scholarly journals High rates of relapse in adolescents crack users after inpatient clinic discharge

2016 ◽  
Vol 65 (3) ◽  
pp. 215-222
Author(s):  
Rosemeri Siqueira Pedroso ◽  
Luciano Santos Pinto Guimarães ◽  
Luciana Bohrer Zanetello ◽  
Veralice Maria Gonçalves ◽  
Ronaldo Lopes-Rosa ◽  
...  
Keyword(s):  
Contingency Management ◽  
Cost Benefit ◽  
Structured Interview ◽  
Therapeutic Modality ◽  
Behavioral Strategies ◽  
Crack Use ◽  
Sociodemographic Profile ◽  
The Cost ◽  
Crack Users

ABSTRACT Objective The objective of the present study was to evaluate 88 adolescent crack users referred to hospitalization and to follow them up after discharge to investigate relapse and factors associated with treatment. Methods Cohort (30 and 90 days after discharge) from a psychiatric hospital and a rehab clinic for treatment for chemical dependency in Porto Alegre between 2011 and 2012. Instruments: Semi-structured interview, conducted to evaluate the sociodemographic profile of the sample and describe the pattern of psychoactive substance use; Crack Use Relapse Scale/CURS; Questionnaire Tracking Users to Crack/QTUC; K-SADS-PL. Results In the first follow-up period (30 days after discharge), 65.9% of participants had relapsed. In the second follow-up period (90 days after discharge), 86.4% of participants had relapsed. Conclusion This is one of the first studies that show the extremely high prevalence of early relapse in adolescent crack users after discharge, questioning the cost/benefit of inpatient treatment for this population. Moreover, these results corroborate studies which suggested, young psychostimulants users might need tailored intensive outpatient treatment with contingency management and other behavioral strategies, in order to increase compliance and reduce drug or crime relapse, but this specific therapeutic modality is still scarce and must be developed in Brazil.

scholarly journals Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery

2015 ◽  
Vol 9 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Aristeidis Alevizopoulos ◽  
Dimitrios Zosimas ◽  
Lamprini Piha ◽  
Milad Hanna ◽  
Konstantinos Charitopoulos
Keyword(s):  
Retrospective Study ◽  
Cost Effectiveness ◽  
Conservative Management ◽  
Ureteral Stone ◽  
Cost Benefit ◽  
Early Surgery ◽  
Ureteral Stones ◽  
Global Cost ◽  
The Cost

Introduction: The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm. Objectives: We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free. Materials and methods: 192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed. Results: Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm). Conclusion: Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.

THE POSSIBILITY OF REDUCING THERAPIST CONTACT AND TOTAL LENGTH OF THERAPY IN THE TREATMENT OF PANIC DISORDER

1999 ◽  
Vol 27 (3) ◽  
pp. 231-247 ◽  
Author(s):  
Cristina Botella ◽  
Azucena García-Palacios
Keyword(s):  
Panic Disorder ◽  
Public Mental Health ◽  
Cost Benefit ◽  
Treatment Programs ◽  
Behavioural Treatment ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Post Test ◽  
The Cost

This study compares the effectiveness of a standard cognitive-behavioural treatment for panic disorder with a reduced therapist contact program supported by self-help materials. This program shortens the total therapy length (from 10 to 5 weeks) and the contact time with the therapist (from 10 to 5 sessions). The sample was mostly referred from a public mental health unit, and it had a low level of education (average of 9.7 years). The subjects were assessed according to several variables related with panic disorder at pre- and post-test, and at 12-month follow-up. The results demonstrated that both programs produced significant improvements for all variables at post-test, the benefits were maintained at follow-up assessment, and even heightened for some of the measures. Also, both treatment programs obtained comparable improvements for most measures. These results suggest that the programs that reduce the contact with the therapist, supported by self-help materials, and shorten the time that the patient suffers from this problem (Margraf, Barlow, Clark, & Telch, 1993) may be a good intervention for the treatment of panic disorder. These programs can help to overcome some of the cost-benefit therapeutic limitations of standard cognitive-behavioural programs.

scholarly journals The Effectiveness of Physiotherapist-Led Arthroplasty Follow-Up Clinics

