Early hospital discharge and readmission jaundice in term babies

Background: Hyperbilirubinemia is a common and often benign disease in the neonatal period. It is the most common cause of readmission in early neonatal period. Prolonged hyperbilirubinemia can result in chronic bilirubin encephalopathy. Increasing the hospital stay of otherwise healthy neonates is not an acceptable solution for medical, social and economic constraints. So, identifying the risk factors for readmission assumes importance. Aim of our study is to identify the risk factors for readmission jaundice in our hospital.Methods: In this study, authors used a questionnaire to find out the risk factors for readmission in those babies who were readmitted with jaundice within 3 weeks of life to our hospital. During the study period, routine treatment practices were followed and there was no deviation from the standard of care for the purpose of research.Results: Of the 2297 deliveries during this study period, 93 babies (4%) were readmitted with jaundice.Among the 93 babies, prevalence of blood group incompatibility was one of the common causes of neonatal jaundice. 46.2% of the babies had an early discharge. Total Serum bilirubin levels were measured by a hospital-based bilirubin assay. Babies with serum bilirubin level above photozones as per American Academy of Pediatrics practice guidelines 2004 were identified and subjected to photo therapy. All the babies in this study responded to photo therapy. No other interventions were needed.Conclusions: Though an early discharge is the most cost-effective strategy in this era of high medical expenditure, we can identify certain high-risk babies, prone for readmission. Blood group incompatibility, infants of primiparous mothers and GDM mothers are more prone to readmission jaundice. Identifying these high-risk babies and educating the mothers is a more cost-effective strategy than prolonging the hospital stay for all babies.

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Which is the most appropriate strategy for nasal screening and Staphylococcus aureus decolonization in total hip arthroplasty patients?

10.21203/rs.3.rs-36213/v1 ◽

2020 ◽

Author(s):

Hisahiro Tonotsuka ◽

Hajime Sugiyama ◽

Ayano Amagami ◽

Keigo Yonemoto ◽

Ryuichi Sato ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Average Cost ◽

Smoking Habit ◽

Cost Effective ◽

Effective Strategy ◽

Total Hip ◽

Cost Effective Strategy

Abstract Background: To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy.Methods: A total of 1654 patients scheduled for primary or revision THA (1464 women, 190 men; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and MRSA/MSSA tests were analyzed according to the following parameters: sex, age ≥80 years, body mass index ≥30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin <3.5 g/dL, glomerular filtration rate <50 mL/min, presence of brain, thyroid, cardiac or pulmonary disease, diabetes, asthma, and smoking habit. The average cost of each strategy was calculated.Results: In total, 29 patients (1.8%) tested positive for MRSA and 445 (26.9%) tested positive for MRSA/MSSA. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for MRSA/MSSA (p=0.003; odds ratio: 1.790; 95% confidence interval: 1.210-2.640). The average cost of each strategy for eradicating MRSA was 1641.3 yen for UD, 285.8 yen for US, and 252.3 yen for TS.Conclusions: No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.

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Which is the most cost-effective strategy for nasal screening and Staphylococcus aureus decolonization in patients undergoing total hip arthroplasty?

10.21203/rs.3.rs-36213/v2 ◽

2020 ◽

Author(s):

Hisahiro Tonotsuka ◽

Hajime Sugiyama ◽

Ayano Amagami ◽

Keigo Yonemoto ◽

Ryuichi Sato ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Average Cost ◽

Bacterial Colonization ◽

Cost Effective ◽

Effective Strategy ◽

Total Hip ◽

Cost Effective Strategy

Abstract Background: To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy.Methods: A total of 1654 patients scheduled for primary or revision THA (1464 females, 190 males; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and S. aureus (including both MRSA and MSSA) tests were analyzed according to the following parameters: sex, age ≥80 years, body mass index ≥30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin <3.5 g/dL, glomerular filtration rate <50 mL/min, presence of brain, thyroid, cardiac or pulmonary disease, diabetes, asthma, smoking status, and whether revision surgery was performed. The average cost of each strategy was calculated.Results: In total, 29 patients (1.8%) tested positive for MRSA and 445 (26.9%) tested positive for S. aureus. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for S. aureus (p=0.003; odds ratio: 1.790; 95% confidence interval: 1.210-2.640). The average cost of each strategy was 1928.3 yen for UD, 717.6 yen for US, and 717.6 yen for TS (for eradicating MRSA), and 1928.3 yen for UD, 1201.6 yen for US, and 1160.4 yen for TS (for eradicating S. aureus).Conclusions: No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.

