scholarly journals Safety & Cost-Effectiveness of Primary Neonatal Posterior Sagittal Ano-recto Plasty (PNPSARP) 

2020 ◽  
Author(s):  
Enaam Raboe ◽  
Yazeed Owiwi ◽  
Alaa Ghallab ◽  
Ameen Alsaggaf ◽  
Mazen Zidan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Parenteral Nutrition ◽  
Bowel Preparation ◽  
Perioperative Complications ◽  
Standard Technique ◽  
Cost Effective ◽  
High Satisfaction ◽  
Vestibular Fistula ◽  
High Satisfaction Rate

Abstract Background: Early repair of Anorectal malformation (ARM) within 6 months may be one of the factors that improve fecal continence. Delayed and multiple-stage repairs require dilatation, strict bowel preparation, fasting and total parenteral nutrition (TPN). PNPSARP requires neither bowel preparation nor parenteral nutrition. We believe it can be achieved within 72 hours of life.Aim: To evaluate the safety, feasibility and cost effectiveness of PNPSARP within 72 hours of life versus delayed or multiple-stage repair of vestibular and perineal fistula. Material & Methods: A retrospective study was carried out of all newborns with ARM at our institute between August 2016 and August 2019. PNPSARP within 72 hours of life was compared with delayed or multiple-stage repair. Neither bowel preparation nor parenteral nutrition was required in the PNPSRP group. Perioperative complications and costs were evaluated. Results: Eight PNPSARP were compared with 7 delayed or multiple stage repair over the study period. Four babies (50%) were operated at day 1 post delivery in the PNPSARP group. Mean operative time (MOT) was 109 minutes (68-155). Mean follow up period was 22 months (12-36). One girl with a vestibular fistula had wound infection. This group had a good outcome with no morbidity, high satisfaction rate and low costs in comparison to delayed or multiple-stage repair.Conclusions: PNPSARP for perineal and vestibular fistula with supportive ancillary services in the first few days of life appears to be safe and cost effective with minimal morbidity. PNPSARP is now the standard technique in our unit.

scholarly journals Safety and efficacy of polydimethylsiloxane (Macroplastique®) in women with stress urinary incontinence: analysis of data from patients who completed three years follow-up

2021 ◽  
Author(s):  
Gamal Ghoniem ◽  
Bilal Farhan ◽  
Mashrin Lira Chowdhury ◽  
Yanjun Chen
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Serious Adverse Events ◽  
Safety And Efficacy ◽  
Medical Centers ◽  
High Satisfaction ◽  
High Satisfaction Rate ◽  
Time Observation ◽  
The Rose

Abstract Introduction and hypothesis This study aimed to report 3-year completed follow-up of the safety and efficacy of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Methods This is a retrospective analysis of all women who completed 3-year follow-up post-MPQ injection(s) at ten medical centers. We used the ROSE registry data report of Macroplastique® [Macroplastique® Real-time Observation of Safety and Effectiveness (ROSE) registry P040050/PAS001 on 2017]. Subjective incontinence outcome and adverse effects were assessed. Results The study included all patients (n = 70) who completed 3-year follow-up after the last MPQ injection. Twenty-four of 70 (34%) patients had two injections; 21/70 (30%) patients reported Stamey grade 0 and 28/70 (40%) reported Stamey grade 1. The overall patient satisfaction was 68% who completed 3-year follow-up. The composite success rate (I-QoL, PGI-S, and Stamey grade improvement) was 51.4%. No serious adverse events (AE) were reported within the completed 3-year follow-up. Conclusions MPQ was found to be safe and efficacious for the treatment of SUI secondary to ISD in women. The overall high satisfaction rate was sustained from baseline to 3 years post-injection. Most complications were minor and transient without sequelae.

