A budget impact model for biosimilar myeloid growth factors (MGFs) within the Oncology Care Model (OCM): An oncology group practice perspective.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 108-108
Author(s):  
Ali McBride ◽  
Weijia Wang ◽  
Edward C. Li ◽  
Sanjeev Balu ◽  
Kim Campbell
Keyword(s):  
Healthcare Utilization ◽  
Healthcare Providers ◽  
Healthcare Resource Utilization ◽  
Utilization Rate ◽  
Emergency Visits ◽  
Practice Perspective ◽  
Oncology Care ◽  
Budget Impact Model ◽  
Cost Implications ◽  
The Cost

108 Background: Value-based programs, such as the OCM, provide incentives for healthcare providers to lower costs and improve patient outcomes. Use of biosimilar vs. reference MGFs for febrile neutropenia (FN) prophylaxis (Px) has been suggested as one strategy to help practices meet these goals. The purpose of this study is to quantify the potential impact of using biosimilar MGFs on OCM metrics from a US practice perspective. Methods: The budgetary impact of two scenarios of MGF Px for a hypothetical panel of 500 patients in 1 year receiving 6 cycles of FN-risk stratified chemotherapy (CT) was assessed; model inputs for the rates of MGF Px based on FN risk were estimated from the literature. The first scenario compares the projected 1-year total (i.e., drug and administration) costs of using LA-EP2006 (a proposed Sandoz pegfilgrastim biosimilar) vs. reference pegfilgrastim, assuming the same MGF utilization rate within the 500 patients. The second scenario evaluates the cost implications of expanding access to LA-EP2006 for 10% more patients receiving intermediate-FN risk CT and the subsequent impact on MGF costs and FN-related healthcare utilization costs (e.g., emergency visits, hospitalizations, outpatient management). MGF costs were derived from publically available data; healthcare resource utilization and costs were estimated from the literature. Results: For 500 patients receiving CT, 107 were estimated to receive MGF Px, resulting in total costs of $3.02 million (M) for reference pegfilgrastim and $2.42 M for LA-EP2006 with $1.05 M in FN-related healthcare utilization costs. If MGF access (using LA-EP2006) were expanded to 10% more patients receiving intermediate-FN risk CT, 129 patients would receive MGF Px at a cost of $2.91 M; FN-related healthcare costs would decrease by $27,155. Conclusions: Using biosimilar vs. reference pegfilgrastim can help OCM-participating practices reduce their drug costs. Potentially, a practice can address an existing gap in FN prevention by expanding biosimilar MGF access for patients receiving intermediate-FN risk CT, which may help to meet OCM metrics such as reducing hospitalizations and emergency visits.

scholarly journals Comparison of healthcare resource utilization and medical costs between patients with seropositive and seronegative rheumatoid arthritis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110248
Author(s):  
Hyoungyoung Kim ◽  
Soo-Kyung Cho ◽  
Seongmi Choi ◽  
Seul Gi Im ◽  
Sun-Young Jung ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Quantile Regression ◽  
Healthcare Utilization ◽  
Medical Costs ◽  
Healthcare Resource Utilization ◽  
Medical Utilization ◽  
Cross Sectional ◽  
Direct Medical Costs ◽  
Using Data ◽  
Sectional Analysis

Objectives: To compare healthcare utilization and medical costs between patients with seronegative (SN) and seropositive (SP) rheumatoid arthritis (RA). Methods: We conducted a nationwide population study using the Korean health insurance claims database in 2016. We divided patients with RA into SN and SP groups and compared healthcare utilization including medications, medical utilization, and direct medical costs for 1 year between the groups in a cross-sectional analysis. Differences in costs between patients with SPRA and SNRA were assessed using the quantile regression model. We performed longitudinal analysis using data from 2012 and 2016 to examine changes over time. Results: A total of 103,815 SPRA and 75,809 SNRA patients were included in the analyses. The SPRA group used significantly more methotrexate (73.2% versus 30.3%) and biologic agents (7.9% versus 2.9%) than the SNRA group. The number of RA-related outpatient visits [6.0 ± 3.7 versus 4.4 ± 4.0 times/year, standardized difference (SD) = 0.41] and annual medical costs per patient ($1027 versus $450/year, SD = 0.25) were higher in the SPRA group than the SNRA group. Quantile regression results indicated that the incremental cost of seropositivity on total medical costs of RA patients gradually increased as medical costs approached the upper quantile. The annual direct medical costs for each patient between 2012 and 2016 increased in both groups: by 25.1% in the SPRA group and 37.6% in the SNRA group. Conclusion: Annual RA-related direct medical costs and RA-related healthcare utilization per patient are higher in patients with SPRA than those with SNRA.

