scholarly journals Safety and cost-effectiveness of single-use endolaser probe reprocessing in vitreoretinal surgery

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Leandro Cabral Zacharias ◽  
Lívia da Silva Conci ◽  
Bianca Partezani Megnis ◽  
Janaina Guerra Falabretti ◽  
Taurino dos Santos Rodrigues Neto ◽  
...  
Keyword(s):  
Average Cost ◽  
Vitreoretinal Surgery ◽  
Cost Effective ◽  
University Hospital ◽  
Second Phase ◽  
Microscopic Evaluation ◽  
Single Use ◽  
Laser Probes ◽  
Two Phases ◽  
The Cost

Abstract Background Endolaser probes have been designed and sold for single-use only. However, in Brazil, they are not included in the list of single-use medical products that are prohibited from being reprocessed and could potentially be reused if safety requirements are accomplished. Therefore, this study aimed to determine and compare the quality, safety and costs of reprocessed versus original single-use endolaser probes of a specific brand and model. Methods The study, conducted at a university hospital in Sao Paulo, Brazil, was divided in two phases. The first one tested the feasibility, sterility and physical integrity of ten reprocessed laser probes. In the second phase, all vitrectomy procedures using endolaser probes (reprocessed and original ones) from August 2017 to October 2019 were evaluated. The operated cases were followed for any signs of infection and number of defective probes for each group were counted. The cost of acquiring a new probe and for all reprocessing stages were evaluated and quantified in US dollars($). Results Microbiologic, residual ethilen oxide and microscopic evaluation of integrity of reprocessed laser probes were all within acceptable range. The second phase of this study included 590 endolaser probes, of which 375 were original and 215 were reprocessed. Functionality rates differed significantly between groups. Among the original probes, 373 (99.47%) were functioning and 2 (0.53%) were non-functioning. Among the reprocessed ones, 201 (93.5%) were functioning and 14 (6.5%) were non-functioning (p < .001). The average cost of one reprocessing was $3.00, and the average cost of an original probe was $150.00. Considering the loss rates, potential savings were $147.60 for each once-reprocessed probe. The frequency of infectious endophthalmitis was null in both groups. Conclusions Our study showed that a single cycle endolaser probe reprocessing was safe and efficient, not associated with increase in endophthalmitis rate and proved to be significantly cost-effective, even considering a greater malfunction rate when compared to the original devices.

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

2021 ◽  
pp. 019459982110268
Author(s):  
Joseph R. Acevedo ◽  
Ashley C. Hsu ◽  
Jeffrey C. Yu ◽  
Dale H. Rice ◽  
Daniel I. Kwon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Submandibular Gland ◽  
Average Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Probability Of Success ◽  
Markov Decision Model ◽  
The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

scholarly journals Nilotinib and Imatinib Utilization in Iran over 14 years

2021 ◽  
Author(s):  
Ava Mansouri ◽  
Kimia Hirbod ◽  
Maryam Taghizadeh-Ghehi ◽  
Aarefeh Jafarzadeh Kohneloo ◽  
Mohammad Solduzian ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Data Extraction ◽  
Insurance Coverage ◽  
Cost Effective ◽  
Insurance Companies ◽  
P Value ◽  
Policy Makers ◽  
Trend Assessment ◽  
Two Phases ◽  
The Cost

