Economic impacts of care by high-volume providers for noncurative esophagogastric cancer: A population-based analysis.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 339-339
Author(s):  
Julie Hallet ◽  
Nicole Look Hong ◽  
Victoria Zuk ◽  
Laura Davis ◽  
Vaibhav Gupta ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Care Delivery ◽  
High Volume ◽  
Population Based ◽  
Dominant Strategy ◽  
Sensitivity Analyses ◽  
Esophagogastric Cancer ◽  
Effectiveness Of Care ◽  
Low Volume

339 Background: Esophagogastric cancer (EGC) is one of the deadliest and costliest malignancies to treat. Care by high-volume providers can provide better outcomes for patients with EGC. Cost implications of volume-based cancer care are unclear. We examined the cost-effectiveness of care by high-volume medical oncology providers for non-curative management of EGC. Methods: We conducted a population-based cohort study of non-curative EGC over 2005-2017 by linking administrative healthcare datasets. High-volume was defined as >11 patients/provider/year. Healthcare costs ($USD/patient/month-survived) were computed from diagnosis to death or end of follow-up from the perspective of the healthcare system using validated costing algorithms. Multivariable quantile regression examined the association between care by high-volume providers and costs. Sensitivity analyses were conducted by varying costing horizons and high-volume definitions. Results: Among 7,011 non-curative EGC patients, median overall survival was superior with care by high-volume providers with 7.0 (IQR: 3.3-13.3) compared to 5.9 (IQR: 2.6-12.1) months (p < 0.001) for low-volume providers. Median costs/patient/month-lived were lower for high-volume providers ($5,518 vs. $5,911; p < 0.001), owing to lower inpatient acute care costs, despite higher medication-associated and radiotherapy costs. Care by high-volume providers was independently associated with a reduction of $599 per patient/month-lived (95% confidence interval: -966 to -331) compared to low-volume providers. The incremental cost-effectiveness ratio was -393. Care by high-volume providers remained the dominant strategy when varying the high-volume definition and the costing time horizon. Conclusions: Care by high-volume providers for non-curative EGC is associated with superior survival and lower healthcare costs, indicating a dominant strategy that may provide an opportunity to improve cost-effectiveness of care delivery.

Relationship between hospital surgical volume, lobectomy rates, and adverse perioperative events at US epilepsy centers

2013 ◽  
Vol 118 (1) ◽  
pp. 169-174 ◽  
Author(s):  
Dario J. Englot ◽  
David Ouyang ◽  
Doris D. Wang ◽  
John D. Rolston ◽  
Paul A. Garcia ◽  
...  
Keyword(s):  
Relative Risk ◽  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
High Volume ◽  
Population Based ◽  
Treatment Center ◽  
Surgical Volume ◽  
Related Factors ◽  
Perioperative Morbidity ◽  
Low Volume

Object Epilepsy surgery remains significantly underutilized. The authors recently reported that the number of lobectomies for localized intractable epilepsy in the US has not changed despite the implementation of clear evidence-based guidelines 10 years ago supporting early referral for surgery. To better understand why epilepsy surgery continues to be underused, the authors' objective was to carefully examine hospital-related factors related to the following: 1) where patients are being admitted for the evaluation of epilepsy, 2) rates of utilization for surgery across hospitals, and 3) perioperative morbidity between hospitals with low versus high volumes of epilepsy surgery. Methods The authors performed a population-based cohort study of US hospitals between 1990 and 2008 using the Nationwide Inpatient Sample (NIS), stratifying epilepsy surgery rates and trends as well as perioperative morbidity rates by hospital surgical volume. Results The number of lobectomies for epilepsy performed at high-volume centers (> 15 lobectomies/year) significantly decreased between 1990 and 2008 (F = 20.4, p < 0.001), while significantly more procedures were performed at middle-volume hospitals (5–15 lobectomies/year) over time (F = 16.1, p < 0.001). No time trend was observed for hospitals performing fewer than 5 procedures per year. However, patients admitted to high-volume centers were significantly more likely to receive lobectomy than those at low-volume hospitals (relative risk 1.05, 95% CI 1.03–1.08, p < 0.001). Also, the incidence of perioperative adverse events was significantly higher at low-volume hospitals (12.9%) than at high-volume centers (6.1%) (relative risk 1.08, 95% CI 1.03–1.07, p < 0.001). Conclusions Hospital volume is an important predictor of epilepsy surgery utilization and perioperative morbidity. Patients with medically refractory epilepsy should be referred to a comprehensive epilepsy treatment center for surgical evaluation by an experienced clinical team.