scholarly journals Gender Differences in the Risk of Ischemic Heart Disease According to Healthcare Utilization and Medication Adherence among Newly Treated Korean Hypertensive Patients

2021 ◽  
Vol 18 (3) ◽  
pp. 1274
Author(s):  
Jiae Shin ◽  
Dongwoo Ham ◽  
Hee Young Paik ◽  
Sangah Shin ◽  
Hyojee Joung
Keyword(s):  
Gender Differences ◽  
Heart Disease ◽  
Medication Adherence ◽  
Ischemic Heart Disease ◽  
Healthcare Utilization ◽  
Healthcare Providers ◽  
Ischemic Heart ◽  
Health Examination ◽  
Men And Women ◽  
Hypertensive Patients

We aimed to investigate gender differences in ischemic heart disease (IHD) according to healthcare utilization and medication adherence among newly treated Korean hypertensive adults. The National Sample Cohort version 2.0 of the National Health Insurance Service was used for analysis. Newly treated hypertensive patients ≥ 20 years and without IHD in 2002 were selected from a population that underwent health examination during 2003–2006. Of those patients, 11,942 men and 11,193 women were analyzed and followed up for 10 years. We determined the association between IHD and healthcare utilization and medication adherence using the Cox proportional hazards model. Hypertensive women patients had a lower risk of IHD than men patients (hazard ratio [HR] = 0.93, 95% confidence interval [CI] 0.88–1.00). The IHD risk was increased in patients who visited healthcare providers > 12 times/person-year (HR = 2.97, 95% CI 2.79–3.17), paid high out-of-pocket expense/person-year (HR = 1.55, 95% CI 1.41–1.69), and had medication nonadherence (HR = 1.67, 95% CI 1.58–1.77). However, the risk was decreased in patients who used both urban and rural areas (HR 0.75, 95% CI 0.67–0.84) and mixed types of providers (HR = 0.93, CI 0.88–0.99). The risk of IHD was significantly different between men and women only in the visiting frequency to healthcare providers (men, HR = 3.21, 95% CI 2.93–3.52; women, HR = 2.78, 95% CI 2.53–3.04, p for interaction = 0.0188). In summary, the risk of IHD was similar according to healthcare utilization and medication adherence between men and women, except visiting frequency to healthcare providers.

Building back smarter—part one: the case for more modular facilities in the NHS

2021 ◽  
Vol 27 (9) ◽  
pp. 1-9
Author(s):  
Isobel Clough
Keyword(s):  
Service Delivery ◽  
Physical Space ◽  
Cost Effective ◽  
Healthcare Services ◽  
Business Case ◽  
Care Quality ◽  
Healthcare Facilities ◽  
Building Maintenance ◽  
Cost Implications ◽  
The Cost

The NHS is facing an unprecedented backlog in both patient care and building maintenance, with severe implications for service delivery, finance and population wellbeing. This article is the first in a series discussing modular healthcare facilities as a potential solution to these issues, providing flexible and cost-effective spaces to allow services to increase capacity without sacrificing care quality. The first of three instalments, this paper will outline the problems facing the NHS estate, many of which have been exacerbated to critical levels by the COVID-19 pandemic, and what this means for service delivery. It will then make the case for modular infrastructure, outlining the potential benefits for healthcare services, staff and patients alike. Using modern methods of construction, this approach to creating physical space in healthcare can provide greater flexibility and a reduced impact on the environment. The next two articles in this series will go on to provide detailed case studies of successful modular implementation in NHS trusts, an analysis of the cost implications and guidance on the commissioning process and building a business case.

