scholarly journals Cost effectiveness of bilateral risk-reducing mastectomy and salpingo-oophorectomy

2019 ◽  
Vol 24 (1) ◽  
Author(s):  
Michael G. Schrauder ◽  
Lisa Brunel-Geuder ◽  
Lothar Häberle ◽  
Marius Wunderle ◽  
Juliane Hoyer ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Cost Effective ◽  
University Hospital ◽  
Inherited Susceptibility ◽  
Combined Operations ◽  
Deep Inferior Epigastric Perforator ◽  
Small Benefit ◽  
Risk Reducing ◽  
Care System

Abstract Background Growing demand for risk-reducing surgery in individuals with inherited susceptibility to cancer leads to the question whether these procedures are cost effective for the executing hospitals. This study compared the clinical costs for bilateral risk-reducing mastectomy (BRRM) with and without different types of reconstruction, risk-reducing salpingo-oophorectomy (RRSO), and their combinations with corresponding reimbursements in the statutory health-care system in Germany. Patients and methods Real total costs of care for BRRM with and without reconstruction, RRSO, and their combinations were calculated as the sum of all personnel and technical costs. These costs calculated in a German University hospital were compared with the sum of all reimbursements in the German DRG-based health-care system. Results While sole RRSO, BRRM without reconstruction, and BRRM with secondary DIEP (deep inferior epigastric perforator)—reconstruction still result in a small benefit, we even found shortfalls for the hospital with all other prophylactic operations under consideration. The calculated deficits were especially high for BRRM with implant-based breast reconstruction and for combined operations when the risk reduction is achieved with a minimum of separate operations. Conclusions Risk-reducing surgery in BRCA-mutation carriers is frequently not cost-covering for the executing hospitals in the German health-care system. Thus, appropriate concepts are required to ensure a nationwide care.

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

scholarly journals Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study

10.2196/18012 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e18012
Author(s):  
Luis J Mena ◽  
Vanessa G Félix ◽  
Rodolfo Ostos ◽  
Armando J González ◽  
Rafael Martínez-Peláez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Health Care System ◽  
Blood Pressure Monitoring ◽  
Cost Effective ◽  
Machine Learning Techniques ◽  
Personal Health ◽  
Usability Study ◽  
British Hypertension Society ◽  
Care System

Background Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. Results The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations.

Cost-effective use of breast biopsy techniques in a veterans health care system

2006 ◽  
Vol 192 (5) ◽  
pp. e37-e41 ◽  
Author(s):  
Allison R. Hatmaker ◽  
Rafe M.J. Donahue ◽  
John L. Tarpley ◽  
A. Scott Pearson
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Breast Biopsy ◽  
Cost Effective ◽  
Veterans Health ◽  
Effective Use ◽  
Care System

scholarly journals Treatment of moderate to severe respiratory COVID-19: a cost-utility analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephen E. Congly ◽  
Rhea A. Varughese ◽  
Crystal E. Brown ◽  
Fiona M. Clement ◽  
Lynora Saxinger
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
Supportive Care ◽  
Health Care System ◽  
Cost Effective ◽  
The United States ◽  
Cost Effective Treatment ◽  
Severe Infections ◽  
Care System

AbstractDespite COVID-19’s significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in only moderate and only severe infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.

scholarly journals Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study (Preprint)

2020 ◽  
Author(s):  
Luis J Mena ◽  
Vanessa G Félix ◽  
Rodolfo Ostos ◽  
Armando J González ◽  
Rafael Martínez-Peláez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Health Care System ◽  
Blood Pressure Monitoring ◽  
Cost Effective ◽  
Machine Learning Techniques ◽  
Personal Health ◽  
Usability Study ◽  
British Hypertension Society ◽  
Care System

BACKGROUND Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. OBJECTIVE This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. METHODS The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. RESULTS The employed artificial neural network model had good average accuracy (&gt;90%) and very strong correlation (&gt;0.90) (<i>P</i>&lt;.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. CONCLUSIONS With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations.

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