scholarly journals Cost-Effectiveness of the FDA Menu Labeling to Reduce Obesity-Associated Cancer Burden in the United States

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1712-1712
Author(s):  
Mengxi Du ◽  
Christina Griecci ◽  
Frederick Cudhea ◽  
Heesun Eom ◽  
John Wong ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Healthcare Costs ◽  
The United States ◽  
Sensitivity Analyses ◽  
Calorie Intake ◽  
Menu Labeling ◽  
Life Years ◽  
Industry Response ◽  
Meta Analyses

Abstract Objectives The FDA menu labeling policy requires chain restaurants with ≥20 outlets to list total calories on menus or menu boards. While obesity is a known risk factor for 13 cancers, the potential impact of this policy on cancer burdens and healthcare costs in the US is unknown. Methods Using a probabilistic cohort state-transition model, we estimated the health impacts, costs, and cost-effectiveness of the FDA menu labeling policy on reducing calorie intake, subsequent weight change, and obesity-related cancer cases among US adults over a lifetime. Baseline demographics and calorie intake from restaurants were estimated using NHANES 2013–2016. Based on published meta-analyses, we assumed that labeling would reduce calorie intake per meal by 7.3%, evaluated with and without an additional 5% reduction through industry reformulations; and assumed only half of these calorie reductions would be sustained by individuals throughout their day (i.e., to account for potential calorie compensation outside restaurants). Changes in BMI were derived from published energy models (0.45 kg lower long-term weight per 55 kcal/d calorie reduction). National cancer rates and healthcare costs were obtained from published sources. Uncertainties of inputs were incorporated in probabilistic sensitivity analyses using 1000 simulations. Results The FDA menu labeling policy was estimated to prevent 31,300 (95% UI: 27,600–35,500) new cancer cases and 18,700 (16,400–21,300) cancer deaths, gaining 134,000 (117,000–153,000) quality-adjusted life years (QALYs) among US adults over a lifetime. Top three cancers prevented were endometrial, post-menopausal breast, and kidney. Accounting for policy implementation and healthcare costs, the policy was net cost saving at $1.74B ($1.55–$1.95B) and $1.76B ($1.46–$2.09B) from healthcare and societal perspectives, respectively. A modest industry response (5% calorie reduction) would prevent a total of 51,800 new cancer cases (47,900–56,400) and 30,900 cancer deaths (28,600–34,000) and increase net savings to $2.87B ($2.68–$3.12B) and $3.19B ($2.86–$3.54B), respectively. Conclusions Our model suggests implementation of the FDA menu calorie labeling policy would substantially reduce incident cancers and deaths and be cost-saving, with even larger effects if accompanied by modest industry reformulation. Funding Sources NIH/NIMHD.

