scholarly journals Comparison of Direct Medical Costs between Automated and Continuous Ambulatory Peritoneal Dialysis

2013 ◽  
Vol 33 (6) ◽  
pp. 679-686 ◽  
Author(s):  
Laura Cortés–Sanabria ◽  
Brenda E. Rodríguez–Arreola ◽  
Victor R. Ortiz–Juárez ◽  
Herman Soto–Molina ◽  
Leonardo Pazarín–Villaseñor ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Generalized Linear Model ◽  
Laboratory Tests ◽  
Cohort Analysis ◽  
Medical Costs ◽  
Emergency Room Visits ◽  
Direct Medical Costs ◽  
Retrospective Cohort Analysis ◽  
Independent Variable ◽  
The Difference

ObjectiveWe set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated.MethodsOur retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries.ResultsNo baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more ( p = 0.001) in APD (US$7084) than in CAPD (US$6071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% – 20% increase for each component—except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008.ConclusionsThe annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.

The Direct and Indirect Costs of Treating the Victims of the 2016 Nice Terror Attacks in a Single Pediatric Hospital

2021 ◽  
pp. 1-4
Author(s):  
Federico Solla ◽  
Eytan Ellenberg ◽  
Virginie Rampal ◽  
Julien Margaine ◽  
Charles Musoff ◽  
...  
Keyword(s):  
Indirect Costs ◽  
Medical Costs ◽  
Pediatric Hospital ◽  
Terror Attack ◽  
Direct And Indirect Costs ◽  
Terror Attacks ◽  
Direct Medical Costs ◽  
Annual Budget ◽  
The Difference ◽  
The Cost

Abstract Objective: To analyze the cost of the terror attack in Nice in a single pediatric institution. Methods: We carried out descriptive analyses of the data coming from the Lenval University Children’s Hospital of Nice database after the July 14, 2016 terror attack. The medical cost for each patient was estimated from the invoice that the hospital sent to public insurance. The indirect costs were calculated from the hospital’s accounting, as the items that were previously absent or the difference between costs in 2016 versus the previous year. Results: The costs total 1.56 million USD, corresponding to 2% of Lenval Hospital’s 2016 annual budget. Direct medical costs represented 9% of the total cost. The indirect costs were related to human resources (overtime, sick leave), revenue shortfall, and security and psychiatric reinforcement. Conclusion: Indirect costs had a greater impact than did direct medical costs. Examining the level and variety of direct and indirect costs will lead to a better understanding of the consequences of terror acts and to improved preparation for future attacks.

scholarly journals 112 Healthcare Utilization and Costs for Patients With Tardive Dyskinesia

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 72-72
Author(s):  
Benjamin Carroll ◽  
Paul Juneau ◽  
Debra Irwin
Keyword(s):  
Mental Health ◽  
Tardive Dyskinesia ◽  
Emergency Room ◽  
Healthcare Utilization ◽  
Resource Utilization ◽  
Cohort Analysis ◽  
Emergency Room Visits ◽  
Retrospective Cohort Analysis ◽  
Health Related ◽  
Pharmaceutical Industries

AbstractIntroductionTardive dyskinesia (TD) is an often-irreversible movement disorder that usually results from prolonged use of antipsychotics. Although the burden of TD on patients’ quality of life has been reported, there is limited evidence of its impact on the healthcare system.ObjectiveTo assess healthcare utilization and costs between TD and non-TD patients in a sample of patients from the commercially insured and Medicare Supplemental US populations.MethodsA retrospective cohort analysis was conducted using Truven MarketScan Commercial/Medicare claims data. For each patient included in the analysis, the index date was set as the first TD diagnosis between 1/1/2008 and 9/30/2014. Patients with TD were then matched to similar patients without TD to compare resource utilization andcosts. Descriptive statistics on the incidence of resource utilization and costs of healthcare were reported.ResultsA total of 1020 patients were included in this analysis. TD patients had significantly greater annual all-cause (TD: $54,656; non-TD: $28,777) and mental health-related (TD: $10,199; non-TD: $2,605) healthcare costs compared with non-TD patients (P<0.01). This was primarily because a higher proportion of the TD patientsexperienced hospitalizations (all-cause 56%; mental health 17%) and emergency room visits (all-cause 62%; mental health 27%) compared with non-TD patients(hospitalizations: all-cause 26%, mental health 5%; emergency room visits: all-cause 41%; mental health 13%) (all P<0.001).ConclusionsPatients identified as being diagnosed with TD demonstrate significantly higher healthcare utilization and costs in the 12 months after diagnosis than do similar patients without TD.Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.Funding AcknowledgementsThis study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.

scholarly journals Racial/ethnic disparities in disability outcomes among post-acute home care patients