Cost-effectiveness of zoledronic (ZOL) acid plus endocrine therapy (ET) in premenopausal women with early breast cancer (EBC) from a Canadian perspective

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 557-557
Author(s):  
K. E. Ougari ◽  
C. Taneja ◽  
O. Sofrygin ◽  
S. Kaura ◽  
T. Delea
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Premenopausal Women ◽  
Cost Effective ◽  
System Perspective ◽  
Healthcare System Perspective ◽  
The Cost ◽  
Canadian Healthcare System ◽  
Canadian Healthcare

557 Background: The Austrian Breast and Colorectal Cancer Study Group Trial 12 (ABCSG-12) examined the efficacy of 3 years (yrs) of treatment with goserelin in combination with ET (anastrozole or tamoxifen) with or without ZOL 4 mg q6 mos in 1,803 premenopausal women with EBC (median age 45 yrs). After a median follow-up of 47.8 mos (max 84 mos), risk of disease-free survival (DFS) events was reduced by 36% (HR = 0.64; p = 0.01) in patients (pts) who received ZOL (ZOL+ET) compared with those who did not (ET). Methods: A Markov model was used to estimate the cost per quality adjusted life years (QALYs) gained of 3 years treatment duration of ZOL+ET versus ET-only in premenopausal women with EBC based on results of the ABCSG-12. A Canadian healthcare system perspective and a lifetime timeframe were used. Outcomes and cost of breast cancer recurrence were based on recent published studies. Results were generated under 2 scenarios regarding duration of benefit (reduction in risk of recurrence) with ZOL: (1) Benefits persist to maximum follow-up in ABCSG-12 (trial benefit); (2) Benefits persist until death (lifetime benefit). Results: The cost of 3 years of ZOL (medication and administration) is 4 191 $CDN. Under the lifetime benefit scenario, 73% of these costs are offset by savings in the cost of recurrences. Under the trial benefit scenario, 12% are offset. QALYs gained are 1.63 yrs and 0.52 yrs under the lifetime and trial benefit scenarios respectively; cost-effectiveness is 1 122 $CDN and 3 675 $CDN per QALY gained respectively, which is well below the 50 000 $CDN per QALY threshold frequently used to assess whether therapies are cost-effective. Conclusions: The combination of ZOL + ET is a cost-effective use of healthcare resources from a Canadian healthcare system perspective. [Table: see text]

scholarly journals Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

2017 ◽  
Vol 22 (4) ◽  
pp. 226-235 ◽  
Author(s):  
Manuel Gomes ◽  
Mark Pennington ◽  
Raphael Wittenberg ◽  
Martin Knapp ◽  
Nick Black ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Base Case ◽  
Memory Assessment ◽  
Life Years ◽  
Follow Up Care ◽  
Related Quality ◽  
Mean Differences ◽  
The Cost

Background Policy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS), but it is unclear how any improvement in patients’ health-related quality of life (HRQL) compares with the associated costs. Aims To evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. Method We analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n = 944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and six months after referral to MAS. We also assessed the cost-effectiveness of MAS across different patient subgroups and clinic characteristics. Results Referral to MAS was associated with gains in DEMQOL (mean gain: 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01). Mean total cost over six months, assuming a societal perspective, was £1899 (£1277 to £2539). This yielded a negative incremental net monetary benefit of −£1724 (−£2388 to −£1085), assuming NICE’s recommended willingness-to-pay threshold (£30,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL. There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p < 0.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than £2500 over six months were relatively more cost-effective (p < 0.01) than MAS with fewer new monthly patients or higher cost per patient. Conclusions Diagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective, in the six months after diagnosis. Longer term evidence is required before drawing conclusions about the cost-effectiveness of MAS.

scholarly journals No recurrence in otoplasty: Is that possible?

