scholarly journals Health information technology interventions and engagement in HIV care and achievement of viral suppression in publicly funded settings in the US: A cost-effectiveness analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. e1003389
Author(s):  
Starley B. Shade ◽  
Elliot Marseille ◽  
Valerie Kirby ◽  
Deepalika Chakravarty ◽  
Wayne T. Steward ◽  
...  
Keyword(s):  
New York ◽  
Cost Saving ◽  
Service Providers ◽  
Cost Effective ◽  
Support Service ◽  
Surveillance Data ◽  
Patient Portal ◽  
Hiv Surveillance ◽  
The Us ◽  
Demonstration Site

Background The US National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined cost-effectiveness from the health system perspective of 6 health information technology (HIT) interventions implemented during 2008 to 2012 in a Ryan White HIV/AIDS Program (RWHAP) Special Projects of National Significance (SPNS) Program demonstration project. Methods/findings HIT interventions were implemented at 6 sites: Bronx, New York; Durham, North Carolina; Long Beach, California; New Orleans, Louisiana; New York, New York (2 sites); and Paterson, New Jersey. These interventions included: (1) use of HIV surveillance data to identify out-of-care individuals; (2) extension of access to electronic health records (EHRs) to support service providers; (3) use of electronic laboratory ordering and prescribing; and (4) development of a patient portal. We employed standard microcosting techniques to estimate costs (in 2018 US dollars) associated with intervention implementation. Data from a sample of electronic patient records from each demonstration site were analyzed to compare prescription of antiretroviral therapy (ART), CD4 cell counts, and suppression of viral load, before and after implementation of interventions. Markov models were used to estimate additional healthcare costs and quality-adjusted life-years saved as a result of each intervention. Overall, demonstration site interventions cost $3,913,313 (range = $287,682 to $998,201) among 3,110 individuals (range = 258 to 1,181) over 3 years. Changes in the proportion of patients prescribed ART ranged from a decrease from 87.0% to 72.7% at Site 4 to an increase from 74.6% to 94.2% at Site 6; changes in the proportion of patients with 0 to 200 CD4 cells/mm3 ranged from a decrease from 20.2% to 11.0% in Site 6 to an increase from 16.7% to 30.2% in Site 2; and changes in the proportion of patients with undetectable viral load ranged from a decrease from 84.6% to 46.0% in Site 1 to an increase from 67.0% to 69.9% in Site 5. Four of the 6 interventions—including use of HIV surveillance data to identify out-of-care individuals, use of electronic laboratory ordering and prescribing, and development of a patient portal—were not only cost-effective but also cost saving ($6.87 to $14.91 saved per dollar invested). In contrast, the 2 interventions that extended access to EHRs to support service providers were not effective and, therefore, not cost-effective. Most interventions remained either cost-saving or not cost-effective under all sensitivity analysis scenarios. The intervention that used HIV surveillance data to identify out-of-care individuals was no longer cost-saving when the effect of HIV on an individual’s health status was reduced and when the natural progression of HIV was increased. The results of this study are limited in that we did not have contemporaneous controls for each intervention; thus, we are only able to assess sites against themselves at baseline and not against standard of care during the same time period. Conclusions These results provide additional support for the use of HIT as a tool to enhance rapid and effective treatment of HIV to achieve sustained viral suppression. HIT has the potential to increase utilization of services, improve health outcomes, and reduce subsequent transmission of HIV.

A multilayer polyurethane foam dressing for pressure ulcer prevention in older hip fracture patients: an economic evaluation

2020 ◽  
Vol 29 (2) ◽  
pp. 120-127
Author(s):  
Cristiana Forni ◽  
Richard Searle
Keyword(s):  
Economic Evaluation ◽  
Cost Saving ◽  
Polyurethane Foam ◽  
Negative Impact ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Effective Strategy ◽  
Cost Effective Strategy ◽  
The Us

Objective: Hospital-acquired pressure ulcers (PU) have a substantial negative impact on patients and continue to impose a cost burden on hospital providers. Since the incidence of fragility fracture is growing, driven by the increase in the older population, it is expected that the overall incidence of associated complications will also increase accordingly. The aim of this economic evaluation was to determine whether the use of a multilayer, silicone-adhesive polyurethane foam dressing (ALLEVYN LIFE, Smith & Nephew, UK) alongside standard prevention (SP) for the prevention of PUs in older patients with hip fractures is a cost-effective strategy, compared with SP alone. Method: A decision-analytic model was constructed to determine the incremental cost and effectiveness of the foam dressing strategy from the perspectives of the Italian and US hospital systems. We also performed one-way and probabilistic sensitivity analyses. Results: The foam dressing intervention was found to be cost saving and more effective than SP in both Italy and the US. Switching to foam dressing and standard prevention would result in an expected cost saving of €733 per patient in Italy and $840 per patient in the US, reducing the per-patient cost of treating PUs by 37-69% and 36–68%, respectively. The one-way and probabilistic sensitivity analyses demonstrate that the strategy remains dominant over a range of values of the input variables. Conclusion: The foam dressing intervention is likely to be a cost-effective strategy compared with standard prevention alone.