2008 ◽  
Vol 90 (2) ◽  
pp. 117-119 ◽  
Author(s):  
MJ Walton ◽  
JC Walton ◽  
M Bell ◽  
BE Scammell
Keyword(s):  
Joint Replacement ◽  
Cost Benefit ◽  
Effective Alternative ◽  
Job Descriptions ◽  
Educational Impact ◽  
Prospective Data ◽  
Orthopaedic Clinic ◽  
Clinic Setting ◽  
The Cost

INTRODUCTION The conventional job descriptions of professionals within the NHS need to evolve in order to meet increasingly stringent targets and demands. One innovation is the introduction of a physiotherapist-led arthroplasty follow-up clinic. We present an audit of 1000 appointments to this clinic. PATIENTS AND METHODS A total of 865 patients were seen with 933 arthroplasties over an 8-month period; 135 appointments were not attended. Prospective data were collected at each attendance. RESULTS Less than 7.5% of patients required re-referral to an orthopaedic consultant, of which 36% were for consideration for further joint replacement. The cost of a physiotherapy appointment was £4.97 compared to £5.04 for a traditional orthopaedic assessment. By reducing the number of follow-up patients seen in orthopaedic clinics, we estimate that each consultant would be able to see two additional new patients per week. CONCLUSIONS Assessment of arthroplasty follow-up outside of the traditional orthopaedic clinic setting is a time-effective alternative; however, the cost-benefit and educational impact is less clear.

scholarly journals An Affordable and Universal Treatment for ‘Barcode’ Upper Lip Wrinkles

2021 ◽  
pp. 1-3
Author(s):  
L. DUPOIRIEUX ◽  
L. DUPOIRIEUX
Keyword(s):  
Cost Benefit ◽  
Healing Time ◽  
Upper Lip ◽  
Nerve Blocks ◽  
The Social ◽  
Cost Benefit Ratio ◽  
Versatile Technique ◽  
The Cost ◽  
Universal Treatment

A study was conducted to assess the cost-benefit ratio of manual dermabrasion with an electrocautery scratch pad for upper lip wrinkles. The study included 15 patients with a follow-up ranging from 4 to 108 months. The post-operative course was uneventful without serious complications and all patients were pleased with the results. The mean healing time was 10 to 15 days. The procedure can be performed safely for out-patients with a mean operative time of 30 minutes. The medical supply for the procedure is easily available worldwide and the cost does not exceed 20 euros per patient. It is also a versatile technique that can be performed under local anaesthesia by a surgeon trained with facial nerve blocks. The only drawback is the social exile during the healing time.

scholarly journals Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009

2017 ◽  
Vol 19 (1) ◽  
pp. 5-23 ◽  
Author(s):  
John Read ◽  
Chelsea Arnold
Keyword(s):  
Electroconvulsive Therapy ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
End Of Treatment ◽  
Persistent Memory ◽  
Contradictory Evidence ◽  
Meta Analyses ◽  
The Cost ◽  
Robust Evidence

Background:A 2010 review of studies, previous reviews and meta-analyses found minimal evidence that electroconvulsive therapy (ECT) for depression was more effective than placebo during the treatment period and no evidence at all of efficacy beyond the end of treatment. The current review explored whether any contradictory evidence has since been generated.Method:MEDLINE and PsycINFO were searched to identify all post-2009 studies that had compared ECT and simulated ECT for depression, or had in any other way generated valid depression data for ECT recipients at two or more points in time.Results:Ninety-one studies met inclusion criteria. There were no new placebo-controlled trials. There have now been no such studies since 1985. Only 4 placebo-controlled studies have ever produced data beyond the end of treatment, none of which have found any advantage for ECT over placebo. Of the 91 studies, only 2 aimed to evaluate the efficacy of ECT. Both were severely flawed. None of the other 89 produced robust evidence that ECT is effective for depression, primarily because at least 60% maintained ECT participants on medication and 89% produced no meaningful follow-up data beyond the end of treatment. No studies investigated whether ECT prevents suicide.Conclusions:There is still no evidence that ECT is more effective than placebo for depression reduction or suicide prevention. Given the well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.