Estimating costs of adverse events (AEs) and healthcare resource use (HRU) in patients with relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) receiving tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel): A summary of real-world evidence.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19551-e19551
Author(s):  
Hongbo Yang ◽  
Cynthia Zhengyun Qi ◽  
Anand Dalal ◽  
Vamsi Bollu ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Real World ◽  
B Cell Lymphoma ◽  
The United States ◽  
Median Number ◽  
Cost Burden ◽  
Real World Evidence ◽  
Car T ◽  
Grade 3 ◽  
Cost Implications ◽  
The Cost

e19551 Background: The AE rates and HRU reported in multiple real-world evidence (RWE) studies of chimeric antigen receptor T-cell (CAR-T) therapies tisa-cel and axi-cel in r/r DLBCL have differed from those in their clinical trials. However, the cost implications from these findings are not well understood in existing literature. This study summarizes information from these RWE studies of tisa-cel and axi-cel and quantifies the associated costs. Methods: A literature review was conducted to identify RWE studies reporting AE rates and HRU of tisa-cel and axi-cel in the United States (US). AE rates and HRU were summarized and the associated costs were estimated using a micro-costing approach. Costs of AE management included hospitalization and pharmacy costs, such as intensive care unit (ICU) stays, inpatient admissions, and medications for the treatment of cytokine release syndrome (CRS) and neurotoxicity events (NE). HRU costs included hospitalization, ICU stays, and outpatient visit costs. Unit costs were from public health databases that are representative of US healthcare system and from literature. Costs were inflated to 2020 US dollars. A range was reported to present evidence if inputs are available from multiple studies. Results were summarized for tisa-cel and axi-cel separately. Results: Four publications were identified: Jaglowski 2019, Pasquini 2019, Riedell 2019, and Jacobson 2020. Across studies, grade 3+ CRS and NE occurred in 1%-4% and 0%-5% of tisa-cel-treated patients and 7%-16% and 20%-35% of axi-cel-treated patients, respectively. Tocilizumab usage was reported in 14%-20% of tisa-cel- and 62%-71% of axi-cel-treated patients. CAR-T infusion was inpatient for 36% of tisa-cel- and 92%-100% of axi-cel-treated patients. The median hospitalization days was 2 for tisa-cel and 15-16 for axi-cel. ICU transfer was observed for 7% and 28%-38% of tisa-cel- and axi-cel-treated patients, respectively, with median stays of 4 and 5 days, respectively. The median number of outpatient visits within 28 days after infusion was 6 for tisa-cel and 4 for axi-cel. The total estimated costs for managing AEs per patient were $843-$1,962 for tisa-cel and $5,979-$10,878 for axi-cel. The total estimated HRU costs per patient were $3,321 for tisa-cel and $32,394-33,166 for axi-cel. Conclusions: RWE studies suggest that patients with r/r DLBCL receiving tisa-cel had numerically lower AE rates, HRU, and cost burden than those receiving axi-cel in the US. The additional cost burden for axi-cel was primarily driven by the incremental ICU and hospitalization care due to a higher proportion of inpatient infusion among patients receiving axi-cel. Further research is warranted to compare the costs associated with the two CAR-Ts in r/r DLBCL.

CHANGES IN THE TECHNICAL AND TECHNOLOGICAL LEVEL OF STEAM CULTIVATORS IN THE XXI CENTURY

2021 ◽  
Vol 2 (143) ◽  
pp. 174-183
Author(s):  
Andrey Yu. Nesmiyan ◽  
◽  
Anastasiya S. Kaymakova ◽  
Yuliya S. Tsench ◽  
Keyword(s):  
Weighted Average ◽  
Specific Weight ◽  
Research Purpose ◽  
Utilization Rate ◽  
Average Value ◽  
Technological Level ◽  
Short Test ◽  
Specific Material ◽  
The Cost