scholarly journals New York City HIV Care Continuum Dashboards: Using Surveillance Data to Improve HIV Care Among People Living With HIV in New York City (Preprint)

2018 ◽  
Author(s):  
Sarah L Braunstein ◽  
Karen Coeytaux ◽  
Charulata J Sabharwal ◽  
Qiang Xia ◽  
Rebekkah S Robbins ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Surveillance Data ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Viral Load Suppression ◽  
Care Continuum ◽  
Hiv Surveillance

BACKGROUND HIV surveillance data can be used to improve patient outcomes. OBJECTIVE This study aimed to describe and present findings from the HIV care continuum dashboards (CCDs) initiative, which uses surveillance data to quantify and track outcomes for HIV patients at major clinical institutions in New York City. METHODS HIV surveillance data collected since 2011 were used to provide high-volume New York City clinical facilities with their performance on two key outcomes: linkage to care (LTC), among patients newly diagnosed with HIV and viral load suppression (VLS), among patients in HIV care. RESULTS The initiative included 21 facilities covering 33.78% (1135/3360) of new HIV diagnoses and 46.34% (28,405/61,298) of patients in HIV care in New York City in 2011 and was extended to a total of 47 sites covering 44.23% (1008/2279) of new diagnoses and 69.59% (43,897/63,083) of New York City patients in care in 2016. Since feedback of outcomes to providers began, aggregate LTC has improved by 1 percentage point and VLS by 16 percentage points. CONCLUSIONS Disseminating information on key facility–level HIV outcomes promotes collaboration between public health and the clinical community to end the HIV epidemic. Similar initiatives can be adopted by other jurisdictions with mature surveillance systems and supportive laws and policies.

scholarly journals Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet?

2016 ◽  
Author(s):  
Moira Verbelen ◽  
Michael E Weale ◽  
Cathryn M Lewis
Keyword(s):  
Genetic Testing ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Genetic Information ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Treatment Needs ◽  
The Us ◽  
The Cost ◽  
The Impact

AbstractPharmacogenetics (PGx) has the potential to personalize pharmaceutical treatments. Many relevant gene-drug associations have been discovered, but PGx guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard healthcare. Progress in this area can be assessed by reviewing economic evaluations to determine the cost-effectiveness of PGx testing versus standard treatment. We performed a review of economic evaluations for PGx associations listed in the US Food and Drug Administration (FDA) Table of Pharmacogenomic Biomarkers in Drug Labeling (http://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm083378.htm). We determined the proportion of evaluations that found PGx guided treatment to be cost-effective or dominant over the alternative strategies, and we estimated the impact on this proportion of removing the cost of genetic testing. Of the 130 PGx associations in the FDA table, 44 economic evaluations, relating to 10 drugs, were identified. Of these evaluations, 57% drew conclusions in favour of PGx testing, of which 30% were cost-effective and 27% were dominant (cost-saving). If genetic information was freely available, 75% of economic evaluations would support PGx guided treatment, of which 25% would be cost-effective and 50% would be dominant. Thus, PGx guided treatment can be a cost-effective and even cost-saving strategy. Having genetic information readily available in the clinical health record is a realistic future prospect, and would make more genetic tests economically worthwhile. However, few drugs with PGx associations have been studied and more economic evaluations are needed to underpin the uptake of genetic testing in clinical practice.

scholarly journals Unit-of-Use Versus Traditional Bulk Packaging

2012 ◽  
Vol 3 (1) ◽  
Author(s):  
Tiffany So ◽  
Albert Wertheimer
Keyword(s):  
Medication Adherence ◽  
Cost Saving ◽  
Medication Safety ◽  
Cost Effective ◽  
Time Saving ◽  
Time Costs ◽  
The Us ◽  
Workflow Efficiency ◽  
Fundamental Reference

