scholarly journals Straight to colonoscopy: the ideal patient pathway for the 2-week suspected cancer referrals?

2011 ◽  
Vol 93 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Andrew D Beggs ◽  
Ravinda D Bhate ◽  
Shashi Irukulla ◽  
Mayen Achiek ◽  
A Muti Abulafi
Keyword(s):  
Demographic Data ◽  
Waiting Times ◽  
Cost Savings ◽  
Cost Effective ◽  
Patient Pathway ◽  
Retrospective Audit ◽  
Cost Effective Method ◽  
The Uk ◽  
The Cost ◽  
The Ideal

INTRODUCTION The UK has a higher mortality for colon cancer than the European average. The UK Government introduced a 2-week referral target for patients with colorectal symptoms meeting certain criteria and 62-day target for the delivery of treatment from the date of referral for those patients diagnosed with cancer. Hospitals are expected to meet 100% and 95% of these targets, respectively; therefore, an efficient and effective patient pathway is required to deliver diagnosis and treatment within this period. It is suggested that ‘straight-to-test’ will help this process and we have examined our implementation of ‘straight-to-colonoscopy’ as a method of achieving this aim. PATIENTS AND METHODS We carried out a retrospective audit of 317 patients referred under the 2-week rule over a 1-year period between October 2004 and September 2005 and were eligible for ‘straight-to-colonoscopy'. Demographic data, appropriateness of referral and colonoscopy findings were obtained. The cost effectiveness and impact on waiting period were also analysed. RESULTS A total of 317 patients were seen within 2 weeks. Cancer was found in 23 patients and all were treated within 62 days. Forty-four patients were determined by the specialist to have been referred inappropriately because they did not meet NICE referral guidelines. No cancer was found in any of the inappropriate referrals. The use of straight-to-test colonoscopy lead to cost savings of £26,176 (£82.57/patient) in this group compared to standard practice. There was no increase in waiting times. CONCLUSIONS Straight-to-colonoscopy for urgent suspected cancer referrals is a safe, feasible and cost-effective method for delivery of the 62-day target and did not lead to increase in the endoscopy waiting list.

scholarly journals The Economic Impact of Weight Regain

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Caroline E. Sheppard ◽  
Erica L. W. Lester ◽  
Anderson W. Chuck ◽  
Daniel W. Birch ◽  
Shahzeer Karmali ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Economic Impact ◽  
Weight Regain ◽  
Cost Savings ◽  
Cost Effective ◽  
Median Percentage ◽  
Weight Recidivism ◽  
Cost Effective Method ◽  
Significant Deficit ◽  
The Cost

Background. Obesity is well known for being associated with significant economic repercussions. Bariatric surgery is the only evidence-based solution to this problem as well as a cost-effective method of addressing the concern. Numerous authors have calculated the cost effectiveness and cost savings of bariatric surgery; however, to date the economic impact of weight regain as a component of overall cost has not been addressed.Methods. The literature search was conducted to elucidate the direct costs of obesity and primary bariatric surgery, the rate of weight recidivism and surgical revision, and any costs therein.Results. The quoted cost of obesity in Canada was $2.0 billion–$6.7 billion in 2013 CAD. The median percentage of bariatric procedures that fail due to weight gain or insufficient weight loss is 20% (average:21.1%±10.1%, range: 5.2–39,n=10). Revision of primary surgeries on average ranges from 2.5% to 18.4%, and depending on the procedure accounts for an additional cost between $14,000 and $50,000 USD per patient.Discussion. There was a significant deficit of the literature pertaining to the cost of revision surgery as compared with primary bariatric surgery. As such, the cycle of weight recidivism and bariatric revisions has not as of yet been introduced into any previous cost analysis of bariatric surgery.

scholarly journals Use of online recruitment strategies in a randomized trial of cancer survivors

2018 ◽  
Vol 15 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Stephen P Juraschek ◽  
Timothy B Plante ◽  
Jeanne Charleston ◽  
Edgar R Miller ◽  
Hsin-Chieh Yeh ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Online Advertising ◽  
Demographic Data ◽  
Cost Effective ◽  
Recruitment Strategies ◽  
Study Staff ◽  
Cost Effective Method ◽  
Online Advertisements ◽  
Online Recruitment ◽  
The Cost

