scholarly journals Cost-effectiveness Analysis of Per-abdominal and Laparoscopic Cholecystectomy

Author(s):  
Shahariar Islam

Cholelithiasis is one of the major problems which need cholecystectomy. Laparoscopic cholecystectomy is a newer technique. But there is a need to evaluate the cost-effectiveness of per-abdominal and laparoscopic method from patients perspective. The study was performed to assess the cost-effectiveness of per-abdominal and laparoscopic cholecystectomy.
Materials and Methods:
This cross sectional study in two sample situations was conducted among 90 purposively selected cholecystectomy patients of which 60 patients underwent laparoscopic cholecystectomy (LC) and 30 patients underwent per-abdominal cholecystectomy (PAC) from three tertiary level government hospitals of Dhaka, Bangladesh at the time of their discharge through face to face interview using a semi-structured questionnaire and checklist. The study found average age 45.33(13.63) and 41.75(13.39) years in PAC and LC respectively. Average monthly income was less in the PAC group Tk.23200.00(12374.61) than LC Tk.24925.00(12166.86). Average duration of suffering from cholelithiasis was 9.50(8.68) months in PAC group and 12.43(17.49) months in LC group. Average hospital stay was 13.97(6.88) days in PAC group while it was 12.02(6.66) days in LC group. Average treatment cost was little higher Tk.21927.407795.89 in LC group than Tk.21466.306261.42 in the PAC group. Both direct cost and indirect cost were also higher in LC group (Tk.18668.305965.67 and Tk.3661.324229.85) than in PAC group (Tk.18228.004624.75 and Tk.3350.004124.58). But these differences were not statistically significant. In both groups treatment cost significantly increased with duration of hospitalization (correlation, p<0.01). Cure rate was significantly high in LC group (94.4%) than in PAC group (86.7%) (χ2, p<0.05).
This study revealed LC method is cost-effective than PAC method. Total treatment cost in LC can be reduced by minimizing hospital cost, laboratory cost and securing the income of the patients which enhance the economic load.

Author(s):  
Ani Rahayu ◽  
Ahmad Fuad Afdhal ◽  
Delina Hasan ◽  
Feriadi Suwarna

The majority of alternative antihypertensive therapies require pharmacoeconomic studies, particularly Cost Effectiveness Analysis, which is useful in balancing patients’ expenditure by determining alternative treatments that represented the most plausible health outcomes with a more reasonable budget. The objective of this study was to compare the cost effectiveness using antihypertensive fixed dose combinations (FDC) of Valsartan-Amlodipine + Furosemide and FDC of Valsartan-HCT + Amlodipin. This research applied the descriptive analytical cross-sectional method and conducted data collection retrospectively from the medical record of hypertensive patients. Meanwhile, the medication cost breakdown was obtained from Outpatient Financial Department of a Type B Hospital in south Jakarta for the period of January - June 2018. Total sample were 74 patients, consisted of 37 patients who used  FDC of Valsartan-Amlodipin + Furosemide, and 37 patients who used FDC of Valsartan-HCT + Amlodipin. The parameters of this research were direct medication cost (consisted of examination cost, laboratory cost and medicines cost), indirect medication cost (consisted accommodation cost and lost productivity cost), while the effectiveness used the MAP average (Mean Arterial Pressure). The result of this research showed that the biggest medication effectiveness to lower the blood pressure is FDC of  Valsartan-Amlodipin + Furosemide, with 32  patients had the average MAP 101,29 mmHg, while the FDC of Valsartan-HCT + Amlodipin with 29 patients had the average MAP 103,59 mmHg. The cost effectiveness based on ACER value of  FDC of Valsartan –HCT + Amlodipin and FDC Valsartan-HCT + Amlodipin sequentially is Rp 3.922.040/MAP and Rp 4.458.034/MAP. In conclusion, the FDC of Valsartan-Amlodipin + Furosemide  was more cost-effective.


2017 ◽  
pp. 100-106
Author(s):  
Thuan Huynh ◽  
Minh Tam Nguyen

Introduction: Child injury is a significant burden for community health care in Vietnam. Besides the fatal injuries, millions of children need hospital care for non-fatal injuries. Investigation on treatment cost and economic burden of the most common non-fatal injuries such as falls, burns, and traffic injuries is very necessary. Objectives: (1) Describe the patterns of falls, burns, and traffic injuries among children admitted with injuries to the Quang Nam Pediatric Hospital; (2) Analyze the treatment cost for falls, burns, and traffic injuries of these patients. Methods: A cross-sectional study on 424 pediatric patients under 16 year old admitted with falls, burns, and traffic injuries to the Quang Nam Pediatric Hospital from 01/6/2014 to 31/3/2015. Results: Most of participants admitted to the hospital for falls (66%), traffic injuries (22,4%). Mild injuries was dominated, burns and traffic injuries were more serious in almost cases and the average of PTS index was 9.4 points. Average total treatment cost was 1,259,200 VN dong, direct cost accounted for 68.4% of total treatment cost. Treatment costs of burns and traffic injuries were higher than that of falls. Key words: burden of disease, treatment cost, injury, children


BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e050629
Author(s):  
Vanessa W Lim ◽  
Hwee Lin Wee ◽  
Phoebe Lee ◽  
Yijun Lin ◽  
Yi Roe Tan ◽  
...  

