Cost-Effective Clinical Decision Making

PEDIATRICS ◽  
1980 ◽  
Vol 65 (2) ◽  
pp. 371.1-371
Author(s):  
Edward J. O'Boyle
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Venous Thromboembolism in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Ke-Xin Sun ◽  
Bin Cui ◽  
Shan-Shan Cao ◽  
Qi-Xiang Huang ◽  
Ru-Yi Xia ◽  
...  
Keyword(s):  
Decision Making ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Base Case ◽  
Effectiveness Analysis ◽  
The Cost

Background: The drug therapy of venous thromboembolism (VTE) presents a significant economic burden to the health-care system in low- and middle-income countries. To understand which anticoagulation therapy is most cost-effective for clinical decision-making , the cost-effectiveness of apixaban (API) versus rivaroxaban (RIV), dabigatran (DAB), and low molecular weight heparin (LMWH), followed by vitamin K antagonist (VKA), in the treatment of VTE in China was assessed.Methods: To access the quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), a long-term cost-effectiveness analysis was constructed using a Markov model with 5 health states. The Markov model was developed using patient data collected from the Xijing Hospital from January 1, 2016 to January 1, 2021. The time horizon was set at 30 years, and a 6-month cycle length was used in the model. Costs and ICERs were reported in 2020 U.S. dollars. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the uncertainties. A Chinese health-care system perspective was used.Results: In the base case, the data of 231 VTE patients were calculated in the base case analysis retrospectively. The RIV group resulted in a mean VTE attributable to 95% effective treatment. API, DAB, and VKA have a negative ICER (−187017.543, −284,674.922, and −9,283.339, respectively) and were absolutely dominated. The Markov model results confirmed this observation. The ICER of the API and RIV was negative (−216176.977), which belongs to the absolute inferiority scheme, and the ICER value of the DAB and VKA versus RIV was positive (110,577.872 and 836,846.343). Since the ICER of DAB and VKA exceeds the threshold, RIV therapy was likely to be the best choice for the treatment of VTE within the acceptable threshold range. The results of the sensitivity analysis revealed that the model output varied mostly with the cost in the DAB on-treatment therapy. In a probabilistic sensitivity analysis of 1,000 patients for 30 years, RIV has 100% probability of being cost-effective compared with other regimens when the WTP is $10973 per QALY. When WTP exceeded $148,000, DAB was more cost-effective than RIV.Conclusions: Compared with LMWH + VKA and API, the results proved that RIV may be the most cost-effective treatment for VTE patients in China. Our findings could be helpful for physicians in clinical decision-making to select the appropriate treatment option for VTE.

Cost-effective clinical decision making

PEDIATRICS ◽  
1977 ◽  
Vol 60 (5) ◽  
pp. 756-759
Author(s):  
Duncan Neuhauser
Keyword(s):  
Decision Making ◽  
Hospital Stay ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Inappropriate Therapy ◽  
X Ray ◽  
Scarce Resources ◽  
Chest X Ray ◽  
The Cost

Are pediatric preoperative chest x-ray examinations worth doing? Sane et al. (p. 669) conclude that they are "medically and economically justified and essential." To answer this question requires at least the following information. What is the cost of the examination (dollars, radiation exposure, cost of further testing and perhaps inappropriate therapy resulting therefrom, and possible prolongation of hospital stay)? What is the benefit? What percent of patients have unsuspected findings; of these, the percent with modified treatment; and of these, what percent benefited therefrom? What was the cost per unit of benefit received? Is there some other use of these scarce resources that would have yielded greater benefits?

Access and organization: putting low intensity interventions to work in clinical services

2010 ◽  
pp. 19-34
Author(s):  
David A. Richards
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Stepped Care ◽  
Clinical Services ◽  
Low Intensity ◽  
Psychological Therapies ◽  
Measuring Outcomes ◽  
Patient Centredness

Chapter 2 unpacks the term ‘access’, suggesting that it has six interlinked components—availability, utilization, effectiveness, equity, efficiency, and patient-centredness—that need to be satisfied if access is to be increased and setting out key strategies for improvement. These include providing cost-effective forms of CBT (low intensity), organizing systems so that they function more effectively (stepped care, collaborative care), routinely measuring outcomes, and providing a clear rationale for clinical decision making. These strategies are now encapsulated in the English Improving Access to Psychological Therapies (IAPT) initiative.

scholarly journals Cost effective use of free to use apps (FAN) in neurosurgery in developing countries: from clinical decision making to educational courses, strengthening the health care delivery