2017 ◽  
Vol 30 (9) ◽  
pp. 1406-1426 ◽  
Author(s):  
Jo-Ana D. Chase ◽  
Liming Huang ◽  
David Russell ◽  
Alexandra Hanlon ◽  
Melissa O’Connor ◽  
...  
Keyword(s):  
Home Care ◽  
Cohort Analysis ◽  
Ethnic Disparities ◽  
Clinical Intervention ◽  
Retrospective Cohort Analysis ◽  
Hispanic Patients ◽  
Information Set ◽  
The Difference ◽  
Adl Disability ◽  
Racial Ethnic

Objective: To examine activities of daily living (ADL) disability outcomes among racially/ethnically diverse elders receiving home care (HC) after hospitalization. Method: We conducted a retrospective cohort analysis of single-agency, 2013-2014 Outcome and Assessment Information Set data from older adults who received post-hospitalization HC ( n = 20,674). We measured overall change in ADL disability by summing the difference of standardized admission and discharge scores from nine individual ADL. Associations between race/ethnicity and overall ADL change scores were modeled using general linear regression, adjusting for covariates consistent with the Disablement Model. Results: Overall, patients experienced improvement in ADL disability from HC admission to discharge. However, Asian, African American, and Hispanic patients experienced significantly less improvement compared with non-Hispanic Whites (all p < .001), even after controlling for covariates. Discussion: Racial/ethnic disparities exist in ADL disability improvement among HC patients. Research is needed to clarify mechanisms underlying these disparities. Disablement Model factors may be targets for clinical intervention.

Direct Medical Costs of Interprosthetic Femoral Fracture Treatment: A cohort analysis

Injury ◽  
2021 ◽  
Author(s):  
Nikolaos K. Kanakaris ◽  
George A. Komnos ◽  
Ganesh Mohrir ◽  
Nick Patsiogiannis ◽  
Joseph Aderinto ◽  
...  
Keyword(s):  
Femoral Fracture ◽  
Cohort Analysis ◽  
Medical Costs ◽  
Fracture Treatment ◽  
Direct Medical Costs

scholarly journals 325 Pretibial Injury and 1 Year Mortality

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Peberdy
Keyword(s):  
Plastic Surgery ◽  
Cohort Analysis ◽  
Frail Patients ◽  
Retrospective Cohort Analysis ◽  
Hospital Patients ◽  
The Difference ◽  
Student’S T ◽  
One Year ◽  
The Uk ◽  
Surgery Department

Abstract Aim Frailty is increasingly recognised as an important factor for patients under the care of surgical departments. Pre-tibial injury is a common presenting problem to plastic surgery units across the UK. We wanted to assess the 1-year mortality of this patient cohort presenting to our unit. Method Retrospective cohort analysis of prospectively maintained clinical database across a calendar year from June 2017 to June 2018. This was perforemd at a UK Regional Plastic Surgery Centre analysinig patients presenting to the Royal Devon and Exeter Hospital. Patients were scored as either frail (Rockwood ≥ 5) or Non-Frail (Rockwood ≤ 4) taken from initial clinical assessment proformas. Results A total of 85 patients were included in the study. Mean age was 76.4 (± 18 years), and mean Rockwood Frailty Score of 3.4. Across all patients presenting to the plastic surgery department with pre-tibial injury there was a 20% (17/85) mortality at one year. In frail patients 1 year mortality was 47.6% (10/21). In Non-Frail patients 1 year mortality was 10.9% (7/64). The difference in mortalitly at 1 year was found to be significantly different in Frail vs Non-Frail patients with P = 0.00009 in an unpaired Student's t Test. Conclusions Frailty is a common condition in patients presenting with pre-tibial injury. This is a significant predictor of 1 year mortality in patients presenting with pre-tibial injury. Standardised evidence-based pathways of care for these patients could help optimise their management. Opportunities for MDT involvement in their care may improve outcomes.

scholarly journals The cost of systemic therapy for metastatic colorectal carcinoma in Slovenia: discrepancy analysis between cost and reimbursement

2015 ◽  
Vol 49 (2) ◽  
pp. 200-208 ◽  
Author(s):  
Tanja Mesti ◽  
Biljana Mileva Boshkoska ◽  
Mitja Kos ◽  
Metka Tekavčič ◽  
Janja Ocvirk
Keyword(s):  
Health Insurance ◽  
Side Effects ◽  
Systemic Therapy ◽  
Medical Costs ◽  
Hospital Treatment ◽  
Cost Assessment ◽  
Actual Cost ◽  
Direct Medical Costs ◽  
The Difference ◽  
The Cost

AbstractBackground. The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia.Methods. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included.Results. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to €3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was €1,900,757.80.Conclusions. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was €1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used is probably one of the reasons for the discrepancy between pay-outs and actual costs. We propose new method for more precise cost assessment in oncology.