Access to care and outcomes for noncurative esophagogastric cancer: A population-based geographic study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 284-284
Author(s):  
Elliott Kenneth Yee ◽  
Natalie Coburn ◽  
Victoria Zuk ◽  
Laura E Davis ◽  
Alyson Mahar ◽  
...  
Keyword(s):  
Access To Care ◽  
System Analysis ◽  
Medical Oncology ◽  
Care Delivery ◽  
Population Based ◽  
Curative Intent ◽  
Poisson Models ◽  
Esophagogastric Cancer ◽  
Choropleth Maps ◽  
Geographic Information System Analysis

284 Background: Esophagogastric cancer (EGC) carries a heavy mortality burden owing largely to high rates of unresectable disease at diagnosis. Among patients not undergoing curative-intent therapy, access to care may vary. We examined the geographic distribution of care delivery and survival across a jurisdiction, and its relationship with distance to cancer centres (CCs), for non-curative EGC. Methods: We conducted a population-based analysis of adults with non-curative EGC from 2005-2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival (OS). We used geographic information system analysis to map locations of CCs and outcomes across census divisions. Regions of discordance between care use and OS were identified with bivariate choropleth maps. Multivariable modified Poisson models assessed the relationship between distance to the nearest CC and outcomes, adjusting for demographic, clinical, and socioeconomic factors. Results: Of 10,228 patients surviving a median of 5.1 months (IQR: 2.0-12.0), 68.6% had medical oncology consultation and 32.2% received chemotherapy. Regions of comparable OS and care delivery were clustered throughout the province. CCs were distributed unevenly, with higher levels in Southern Ontario. Higher-level CCs clustered in regions with higher rates of consultation, chemotherapy use, and OS. Each increment in distance from location of residence to the nearest CC (11-50, 51-100, and ≥101 km) was associated with lower likelihood of seeing medical oncology and receiving chemotherapy, and inferior OS, compared to ≤10 km. Conclusions: A third of patients with non-curative EGC did not see medical oncology, and the majority did not receive chemotherapy. Care delivery and OS exhibited high geographic variability. Location of residence influenced access to care and OS, with inferior outcomes for those living further from a CC. These findings are important for designing interventions and policies to reduce disparities in access to care and outcomes for non-curative EGC.

scholarly journals Scenario-based Cost Analysis for Vegetable Grafting Nurseries of Different Technologies and Sizes

HortScience ◽  
2014 ◽  
Vol 49 (7) ◽  
pp. 917-930 ◽  
Author(s):  
Myles Lewis ◽  
Chieri Kubota ◽  
Russell Tronstad ◽  
Young-Jun Son
Keyword(s):  
Cost Analysis ◽  
Capital Investment ◽  
High Volume ◽  
The United States ◽  
Production Costs ◽  
Sensitivity Analyses ◽  
Capital Costs ◽  
High Volume Production ◽  
Volume Production ◽  
Low Volume

Grafting of fruiting vegetables is a relatively new advent in the United States with promise as a technology to improve both yields and the environment. However, investing in a commercial-sized grafting enterprise requires substantial capital investment and is a risky endeavor. A tool to help evaluate grafting costs for different production technologies and sizes of operation is a useful decision aid for individuals investing in new or modifying existing operations to produce grafted plants. Using a combination of engineering and financial equations, a scenario-based analysis was completed to obtain approximate capital and variable costs per plant for both new and existing production facilities. For exemplary purposes, four scenarios consisting of two different crops (tomato and watermelon) at two production sizes with different technology levels [low-volume manual grafting (one million plants per year) and high-volume fully automated grafting (100 million plants per year)] are presented to compare costs. For simplification purpose, consistent weekly production was assumed in the cost simulation. Total capital costs were $115,127 and $118,974 for low-volume production for grafted tomato and watermelon plants, respectively. They were $21.6 million and $16.7 million under high-volume production for tomato and watermelon, respectively. Among the four scenarios evaluated, variable costs per plant (costs of plants produced) were lowest for watermelons with high-volume production ($0.089 per plant), suggesting that production costs of grafted plants could decrease by scaling up production and introducing automation. Sensitivity analyses for high-volume production of tomato showed that the electricity rate, grafting clip price, and grafting robot speed were factors with the greatest influence on costs of plants. Scenario-based cost analysis was shown to be an effective tool for developing strategies to reduce the price of grafted plants.

