients. A maximum cost reduction of −€653 025 (95% CI, −€1 204 243 to −€169 120) per 1000 patients could be achieved if iCSF leakage would be reduced with 75% in all patients, with 72 cases of iCSF leakage avoided.ConclusionsPostoperative iCSF leakage after intradural cranial surgery increases healthcare costs significantly and substantially. From a health economic perspective preventative measures to avoid iCSF leakage should be pursued.

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MiCheck performance: Comparator trial of MiCheck with PHI, % free PSA and PSA—The impact on decision making for prostate biopsy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.199 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 199-199 ◽

Cited By ~ 1

Author(s):

Neal D. Shore ◽

Daniel R. Saltzstein ◽

Christopher Michael Pieczonka ◽

Jennifer Lynn Beebe-Dimmer ◽

Julie J. Ruterbusch ◽

...

Keyword(s):

Decision Making ◽

Health Economic ◽

Prostate Biopsy ◽

Cost Savings ◽

Workflow Model ◽

Serum Samples ◽

Multiple Cancer ◽

Health Economic Analysis ◽

Free Psa ◽

The Impact

199 Background: A more accurate diagnostic test is still needed to enhance decision-making regarding prostate biopsy. MiCheck is a triage test to assist in a decision to proceed to prostate biopsy. It measures multiple cancer related proteins in blood while combining this information with clinical factors. It has been optimised to differentiate between aggressive (AgCaP) and non-aggressive (non-AgCaP) prostate cancer. The MiCheck-01 clinical trial collected samples from patients who proceeded to biopsy on the basis of an elevated age adjusted PSA. The performance of MiCheck was compared with PSA, %free PSA and PHI. Methods: Serum samples were tested according to the MiCheck manufacturer’s instructions. Patient samples were also tested using a standard PSA assay and additionally underwent PHI and % free PSA measurement. A range of different MiCheck cutpoints were examined for test performance and one chosen following consultation with Urologists and Clinical Chemists. This algorithm was applied to all evaluable patients from the trial and the outputs used for the development of a health economic model. The net cost impact of using MiCheck was assessed. Results: The best performing MiCheck algorithm demonstrated a high AUC when differentiating AgCaP from non-AgCaP. MiCheck demonstrated a higher AUC than PSA, %free PSA and PHI in this population. Furthermore, the algorithm was superior to the other tests in PSA 4-10ng/ml range. The derived algorithm was applied to patients from the trial using a high sensitivity cutpoint. At this cutpoint, 25% of biopsies were avoided while only 5 (4%) AgCaP patients underwent a later diagnosis. A diagnostic workflow model of how the test might be employed by the clinician was constructed. This was applied to a health economic analysis demonstrating significant cost savings (between $2,744 and 5,047 per patient in year one) when incorporating MiCheck to standard of care. Conclusions: The MiCheck test demonstrates a superior ability to discriminate between AgCaP and non-AgCaP in comparison to PSA,PHI, and % free PSA. Use of the MiCheck test would assist clinicians in assessing the need for a prostate biopsy and provide significant healthcare cost savings.

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71. Are video interviews a good alternative to in person interviews in assessing international applicants' skills?

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2832 ◽

2007 ◽

Vol 30 (4) ◽

pp. 67

Author(s):

M. Alameddine ◽

K. Imrie ◽

S. Akers ◽

S. Verma

Keyword(s):

Nursing Education ◽

Pilot Study ◽

Psychological Treatment ◽

Cost Savings ◽

Good Alternative ◽

Average Score ◽

Global Rating ◽

Problem Solving Skills ◽

Global Satisfaction ◽

Personal Connection

We developed and administered two questionnaires to assess the interview experience of both interviewers and applicants during postgraduate medical selection interviews. Using a 5 point likert scale, the questionnaires assessed three areas (1) ability to show/assess communication, interpersonal and problem solving skills; (2) ability to know the other side well and (3) level of comfort with the interview. Interviewers and applicants were asked to provide a global rating for the interview. The questionnaires were administered to both candidates and applicants from 6 departments in 18 in-person and 12 video interviews. 30 applicant and 87 interviewer survey forms were collected and analyzed. T-tests were used to compare the means of the two groups and significance levels were analyzed. Both interviewers and applicants had a higher average global satisfaction for video interviews compared to in person interviews. No difference was indicated in the ability of interviewers to assess the applicants’ skills between the two types of interviews. For both interviewers and applicants, video interviews, compared to in person interview, had a lower average score for connecting personally & establishing rapport and for satisfaction with administrative arrangements. Video interviewed applicants had a 50% probability of getting accepted in a program compared to 22% of in person interviewed candidates. We conclude that video interviews appear to be a valuable alternative to in-person interviews, with some sacrifice in personal connection and rapport. Video interviews result in significant time and cost savings for international applicants and have potential implications for the CaRMS process as well. Sackett KM, Campbell-Heider N, Blyth JB. The evolution and evaluation of videoconferencing technology for graduate nursing education. Comput Inform Nurs. 2004 (Mar-Apr); 22(2):101-6. Shepherd L, Goldstein D, Whitford H, Thewes B, Brummell V, Hicks M. The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: results of a pilot study. J Pain Symptom Manage 2006 (Nov); 32(5):453-61. Arena J, Dennis N, Devineni T, Maclean R, Meador K. A pilot study of feasibility and efficacy of telemedicine-delivered psychophysiological treatment for vascular headache. Telemed J E Health 2004 (Winter); 10(4):449-54.

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Remotely Delivered Monitoring and Management of Diabetes-Related Foot Disease: An Overview of Systematic Reviews

Journal of Diabetes Science and Technology ◽

10.1177/19322968211012456 ◽

2021 ◽

pp. 193229682110124

Author(s):

Aaron Drovandi ◽

Shannon Wong ◽

Leonard Seng ◽

Benjamin Crowley ◽

Chanika Alahakoon ◽

...

Keyword(s):

Cost Effectiveness ◽

Systematic Reviews ◽

Urban Areas ◽

Meta Analysis ◽

Risk Of Bias ◽

Limb Amputation ◽

Current Evidence ◽

Or Management ◽

Foot Disease ◽

Poor Reporting

Background: Diabetes-related foot disease (DFD) management requires input from multiple healthcare professionals, and has worse outcomes for people living in remote localities by comparison to urban areas. Remotely delivered healthcare may reduce this disparity. This overview summarizes current evidence on the effectiveness, stakeholder perceptions, and cost-effectiveness of remotely delivered healthcare for DFD. Methods: A search of 5 databases was conducted to identify systematic reviews published between January 2000 and June 2020. Eligible reviews were those evaluating remotely delivered monitoring or management of patients at risk of or with active DFD, or clinicians managing these patients. Risk of bias was assessed using the AMSTAR-2 tool. Results: Eight reviews were eligible for inclusion, including 88 primary studies and 8509 participants, of which 36 studies involving 4357 participants evaluated remotely delivered monitoring or management of DFD. Only one review had a low risk of bias, with most reviews demonstrating limited search strategies and poor reporting of participants. Evidence on effectiveness was mixed, with meta-analyses demonstrating long-term ulcer healing and mortality were not significantly different between telehealth and standard care groups, although the lower-limb amputation rate was significantly decreased in one meta-analysis. Perceptions of telehealth by patients and clinicians were generally positive, whilst acknowledging limitations relating to access and use. Cost-effectiveness data were limited, with poor reporting preventing clear conclusions. Conclusions: Remotely delivered healthcare of DFD is well received by patients and clinicians, but its effectiveness is unclear. High quality trials are needed to evaluate the risks and benefits of remotely delivered DFD management.

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