Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis

Background Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community. Methods We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana. Results Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT). Conclusions Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don’t forgo prenatal care for fear of punitive consequences.

O Mar Não Está para Peixe: Análise de Custos Incrementais na Pandemia

ABSTRACT This teaching case aims to understand how incremental cost analysis can be applied in decision-making. The case portrays a fishing company in the segment that suffered a disruption in demand from the international market as a result of the COVID-19 pandemic. Its managers, who already acted to mitigate previous financial problems, now need to decide how to dispose of fish production during the pandemic. The case encourages the development of analytical competence on the impact of a rupture in demand, the identification of relevant costs for decision-making from an income statement, and managerial decision-making based on incremental cost analyzes. This case, based on interviews and estimated accounting data, was designed for undergraduate and graduate courses focused on costs in the areas of Business and Accounting.

The Sea is Getting Rough: Analysis of Incremental Costs during the Pandemic

ABSTRACT This teaching case aims to understand how incremental cost analysis can be applied in decision-making. The case portrays a fishing company in the segment that suffered a disruption in demand from the international market as a result of the COVID-19 pandemic. Its managers, who already acted to mitigate previous financial problems, now need to decide how to dispose of fish production during the pandemic. The case encourages the development of analytical competence on the impact of a rupture in demand, the identification of relevant costs for decision-making from an income statement, and managerial decision-making based on incremental cost analyzes. This case, based on interviews and estimated accounting data, was designed for undergraduate and graduate courses focused on costs in the areas of Business and Accounting.

Efficiency and resource allocation: the Hungarian managed health care system

The managed health care system (MHCS) was introduced and applied in Hungary between 1999 and 2009. The gradually expanding system covered only 22% of the population and included exclusively the curative-preventive health care, subsidy on medicaments, subsidy on therapeutic appliances and the spa service. Like anywhere else it was cost-effectiveness that was expected from the MHCS without the adverse effect in the quality of the health service. To decide whether the MHCS was successful in Hungary or not, we compare it with the results of those segments of the health system where the MHCS was not introduced. We use the method of the incremental cost analysis. We are making our comparison exclusively on the basis of health economics aspects, because no difference has evolved in the quality of the medical attendances. We will see that where the MHCS was applied, the medical attendance became cheaper, at those places where the MHCS was not applied the medical attendance became more expensive, causing a chronic financial deficit (137785 million HUF). Although the MHCS managed from less money, it gained 17767 million HUF during the mentioned ten years. We are going to present the general features of the MHCS and support the fact that the outcome of the managed care concept was rationalized and the savings in several segments of health care, by means of empirical evidence. Journal of Economic Literature (JEL) classification: I150, I180, G220, G320, H520.

A comparative cost analysis of picture archiving and communications systems (PACS) versus conventional radiology in the private sector

Background: Radiology is rapidly advancing, with a global transition to digital imaging technology to improve productivity and enhance communication. The major challenge confronting radiology practices is to demonstrate cost savings and productivity gains when a picture archiving and communication system (PACS) is established.Aim: To undertake an incremental cost analysis of PACS compared with conventional radiology to determine productivity gains, if any, at two private hospitals in Durban.Method: An incremental cost analysis for chest radiographs, computed tomography and magnetic resonance imaging brain scans with and without contrast were performed. The overall incremental cost for PACS in comparison with a conventional radiology site was determined. The net present value was also determined to evaluate the capital budgeting requirements for both systems.Results: The incremental cost of both capital and the radiology information system for installing PACS shows an expected increase. The incremental PACS image cost shows a reduction.Conclusion: The study provides a benchmark for the cost incurred when implementing PACS. It also provides a decision framework for radiology departments that plan to introduce PACS and helps to determine the feasibility of its introduction.

An incremental cost analysis of telehealth in Nova Scotia from a societal perspective

We examined the costs of telehealth in Nova Scotia from a societal perspective. The clinical outcomes of telepsychiatry and teledermatology services were assumed to be similar to those for conventional face-to-face consultations. Cost information was obtained from the Nova Scotia Department of Health, the Canadian Institute for Health Information, and questionnaires to patients, physicians and telehealth coordinators. There were 215 questionnaires completed by patients, 135 by specialist physicians and eight by telehealth coordinators. Patient costs for a face-to-face consultation ranged from $240 to $1048 (all costs in Canadian dollars), whereas patient costs for telehealth were lower, from $17 to $70. However, from a societal perspective, the overall cost of providing face-to-face services was lower than for telehealth: the total costs for face-to-face services ranged from $325 to $1133, while the total costs for telehealth services ranged from $1736 to $28,084. A threshold analysis showed that, above a certain patient workload, telehealth services would be more cost-effective than face-to-face services from a societal perspective. This workload is attainable in Nova Scotia.