scholarly journals Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Weiyi Ni ◽  
Wolfgang G. Kunz ◽  
Mayank Goyal ◽  
Lijin Chen ◽  
Yawen Jiang
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Healthcare Costs ◽  
Time Window ◽  
Time Windows ◽  
Sensitivity Analyses ◽  
Health State ◽  
The Impact

Abstract Background Although endovascular therapy (EVT) improves clinical outcomes in patients with acute ischemic stroke, the time of EVT initiation significantly influences clinical outcomes and healthcare costs. This study evaluated the impact of EVT treatment delay on cost-effectiveness in China. Methods A model combining a short-term decision tree and long-term Markov health state transition matrix was constructed. For each time window of symptom onset to EVT, the probability of receiving EVT or non-EVT treatment was varied, thereby varying clinical outcomes and healthcare costs. Clinical outcomes and cost data were derived from clinical trials and literature. Incremental cost-effectiveness ratio and incremental net monetary benefits were simulated. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model. The willingness-to-pay threshold per quality-adjusted life-year (QALY) was set to ¥71,000 ($10,281). Results EVT performed between 61 and 120 min after the stroke onset was most cost-effective comparing to other time windows to perform EVT among AIS patients in China, with an ICER of ¥16,409/QALY ($2376) for performing EVT at 61–120 min versus the time window of 301–360 min. Each hour delay in EVT resulted in an average loss of 0.45 QALYs and 165.02 healthy days, with an average net monetary loss of ¥15,105 ($2187). Conclusions Earlier treatment of acute ischemic stroke patients with EVT in China increases lifetime QALYs and the economic value of care without any net increase in lifetime costs. Thus, healthcare policies should aim to improve efficiency of pre-hospital and in-hospital workflow processes to reduce the onset-to-puncture duration in China.

Abstract 16842: Cost-Effectiveness of Antibiotic-Eluting Envelopes for Prevention of Infections Associated With Cardiac Implantable Electronic Devices

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ronuk Modi ◽  
Peter Zimetbaum ◽  
Nicolas Isaza ◽  
Paola Calvachi ◽  
Inbar Raber ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Healthcare Costs ◽  
Electronic Devices ◽  
Sensitivity Analyses ◽  
Healthcare Sector ◽  
Term Survival ◽  
Cardiac Implantable Electronic Devices ◽  
Life Years ◽  
Increased Risk

Introduction: Infections of cardiac implantable electronic devices result in substantial morbidity and healthcare costs. Using an antibiotic-eluting envelope (AEE) during implantation may reduce the incidence of device-related infection. We examined the cost-effectiveness of an AEE in patients receiving CRT-D devices. Methods: This analysis was conducted independent of the trial sponsor. We developed a state-transition Markov model to compare the use of an AEE with usual care during CRT-D initial implantation or reimplantation. Effectiveness of the AEE (unit cost $1000) was estimated from the Worldwide Randomized Antibiotic Envelope Infection Prevention Trial. Other inputs were derived from prior trials, registries, vital statistics, and nationally representative datasets. Long-term survival was projected using a non-parametric approach. The model reported incidence of infections, mortality, quality-adjusted life years (QALYs), and direct healthcare costs. Future costs and QALYs were discounted by 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER) of AEE use from the US healthcare sector perspective over a lifetime analytic horizon. We assumed a cost-effectiveness threshold of $100,000 per QALY gained. Results: Use of an AEE at initial CRT-D implantation added 0.008 QALYs per patient at an incremental cost of $918 (ICER $118,000/QALY). Due to higher infection rates, the use of AEE in reimplantation procedures was more economically attractive (ICER $55,900/QALY). One-way sensitivity analyses showed an inverse relationship between ICER and rate of infection. The ICER was less than $100,000/QALY with infection rate greater than 2.42% in the first year after new CRT-D (Figure 1). Conclusions: At current prices, use of AEE is cost-effective for CRT-D reimplantation procedures but not for initial CRT-D implants. Cost-effectiveness of AEEs may be improved by restricting use to patients at increased risk of infection.