Most modern agricultural machines and tools consist of components, the main parameters, design features of which were justified in the first half of the twentieth century. Slowly and evolutionarily, these technical means are developing. (Research purpose) The research purpose is in identifying general trends in the technical and technological level of steam cultivators in the first quarter of the XXI century. (Materials and Methods) For the study there was analyzed the data of the short test reports of the selected machines. The production of steam cultivators in the Russian Federation is gradually increasing. (Results and discussion) For ten years of the beginning of the XXI century, only 27 machines were provided for testing, and from 2014 to 2017 – more than 40, while for "old" cultivators, the weighted average value of the tractor traction class was 2.8, for new ones it is about of four. For the study period (on average 10 years) the quality of soil cultivation in terms of such parameters as deviation from the specified depth of cultivation, crumbling and combing of the field surface has not changed much. The productivity of cultivator units increased by 7-21 percents, which is explained not only by an increase in the power of tractors, but also by an increase in the utilization rate of charge time on average from 0.72 to 0.77. The specific weight of the "new" cultivators was on average 22 kilogram-meters less than that of the "old" analogues, which can be explained by the evolution of their designs. (Conclusions) Increasing the class of tractors by one "level" the specific material consumption of the cultivators aggregated with them increases by about 58 kilogram-meters for both "old" and " new " cultivators. With an increase in the width of the tools from 4 to 16 meters, their weight will increase by 8 times, which affects the cost and operational and environmental characteristics of wide-reach cultivators.

A comparative study of qualitative immunochemical screening assays for the combined measurement of T-2/HT-2 in cereals and cereal-based products

2011 ◽  
Vol 4 (4) ◽  
pp. 385-394 ◽  
Author(s):  
J. Meneely ◽  
F. Ricci ◽  
S. Vesco ◽  
M. Abouzied ◽  
M. Sulyok ◽  
...  
Keyword(s):  
Sample Preparation ◽  
Low Cost ◽  
Ease Of Use ◽  
The Other ◽  
Accuracy And Precision ◽  
Cost Implications ◽  
Electrochemical Array ◽  
The Cost ◽  
Preparation Techniques ◽  
Speed Of Analysis

Many different immunochemical platforms exist for the screening of naturally occurring contaminants in food from the low cost enzyme linked immunosorbent assays (ELISA) to the expensive instruments such as optical biosensors based on the phenomenon of surface plasmon resonance (SPR). The primary aim of this study was to evaluate and compare a number of these platforms to assess their accuracy and precision when applied to naturally contaminated samples containing HT-2/T-2 mycotoxins. Other important factors considered were the speed of analysis, ease of use (sample preparation techniques and use of the equipment) and ultimately the cost implications. The three screening procedures compared included an SPR biosensor assay, a commercially available ELISA and an enzymelinked immunomagnetic electrochemical array (ELIME array). The qualitative data for all methods demonstrated very good overall agreements with each other, however on comparison with mass spectrometry confirmatory results, the ELISA and SPR assay performed slightly better than the ELIME array, exhibiting an overall agreement of 95.8% compared to 91.7%. Currently, SPR is more costly than the other two platforms and can only be used in the laboratory whereas in theory both the ELISA and ELIME array are portable and can be used in the field, but ultimately this is dependent on the sample preparation techniques employed. Sample preparative techniques varied for all methods evaluated, the ELISA was the most simple to perform followed by that of the SPR method. The ELIME array involved an additional clean-up step thereby increasing both the time and cost of analysis. Therefore in the current format, field use would not be an option for the ELIME array. In relation to speed of analysis, the ELISA outperformed the other methods.

scholarly journals Proposal of resources optimization in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation

2016 ◽  
Vol 66 (4) ◽  
Author(s):  
Tommaso Diaco ◽  
Geremia Milanesi ◽  
Daniela Zaniboni ◽  
Massimo Gritti ◽  
Gianna Zavatteri ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Average Length ◽  
Mean Value ◽  
Hospital Treatment ◽  
Utilization Rate ◽  
Average Length Of Stay ◽  
Use Of Resources ◽  
Acute Patient ◽  
The Cost ◽  
Acute Patients

weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. Working hypotesis: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. Results: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transfered from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. Conclusion: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.