2010 ◽  
Vol 138 (9-10) ◽  
pp. 546-550 ◽  
Author(s):  
Katarina Andjelkov ◽  
Marcos Sforza ◽  
Renato Zaccheddu ◽  
Goran Lazovic ◽  
Miodrag Colic
Keyword(s):  
Plastic Surgery ◽  
Postoperative Care ◽  
Operative Procedure ◽  
Surgical Practice ◽  
Prominent Ears ◽  
Satisfaction Rate ◽  
High Satisfaction ◽  
High Satisfaction Rate ◽  
Original Procedure

Introduction. Otoplasty or correction of prominent ears, is one of most commonly performed surgeries in plastic surgery both in children and adults. Until nowadays, there have been more than 150 techniques described, but all with certain percentage of recurrence which varies from just a few up to 24.4%. Objective. The authors present an otoplasty technique, a combination of Mustardj?s original procedure with other techniques, which they have been using successfully in their everyday surgical practice for the last 9 years. The technique is based on posterior antihelical and conchal approach. Methods. The study included 102 patients (60 males and 42 females) operated on between 1999 and 2008. The age varied between 6 and 49 years. Each procedure was tailored to the aberrant anatomy which was analyzed after examination. Indications and the operative procedure are described in stepby- step detail accompanied by drawings and photos taken during the surgery. Results. All patients had bilateral ear deformity. In all cases was performed a posterior antihelical approach. The conchal reduction was done only when necessary and also through the same incision. The follow-up was from 1 to 5 years. There were no recurrent cases. A few minor complications were presented. Postoperative care, complications and advantages compared to other techniques are discussed extensively. Conclusion. All patients showed a high satisfaction rate with the final result and there was no necessity for further surgeries. The technique described in this paper is easy to reproduce even for young surgeons.

scholarly journals Modeling the Cost-effectiveness of Esophageal Cancer Screening in China

2020 ◽  
Author(s):  
Yuanyuan LI ◽  
Lingbin Du ◽  
Youqing Wang ◽  
Yuxuan Gu ◽  
Xuemei Zhen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Esophageal Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cost Effective ◽  
Endoscopic Screening ◽  
Lugol’S Iodine ◽  
Iodine Staining ◽  
The Cost

Abstract Background : This study aimed to examine the cost-effectiveness of standard endoscopic screening with Lugol’s iodine staining for EC (esophageal cancer) screening in China. Methods : A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups according to five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) endoscopic screening with Lugol’s iodine staining with annual follow-up for low-grade intraepithelial neoplasia; and (3) endoscopic screening with Lugol’s iodine staining without follow-up. Quality-adjusted life-years (QALYs) indicated the effectiveness . The incremental cost-effectiveness ratio (ICER) was used as the evaluating indicator. Sensitivity analysis was performed to assess the robustness of the model. Results : Screening with follow-up was the undominated strategy, which saved USD 10942.57 and USD 6611.73 for individuals aged 40-44 and 45-49 years, respectively, per QALY gained. For those aged 50-69 years, the nonscreening scenarios were undominated. Screening without follow-up were extended dominated strategies. Compared to screening strategies without follow-up, all the follow-up strategies were found to be cost effective, with the ICER increasing from 299.57 USD/QALY for individuals 40-44 years to 1617.72 USD/QALY for individuals 65-69 years. Probabilistic sensitivity analysis supported the results of the base case analysis. Conclusions : EC screening with follow-up targeting individuals aged 40-49 years was the most cost-effective strategy.

scholarly journals Cost-effectiveness of TB treatments to Burmese and Laotian patients by Thai hospitals on the border with Myanmar and Laos

2019 ◽  
Vol 34 (1) ◽  
pp. 13-21
Author(s):  
Onn Laingoen ◽  
Tawatchai Apidechkul ◽  
Panupong Upala ◽  
Ratipark Tamornpark ◽  
Chaleerat Foungnual ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Care Program ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Content Type ◽  
Total Cost ◽  
Tb Treatment ◽  
Retrospective Data Collection ◽  
The Cost