Background/Aims: Despite widespread Internet adoption, online advertising remains an underutilized tool to recruit participants into clinical trials. Whether online advertising is a cost-effective method to enroll participants compared to other traditional forms of recruitment is not known. Methods: Recruitment for the Survivorship Promotion In Reducing IGF-1 Trial, a community-based study of cancer survivors, was conducted from June 2015 through December 2016 via in-person community fairs, advertisements in periodicals, and direct postal mailings. In addition, “Right Column” banner ads were purchased from Facebook to direct participants to the Survivorship Promotion In Reducing IGF-1 Trial website. Response rates, costs of traditional and online advertisements, and demographic data were determined and compared across different online and traditional recruitment strategies. Micro-trials optimizing features of online advertisements were also explored. Results: Of the 406 respondents to our overall outreach efforts, 6% (24 of 406) were referred from online advertising. Facebook advertisements were shown over 3 million times (impressions) to 124,476 people, which resulted in 4401 clicks on our advertisement. Of these, 24 people ultimately contacted study staff, 6 underwent prescreening, and 4 enrolled in the study. The cost of online advertising per enrollee was $794 when targeting a general population versus $1426 when accounting for strategies that specifically targeted African Americans or men. By contrast, community fairs, direct mail, or periodicals cost $917, $799, or $436 per enrollee, respectively. Utilization of micro-trials to assess online ads identified subtleties (e.g. use of an advertisement title) that substantially impacted viewer interest in our trial. Conclusion: Online advertisements effectively directed a relevant population to our website, which resulted in new enrollees in the Survivorship Promotion In Reducing IGF-1 Trial at a cost comparable to traditional methods. Costs were substantially greater with online recruitment when targeting under-represented populations, however. Additional research using online micro-trial tools is needed to evaluate means of more precise recruitment to improve yields in under-represented groups. Potential gains from faster recruitment speed remain to be determined.

CAD Of Anticorrosive Protection Of Steel Structures

2019 ◽  
pp. 18-23
Keyword(s):  
Protective Coating ◽  
Computer Aided Design ◽  
Steel Structures ◽  
Cost Effective ◽  
Operating Conditions ◽  
Computational Tool ◽  
Protection Method ◽  
Cost Effective Method ◽  
The Cost ◽  
Aided Design

The choice of cost-effective method of anticorrosive protection of steel structures is an urgent and time consuming task, considering the significant number of protection ways, differing from each other in the complex of technological, physical, chemical and economic characteristics. To reduce the complexity of solving this problem, the author proposes a computational tool that can be considered as a subsystem of computer-aided design and used at the stage of variant and detailed design of steel structures. As a criterion of the effectiveness of the anti-corrosion protection method, the cost of the protective coating during the service life is accepted. The analysis of existing methods of steel protection against corrosion is performed, the possibility of their use for the protection of the most common steel structures is established, as well as the estimated period of effective operation of the coating. The developed computational tool makes it possible to choose the best method of protection of steel structures against corrosion, taking into account the operating conditions of the protected structure and the possibility of using a protective coating.

Pound Wise and Penny Foolish? Weight Loss and The Dynamics of Health Care Spending

2011 ◽  
Vol 14 (2) ◽  
Author(s):  
Thomas G Koch
Keyword(s):  
Weight Loss ◽  
Cost Savings ◽  
Cost Effective ◽  
Economic Consequences ◽  
Health Care Spending ◽  
Order Of Magnitude ◽  
Dynamic Measures ◽  
The Cost ◽  
The Impact ◽  
The Relationship

Current estimates of obesity costs ignore the impact of future weight loss and gain, and may either over or underestimate economic consequences of weight loss. In light of this, I construct static and dynamic measures of medical costs associated with body mass index (BMI), to be balanced against the cost of one-time interventions. This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective.

scholarly journals Is an integrated model of school eye health delivery more cost-effective than a vertical model? An implementation research in Zanzibar