ObjectivesWHO recommends that low burden countries consider systematic screening and treatment of latent tuberculosis infection (LTBI) in migrants from high incidence countries. We aimed to determine LTBI prevalence and risk factors and evaluate cost-effectiveness of screening and treating LTBI in migrants to Singapore from a government payer perspective.DesignCross-sectional study and cost-effectiveness analysis.SettingMigrants in Singapore.Participants3618 migrants who were between 20 and 50 years old, have not worked in Singapore previously and stayed in Singapore for less than a year were recruited.Primary and secondary outcome measuresCosts, quality-adjusted life-years (QALYs), threshold length of stay, incremental cost-effectiveness ratios (ICERs), cost per active TB case averted.ResultsOf 3584 migrants surveyed, 20.4% had positive interferon-gamma release assay (IGRA) results, with the highest positivity in Filipinos (33.2%). Higher LTBI prevalence was significantly associated with age, marital status and past TB exposure. The cost-effectiveness model projected an ICER of S$57 116 per QALY and S$12 422 per active TB case averted for screening and treating LTBI with 3 months once weekly isoniazid and rifapentine combination regimen treatment compared with no screening over a 50-year time horizon. ICER was most sensitive to the cohort’s length of stay in Singapore, yearly disease progression rates from LTBI to active TB, followed by the cost of IGRA testing.ConclusionsFor LTBI screening and treatment of migrants to be cost-effective, migrants from high burden countries would have to stay in Singapore for ~50 years. Risk-stratified approaches based on projected length of stay and country of origin and/or age group can be considered.


Author(s):  
Dnyanesh Limaye ◽  
Krishna Todi ◽  
Jay Shroff ◽  
Ashutosh Ramaswamy ◽  
Priyanka Kulkarni ◽  
...  

Background: Diabetes is fast gaining the status of a potential epidemic in India, with >62 million individuals currently diagnosed with the disease. India currently faces an uncertain future in relation to the potential burden that diabetes may impose on the country. An estimated US$ 2.2 billion would be needed to sufficiently treat all cases of type 2 diabetes mellitus (T2DM) in India. Many interventions can reduce the burden of this disease. However, health care resources are limited; thus, interventions for diabetes treatment should be prioritized. The present study assesses the cost-effectiveness of antidiabetic drugs in patients with T2DM from Mumbai, India.Methods: A prospective cross-sectional study was performed to assess the cost-effectiveness of antidiabetic drugs in patients with T2DM. Face-to-face interviews were conducted by using a validated questionnaire in a total of 152 (76 males, 76 females) patients with T2DM from F-North Ward, Mumbai, India. Cost-effectiveness was determined on the basis of cost of antidiabetic drug/s, efficacy, adverse drug reactions, safety of administration, frequency of administration, and bioavailability. Results: For treatment of T2DM in non-obese participants, Glimepiride+Pioglitazone costed least (`3.7) per unit of effectiveness followed by Glimepiride (`6.6), Gliclazide (`8.1), Repaglinide (`24.5), and Vildagliptin (`45.2). For treatment of T2DM in obese participants, Metformin cost least (` 6.7) per unit of effectiveness followed by Glimepiride + Metformin (`5.9) and Repaglinide (`24.5). Conclusions: In case of non-obese participants, cost effectiveness and prescribed treatments did not show a match, while for obese participants prescribed treatments were in line with cost effectiveness. 


2015 ◽  
Vol 6 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Hanna Norrlid ◽  
Peter Dahm ◽  
Gunnel Ragnarson Tennvall

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.


2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Abiodun Ogunniyi ◽  
Magbagbeola David Dairo ◽  
Hannah Dada-Adegbola ◽  
Ikeoluwapo O. Ajayi ◽  
Adebola Olayinka ◽  
...  

