scholarly journals Cost comparison among punctate midline myelotomy, intrathecal pain pump, and spinal cord epidural stimulator

2020 ◽  
Vol 11 ◽  
pp. 25 ◽  
Author(s):  
Zaid Aljuboori ◽  
Kimberly Meyer ◽  
Mayur Sharma ◽  
Tyler Ball ◽  
Haring Nauta
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Visceral Pain ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Cost Comparison ◽  
Pain Pump ◽  
The Mean ◽  
The Cost

Background: Invasive pain procedures can be valuable tools to manage chronic pain. Here, we compared the costs of three procedures used to address chronic pain; punctate midline myelotomy (PMM), placement of a spinal cord stimulator (SCS), or placement of an intrathecal pain pump (ITPP). Case Description: This retrospective chart review yielded 9 patients with chronic pain syndromes; 3 had PMM, 3 had SCS, and 3 had ITPP procedures. Variables studied included; pain type, the procedures performed, and the cost of each procedure. The Wilcoxon rank-sum and one-way analysis of variance were used to compare the three groups (P < 0.05). PMM was performed for patients with chronic nonmalignant visceral pain and SCS was utilized for failed back syndrome, while ITPP was placed in two patients with chronic visceral cancer pain and one patient with chronic somatic cancer pain. The mean length of stay was significant shorter for SCS and PMM versus ITPP (e.g., 1, 3.6 ± 0.6 and 15 ± 5.6 days). The mean procedure costs were significantly higher for SCS versus PMM and ITPP (105,234, $71,087, and $79,333); for the latter PMM and ITPP, procedural costs were not significantly different. Conclusion: For the three pain procedures discussed in this report, PMM is the most cost-effective as it obviates the need for efficacy trials, and there are: no implant device costs, no medication refills, no maintenance costs, and no complication management costs.

scholarly journals Cost analysis of cordotomy and intrathecal pain pump placement for refractory cancer pain

2020 ◽  
Vol 11 ◽  
pp. 72 ◽  
Author(s):  
Zaid Aljuboori ◽  
William Burke ◽  
Kimberly Meyer ◽  
Brian Williams
Keyword(s):  
Cancer Pain ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Cost Savings ◽  
Left Knee ◽  
Cost Comparison ◽  
Refractory Pain ◽  
Pain Pump ◽  
The Cost

Background: Cancer pain can be debilitating and 10–20% of patients will have refractory pain despite optimal medical management. Here, we present a cost comparison of treating terminal cancer patients with intravenous (IV) narcotics, anterolateral cordotomy, or intrathecal pain pump (ITPP) placement. Case Description: We evaluated and treated 2 patients with metastatic breast cancer and expected survivals of <1 year. The first patient, a 53-year-old female, had tumor invasion of the right chest wall and had failed oral pain regimens; she was admitted to receive IV Dilaudid as patient-controlled analgesia (PCA). After 7 days of treatment without improvement, she underwent a left-sided C1-2 cordotomy. For her, the cost of the cordotomy was $18,462 and the expenses for 7 days hospital stay with PCA was $89,884; the total was $108,346. The second patient, a 60-year-old female, had severe somatic pain due to invasion by tumor of the left knee cap. She, too, has failed oral therapy and was receiving in-hospital IV Dilaudid PCA. Following 2 days of failed treatment, a morphine ITPP was placed and effectively treated her pain. In patient 2, the cost of the ITPP was $80,603 and the expenses for 8 days of the hospital stay with PCA came to $84,785; the total was $165,389. Conclusion: The treatment of refractory pain in cancer patients is challenging. It requires invasive procedures such as cordotomy or ITPP. Although procedures may yield comparable pain control, there was a significant cost savings for cordotomy versus ITPP ($57,043 saved).

scholarly journals Addition of Flucytosine to Fluconazole for the Treatment of Cryptococcal Meningitis in Africa: A Multicountry Cost-effectiveness Analysis

2019 ◽  
Vol 70 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Tinevimbo Shiri ◽  
Angela Loyse ◽  
Lawrence Mwenge ◽  
Tao Chen ◽  
Shabir Lakhi ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cryptococcal Meningitis ◽  
Cost Effective ◽  
Immunodeficiency Virus ◽  
The Mean ◽  
The Cost ◽  
The Impact ◽  
Costing Analysis ◽  
Very High