Background: Tyrosine Kinase Inhibitors (TKIs) are drugs of choice for Chronic Myeloid Leukemia (CML) treatment. CML healthcare costs greatly exceed of other haematological malignancies treatment mostly due to TKIs. There are several generic and brand preparations of imatinib and nilotinib, the only available TKIs, in Iran with different prices and varied insurance coverage. We have studied TKIs utilization and also investigate the effect of different insurance coverage on TKIs utilization in Iran. Methods: This was drug utilization study about Imatinib and Nilotinib over 14 years. It was conducted in two phases; data extraction from pharmaceutical wholesale data (2003-2017) for utilization trend assessment and registered data of prescriptions from Sizdah-Aban Pharmacy (2011-2014) for utilization trend and insurance coverage assessment such as; prescriptions frequency, number of TKIs, insurance companies and their cost coverage in each prescription. Results: Imatinib consumption increased significantly from 2003 to 2013. This trend stopped afterward. Nilotinib consumption had ascending trend. The trend line of years 2014 to 2017 was steeper and statistically significant (β=0.0014, p-value=0.02). The amount of nilotinib cost coverage by insurance companies increased significantly from 2011 to 2014 (p-value=0.04). The coverage of imatinib costs by insurance companies changed slightly during the study period that was not statistically significant. Frequency of prescriptions with full cost coverage doubled for nilotinib, while did not change remarkably for imatinib, from 2011 to 2014. Mean (SD) of imatinib and nilotinib counts per prescription was significantly higher in prescriptions for which 100% of the cost was covered. Conclusion: We found increasing trend in nilotinib utilization and observed some effects from nilotinib cost coverage by insurance on its consumption. This study made a clear picture for policy makers to monitor imatinib and nilotinib use appropriateness and design the proper cost-effective studies to make evidence-based decisions.

scholarly journals Obtaining Journal Titles via Big Deals Most Cost Effective Compared to Individual Subscriptions, Pay-Per-View, and Interlibrary Loan

2016 ◽  
Vol 11 (1) ◽  
pp. 66 ◽  
Author(s):  
Kathleen Reed
Keyword(s):  
Average Cost ◽  
Research University ◽  
Academic Library ◽  
Cost Effective ◽  
The United States ◽  
Journal Subscription ◽  
Public Research University ◽  
Medical Libraries ◽  
The Cost ◽  
Design Cost

A Review of: Lemley, T., & Li, J. (2015). "Big deal” journal subscription packages: Are they worth the cost? Journal of Electronic Resources in Medical Libraries, 12(1), 1-10. http://dx.doi.org/10.1080/15424065.2015.1001959 Abstract Objective – To determine if “Big Deal” journal subscription packages are a cost-effective way to provide electronic journal access to academic library users versus individual subscriptions, pay-per-view, and interlibrary loans (ILL). Design – Cost-per-article-use analysis. Setting – Public research university in the United States of America. Subjects – Cost-per-use data from 1) journals in seven Big Deal packages, 2) individually subscribed journals, 3) pay-per-view from publishers’ websites, and 4) interlibrary loans. Methods – The authors determined cost-per-use for Big Deal titles by utilizing COUNTER JR1 metric Successful Full-Text Article Request (SFTAR) reports. Individual journal subscription cost-per-use data were obtained from individual publishers or platforms. Pay-per-view cost was determined by recording the price listed on publishers’ websites. ILL cost-per-use was established by reviewing cost-per-article obtained from libraries outside of reciprocal borrowing agreement networks. With the exception of pay-per-view numbers, title cost-per-use was averaged over a three-year period from 2010 through 2012. Main Results – Cost-per-article use for journals from Big Deals varied from $2.11 to $9.42. For individually subscribed journals, the average cost-per-article ranged from $0.25 to $84.00. Pay-per-view charges ranged from $15.00 to $80.00, with an average cost of $37.72. Conclusion – The authors conclude that Big Deals are cost effective, but that they consume such a large amount of funds that they limit the purchase of other resources. The authors go on to outline the options for libraries thinking about Big Deal packages. First, libraries should keep Big Deal packages in place if the average cost-per-article is less than individual subscriptions. Second, libraries could subscribe only to the most-used journals in Big Deals, cancel the packages, and rely on ILL and pay-per-view access. Third, consortia could be joined to favourably negotiate Big Deal package prices. Fourth, Big Deals could be dropped completely. Fifth, individual libraries armed with JR1 reports can negotiate with publishers for better deals.