2021 ◽  
Vol 6 (1) ◽  
pp. e000561
Author(s):  
Ving Fai Chan ◽  
Fatma Omar ◽  
Elodie Yard ◽  
Eden Mashayo ◽  
Damaris Mulewa ◽  
...  
Keyword(s):  
Implementation Research ◽  
Cost Savings ◽  
Cost Effective ◽  
Integrated Model ◽  
Health Screening ◽  
High Coverage ◽  
Health Delivery ◽  
Screening Cost ◽  
Eye Health ◽  
The Cost

ObjectiveTo review and compare the cost-effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar.Methods and analysisThis 6-month implementation research was conducted in four districts in Zanzibar. Nine and ten schools were recruited into the IM and VM, respectively. In the VM, teachers conducted eye health screening and education only while these eye health components were added to the existing school feeding programme (IM). The number of children aged 6–13 years old screened and identified was collected monthly. A review of project account records was conducted with 19 key informants. The actual costs were calculated for each cost categories, and costs per child screened and cost per child identified were compared between the two models.ResultsScreening coverage was 96% and 90% in the IM and VM with 297 children (69.5%) from the IM and 130 children (30.5%) from VM failed eye health screening. The 6-month eye health screening cost for VM and IM was US$6 728 and US$7 355. The cost per child screened for IM and VM was US$1.23 and US$1.31, and the cost per child identified was US$24.76 and US$51.75, respectively.ConclusionBoth models achieved high coverage of eye health screening with the IM being a more cost-effective school eye health delivery screening compared with VM with great opportunities for cost savings.

scholarly journals Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization

2015 ◽  
Vol 4 (6) ◽  
pp. 82 ◽  
Author(s):  
Julie M. Mhlaba ◽  
Emily W. Stockert ◽  
Martin Coronel ◽  
Alexander J. Langerman
Keyword(s):  
United States ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Waste Reduction ◽  
Significant Cost ◽  
Instrument Type ◽  
Hospital Revenue ◽  
Potential Strategy ◽  
The Cost

Objective: Operating rooms (OR) generate a large portion of hospital revenue and waste. Consequently, improving efficiency and reducing waste is a high priority. Our objective was to quantify waste associated with opened but unused instruments from trays and to compare this with the cost of individually wrapping instruments.Methods: Data was collected from June to November of 2013 in a 550-bed hospital in the United States. We recorded the instrument usage of two commonly-used trays for ten cases each. The time to decontaminate and reassemble instrument trays and peel packs was measured, and the cost to reprocess one instrument was calculated.Results: Average utilization was 14% for the Plastic Soft Tissue Tray and 29% for the Major Laparotomy Tray. Of 98 instruments in the Plastics tray (n = 10), 0% was used in all cases observed and 59% were used in no observed cases. Of 110 instruments in the Major Tray (n = 10), 0% was used in all cases observed and 25% were used in no observed cases. Average cost to reprocess one instrument was $0.34-$0.47 in a tray and $0.81-$0.84 in a peel pack, or individually-wrapped instrument.Conclusions: We estimate that the cost of peel packing an instrument is roughly two times the cost of tray packing. Therefore, it becomes more cost effective from a processing standpoint to package an instrument in a peel pack when there is less than a 42%-56% probability of use depending on instrument type. This study demonstrates an opportunity for reorganization of instrument delivery that could result in a significant cost-savings and waste reduction.

scholarly journals Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021256 ◽  
Author(s):  
Estela Capelas Barbosa ◽  
Talitha Irene Verhoef ◽  
Steve Morris ◽  
Francesca Solmi ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Service ◽  
Cost Effective ◽  
Uncertainty Interval ◽  
The Uk ◽  
The Cost ◽  
Training And Support ◽  
Domestic Violence And Abuse ◽  
Service Perspective ◽  
Health Service Perspective

ObjectivesTo evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.Design and settingCost–utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.ParticipantsBased on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.InterventionsThe IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.ResultsThe IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval −£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval −0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence.ConclusionThe IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.