Background. Unavailability of accurate, rapid, reliable, and cost-effective malaria diagnostic instruments constitutes major a challenge to malaria elimination. We validated alternative malaria diagnostic instruments and assessed their comparative cost-effectiveness. Method. Using a cross-sectional study design, 502 patients with malaria symptoms at selected health facilities in Ibadan between January and April 2014 were recruited consecutively. We examined malaria parasites using Cyscope®, QBC, and CareStart™ and results were compared to light microscopy (LM). Validity was determined by assessing sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Costs per hour of use for instruments and turnaround time were determined. Result. Sensitivity of the instruments was 76.0% (CareStart), 95.0% (Cyscope), and 98.1% (QBC). Specificity was 96.0% (CareStart), 87.3% (Cyscope), and 85.5% (QBC). PPV were 65.2%, 67.5%, and 84.7%, while NPV were 93.6%, 98.6%, and 99.4% for CareStart, Cyscope, and QBC with Kappa values of 0.75 (CI = 0.68–0.82) for CareStart, 0.72 (CI = 0.65–0.78) for Cyscope, and 0.71 (CI = 0.64–0.77) for QBC. Average cost per hour of use was the lowest ($2.04) with the Cyscope. Turnaround time was the fastest with Cyscope (5 minutes). Conclusion. Cyscope fluorescent microscope had the shortest turnaround time and is the most cost-effective of all the malaria diagnostic instruments evaluated.


2017 ◽  
pp. 26-31
Author(s):  
Abebaw Tegegn Damtie ◽  
Assen Muhe Getahun

Background: World Health Organization and Ministry of Health (Uganda) recommend use of microscopy for parasitological confirmation of malaria. Microscopy involves either Giemsa or Fields staining techniques. Ministry of Health prefers and recommends use of Giemsa staining technique but most health facilities still use Fields staining technique. The objective of this study was to compare the cost-effectiveness of Giemsa and Fields staining techniques in order to inform malaria diagnosis policy and practice in Uganda. Methods: This was a cross sectional cost effectiveness analysis from the providers perspective covering the period between April 25, 2014 and June 15, 2014. The study involved 243 children below five years of age presenting at Acute Care Unit laboratory for malaria test before admission. Giemsa and Fields staining techniques were compared with Polymerase Chain Reaction as the gold standard. Decision tree analytic model in TreeAge was used for the cost effectiveness analysis. Results: Fields and Giemsa staining techniques cost US $ 0.030 and US $ 0.769 respectively. Correctly diagnosed cases were 227 and 230 for Fields and Giemsa staining techniques respectively. The proportion of correctly diagnosed cases was 93.4% for Fields and 94.7% for Giemsa. Incremental cost effectiveness ratio was 0.35 US $ per additional correctly diagnosed case. Conclusion: Fields staining technique was more cost effective than Giemsa staining technique; provided a higher number of correctly diagnosed cases at a lower cost than Giemsa staining technique. Fields staining technique is recommended as staining technique for malaria diagnosis at the Acute Care Unit of Mulago National Referral Hospital. This implies that even with introduction of more superior staining techniques for laboratory diagnosis of malaria, Field staining technique is still a cost effective technique to be used in resource limited settings with high malaria burden like Uganda and Africa at large.


Author(s):  
Eny Nurhikma ◽  
Randa Wulaisfan ◽  
Musdalipah Musdalipah

Today, in various countries, especially in Indonesia, the cost of health services is increasing. Hypertension is a degenerative disease that requires health costs for a long time. Increasing costs due to increasing chronic diseases threaten access and quality of health services, by which it is necessary to find a solution to overcome the problem of health financing. One method used is to analyze the guidelines for hypertension therapy and drug classes in the pharmacoeconomic aspects, namely Cost Effectiveness Analysis. This study aims to analyze the effectiveness of antihypertensive combination therapy in hypertensive patients at Bhayangkara Hospital, Kendari in 2019. The research method is descriptive with cross sectional study design. The analysis conducted is the cost effectiveness analysis (CEA) performed by calculating direct medical costs, the effectiveness of therapy based on blood pressure that reaches the target and calculating the value of ACER (Average Cost Effectiveness Ratio) and ICER (Incremenal Cost Effectiveness Ratio). Data were collected prospectively which fulfilled the inclusion and exclusion criteria. The results showed the therapeutic effectiveness and the value of ACER obtained from 31 hypertensive patients were a combination of Candesartan – Bisoprolol  that was ACER value of 85.71% (2,314), and combination of Candesartan – Amlodipin of 70.58% (2,643). ICER value of 7,832 indicates that the price of drugs is more expensive but more effective therapy.Keywords : cost effective, ACER, ICER, Hypertension, Candesartan, Amlodipin Abstrak: Dewasa ini, diberbagai negara khususnya di Indonesia biaya pelayanan kesehatan semakin meningkat. Hipertensi merupakan salah satu penyakit degeneratif yang membutuhkan biaya kesehatan dalam jangka waktu yang lama. Peningkatan biaya akibat semakin meningkatnya penyakit kronik mengancam akses dan mutu pelayanan kesehatan, olehnya itu perlu dicari solusi untuk mengatasi masalah pembiayaan kesehatan. Salah satu metode yang dilakukan yaitu dengan menganalisis pedoman terapi hipertensi dan golongan obat dalam aspek farmakoekonomi, yaitu Analisis Efektivitas Biaya. Penelitian ini bertujuan untuk menganalisis efektivitas terapi kombinasi antihipertensi pada pasien hipertensi di Rumah Sakit Bhayangkara Kendari tahun 2019. Metode penelitian ialah deskriptif dengan rancangan cross sectional study. Data diambil secara prospektif yang memenuhi kriteria inklusi dan eksklusi. Analisis yang dilakukan adalah cost effectiveness analysis (CEA) dilakukan dengan menghitung biaya medik langsung, efektivitas terapi berdasarkan tekanan darah yang mencapai target dan menghitung nilai ACER (Average Cost Effectiveness Ratio) dan ICER (Incremenal Cost Effectiveness Ratio). Hasil penelitian menunjukkan efektifitas terapi dan nilai ACER yang diperoleh dari 31 pasien hipertensi ialah kombinasi Candesartan – Bisoprolol  yaitu nilai ACER sebesar 85,71%  (2.314), dan kombinasi Candesartan – Amlodipin  sebesar 70,58% (2.643). Nilai ICER  sebesar 7.832 menunjukkan bahwa harga obat lebih mahal namun terapi lebih efektif. Kata Kunci : Efektivitas biaya, ACER, ICER, Hipertensi, Candesartan, Amlodipin


