Analytical decision model for the cost-effective management of solitary pulmonary nodules.

1998 ◽  
Vol 16 (6) ◽  
pp. 2113-2125 ◽  
Author(s):  
S S Gambhir ◽  
J E Shepherd ◽  
B D Shah ◽  
E Hart ◽  
C K Hoh ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Decision Analysis ◽  
Cost Savings ◽  
Pulmonary Nodules ◽  
Cost Effective ◽  
Solitary Pulmonary Nodules ◽  
Potential Cost ◽  
Positron Emission ◽  
The Cost ◽  
Analysis Models

PURPOSE AND METHODS Multiple strategies are currently being used to manage patients who present with indeterminate solitary pulmonary nodules (SPN). We have used decision-analysis models to assess the cost-effectiveness of various strategies for the diagnosis and management of SPN. Four decision strategies were compared: a wait and watch strategy, a surgery strategy, a computed tomography (CT)-based strategy, and a CT-plus-positron emission tomography (PET) strategy. An incremental cost-effectiveness ratio (ICER) was used to compare all strategies to the wait and watch strategy. RESULTS A CT-plus-PET strategy was the most cost-effective over a large pretest likelihood (probability of having a malignant nodule), with a range of 0.12 to 0.69. Furthermore, within this likelihood range, the potential cost savings of using the CT-plus-PET strategy over the CT strategy ranged from $91 to $2,200 per patient. This translates to a yearly national savings of approximately $62.7 million. CONCLUSION Decision-analysis modeling indicates the potential cost-effectiveness of [18F]2-fluoro-2-deoxy-D-glucose (FDG)-PET in the management of SPN. Furthermore, the decision trees developed can be used to model various features of the management of SPN, including modeling the cost-effectiveness of other newly emerging technologies.

scholarly journals Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections

2019 ◽  
Vol 70 (12) ◽  
pp. 2461-2468 ◽  
Author(s):  
Nicole M White ◽  
Adrian G Barnett ◽  
Lisa Hall ◽  
Brett G Mitchell ◽  
Alison Farrington ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Environmental Cleaning ◽  
Monetary Benefit ◽  
Healthcare Associated ◽  
The Cost ◽  
Net Monetary Benefit ◽  
Hospital Cleaning

Abstract Background Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016–2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. Methods A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. Results Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. Conclusions A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2020 ◽  
Author(s):  
Colman Taylor ◽  
Annet C Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Sodium Intake ◽  
Intervention Strategy ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
Life Years ◽  
The Cost

Abstract Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and IHD events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

scholarly journals Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-216948
Author(s):  
Fiona J Gilbert ◽  
Scott Harris ◽  
Kenneth A Miles ◽  
Jonathan R Weir-McCall ◽  
Nagmi R Qureshi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Accuracy ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Sensitivity Specificity

IntroductionDynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these.MethodsIn this prospective multicentre trial, 380 participants with an SPN (8–30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model.Results312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred.ConclusionsPET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective.Trial registration numberNCT02013063

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2020 ◽  
Author(s):  
Colman Taylor ◽  
Annet C Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Ischaemic Heart Disease ◽  
Sodium Intake ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
The Cost

Abstract BackgroundDietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.MethodsThe three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). ConclusionThis research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

Plastic Liners for Offshore Production Lines: A Cost Effective Alternative Solution to Corrosion Resistant Alloys?

2021 ◽  
Author(s):  
Thomas Delaplace ◽  
Morgan Gouriou ◽  
Denis Melot
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Sensitivity Study ◽  
Cost Comparison ◽  
Production Lines ◽  
Potential Cost ◽  
Corrosion Resistant ◽  
Offshore Production ◽  
Design Requirements ◽  
The Cost

Abstract This paper presents the investigations performed by TotalEnergies and Saipem on the cost effectiveness potential of internal plastic lining for corrosion protection of offshore production lines. Objective was to better understand for a complete EPCI cost comparison the various parameters that could have a significant impact on the potential savings associated with the use of plastic lining instead of CRAs (Corrosion Resistant Alloys) for very corrosive production fluids such as sour gases. An extensive cost comparison study between CRA lining and plastic lining for offshore production lines was performed considering sensitivity on several parameters: 3 pipe diameters, S-Lay, Reel-Lay and J-Lay installation, sensitivity to external thermal insulation requirements, mechanical and design requirements, to pipe length and fixed costs (technologies and vessels). A dedicated calculation tool for system design and cost assessment was built on purpose for this sensitivity study. Costs were assessed for the various cases, starting from pipe design, then assessing procurement costs, fabrication costs then installation costs with preliminary cycle time assessment. Project management and engineering costs have been considered to obtain comparative EPCI (as installed) cost assessments for the various study cases. Plastic lining appears to be a cost-effective solution installed in J-Lay or S-Lay in addition to reeling (up to 45% of potential cost savings on installed line compared to CRA lining). The main driver for the cost savings is associated to the procurement of the pipes and associated lining, including pipe manufacturing. Some smaller savings can also be obtained from the offshore cycle times in J-Lay and S-Lay as the CRA welding add a significant operation time in comparison with standard CS welds. The fixed additional costs associated to the plastic lining (specific tooling for example) can be quickly amortized after a few kilometers thanks to the material cost savings. Integrating them as a company investment allows to unlock costs savings even for shorter lines. The thermal contribution of the plastic liner is also interesting regarding the overall pipe insulation design. This study completes the works already performed by the industry on the offshore costs of plastic lining as it considers the whole EPCI CAPEX costs from the Contractor and Operator points of view and offshore experience. The study integrates the S-Lay and J-Lay installation methods (while previous studies mainly focused on Reel-Lay) and includes an extensive sensitivity study with various key parameters such as pipe sizes, pipe design requirements, material costs and offshore operation times to get a general overview of potential benefits associated with plastic linings for offshore production lines transporting corrosive fluids such as sour gases.