Estimating the real cost of adjuvant (adj) trastuzumab (T) in patients (pts) with HER-2+ (H+) early stage breast cancer (ESBC): Potential impact of reduced use of expensive oncology drugs (EOD) in metastatic breast cancer (MBC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6534-6534
Author(s):  
R. O'Cearbhaill ◽  
E. Wilson ◽  
A. deFrein ◽  
Z. Qadir ◽  
D. McDonnell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Metastatic Breast ◽  
Cost Effective ◽  
Societal Cost ◽  
University Hospital ◽  
The Real ◽  
Real Cost ◽  
The Mean ◽  
The Cost

6534 Background: Pts with H+ early stage BC have an approximately 35% risk of developing MBC (BCIRG001). T has been reported to reduce this risk by 33–50%, but costs approximately €;30k per pt, a burden some health systems deem unsustainable. This risk reduction might however result in decreased utilization of EOD in MBC, lowering the societal cost of adjT. We attempted to estimate the cost per relapse prevented (Crp), and the real cost of adjT, allowing for potential savings in prevented cases of MBC. Methods: We conducted a retrospective analysis of the mean cost per pt of AdjT (1 year) and of EOD in MBC in St. Vincent's University Hospital. We devised an equation to calculate the Crp for adj T. Crp=[A-M(NRA/104)]/[NRA/104] where A = cost per pt for adjT, M = EOD cost per pt with MBC, N = % of pts relapsing after standard adj treatment, RA = % reduction in the risk of relapse after adjT (over standard adj). Results: H+ pts with MBC received T (average 34 cycles €;2,400 each) with a combination of the following drugs: docetaxel (x8 €;1,500), gemcitabine (x5 €;1,215), capecitabine (x8 €;400), vinorelbine ( x19 €;187). Only 2 pts received bevacizumab (Bev) (x15 €;3,000). In our unit the mean EOD cost per pt with MBC was €;108k. The cost per relapse prevented for a 33% and a 50% reduction in relapse rate would be €;152k and €;63k, respectively. Furthermore, assuming a 50% reduction in the rate of relapse (from 35 to 17.5%) the real cost of adjT per pt treated is not €;30k, but approximates €;11k (€;30k×100-{17.5x €;108k}). Conclusions: The reduced utilization of EOD in MBC likely has a very beneficial impact on the societal cost of adjT. Confirmation of the efficacy of shorter adjT (e.g. FinnHer) would produce further benefit. The increasing use of novel EOD in MBC e.g. Bev would make adjT even more cost-effective. No significant financial relationships to disclose.

scholarly journals Is tobacco Quitline cost effective in India?

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Raj Kumar ◽  
Shyam Kanhaiya Saroj
Keyword(s):  
Average Cost ◽  
Tobacco Cessation ◽  
Cost Effective ◽  
Effective Measure ◽  
Counselling Services ◽  
Control Intervention ◽  
The Mean ◽  
The Cost ◽  
Cost Effective Measure ◽  
The Ideal

Quitlines are effective, evidence-based tobacco cessation interventions that help tobacco users quit through a variety of services. The present study was done to evaluate the cost effectiveness of the National Tobacco Quitline Service (NTQLS). We calculated twoyear program use and costs for establishment, salary of the staff, media promotions, intervention services, Quitline registration calls and the number of quitters since inception of NTQLS in the year 2016, we examined whether NTQLS is cost-effective or not. Out of 63,350 callers, 9420 (97.9% males) callers with the mean ±SD age at 37.5±12.6 years; were registered for tobacco cessation counselling services at the National Tobacco Quitline Services (NTQLS) between 30th May 2016 and 31st May 2018. 3012 (32%) quitted their tobacco use till the last proactive calls. Average cost per completed counselling was 22.37 US$. Our study concludes that Tobacco Quitline as a tobacco control intervention is an excellent investment and cost-effective measure in India. Average cost per quitter at 69.96 US$ is comparatively very low to other country’s Quitline, representing the ideal utilization of funds.