1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 171-177 ◽  
Author(s):  
Peter G. Blake ◽  
Jet Floyd ◽  
Evelyn Spanner ◽  
Karen Peters

Our objective was to investigate the extra cost associated with implementing an adequacy program in peritoneal dialysis (PO) and to evaluate the cost effectiveness of a variety of PO prescriptions. This was a cross-sectional study of all 37 patients attending the PO clinic at a university teaching hospital. Extra costs incurred on dialysate, tubing, and cyclers as a consequence of implementing an adequacy program in PO were measured. Costs per unit KT/V for a variety of PO prescriptions were also calculated. Thirteen patients (35%) required an alteration in prescription for adequacy reasons. The average extra costs incurred for all patients was Cdn. $2,323 per annum, which represents a 16% increase per patient. The most costeffective prescriptions were high volume continuous ambulatory peritoneal dialysis (CAPO) and automated peritoneal dialysis (APO) with two daytime dwells. The least cost-effective prescriptions were day dry APO and high volume APO with only one daytime dwell. Significant extra expense is incurred when an adequacy program is implemented in PO. This is mainly due to the requirement to put more patients on APO. An alternative pricing policy for PO is suggested.


Author(s):  
Hossein Ebrahimi Pour ◽  
Elahe Pourahmadi ◽  
Reza Vafayinezhad ◽  
Shapour Badie Aval ◽  
Ahra Keyvanlou ◽  
...  

Background: Pre-hospital care plays an important role in managing patients who require emergency services and preserving human life. The aim of this study was to evaluate the cost of completed public pre-hospital emergency missions according to the activity-based costing model and to compare it with the cost of private pre-hospital emergency services in Mashhad in 2016. Methods: In this applied and descriptive cross-sectional study, the data were collected using a researcher-made form 4 major groups of costs were identified to estimate the total costs: 1- Personnel salaries, 2- Current expenses 3- Medical consumables 4- Depreciation. The cost of providing pre-hospital services was calculated based on the activity-based costing. Eventually, the cost of pre-hospital emergency services was compared between the public and private sectors. To investigate the cost-effective factors for missions, multiple regression analysis, Breusch-Pagan, Ramsey RESET, Swilk, and Linktest diagnostic tests were used by  Stata 11.0 software. Results: The average cost of each mission was equal to 2114337 ± 217786 thousand Rials in 58 emergency medical centers of Mashhad in 2016. Of this cost, 78.51 %, (1660129 ± 1578445 Rials) was related to employees' salaries, 19.24 % (406842 ± 375083 Rials) was related to the current costs of each center, 0.23 % (4796 ± 4476 Rials) was related to depreciation, and 2/02 % (42761 ± 42822 Rials) was related to medical consumables in each pre-hospital emergency mission. The value of contract with an emergency pre-hospital emergency was 1104000 Rials for each mission in 2016, which is almost half of the cost related to the public pre-hospital. Results of the regression model estimation also showed that among the variables of the model, the fuel cost variable was identified as an effective variable on the cost of each mission (p = 0.0001). Conclusion: The private sector provides pre-hospital emergency services at a lower cost. Moreover, before establishing a pre-hospital pre-service center, the cost-effectiveness of establishing a center in each region should be checked.


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