The cost of consent: why healthcare providers must be compliant with the Montgomery principles

2020 ◽  
Vol 102-B (5) ◽  
pp. 550-555
Author(s):  
Nick Birch ◽  
Nick V. Todd
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
International Comparisons ◽  
Point Of View ◽  
Public Healthcare ◽  
Health Board ◽  
Malpractice Claim ◽  
The Usa ◽  
The Uk ◽  
The Cost

The cost of clinical negligence in the UK has continued to rise despite no increase in claims numbers from 2016 to 2019. In the US, medical malpractice claim rates have fallen each year since 2001 and the payout rate has stabilized. In Germany, malpractice claim rates for spinal surgery fell yearly from 2012 to 2017, despite the number of spinal operations increasing. In Australia, public healthcare claim rates were largely static from 2008 to 2013, but private claims rose marginally. The cost of claims rose during the period. UK and Australian trends are therefore out of alignment with other international comparisons. Many of the claims in orthopaedics occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent. The UK and USA have similar rates (26% and 24% respectively), but in Germany the rate is 14% and in Australia only 2%. This paper considers the drivers for the increased cost of clinical negligence claims in the UK compared to the USA, Germany and Australia, from a spinal and orthopaedic point of view, with a focus on “failure to warn” and lack of compliance with the principles established in February 2015 in the Supreme Court in the case of Montgomery v Lanarkshire Health Board. The article provides a description of the prevailing medicolegal situation in the UK and also calculates, from publicly available data, the cost to the public purse of the failure to comply with the principles established. It shows that compliance with the Montgomery principles would have an immediate and lasting positive impact on the sums paid by NHS Resolution to settle negligence cases in a way that has already been established in the USA. Cite this article: Bone Joint J 2020;102-B(5):550–555.

scholarly journals Next Generation Architect

2021 ◽  
Author(s):  
◽  
Terian Le Compte
Keyword(s):  
Affordable Housing ◽  
Living Conditions ◽  
Next Generation ◽  
Design Quality ◽  
Building Information Modelling ◽  
Building Information ◽  
Cost Implications ◽  
The Cost

<p>The stereotype of an architect is expensive, with minimal consideration and awareness towards cost and budget. This is damaging the reputation of the profession. This thesis will look at the Next Generation Architect who combines both design and construction to understand the cost implications from the start to the completion of the project. A Next Generation Architect works with an innovative approach that is more affordable to how they currently practice. They design houses that are both economical and retain a strong design quality, through the value of the aesthetics, materials, and living conditions. An effective architect should be able to design, mindful of costs, along with the implications involved and actively manage the costs, based on design decisions made.  This research will commence by exploring tactics of affordability, housing economics, and costing and design tactics, to portray exemplars of affordable housing. Elements will be costed with data from QV costbuilder implemented through the use of Building information modelling (BIM) through Revit. The architectural value will explore the use of materials, living conditions, economics, and lifecycle to optimise the design. A series of precedents will be analysed to gain an understanding of the techniques of affordable methods used within New Zealand’s construction industry.  This thesis aims to provide architecturally designed and preliminarily costed affordable architectural products. Through a series of architecturally designed standalone houses that explore affordability, and tested through the use of architecture as a product across four sites, displaying different site conditions of the Wellington region.  This thesis will portray efficient, economic building and design techniques and cost monitoring while retaining a strong architectural quality.  The aim is to convey the contemporary role of a Next Generation Architect who works accurately with value. Who is mindful of costs and designs economically, without compromising the quality of an architecturally designed product.</p>

Liberalization at Any Cost? Implications of IMF Policy for Sovereignty and Stability in East Asia

2000 ◽  
Vol 15 (1) ◽  
pp. 43-56
Author(s):  
Michael Spaulding
Keyword(s):  
East Asia ◽  
International Political Economy ◽  
Free Market ◽  
East Asian ◽  
Financial Governance ◽  
State Governance ◽  
The Stability ◽  
Cost Implications ◽  
The Cost ◽  
The Impact

Globalization pits pressures for liberalization against state claims to political and economic sovereignty. Less powerful states in particular face strong pressure from the international trade regime to liberalize their economies irrespective of the impact on domestic stability and national goals. East Asia has been a hold-out against the global trend toward liberalization. This paper shows that the bail-out package demanded by the IMF in 1997 during the East Asian financial crisis imposed unprecedented restrictions on state governance without regard for long-term implications. The paper argues that the IMF's motivation was to harmonize financial governance of the affected economies with Western practices. However, the cost of this initiative to the stability of the region has been overlooked. The East Asian region has carved out for itself a unique niche in the international political economy by resisting penetration of Western finance capital. Already governments have fallen and deep resentments have been sewn over the reversal. More seriously for the future, assumptions that free-market liberalism can be imposed top-down ignore the extent to which economic institutions and preferences are embedded in culture.

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