FA03.06: THE COST BENEFIT OF A WATCH AND WAIT POLICY FOR COMPLETE CLINICAL RESPONDERS FOLLOWING NEO-ADJUVANT THERAPY IN ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 7-7
Author(s):  
Asila Abdelatif ◽  
Thomas Walsh ◽  
Arielle Coomara
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
Cost Benefit ◽  
Control Group ◽  
Watch And Wait ◽  
Life Years ◽  
The Mean ◽  
The Cost

Abstract Background Survival for esophageal cancer remains poor despite neo-adjuvant chemo-radiotherapy (nCRT) and surgical resection. The median survival for nCRT plus surgery in the CROSS trial was 48 months with a pathological complete response (pCR) rate of 29%. All pCR patients will have been clinical complete responders (cCR) and while surveillance and salvage surgery (S + SS) for cCR in rectal cancer is well investigated, it is unclear whether the outcomes are similar in esophageal cancer. As morbidity and mortality following esophagectomy is high, avoidance of surgery for predicted pCR would represent a clear advantage. Our unit offers a supported choice for cCR patients to opt for surgery or for surveillance. There is currently no literature on the cost benefit of a watch and wait policy for esophageal cancer patients with a complete clinical response. Methods We identified all cCR patients from a prospectively collected database of esophageal cancer patients offered curative treatment with nCRT from 1999 to 2017. We costed the S + SS group for whom accurate costing data was available and we matched these, according to time of follow up, to a control group of cCR who underwent surgery. Cost (from the National DRG cost manual) was calculated based on cost of surgery, ICU stay, admission length, and follow up radiological and endoscopic procedures. The data was analysed using a two-tailed, equal variance t-test. Results Of 237 patients who received nCRT, 86 had a cCR. Of these, 15 patients in the S + SS fulfilled the selection criteria with a mean follow up of 10.2 compared with 10.4 months in the control group (P = 0.925). The mean number of days in hospital was 19.2 vs. 43.2 days consecutively during the follow up period. The mean estimated cost to the HSE was €91,480 for S + SS compared with €301,280 for the controlled surgery group (P = 0.01). Conclusion This study identified a significant cost benefit for surveillance over surgery. Further studies are required to accurately identify those who cannot benefit from surgery and to assess quality of life years gained and cost per year of life are needed. Disclosure All authors have declared no conflicts of interest.

The economical impact of subcutaneous amifostine in the Kaiser Permanente health care system

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18526-18526
Author(s):  
R. Wang ◽  
J. Hastings ◽  
M. A. Tome
Keyword(s):  
Smoking Status ◽  
Cost Savings ◽  
Cost Benefit ◽  
Late Complications ◽  
Smoking History ◽  
Control Group ◽  
Total Cost ◽  
Study Results ◽  
The Cost

18526 Background: We have previously shown that Subcutaneous amifostine (SQ A) was safe and effective in decreasing the early and late complications of patients (PTS) treated with radiotherapy (RT) or chemoradiotherapy (CRT) for head and neck cancer (HNC). We have further observed that the QOL is better for many PTS treated with SQ A compared with historical controls (HC). Although we believe we cannot put a price on QOL, we hypothesized that the use of SQ A could result in cost savings to our institution because of the observed decrease in treatment-related complications. Methods: From May 2001 to October 2004, we treated 52 consecutive HNC PTS with RT or CRT and daily SQ A. PTS treated in our SQ A protocol received 500 mg of SQ A at least 30 minutes prior to daily RT. In order to be included in our present study, SQ A PTS had to have completed at least 80% of the prescribed SQ A dose. These PTS were then matched with HC based on age, sex, stage, primary site, smoking status, co-morbidiites, and treatment (RT or CRT). Fourteen PTS treated with SQ A (SQ A Group) were successfully matched with HC (Control Group). The entire costs of these 28 PTS to our institution (including the cost of SQ A) was obtained using our Management Accounting and Analysis database. Cost data was obtained at 6 months and 12 months after the completion of treatment. The median follow-up is 18 months (range 12–31). The economical impact of SQ A on xerostomia and dental care were not addressed in this study. Results: Ten PTS received RT and 18 received CRT. At 6 months of follow-up, the total cost for the Control Group was $196,789 versus $211,711 for the SQ A Group (p= 0.59). At 12 months, the total cost in the Control Group and SQ A Group were $287,594 and $275,654 respectively (p = 0.51). Within the SQ A Group, the cost was lowest in PTS who had never smoked or had a remote (>5 years) smoking history (p < 0.01). Conclusions: This study primarily addresses one of SQ A’s cytoprotective properties, mucositis. Our analysis suggests that we were able to offset the cost of SQ A in most PTS because of fewer complications observed in this group. The cost benefit of SQ A appears to be greater at 12 months vs. 6 months after treatment, suggesting continued cytoprotection. QOL is better in the SQ A Group. We plan to continue to follow these PTS and accrue new ones in a prospective fashion. [Table: see text]