Abstract Background Mortality from cryptococcal meningitis remains very high in Africa. In the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) trial, 2 weeks of fluconazole (FLU) plus flucytosine (5FC) was as effective and less costly than 2 weeks of amphotericin-based regimens. However, many African settings treat with FLU monotherapy, and the cost-effectiveness of adding 5FC to FLU is uncertain. Methods The effectiveness and costs of FLU+5FC were taken from ACTA, which included a costing analysis at the Zambian site. The effectiveness of FLU was derived from cohorts of consecutively enrolled patients, managed in respects other than drug therapy, as were participants in ACTA. FLU costs were derived from costs of FLU+5FC in ACTA, by subtracting 5FC drug and monitoring costs. The cost-effectiveness of FLU+5FC vs FLU alone was measured as the incremental cost-effectiveness ratio (ICER). A probabilistic sensitivity analysis assessed uncertainties and a bivariate deterministic sensitivity analysis examined the impact of varying mortality and 5FC drug costs on the ICER. Results The mean costs per patient were US $847 (95% confidence interval [CI] $776–927) for FLU+5FC, and US $628 (95% CI $557–709) for FLU. The 10-week mortality rate was 35.1% (95% CI 28.9–41.7%) with FLU+5FC and 53.8% (95% CI 43.1–64.1%) with FLU. At the current 5FC price of US $1.30 per 500 mg tablet, the ICER of 5FC+FLU versus FLU alone was US $65 (95% CI $28–208) per life-year saved. Reducing the 5FC cost to between US $0.80 and US $0.40 per 500 mg resulted in an ICER between US $44 and US $28 per life-year saved. Conclusions The addition of 5FC to FLU is cost-effective for cryptococcal meningitis treatment in Africa and, if made available widely, could substantially reduce mortality rates among human immunodeficiency virus–infected persons in Africa.

Central and Peripheral Nervous System

2021 ◽  
Author(s):  
Esther Benedetti ◽  
James Burnett ◽  
Meredith Degnan ◽  
Danielle Horne ◽  
Andres Missair ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Cancer Pain ◽  
Pain Perception ◽  
Visceral Pain ◽  
Influential Factors ◽  
Electrical Transmission ◽  
Somatic Pain ◽  
Spine Pain

The neuronal, chemical, and electrical transmission of pain is a complex and intricate subject that continues to be studied and expounded. This review discusses the relevant physiology and influential factors contributing to the experience and subjective variation in a variety of acute and chronic pain presentations. This review contains 4 figures, 4 tables, and 30 references Keywords: acute pain, chronic pain, somatic pain, neuropathic pain, visceral pain, nociception, pain perception, gender-related pain, cancer pain, spine pain

scholarly journals The cost of immunising at the general practice level

2009 ◽  
Vol 1 (4) ◽  
pp. 286 ◽  
Author(s):  
Nikki Turner ◽  
Paul Rouse ◽  
Stacey Airey ◽  
Helen Petousis-Harris
Keyword(s):  
General Practice ◽  
Cost Allocation ◽  
Cost Model ◽  
Cost Effective ◽  
Fee For Service ◽  
Activity Based Costing ◽  
Childhood Immunisation ◽  
Practice Nurses ◽  
The Mean ◽  
The Cost

INTRODUCTION: Childhood immunisation is one of the most cost-effective activities in health care. However, New Zealand (NZ) has failed to achieve national coverage targets. NZ general practice is the primary site of service delivery and is funded on a fee-for-service basis for delivery of immunisation events. AIM: To determine the average cost to a general practice of delivering childhood immunisation events and to develop a cost model for the typical practice. METHODS: A purposeful selection of 24 diverse practices provided data via questionnaires and a daily log over a week. Costs were modelled using activity-based costing. RESULTS: The mean time spent on an immunisation activity was 23.8 minutes, with 90.7% of all staff time provided by practice nurses. Only 2% of the total time recorded was spent on childhood immunisation opportunistic activities. Practice nurses spent 15% of their total work time on immunisation activity. The mean estimated cost per vaccination event was $25.90; however, there was considerable variability across practices. A ‘typical practice’ model was developed to better understand costs at different levels of activity. CONCLUSIONS: The current level of immunisation benefit subsidy is considerably lower than the cost of a standard vaccination event, although there is wide variability across practices. The costs of delivery exceeding the subsidy may be one reason why there is an apparently small amount of time spent on extra opportunistic activities and a barrier to increasing efforts to raise immunisation rates. KEYWORDS: Immunisation; vaccination; patient care management; cost analysis; cost allocation

scholarly journals Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Ahmad Gholami ◽  
Jassem Azizpoor ◽  
Elham Aflaki ◽  
Mehdi Rezaee ◽  
Khosro Keshavarz
Keyword(s):  
Rheumatoid Arthritis ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The Other ◽  
Cost Data ◽  
Fars Province ◽  
Study Results ◽  
The Mean ◽  
The Cost