scholarly journals Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

2021 ◽  
Author(s):  
Kit N Simpson ◽  
Michael J Fossler ◽  
Linda Wase ◽  
Mark A Demitrack
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
Protein Signaling ◽  
Opioid Receptor Agonist ◽  
Cost Effective Alternative ◽  
Μ Opioid Receptor ◽  
The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

scholarly journals Evaluation of the cost-effectiveness of buprenorphine in treatment of chronic pain using competing EQ-5D weights

2015 ◽  
Vol 6 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Hanna Norrlid ◽  
Peter Dahm ◽  
Gunnel Ragnarson Tennvall
Keyword(s):  
Chronic Pain ◽  
Cost Effectiveness ◽  
Treatment Cost ◽  
Cost Effective ◽  
Elderly Persons ◽  
Physician Visits ◽  
Annual Treatment ◽  
The Uk ◽  
The Cost ◽  
Annual Treatment Cost

AbstractBackground and aimsChronic pain is a life altering condition and common among elderly persons. The 7-day buprenorphine patch could be a suitable treatment for managing chronic pain of moderate severity in elderly patients in Sweden.The objective of this analysis was to investigate the cost-effectiveness of the 7-day buprenorphine patch, versus no treatment, in patients >50 years old who suffer from moderate pain in a health economic perspective. An additional aim was to evaluate how the cost-effectiveness is affected by the choice of EQ-5D weights.MethodsThe annual treatment cost and the potential gains in health-related quality of life (HRQoL) of buprenorphine, compared to no treatment, were evaluated. Original EQ-5D data were collected from four clinical reference studies at baseline and at the final visit. Treatment effects on HRQoL were then assessed using both UK and Swedish EQ-5D weights. Annual treatment costs were calculated based on costs of physician visits and pharmaceuticals.The optimal treatment dose was 10-15 μg/h and the analysis was hence performed on both a 10- and a 15 μg/h buprenorphine patch.ResultsThe analysis of buprenorphine treatment resulted in improved HRQoL in all reference studies, irrespective of choice of EQ-5D weight set. The change in quality adjusted life years (QALYs) varied with a gain of 0.042-0.118 using the UK weights and 0.020-0.051 with the Swedish weights. The average annual treatment cost was SEK14454 for the 10μg/h patch and SEK17 017 for the 15 μg/h patch, while cost for the no-treatment alternative was SEK 9 960. The base case incremental cost-effectiveness ratios (ICER) with the UK weights were SEK 40000-SEK 170000 and SEK 90000-SEK 350000 when applying the Swedish weights. The corresponding ICER-span in the sensitivity analysis was SEK 15 000-SEK 400 000 when applying the UK weights and SEK 30 000-SEK 840 000 with the Swedish weights (SEK 100 is about €11).ConclusionsThe results imply that the 7-day buprenorphine patch may be a cost-effective treatment of moderate chronic pain in patients over 50 years of age. The UK and the Swedish EQ-5D weights generated vastly different HRQoL estimates but buprenorphine remains cost-effective regardless choice of weight set.

Method of Fuels and Lubricants Performance Properties Requirements Management

2021 ◽  
Vol 624 (2) ◽  
pp. 16-24
Author(s):  
Yu. M. Pimenov ◽  
◽  
A. V. Ulit’ko ◽  
V. A. Sereda ◽  
◽  
...  
Keyword(s):  
Cost Effective ◽  
Life Cycles ◽  
Requirements Management ◽  
Performance Properties ◽  
Operational Conditions ◽  
Quantitative Expression ◽  
Laboratory Bench ◽  
Motor Fuels ◽  
Cost Effective Method ◽  
The Cost

The cost-effective method of fuels and lubricants performance properties requirements management is proposed. Method ensures effectiveness enhancement of equipment and of fuels and lubricants life cycles; it includes requirements establishment (constructing of conceptual and empirical models of requirements), their quantitative expression through highly informative indicators of fuels and lubricants propensity for transformations, then approbation with the use of laboratory, bench and test stands tests, specification, assessment of realization in real world equipment operational conditions, effectiveness evaluation and modification of requirements. Some illustrations of application of the new method phases with regards to motor fuels and hydraulic fluid are provided.

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