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Cost-Effectiveness Analysis of High-Risk Groups Tuberculosis Screening in Malaysia

Frontiers in Public Health ◽

10.3389/fpubh.2021.699735 ◽

2021 ◽

Vol 9 ◽

Author(s):

Nor Zam Azihan Mohd Hassan ◽

Asmah Razali ◽

Mohd Ridzwan Shahari ◽

Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran ◽

Juanita Halili ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Incremental Cost ◽

Screening Program ◽

Cost Effective ◽

Risk Groups ◽

Effective Strategy ◽

Tree Model ◽

Cost Effective Strategy ◽

The Cost

Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.

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Cost Effectiveness Analysis Of High-Risk Group Tb Screening In Malaysia

10.21203/rs.3.rs-113831/v1 ◽

2020 ◽

Author(s):

Nor Zam Azihan Mohd Hassan ◽

Asmah Razali ◽

Mohd Ridzwan Shahari ◽

Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran ◽

Juanita Halili ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Risk Group ◽

Cost Effective ◽

Risk Groups ◽

High Risk Group ◽

Effective Strategy ◽

Tree Model ◽

Cost Effective Strategy ◽

The Cost

Abstract Background: Screening of high-risk groups for TB is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia.Methods: A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk group from provider perspective using a secondary data from year 2016 to 2018. The outcome is presented in term of cost per TB case detected and the ICER. Deterministic and Probabilistic Sensitivity Analysis were also performed to measure the robustness of the model.Results: The most cost-effective strategy was TB screening among PL HIV, with MYR 2,597.00 per one TB case detected. This is followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24 and MYR 4,327.76 per one TB case detected respectively. There was an incremental costs of MYR 2.49 per screening, and 3.4 TB case detection per 1000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost effectiveness efficacy among PL HIV.Conclusions: Results of the study suggest prioritization of high-risk group TB screening programme by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has lower cost per TB case detected.

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What is the most cost‐effective strategy for nasal screening and Staphylococcus aureus decolonization in patients undergoing total hip arthroplasty?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04008-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hisahiro Tonotsuka ◽

Hajime Sugiyama ◽

Ayano Amagami ◽

Keigo Yonemoto ◽

Ryuichi Sato ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Average Cost ◽

Bacterial Colonization ◽

Cost Effective ◽

Effective Strategy ◽

Total Hip ◽

Cost Effective Strategy

Abstract Background To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy. Methods A total of 1654 patients scheduled for primary or revision THA (1464 female, 190 male; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and S. aureus (including both MRSA and MSSA) tests were analyzed according to the following parameters: sex, age ≥ 80 years, body mass index ≥ 30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin < 3.5 g/dL, glomerular filtration rate < 50 mL/min, presence of brain, thyroid, cardiac, or pulmonary disease, diabetes, asthma, smoking status, and whether revision surgery was performed. The average cost of each strategy was calculated. Results In total, 29 patients (1.8 %) tested positive for MRSA and 445 (26.9 %) tested positive for S. aureus. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for S. aureus (p = 0.003; odds ratio: 1.790; 95 % confidence interval: 1.210–2.640). The average cost of each strategy was 1928.3 yen for UD, 717.6 yen for US, and 717.6 yen for TS (for eradicating MRSA), and 1928.3 yen for UD, 1201.6 yen for US, and 1160.4 yen for TS (for eradicating S. aureus). Conclusions No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.

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