2016 ◽  
Vol 18 (3) ◽  
pp. 36 ◽  
Author(s):  
Amit Thapa ◽  
Bidur KC ◽  
Bikram Shakya
Keyword(s):  
Decision Making ◽  
Developing Countries ◽  
Data Storage ◽  
Clinical Decision Making ◽  
Care Delivery ◽  
Medical Knowledge ◽  
Cost Effective ◽  
Clinical Decision ◽  
Good Communication ◽  
Related Data

Introduction and Objective: Financial limitations and scarcity of technological knowledge is a major hurdle to good communication platform, data storage and dissemination of medical knowledge in developing countries. Out of necessity we used free to use apps in our practice. We studied the applicability and cost effective aspect of a systematic use of these apps in neurosurgery.Materials and Methods: We designed Free to use apps in neurosurgery (FAN) module in 4 phases at KMCTH over the last 3 years. We used free apps like viber, dropbox, skype and vlc media player on 3G and wifi. Users were trained in ethics and measures to ensure confidentiality and privacy of patient related data. Endpoints studied were feasibility, reliability, cost effectiveness and overall satisfaction of the users.Results: In the FAN module, viber app was used to send pictures of digital imagings (DI) using smartphones within 30 minutes enabling quick decision by the consultants. Dropbox not only helped store images but also helped quick verification of discharge summaries as early as 15 minutes increasing overall efficiency. With Skype, consultants could be contacted even when they were abroad and using FAN they remain updated of their patients. Using skype and vlc, 2 operative live workshops from abroad was transmitted live with good visual and audio reception allowing question answer sessions with the faculties. Users’ satisfaction was more than 90%.Conclusion: FAN module helped in quick reliable decision making, allowing for instantaneous communication and storing data and exchange of knowledge across countries.

Routine monitoring of liver function tests in lung cancer resections – a necessary burden?

2019 ◽  
Vol 64 (3) ◽  
pp. 86-90
Author(s):  
NA Bradley ◽  
ED Kennedy ◽  
M Asif
Keyword(s):  
Decision Making ◽  
Liver Function ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Liver Function Tests ◽  
Function Tests ◽  
Routine Monitoring ◽  
Effective Manner ◽  
Collect Patient Data

Background Increased availability of routine investigations results in significant over-investigation, burdening patients with unnecessary tests as well as increasing cost. We aimed to identify the extent of monitoring of liver function tests in lung resections, and to ascertain whether any impact on clinical decision-making occurred. Methods Cases were identified using theatre records coded as “lobectomy/bilobectomy” in the three-month period 20 June 2017 to 20 September 2017. Electronic records were used to collect patient data. Results A total of 91 cases were included; 77 (85%) patients had 1 set of pre-operative LFTs, 12 (13%) patients had 2 sets, and 2 (2%) patients had 0 sets; 69 (76%) had normal LFTs pre-operatively; 298 sets of LFTs were measured post-operatively, with a median of 3 sets per patient; 61 (67%) patients had either normal or static LFTs post-operatively, 13 (14%) had isolated rise in GGT, 16 (17%) had derangement of ALT and AST, and 1 patient (1%) had deranged ALP. Altered clinical decision-making due to LFTs derangement was recorded in two cases (2%). Conclusion Clinicians have an obligation to justify expense, and practise in a cost-effective manner. Our data suggest that the routine perioperative monitoring of LFTs in thoracic surgery does not give any clear benefit to patient care.

The Evaluation of a Microcomputer Scoring Program to Mark Examinee Write-in Responses

1993 ◽  
Vol 9 (1) ◽  
pp. 79-88 ◽  
Author(s):  
Peter H. Harasym ◽  
S. Tunde Gondocz ◽  
J. Allan McCreary
Keyword(s):  
Decision Making ◽  
Computer Program ◽  
Clinical Decision Making ◽  
Learning Experiences ◽  
Cost Effective ◽  
Clinical Decision

A study was undertaken to determine the feasibility of using a computer program to mark examinee write-in responses. It compared the performance of a computer against that of physician markers. A new examination designed to assess clinical decision-making was administered to eighteen residents. The write-in responses on twenty-three questions were marked both by physicians and a microcomputer. The study found the computer to be more consistent in marking, equally as cost effective, and as valid as physician markers. Since the computer provided question statistics (i.e., means, frequencies of examinees' responses) it was evaluated to be better and more helpful than physician markers by providing data useful for improving examination questions and learning experiences.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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