Exit-Site Relocation: A Novel, Straightforward Technique for Exit-Site Infections

2019 ◽  
Vol 39 (4) ◽  
pp. 350-355 ◽  
Author(s):  
Dimitrios Kirmizis ◽  
Elaine Bowes ◽  
Behzad Ansari ◽  
Hugh Cairns
Keyword(s):  
Peritoneal Dialysis ◽  
Local Anesthetic ◽  
Cohort Analysis ◽  
Exit Site ◽  
Day Case ◽  
Exit Site Infection ◽  
Patient Morbidity ◽  
Retrospective Cohort Analysis

BackgroundExit-site infection (ESI) and tunnel infection (TI) of the peritoneal dialysis (PD) catheter are significant causes of catheter or even method loss as well as patient morbidity. Among the methods that have been in use thus far, the removal and replacement of the catheter often needs to be followed by switching temporarily to hemodialysis, whereas catheter splicing or unroofing of the tunnel tract and shaving/removal of the superficial catheter cuff have not gained universal acceptance thus far.MethodsWe treat chronic ESI with exit-site relocation under local anesthetic with removal of the external cuff. For the purposes of this study, we conducted a retrospective cohort analysis of all exit-site relocations performed using that technique over a 5-year period.ResultsTwenty-seven patients (16 male, mean age 58 years, range 23 – 81 years) with chronic ESI underwent exit-site relocation under local anesthetic as a day-case procedure. Follow-up was 47.5 ± 22.4 months (range 10.8 – 79.4 months). No dialysate leaks occurred following the procedure. Peritoneal dialysis was resumed immediately. The procedure resulted in long-term resolution of the infection in 20 of the 27 patients (74%). In 7 patients (26%), the catheter had to be removed eventually, either because of ESI recurrence (5 patients) or TI (2 patients), which in 2 cases was subsequently complicated by PD peritonitis, and the patients were switched to hemodialysis.ConclusionThe technique described herein is a safe, straightforward, and effective method for the treatment of chronic ESI while the patient remains on PD and avoids switching to hemodialysis.

scholarly journals PP040 Hospitalization Costs In Schizophrenia: Long-acting Injectable Antipsychotics Versus Oral Antipsychotic Use

2017 ◽  
Vol 33 (S1) ◽  
pp. 89-89
Author(s):  
Mallik Greene ◽  
Eunice Chang ◽  
Ann Hartry ◽  
Michael Broder
Keyword(s):  
Cohort Analysis ◽  
Charlson Comorbidity Index Score ◽  
Retrospective Cohort Analysis ◽  
Final Sample ◽  
Hospitalization Costs ◽  
Medicaid Population ◽  
Comorbidity Index ◽  
The Difference ◽  
Oral Antipsychotic ◽  
Long Acting

INTRODUCTION:Existing findings on effectiveness of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics in preventing hospitalizations are inconclusive. This study was conducted to compare hospitalization costs between Medicaid patients diagnosed with schizophrenia who initiated a LAI and those who changed from one oral antipsychotic to another.METHODS:This retrospective cohort analysis used the Truven Health Analytics MarketScan® Medicaid claims database to study patients ≥18 years with schizophrenia. The two cohorts were: “LAI”, defined as initiating LAI (no prior LAI therapy) between 1 January 2013 and 30 June 2014; and “oral”, defined as changing from one oral antipsychotic to another during the same period. The first day of LAI or the new oral antipsychotic was the index date. A linear regression model was conducted to estimate hospitalization costs.RESULTS:The final sample included 2,861 (36.7 percent) LAI and 4,926 (63.3 percent) oral users. Compared to oral users, LAI patients were younger (mean (Standard Deviation, SD): 39.9 (13.2) versus 42.7 (13.1); p<.001) and had a lower mean Charlson Comorbidity Index score (mean (SD): 1.1 (1.9) versus 1.7 (2.3); p<.001). Of the 877 LAI initiators and 1,688 oral users who were hospitalized during the 1-year post-index follow-up period, the unadjusted mean hospitalization costs for LAI and oral users were USD32,626 and USD36,048, respectively. After adjusting for patient demographic and clinical characteristics, baseline medication use, and baseline ED or hospitalizations, the adjusted average hospitalization costs were USD1,170 lower in LAI initiators than oral users. None of the unadjusted or adjusted differences were statistically significant.CONCLUSIONS:This real-world study suggests that among hospitalized patients, hospitalization costs are lower in LAI initiators than in oral antipsychotic users, although the difference is not statistically significant. Our study is limited as our results are reflective of a multi-state Medicaid population. Future studies are warranted to confirm the results in non-Medicaid patient populations.

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