Background: The choice between unit-of-use versus traditional bulk packaging in the US has long been a continuous debate for drug manufacturers and pharmacies in order to have the most efficient and safest practices. Understanding the benefits of using unit-of-use packaging over bulk packaging by US drug manufacturers in terms of workflow efficiency, economical costs and medication safety in the pharmacy is sometimes challenging. Methods: A time-saving study comparing the time saved using unit-of-use packaging versus bulk packaging, was examined. Prices between unit-of-use versus bulk packages were compared by using the Red Book: Pharmacy's Fundamental Reference. Other articles were reviewed on the topics of counterfeiting, safe labeling, and implementation of unit-of-use packaging. Lastly, a cost-saving study was reviewed showing how medication adherence, due to improved packaging, could be cost-effective for patients. Results: When examining time, costs, medication adherence, and counterfeiting arguments, unit-of-use packaging proved to be beneficial for patients in all these terms.   Type: Student Project

Will Rivaroxaban Be Cost-Effective for Prevention of Venous Thromboembolism after Total Hip Replacement in US Patients?

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1290-1290 ◽  
Author(s):  
Louis Kwong ◽  
Alexander Diamantopoulos ◽  
Fiona Forster ◽  
Nishan Sengupta ◽  
Michael Lees
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Cost Saving ◽  
Hip Replacement ◽  
Primary Outcome ◽  
Cost Effective ◽  
Vein Thrombosis ◽  
The Us ◽  
Nurse Time ◽  
Deep Vein

Abstract Introduction: Rivaroxaban is a novel, oral, direct Factor Xa inhibitor submitted to US FDA for approval for the prevention of venous thromboembolism (VTE) after major orthopaedic surgery and is also in development for prevention and treatment of thromboembolic disorders. A recently published Phase III trial, RECORD1, compared rivaroxaban 10 mg once daily (od) with subcutaneous (sc) enoxaparin 40 mg od as VTE prophylaxis over 35 days in patients following total hip replacement (THR). The primary outcome (deep vein thrombosis, pulmonary embolism, and all-cause mortality) occurred in 1.1% of rivaroxaban patients and in 3.7% of enoxaparin patients (RRR 70%; p<0.001). The recently published RECORD2 compared 35 days’ rivaroxaban prophylaxis (10 mg od) with a short-term,10–14 day enoxaparin regimen (40 mg od) followed by placebo. The primary outcome occurred in 2.0% of the rivaroxaban group and 9.3% of the enoxaparin + placebo group (RRR 79%; p<0.001). The two drugs had similar safety profiles. This analysis compares the cost-effectiveness of 5 weeks’ prophylaxis with rivaroxaban in patients undergoing THR from US payer’s perspective. Methods: Three Economic decision models were developed based on the efficacy and safety parameters from individual RECORD1 and RECORD2 trials as well as combined RECORD1and 2 results, due to different treatment durations with enoxaparin (35 days in RECORD1 and 14 days in RECORD 2) vs. 35 days’ rivaroxaban. The models followed patients for up to 1 year post THA. The clinical efficacy (deep vein thrombosis [DVT], pulmonary embolism [PE], and symptomatic VTE events) and safety profiles of both drugs during the period of prophylaxis were obtained from the published RECORD1 and 2 trials, while the incidence of VTE up to 90 days following surgery was extrapolated based on epidemiological data (Quinlan et al., 2007). The incidence of recurrent VTE and post-thrombotic syndrome beyond this period was based on clinical data (Prandoni et al., 1997). The treatment costs for symptomatic VTE and major bleeding were taken from published sources in the US. For costing purposes, the duration of hospitalization for THA was obtained from a published US orthopaedic registry (3 days). It was also conservatively assumed that no incremental nurse time or home visit costs were associated with sc enoxaparin injection. Since rivaroxaban is not yet approved in the US, the economic model assumed similar drug acquisition costs to enoxaparin 40mg od. Results: Using rivaroxaban for 35 days appears to be a cost-effective and, in some instances, a cost-saving option compared with enoxaparin. The 1-year economic model based on RECORD2 (vs. 14 days’ enoxaparin) showed that 35 days’ rivaroxaban was associated with an incremental cost per symptomatic event avoided of $5,945. The analysis based on RECORD1 with a 35-day duration with both drugs showed that rivaroxaban resulted in an $82 cost saving, and a reduction of 6 symptomatic events per 1000 patients undergoing THR. Similarly, the –combined analysis based on RECORD 1and 2 showed a $19 cost saving and a reduction of 14 symptomatic events per 1000 patients favoring rivaroxaban. This improvement was driven primarily by the reduced costs of hospitalization for symptomatic events. Sensitivity analyses including the costs associated with home nurse time or training patients to self-administer enoxaparin showed potential for more cost-savings if patients receive oral rivaroxaban. Conclusions: Despite the clinical benefits of extended prophylaxis for up to 5 weeks with enoxaparin, and its recommendations in the guidelines, its use is limited in current US clinical practice, potentially due to inconvenience and high cost. Oral rivaroxaban given for 5 weeks has the potential to be cost effective, based on its superior efficacy over enoxaparin in patients undergoing THR. With more than 150,000 US patients having hip replacement annually, the benefits of using rivaroxaban could be significant.