Purpose The purpose of this paper is to estimate the cost-effectiveness of tuberculosis (TB) treatment and care in two Thai hospitals located on the borders with Myanmar and Laos. Design/methodology/approach A retrospective data collection was conducted to analyze all costs relevant to TB treatment and care from Mae Sai and Chiang Sean Hospitals. The cost related to TB treatment and care and the number of successful TB treatment from January 1 to December 31, 2017 were used for the calculation. The cost-effectiveness ratio (C/E) and the incremental cost-effectiveness ratio (ICER) were the outcomes. Findings In 2017, the total cost of the TB treatment and care program at Mae Sai Hospital was 482,728.94 baht for 57 TB patients. The cast per treated case per year was 8,468.93 baht. The C/E was 10,971.11 baht per successful TB treatment (44 successful cases). The total cost of the TB treatment and care program at Chiang Sean Hospital was 330,578.73 baht for 39 TB patients. The cost per treated case per year was 8,476.38 baht. The C/E was 22,038.58 baht per successful TB treatment (15 successful cases). The ICER was 5,246.56 baht. The Mae Sai Hospital model was more cost-effective in terms of the treatment and care provided to Burmese patients with TB than the Chiang Sean Hospital model for Laotian patients with TB. Originality/value To improve the cost-effectiveness of TB treatment and care programs for foreign patients in hospitals located on the Thai border, focus should be placed on patient follow-up at the community or village level.

scholarly journals Sodium Nitrite–Mediated Cardioprotection in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Cost-Effectiveness Analysis

2018 ◽  
Vol 24 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Daniel A. Jones ◽  
Peter Whittaker ◽  
Krishnaraj S. Rathod ◽  
Amy J. Richards ◽  
Mervyn Andiapen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Sodium Nitrite ◽  
Cost Effective ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Cost

Objectives: In the follow-up of patients in a trial of intracoronary sodium nitrite given during primary percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI), we found a reduction in the incidence of major adverse cardiac events (MACEs). Specifically, MACE rates were 5.2% versus 25.0% with placebo at 3 years ( P = .013). Such MACE reductions should also be associated with economic benefit. Thus, we assessed the cost utility of sodium nitrite therapy versus standard primary PCI only. Methods and Results: We developed a model to simulate costs and quality-adjusted life years (QALYs) over the first 36 months after ST-Segment Elevation Myocardial Infarction (STEMI). Decision tree analysis was used to assess different potential cardiovascular outcomes after STEMI for patients in both treatment groups. Model inputs were derived from the NITRITE-AMI study. Cost of comparative treatments and follow-up in relation to cardiovascular events was calculated from the United Kingdom National Health Service perspective. Higher procedural costs for nitrite treatment were offset by lower costs for repeat revascularization, myocardial infarction, and hospitalization for heart failure compared to primary PCI plus placebo. Nitrite treatment was associated with higher utility values (0.91 ± 0.19 vs 0.82 ± 0.30, P = .041). The calculated incremental cost-effectiveness ratio of £2177 per QALY indicates a cost-effective strategy. Furthermore, positive results were maintained when input parameters varied, indicating the robustness of our model. In fact, based on the difference in utility values, the cost of nitrite could increase by 4-fold (£2006 per vial) and remain cost-effective. Conclusion: This first analysis of sodium nitrite as a cardioprotective treatment demonstrates cost-effectiveness. Although more comparative analysis and assessment of longer follow-up times are required, our data indicate the considerable potential of nitrite-mediated cardioprotection.

Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes

2016 ◽  
Vol 32 (6) ◽  
pp. 661-667 ◽  
Author(s):  
David Winters ◽  
Robin Casten ◽  
Barry Rovner ◽  
Ann Murchison ◽  
Benjamin E. Leiby ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Supportive Therapy ◽  
Cost Effective ◽  
Care Utilization ◽  
Diabetic Patients ◽  
Cost Effectiveness Ratio ◽  
Eye Exams ◽  
The Cost ◽  
To Receive

Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.

scholarly journals Tenofovir disoproxil fumarate in pregnancy for prevention of mother to child transmission of hepatitis B in a rural setting on the Thailand-Myanmar border: a cost-effectiveness analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marieke Bierhoff ◽  
Chaisiri Angkurawaranon ◽  
Marcus J. Rijken ◽  
Kanlaya Sriprawa ◽  
Pachinee Kobphan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis B ◽  
Cost Effective ◽  
Hbv Dna ◽  
Gdp Per Capita ◽  
Per Capita ◽  
The Cost ◽  
Mother To Child ◽  
Hbv Transmission