scholarly journals Cost-effectiveness analysis of hernioplasties before and after the implementation of the ACERTO project

2020 ◽  
Vol 47 ◽  
Author(s):  
JOSÉ EDUARDO DE AGUILAR NASCIMENTO ◽  
ALBERTO BICUDO SALOMÃO ◽  
MARA REGINA ROSA RIBEIRO ◽  
ROBERTA FERREIRA DA SILVA ◽  
WESLEY SANTANA CORREA ARRUDA
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Hospital Costs ◽  
University Hospital ◽  
Outcome Variable ◽  
Second Phase ◽  
Site Infection ◽  
Cost Information ◽  
Before And After ◽  
Two Phases

ABSTRACT Objective: to compare hospital costs and clinical outcomes in inguinal and incisional hernioplasty before and after implementation of the ACERTO project in a university hospital. Methods: retrospective study of 492 patients undergoing either inguinal hernioplasty (n=315) or incisional hernioplasty (n=177). The investigation involved two phases: between January 2002 and December 2005, encompassing cases admitted before the implementation of the ACERTO protocol (PRE-ACERTO period), and the other phase, with cases operated between January 2006 and December 2011, after the implementation of the protocol (ACERTO period). The main outcome variable was the comparison of the mean hospital costs between the two periods. As secondary endpoints, we analyzed the length of stay, the surgical site infection rate and mortality. We used the cost method suggested by Public Sector Cost Information System. Results: surgical site infection was higher (p = 0.039) in the first phase of the study for both inguinal hernia operations (2 (1.6%) versus 0 (0%) cases) and incisional hernioplasty (5 (7.6%) versus 3 (2.7%) cases). The length of stay decreased one day after the implementation of the ACERTO protocol (p=0.005). There was a reduction in costs per patient from R$ 4,328.58 per patient in the first phase to R$ 2,885.72 in the second phase (66.7% reduction). Conclusion: there was a reduction in infectious morbidity, length of stay and hospital costs in hernioplasty after the implementation of the ACERTO protocol.

Is Continuous Subglottic Suctioning Cost-Effective for the Prevention of Ventilator-Associated Pneumonia?

2011 ◽  
Vol 32 (2) ◽  
pp. 131-135 ◽  
Author(s):  
Corinne Hallais ◽  
Véronique Merle ◽  
Pierre-Gildas Guitard ◽  
Anne Moreau ◽  
Valérie Josset ◽  
...  
Keyword(s):  
Cost Benefit Analysis ◽  
Tertiary Care ◽  
Cost Effective ◽  
Additional Cost ◽  
University Hospital ◽  
Incidence Density ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Surgical Intensive Care ◽  
The Cost

Objective.To establish whether continuous subglottic suctioning (CSS) could be cost-effective.Design.Cost-benefit analysis, based on a hypothetical replacement of conventional ventilation (CV) with CSS.Setting.A surgical intensive care unit (SICU) of a tertiary care university hospital in France.Patients.All consecutive patients receiving ventilation in the SICU in 2006.Methods.Efficacy data for CSS were obtained from the literature and applied to the SICU of our hospital. Costs for CV and CSS were provided by the hospital pharmacy; costs for ventilator-associated pneumonia (VAP) were obtained from the literature. The cost per averted VAP episode was calculated, and a sensitivity analysis was performed on VAP incidence and on the number of tubes required for each patient.Results.At our SICU in 2006, 416 patients received mechanical ventilation for 3,487 ventilation-days, and 32 VAP episodes were observed (7.9 episodes per 100 ventilated patients; incidence density, 9.2 episodes per 10,000 ventilation-days). Based on the hypothesis of a 29% reduction in the risk of VAP with CSS than CV, 9 VAP episodes could have been averted. The additional cost of CSS for 2006 was estimated to be €10,585.34. The cost per averted VAP episode was €1,176.15. Assuming a VAP cost of €4,387, a total of 3 averted VAP episodes would neutralize the additional cost. For a low VAP incidence of 6.6%, the cost per averted VAP would be €1,323. If each patient required 2 tubes during ventilation, the cost would be €1,383.69 per averted VAP episode.Conclusion.Replacement of CV with CSS was cost-effective even when assuming the most pessimistic scenario of VAP incidence and costs.