scholarly journals A Data Visualization and Dissemination Resource to Support HIV Prevention and Care at the Local Level: Analysis and Uses of the AIDSVu Public Data Resource

10.2196/23173 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e23173 ◽  
Author(s):  
Patrick Sean Sullivan ◽  
Cory Woodyatt ◽  
Chelsea Koski ◽  
Elizabeth Pembleton ◽  
Pema McGuinness ◽  
...  
Keyword(s):  
Public Health ◽  
Population Based ◽  
Surveillance Data ◽  
Public Health Decision ◽  
Hiv Surveillance ◽  
Related Data ◽  
Health Decision Making ◽  
Hiv Epidemic ◽  
The Us ◽  
Health Decision

Background AIDSVu is a public resource for visualizing HIV surveillance data and other population-based information relevant to HIV prevention, care, policy, and impact assessment. Objective The site, AIDSVu.org, aims to make data about the US HIV epidemic widely available, easily accessible, and locally relevant to inform public health decision making. Methods AIDSVu develops visualizations, maps, and downloadable datasets using results from HIV surveillance systems, other population-based sources of information (eg, US Census and national probability surveys), and other data developed specifically for display and dissemination through the website (eg, pre-exposure prophylaxis [PrEP] prescriptions). Other types of content are developed to translate surveillance data into summarized content for diverse audiences using infographic panels, interactive maps, local and state fact sheets, and narrative blog posts. Results Over 10 years, AIDSVu.org has used an expanded number of data sources and has progressively provided HIV surveillance and related data at finer geographic levels, with current data resources providing HIV prevalence data down to the census tract level in many of the largest US cities. Data are available at the county level in 48 US states and at the ZIP Code level in more than 50 US cities. In 2019, over 500,000 unique users consumed AIDSVu data and resources, and HIV-related data and insights were disseminated through nearly 4,000,000 social media posts. Since AIDSVu’s inception, at least 249 peer-reviewed publications have used AIDSVu data for analyses or referenced AIDSVu resources. Data uses have included targeting of HIV testing programs, identifying areas with inequitable PrEP uptake, including maps and data in academic and community grant applications, and strategically selecting locations for new HIV treatment and care facilities to serve high-need areas. Conclusions Surveillance data should be actively used to guide and evaluate public health programs; AIDSVu translates high-quality, population-based data about the US HIV epidemic and makes that information available in formats that are not consistently available in surveillance reports. Bringing public health surveillance data to an online resource is a democratization of data, and presenting information about the HIV epidemic in more visual formats allows diverse stakeholders to engage with, understand, and use these important public health data to inform public health decision making.

scholarly journals A Data Visualization and Dissemination Resource to Support HIV Prevention and Care at the Local Level: Analysis and Uses of the AIDSVu Public Data Resource (Preprint)

2020 ◽  
Author(s):  
Patrick Sean Sullivan ◽  
Cory Woodyatt ◽  
Chelsea Koski ◽  
Elizabeth Pembleton ◽  
Pema McGuinness ◽  
...  
Keyword(s):  
Public Health ◽  
Population Based ◽  
Surveillance Data ◽  
Public Health Decision ◽  
Hiv Surveillance ◽  
Related Data ◽  
Health Decision Making ◽  
Hiv Epidemic ◽  
The Us ◽  
Health Decision