Abstract Background Hepatitis B Virus (HBV) is transmitted from mother to child which can be prevented via birth dose vaccine combined with three follow up hepatitis B vaccines, hepatitis B immunoglobulins (HBIG), and maternal antiviral treatment with Tenofovir Disoproxil Fumarate (TDF). This study evaluates the cost effectiveness of six strategies to prevent perinatal HBV transmission in a resource limited setting (RLS) on the Thailand-Myanmar border. Methods The cost effectiveness of six strategies was tested by a decision tree model in R. All strategies included birth and follow up vaccinations and compared cost per infection averted against two willingness to pay thresholds: one-half and one gross domestic product (GDP) per capita. Strategies were: 1) Vaccine only, 2) HBIG after rapid diagnostic test (RDT): infants born to HBsAg+ are given HBIG, 3) TDF after RDT: HBsAg+ women are given TDF, 4) TDF after HBeAg test: HBeAg+ women are given TDF, 5) TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF, 6) HBIG & TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF and their infants are given HBIG. One-way and probabilistic sensitivity analyses were conducted on the cost-effective strategies. Results Vaccine only was the least costly option with TDF after HBeAg test strategy as the only cost-effective alternative. TDF after HBeAg test had an incremental cost-effectiveness ratio of US$1062; which would not be considered cost-effective with the lower threshold of one-half GDP per capita. The one-way sensitivity analysis demonstrated that the results were reasonably robust to changes in single parameter values. The PSA showed that TDF after HBeAg test had an 84% likelihood of being cost effective at a willingness to pay threshold of one GDP per capita per infection averted. Conclusions We found that TDF after HBeAg test has the potential to be cost-effective if TDF proves effective locally to prevent perinatal HBV transmission. The cost of TDF treatment and reliability of the RDT could be barriers to implementing this strategy. While TDF after RDT may be a more feasible strategy to implement in RLS, TDF after HBeAg test is a less costly option.

scholarly journals Aspiration sclerotherapy: a novel and cost-effective approach to the management of hydroceles in a developing country

2017 ◽  
Vol 4 (12) ◽  
pp. 3884
Author(s):  
Arijit Roy ◽  
Vijay Jain ◽  
Jahar Majumdar
Keyword(s):  
Success Rate ◽  
Indirect Costs ◽  
Cost Effective ◽  
Prophylactic Antibiotics ◽  
Chi Square ◽  
Cost Effective Approach ◽  
High Satisfaction ◽  
Chi Square Test ◽  
A Prospective Study

Background: The present study was carried out with an aim to perform a prospective study to establish the role of sodium tetradecyl sulfate (3 %) (STDS) as a safe and effective sclerosant in the management of primary hydroceles.Methods: Sclerotherapy was performed with 3 % STDS on an outdoor basis. The amount of sclerosant injected depended on the amount of fluid drained. All patients were given prophylactic antibiotics. Patients were clinically reassessed at 1 week, 1 month, 3 months, and 6 months and earlier if complications occurred. All patients were given prophylactic antibiotics.  The data were analyzed using Statistical Package for Social Sciences Version 15.0. The data have been represented as frequencies and percentages. Chi-square test was used to compare the data. A total of 57 patients with primary vaginal hydrocele gave consent for being enrolled in the study. The age of patients ranged from 18 to 65 years with a mean age of 35.72±13.18 years.Results: The success rate at the end of the study was observed to be 84.2 %. As regards patient satisfaction, in present study, in a limited time period of follow up, all the patients who had a successful procedure were satisfied.Conclusion: Overall, sclerotherapy was observed to be a relatively cost-effective (including both direct and indirect costs) procedure with low complications, high satisfaction, faster return to work and a high success rate within the limited period of follow-up.

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