Introduction. Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease that causes joint destruction. The condition imposes a significant economic burden on patients and societies. The present study is aimed at evaluating the cost-effectiveness of Infliximab, Adalimumab, and Etanercept in treating rheumatoid arthritis in Iran. Methods. This is a cost-effectiveness study of economic evaluation in which the Markov model was used. The study was carried out on 154 patients with rheumatoid arthritis in Fars province taking Infliximab, Adalimumab, and Etanercept. The patients were selected through sampling. In this study, the cost data were collected from a community perspective, and the outcomes were the mean reductions in DAS-28 and QALY. The cost data collection form and the EQ-5D questionnaire were also used to collect the required data. The results were presented in the form of an incremental cost-effectiveness ratio, and the sensitivity analysis was used to measure the robustness of the study results. The TreeAge Pro and Excel softwares were used to analyze the collected data. Results. The results showed that the mean costs and the QALY rates in the Infliximab, Adalimumab, and Etanercept arms were $ 79,518.33 and 12.34, $ 91,695.59 and 13.25, and $ 87,440.92 and 11.79, respectively. The one-way sensitivity analysis confirmed the robustness of the results. In addition, the results of the probabilistic sensitivity analysis (PSA) indicated that on the cost-effectiveness acceptability curve, Infliximab was in the acceptance area and below the threshold in 77% of simulations. The scatter plot was in the mentioned area in 81% and 91% of simulations compared with Adalimumab and Etanercept, respectively, implying lower costs and higher effectiveness than the other two alternatives. Therefore, the strategy was more cost-effective. Conclusion. According to the results of this study, Infliximab was more cost-effective than the other two medications. Therefore, it is recommended that physicians use this medication as the priority in treating rheumatoid arthritis. It is also suggested that health policymakers consider the present study results in preparing treatment guidelines for RA.

scholarly journals Evaluation of the cost-effectiveness of buprenorphine in treatment of chronic pain using competing EQ-5D weights

2015 ◽  
Vol 6 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Hanna Norrlid ◽  
Peter Dahm ◽  
Gunnel Ragnarson Tennvall
Keyword(s):  
Chronic Pain ◽  
Cost Effectiveness ◽  
Treatment Cost ◽  
Cost Effective ◽  
Elderly Persons ◽  
Physician Visits ◽  
Annual Treatment ◽  
The Uk ◽  
The Cost ◽  
Annual Treatment Cost

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.

Cost Comparison of Fan-Out WLP vs. Embedded Die

2011 ◽  
Vol 2011 (DPC) ◽  
pp. 001003-001018
Author(s):  
Alan Palesko ◽  
Jan Vardaman
Keyword(s):  
Cost Model ◽  
Form Factors ◽  
Cost Effective ◽  
Cost Comparison ◽  
Package Design ◽  
Supply Chain Logistics ◽  
Cost Effective Approach ◽  
Large Production ◽  
The Cost ◽  
Cost Differences

Fabricating the package after the die is placed can result in smaller form factors, increased performance, and improved supply chain logistics for OEMs. There are many different approaches for this packaging technique, but two of the most prominent are Fan-Out WLP and Embedded Die. Fan-Out WLP leverages existing semiconductor technology for a cost effective approach to achieve relatively tight package design rules. The Embedded Die strategy leverages existing PCB lamination technology for cost-reduction through scale: fabricating many small packages on large production panels. We will examine the cost differences and similarities between Fan-Out WLP and Embedded Die strategies by developing a comprehensive cost model for each technology. We will then analyze the manufacturing costs (labor, material, depreciation, yield loss, and tooling) and yield impacts across a variety of designs to demonstrate the cost differences and similarities in each packaging technology.