BACKGROUND AIDSVu is a public resource for visualizing HIV surveillance data and other population-based information relevant to HIV prevention, care, policy, and impact assessment. OBJECTIVE The site, AIDSVu.org, aims to make data about the US HIV epidemic widely available, easily accessible, and locally relevant to inform public health decision making. METHODS AIDSVu develops visualizations, maps, and downloadable datasets using results from HIV surveillance systems, other population-based sources of information (eg, US Census and national probability surveys), and other data developed specifically for display and dissemination through the website (eg, pre-exposure prophylaxis [PrEP] prescriptions). Other types of content are developed to translate surveillance data into summarized content for diverse audiences using infographic panels, interactive maps, local and state fact sheets, and narrative blog posts. RESULTS Over 10 years, AIDSVu.org has used an expanded number of data sources and has progressively provided HIV surveillance and related data at finer geographic levels, with current data resources providing HIV prevalence data down to the census tract level in many of the largest US cities. Data are available at the county level in 48 US states and at the ZIP Code level in more than 50 US cities. In 2019, over 500,000 unique users consumed AIDSVu data and resources, and HIV-related data and insights were disseminated through nearly 4,000,000 social media posts. Since AIDSVu’s inception, at least 249 peer-reviewed publications have used AIDSVu data for analyses or referenced AIDSVu resources. Data uses have included targeting of HIV testing programs, identifying areas with inequitable PrEP uptake, including maps and data in academic and community grant applications, and strategically selecting locations for new HIV treatment and care facilities to serve high-need areas. CONCLUSIONS Surveillance data should be actively used to guide and evaluate public health programs; AIDSVu translates high-quality, population-based data about the US HIV epidemic and makes that information available in formats that are not consistently available in surveillance reports. Bringing public health surveillance data to an online resource is a democratization of data, and presenting information about the HIV epidemic in more visual formats allows diverse stakeholders to engage with, understand, and use these important public health data to inform public health decision making.

New Paradigm for State Department of Transportation Environmental Initiatives: New York State’s Guidelines and Procedures

2000 ◽  
Vol 1702 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Gary McVoy ◽  
Mark Sengenberger ◽  
Elizabeth Novak
Keyword(s):  
New York ◽  
New York State ◽  
Cost Effective ◽  
State Department ◽  
Regulatory Compliance ◽  
Environmental Benefits ◽  
Environmental Damage ◽  
York State Department ◽  
Department Of Transportation ◽  
New Paradigm

Public-works agencies have an obligation to enhance the environment as opportunities arise. The New York State Department of Transportation (NYSDOT) has developed an environmental initiative to make an affirmative contribution to the environment, using the department’s organizational strengths. The environmental initiative is a paradigm shift applicable to all departments of transportation (DOTs). Conventional reactive regulatory compliance can reduce unnecessary environmental damage and sometimes gain grudging regulatory agency cooperation; however, it is not a positive, satisfying way of doing the people’s work. Through proactive steps, NYSDOT has become an important part of the state’s environmental solution (often at little or no additional cost) and has changed its working relationships with environmental agencies and groups. As these agencies and groups have become partners, instead of adversaries, permit-approval times have improved, mitigation costs have declined, morale has improved, and cost-effective environmental benefits are being realized. Procedures are outlined to apply the engineering capabilities of a DOT to the environmental-stewardship responsibilities shared by all governmental organizations.

Functioning of Ukrainian Bureau in Washington D. C. (March 1939 – May 1940)

2019 ◽  
pp. 142-157
Author(s):  
Danylo Kravets
Keyword(s):  
New York ◽  
The United States ◽  
College Degrees ◽  
The Us ◽  
Us Government ◽  
General Functioning ◽  
History Of ◽  
Governmental Institutions ◽  
History Of Journalism ◽  
The Military

The aim of the Ukrainian Bureau in Washington was propaganda of Ukrainian question among US government and American publicity in general. Functioning of the Bureau is not represented non in Ukrainian neither in foreign historiographies, so that’s why the main goal of presented paper is to investigate its activity. The research is based on personal papers of Ukrainian diaspora representatives (O. Granovskyi, E. Skotzko, E. Onatskyi) and articles from American and Ukrainian newspapers. The second mass immigration of Ukrainians to the US (1914‒1930s) has often been called the «military» immigration and what it lacked in numbers, it made up in quality. Most immigrants were educated, some with college degrees. The founder of the Ukrainian Bureau Eugene Skotzko was born near Western Ukrainian town of Zoloczhiv and immigrated to the United States in late 1920s after graduating from Lviv Polytechnic University. In New York he began to collaborate with OUN member O. Senyk-Hrabivskyi who gave E. Skotzko task to create informational bureau for propaganda of Ukrainian case. On March 23 1939 the Bureau was founded in Washington D. C. E. Skotzko was an editor of its Informational Bulletins. The Bureau biggest problem was lack of financial support. It was the main reason why it stopped functioning in May 1940. During 14 months of functioning Ukrainian Bureau in Washington posted dozens of informational bulletins and send it to hundreds of addressees; E. Skotzko, as a director, personally wrote to American governmental institutions and foreign diplomats informing about Ukrainian problem in Europe. Ukrainian Bureau activity is an inspiring example for those who care for informational policy of modern Ukraine.Keywords: Ukrainian small encyclopedia, Yevhen Onatsky, journalism, worldview, Ukrainian state. Keywords: Ukrainian Bureau in Washington, Eugene Skotzko, public opinion, history of journalism, diaspora.

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