scholarly journals The Cost-Effectiveness of Lifestyle Interventions for Preventing Diabetes in a Health Resource-Limited Setting

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jing Ma ◽  
Xu Wan ◽  
Bin Wu
Keyword(s):  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Service Providers ◽  
Cost Effective ◽  
Dominant Strategy ◽  
Economic Outcomes ◽  
Medical Expenditure ◽  
Sensitivity Analyses ◽  
Life Years ◽  
The Cost

Aims. Type 2 diabetes mellitus (T2DM) is a health challenge in China, and the economic outcomes of lifestyle intervention are critically important for policymakers. This study estimates the lifetime economic outcomes of lifestyle intervention among the prediabetic population in the Chinese context. Methods. We developed a mathematical model to compare the cost-effectiveness of lifestyle intervention and no prevention in the prediabetic population. Efficacy and safety, medical expenditure, and utility data were derived from the literature, which was assigned to model variables for estimating the quality-adjusted life-years (QALYs) and costs as well as incremental cost-effectiveness ratios (ICERs). The analysis was conducted from the perspective of Chinese healthcare service providers. One-way and probabilistic sensitivity analyses were performed. Results. Compared with no prevention, lifestyle intervention averted 9.53% of T2DM, which translated into an additional 0.52 QALYs at a saved cost of $700 by substantially reducing the probabilities of macro- and microvascular diseases. This finding indicated that lifestyle intervention was a dominant strategy. The sensitivity analyses showed the model outputs were robust. Conclusions. Lifestyle intervention is a very cost-effective alternative for prediabetic subjects and worth implementing in the Chinese healthcare system to reduce the disease burden related to T2DM.

Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

2015 ◽  
Vol 36 (4) ◽  
pp. 438-444 ◽  
Author(s):  
Raghu U. Varier ◽  
Eman Biltaji ◽  
Kenneth J. Smith ◽  
Mark S. Roberts ◽  
M. Kyle Jensen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Clostridium Difficile ◽  
Healthcare System ◽  
Fecal Microbiota Transplantation ◽  
Dominant Strategy ◽  
Fecal Microbiota ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Years ◽  
The Cost

OBJECTIVEClostridium difficile infection (CDI) places a high burden on the US healthcare system. Recurrent CDI (RCDI) occurs frequently. Recently proposed guidelines from the American College of Gastroenterology (ACG) and the American Gastroenterology Association (AGA) include fecal microbiota transplantation (FMT) as a therapeutic option for RCDI. The purpose of this study was to estimate the cost-effectiveness of FMT compared with vancomycin for the treatment of RCDI in adults, specifically following guidelines proposed by the ACG and AGA.DESIGNWe constructed a decision-analytic computer simulation using inputs from the published literature to compare the standard approach using tapered vancomycin to FMT for RCDI from the third-party payer perspective. Our effectiveness measure was quality-adjusted life years (QALYs). Because simulated patients were followed for 90 days, discounting was not necessary. One-way and probabilistic sensitivity analyses were performed.RESULTSBase-case analysis showed that FMT was less costly ($1,669 vs $3,788) and more effective (0.242 QALYs vs 0.235 QALYs) than vancomycin for RCDI. One-way sensitivity analyses showed that FMT was the dominant strategy (both less expensive and more effective) if cure rates for FMT and vancomycin were ≥70% and <91%, respectively, and if the cost of FMT was <$3,206. Probabilistic sensitivity analysis, varying all parameters simultaneously, showed that FMT was the dominant strategy over 10, 000 second-order Monte Carlo simulations.CONCLUSIONSOur results suggest that FMT may be a cost-saving intervention in managing RCDI. Implementation of FMT for RCDI may help decrease the economic burden to the healthcare system.Infect Control Hosp Epidemiol 2014;00(0): 1–7

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