Cost Comparison of Fan-out Wafer Level Packaging and Flip Chip Packaging

2017 ◽  
Vol 2017 (DPC) ◽  
pp. 1-37 ◽  
Author(s):  
Amy Lujan
Keyword(s):  
Flip Chip ◽  
Cost Effective ◽  
Cost Comparison ◽  
Cost Modeling ◽  
Wafer Level ◽  
Design Features ◽  
Wafer Level Packaging ◽  
Flip Chip Packaging ◽  
The Right ◽  
The Cost

In recent years, there has been increased focus on fan-out wafer level packaging with the growing inclusion of a variety of fan-out wafer level packages in mobile products. While fan-out wafer level packaging may be the right solution for many designs, it is not always the lowest cost solution. The right packaging choice is the packaging technology that meets design requirements at the lowest cost. Flip chip packaging, a more mature technology, continues to be an alternative to fan-out wafer level packaging. It is important for many in the electronic packaging industry to be able to determine whether flip chip or fan-out wafer level packaging is the most cost-effective option. This paper will compare the cost of flip chip and fan-out wafer level packaging across a variety of designs. Additionally, the process flows for each technology will be introduced and the cost drivers highlighted. A variety of package sizes, die sizes, and design features will be covered by the cost comparison. Yield is a key component of cost and will also be considered in the analysis. Activity based cost modeling will be used for this analysis. With this type of cost modeling, a process flow is divided into a series of activities, and the total cost of each activity is accumulated. The cost of each activity is determined by analyzing the following attributes: time required, labor required, material required (consumable and permanent), capital required, and yield loss. The goal of this cost comparison is to determine which design features drive a design to be packaged more cost-effectively as a flip chip package, and which design features result in a lower cost fan-out wafer level package.

A case history of a cost effective 3D seismic survey over the Perth Basin, Western Australia

1989 ◽  
Vol 20 (2) ◽  
pp. 229
Author(s):  
S.C. Stewart ◽  
B.J. Evans
Keyword(s):  
Western Australia ◽  
Three Dimensional ◽  
Cost Effective ◽  
Cost Comparison ◽  
Seismic Survey ◽  
3D Seismic ◽  
Seismic Surveying ◽  
History Of ◽  
The Cost ◽  
Funded Research Project

As part of an industry funded research project into the application of the technique of LOFOLD3D land seismic surveying, a four fold three dimensional seismic survey was performed in the Perth Basin at Moora, Western Australia in July 1987. The volume covered an area of four kilometres by just under two kilometres, producing a total of 23,000 common midpoint traces. The objective was to collect and process the data in such a manner that a three dimensional structural interpretation would result, which would be the same as that resulting from a conventional three dimensional survey. A cost comparison indicates that a commercial LOFOLD3D survey would reduce the cost of performing a land 3D survey to an estimated 20% of the full fold equivalent, and the technique therefore offers potential for substantial savings if it is adopted on a commercial basis.

scholarly journals The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

2013 ◽  
Vol 40 (6) ◽  
pp. 795-799
Author(s):  
Waseem Sharieff ◽  
Anthony Whitton ◽  
Tom Chow ◽  
Doug Wyman ◽  
James Wright ◽  
...  
Keyword(s):  
Incremental Cost ◽  
Cost Effective ◽  
High Volume ◽  
Sensitivity Analyses ◽  
Patient Volume ◽  
Multiple Lesions ◽  
Robotic Radiosurgery ◽  
The Mean ◽  
Main Determinants ◽  
The Cost

Background:Radiosurgery can be delivered through a variety of modalities including robotic and fixed gantry linacbased systems. They appear equally effective and safe. Thus, community need and costs remain the main determinants for choosing a given modality. We performed an economic evaluation to identify settings in which one modality could be preferred over the other.Methods:Using local estimates of resource volumes and unit prices, we computed the incremental cost/patient of robotic radiosurgery compared to fixed-gantry radiosurgery from a payer's perspective. By varying parameters of resource volumes, we performed a probabilistic analysis stratified by number of brain lesions. in addition, we performed sensitivity analyses to examine the effect of patient volume on cost/patient.Results:The cost of robotic radiosurgery was $4,783/patient, and cost of fixed-gantry radiosurgery was $5,166/patient. The mean incremental cost was $-383 (95% interval: $-670, $110) for all lesions, $78 ($23, $123) for solitary lesions, and $-610 ($-679, $-534) for multiple lesions. The cost/patient of robotic radiosurgery varied from $5,656 (low volume setting) to $4,492 (high volume setting).Conclusion:in settings of moderate to high volume (6-10 hours of daily operation), and in multiple lesions, robotic radiosurgery is more cost effective than fixed-gantry radiosurgery.

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