scholarly journals The potential of real-time analytics to improve care for mechanically ventilated patients in the intensive care unit: an early economic evaluation

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Lytske Bakker ◽  
Katerina Vaporidi ◽  
Jos Aarts ◽  
William Redekop
Keyword(s):  
Intensive Care ◽  
Cost Effectiveness ◽  
Real Time ◽  
Cost Savings ◽  
Cost Effective ◽  
Potential Cost ◽  
Lifetime Horizon ◽  
Scenario Analyses ◽  
Life Years ◽  
The Impact

Abstract Background Mechanical ventilation services are an important driver of the high costs of intensive care. An optimal interaction between a patient and a ventilator is therefore paramount. Suboptimal interaction is present when patients repeatedly demand, but do not receive, breathing support from a mechanical ventilator (> 30 times in 3 min), also known as an ineffective effort event (IEEV). IEEVs are associated with increased hospital mortality prolonged intensive care stay, and prolonged time on ventilation and thus development of real-time analytics that identify IEEVs is essential. To assist decision-making about further development we estimate the potential cost-effectiveness of real-time analytics that identify ineffective effort events. Methods We developed a cost-effectiveness model combining a decision tree and Markov model for long-term outcomes with data on current care from a Greek hospital and literature. A lifetime horizon and a healthcare payer perspective were used. Uncertainty about the results was assessed using sensitivity and scenario analyses to examine the impact of varying parameters like the intensive care costs per day and the effectiveness of treatment of IEEVs. Results Use of the analytics could lead to reduced mortality (3% absolute reduction), increased quality adjusted life years (0.21 per patient) and cost-savings (€264 per patient) compared to current care. Moreover, cost-savings for hospitals and health improvements can be incurred even if the treatment’s effectiveness is reduced from 30 to 10%. The estimated savings increase to €1,155 per patient in countries where costs of an intensive care day are high (e.g. the Netherlands). There is considerable headroom for development and the analytics generate savings when the price of the analytics per bed per year is below €7,307. Furthermore, even when the treatment’s effectiveness is 10%, the probability that the analytics are cost-effective exceeds 90%. Conclusions Implementing real-time analytics to identify ineffective effort events can lead to health and financial benefits. Therefore, it will be worthwhile to continue assessment of the effectiveness of the analytics in clinical practice and validate our findings. Eventually, their adoption in settings where costs of an intensive care day are high and ineffective efforts are frequent could yield a high return on investment.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Colman Taylor ◽  
Annet C. Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Ischaemic Heart Disease ◽  
Sodium Intake ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
The Cost

Abstract Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam. Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

scholarly journals Piemonte

2012 ◽  
Vol 13 (2S) ◽  
pp. 52-54
Author(s):  
Roberto Gasparini ◽  
Donatella Panatto ◽  
Bruna Dirodi ◽  
Rosa Prato ◽  
Gianni Amunni ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Vaccination Strategy ◽  
Cost Effective ◽  
Genital Warts ◽  
Quadrivalent Vaccine ◽  
Protective Activity ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Quadrivalent Vaccines

In Piemonte region 82% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 33 cases of cervicocarcinoma and 15 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (11,974 €/QALY).

scholarly journals Sardegna

2012 ◽  
Vol 13 (2S) ◽  
pp. 58-60
Author(s):  
Roberto Gasparini ◽  
Donatella Panatto ◽  
Bruna Dirodi ◽  
Rosa Prato ◽  
Gianni Amunni ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Vaccination Strategy ◽  
Cost Effective ◽  
Genital Warts ◽  
Quadrivalent Vaccine ◽  
Protective Activity ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Quadrivalent Vaccines

In Sardegna region 75% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 17 cases of cervicocarcinoma and 8 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (10,841 €/QALY).

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