Pharmacoeconomic analysis of bronchial asthma prophylaxis in adults and children with allergic rhinitis with sublingual allergen-specific immunotherapy

2021 ◽  
Author(s):  
Valeriya A Lemeshko ◽  
Svetlana S Ratushnyak ◽  
Filipp V Gorkavenko ◽  
Evgeniya V Nazarova ◽  
Natalia I Ilina ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Cost Benefit Analysis ◽  
Therapy Group ◽  
Pharmacoeconomic Analysis ◽  
Cost Benefit ◽  
Symptomatic Therapy ◽  
Tree Model ◽  
Allergen Specific Immunotherapy ◽  
The Cost

AIMS: to evaluate the cost-effectiveness of sASIT in children and adult patients with allergic rhinitis and / or allergic rhinoconjunctivitis. MATERIALS AND METHODS: the hypothesis of the study was based on results of the study by Devillier P. et al., 2019, according to which the incidence of asthma was 13.7% and 17.0% in the sASIT + symptomatic therapy groups and the symptomatic therapy group (odds ratio - 0.776, 95% confidence interval (0.622; 0.968)). Pharmacoeconomic study based on decision tree model. Costs taken into account: cost of sASIT, symptomatic therapy, diagnostics and routine follow-up visits due to BA, outpatient BA drug therapy, the cost of hospitalization due to BA. The modeling horizon was 5 years, including 2 years of sASIT therapy and 3 years of follow-up. RESULTS: the cost per patient when using sASIT in combination with symptomatic therapy was 166,711.93 rubles, with symptomatic therapy - 101,700.35 rubles. The CER for sASIT in combination with symptomatic therapy was 193,177.20 rubles. per 1 prevented case of asthma, for symptomatic therapy - 122,530.55 rubles. for 1 prevented case of BA. Thus, the cost of 1 averted AB case when using sASIT in combination with symptomatic therapy is 57.7% higher than with symptomatic therapy. According to the results of the cost-benefit analysis, ICUR for an additional year of life adjusted for its quality (QALY) when performing sASIT in combination with symptomatic therapy compared with symptomatic therapy alone in children and adults was 567,365.48 rubles, which is less than calculated willingness to pay threshold (WTPT) (RUB 2,248,898.50). CONCLUSIONS: based on the results of comparing the cost of 1 added QALY and WTPT, it can be concluded that sASIT in combination with symptomatic therapy compared to symptomatic therapy alone is potentially cost-effective in children and adults with AR.

Plasma Exchange: The Cost/benefit Ratio and the Critical Revision of Indications

1993 ◽  
Vol 16 (5_suppl) ◽  
pp. 173-176 ◽  
Author(s):  
M. Valbonesi ◽  
G. Florio ◽  
G. Lercari ◽  
P. Carlier ◽  
M.R. Ruzzenenti ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Cost Benefit ◽  
Therapeutic Modality ◽  
Benefit Ratio ◽  
Therapeutic Procedures ◽  
Acute Renal Insufficiency ◽  
Cost Benefit Ratio ◽  
Hospital Stays ◽  
Critical Revision ◽  
The Cost

The number of conditions that can benefit from Plasma-Exchange (PE) continues to grow. We have recently added to the list the Cyclosporin-A induced hypertrygliceridemia and myoglobinuric acute renal insufficiency. Such as any therapeutic measure for PE, four evolutive phases can be recognized: the discovery and research, the confirmation of indications, the routine applications and the decline, when new more powerful tools are offered by culture or technology. We have participated in the first three phases during the last 20 years. Not necessarily all experiences were favourable. Nonetheless, we feel that, for the time being, a hemapheresis unit is an absolute necessity for a medium - sized hospital even if only therapeutic procedures are carried out. The phase four, decline of interest and applications, cannot be foreseen. Finally the ability of PE to shorten substantially the length of hospital stays along with the ease with which procedure can be performed on ambulatory patients, substantiate a favourable cost/benefit ratio for this therapeutic modality.

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