scholarly journals Mitigation of Damage in the Context of Remedies for Breach of Contract

2019 ◽  
Vol 15 (2) ◽  
pp. 293-340
Author(s):  
Anne Michaud
Keyword(s):  
Common Law ◽  
Civil Law ◽  
Conclusive Evidence ◽  
Point Of View ◽  
Second Phase ◽  
Breach Of Contract ◽  
Physical Injuries ◽  
Course Of Action ◽  
Two Phases ◽  
The Cost

When I began this article my main objective was to show why the concept of mitigation of damage, which is so extensively used in common law, was apparently non-existent in civil law. Right from the beginning, however, I found conclusive evidence which proved that the concept of mitigation actually exists in civil law too; my purpose was then transformed into explaining how this concept works in two systems of law that are so different in their approaches and their methodologies. In order to make this study manageable, I have focused on the links between the concept of mitigation and the problem of pecuniary loss following a breach of contract. Consequently, issues pertaining to tort, physical injuries to persons and things, and claims to liquidate sums, as in debt, will be dealt with only incidentally. Regrettably, this course of action will leave open many interesting questions related to mitigation, mainly in tort but also in contract. Nevertheless, I trust that the present study will constitute a useful basis for further analysis on this subject. I have divided this work into two parts, devoted to the two phases of recovery following a breach of contract. The first phase concerns the choice of which losses fall under the protection of the law, among all those claimed by the plaintiff. I propose to call this phase measuring the extent of the loss. The second phase involves the determination of what the defendant will have to do in order to compensate the plaintiff; when this compensation takes a pecuniary form it involves the assessment of the pecuniary value of the loss. The first of these phases primarily concerns the extent of losses and the question of what damage counts for compensation; this particular aspect of the issue of mitigation is the subject of Part I of this article. The connection between mitigation and the pecuniary evaluation of a plaintiff's damages is examined in Part II where I focus on the effects of inflation and other factors that influence the cost of compensation. Finally, from a comparative point of view, one of the main interests of the present study lies in observing that the concept of mitigation has achieved a different status in civil law and in common law. The conclusion of this work explores this situation, and aims at explaining the historical and juridical circumstances that may have caused common law to attain higher levels of generality and of abstraction than civil law with regard to the issue of mitigation.

scholarly journals An approach based on Clustering AH and VND for Supply Chain Management

2021 ◽  
Vol 14 (1) ◽  
pp. 306-315
Author(s):  
Fadoua Oudouar ◽  
◽  
El Zaoui ◽  
Keyword(s):  
Second Phase ◽  
Variable Neighborhood Descent ◽  
Location Routing Problem ◽  
Routing Problem ◽  
New Approach ◽  
Location Routing ◽  
Sweep Algorithm ◽  
Two Phases ◽  
The Cost ◽  
Capacitated Location

In this work, we present a new approach to solve the Capacitated Location-Routing Problem (CLRP). The aim of this method is to determine the depot locations, to assign customers to facilities and to define routes for each depot to serve the associated clients. The proposed approach contains two phases, which are the constructive phase and the improvement phase. In the first phase, we select the depots to be opened, allocate the customers to open depots using a Hierarchical Ascendant (HA) method and we solve the vehicle routing problem for each depot using Sweep algorithm. In the second phase, we apply a Variable Neighborhood Descent (VND) with three structures in order to optimize the cost obtained by the first phase. Two sets of well-known instances from the literature are used to evaluate the performance of this method, and the numerical results obtained are compared with the experimental results of other methods. Results show that our method is competitive with respect to the best-known solutions (BKSs) and demonstrate its efficiency in comparison with other approaches.

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