Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system

2015 ◽  
Vol 39 (1) ◽  
pp. 12 ◽  
Author(s):  
Joshua M. Byrnes ◽  
Tracy A. Comans
Keyword(s):  
Cost Saving ◽  
Cost Savings ◽  
Medical Practitioner ◽  
Sensitivity Analyses ◽  
Medical Practitioners ◽  
Medical Specialists ◽  
The Government ◽  
The Impact ◽  
Direct Referral ◽  
Out Of Pocket Costs

Objective To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. Methods A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Results Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government of up to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. Conclusions The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving. What is known about the topic? Extending Medicare rebates payable to patients when physiotherapists directly refer patients to specialist medical practitioners is a contentious topic. Physiotherapy groups have argued that direct referral with a rebate would allow faster access to consultant advice resulting in better patient care. However, it has also been argued that widening criteria for rebates would increase overall costs to Medicare Australia. What does this paper add? This analysis finds that allowing direct referral with a rebate would result in a cost saving to both the government funder and patient out-of-pocket costs. What are the implications for practitioners? Policymakers should consider widening the criteria for rebates payable for referral to medical specialists to include physiotherapists, as this could result in faster management of patients and cost savings for both patients and Medicare Australia.

scholarly journals Implications of Achieving TICI 2b Versus TICI 3 Reperfusion in Patients With Ischemic Stroke: A Cost-Effectiveness Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Xiao Wu ◽  
Dheeraj Gandhi ◽  
Charles C Matouk ◽  
Joseph Schindler ◽  
Danny Hughes ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cost Saving ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Old Patients ◽  
Life Years ◽  
Outcome Differences

Abstract INTRODUCTION The degree of successful reperfusion of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) is one of the critical and potentially modifiable determinants of clinical outcome. Differences in outcomes between patients with TICI 2b vs TICI 3 reperfusion have recently been highlighted. This study examines the public health and cost implications of achieving TICI 2b vs TICI 3 reperfusion. METHODS A decision-analytic study was performed to estimate the lifetime quality-adjusted life years (QALY) and associated costs based on the degree of reperfusion achieved. The base case calculations and multiple one-way sensitivity analyses were performed for AIS patients with LVO undergoing MT in 3 age groups: 55, 65, and 75 yr old, respectively. RESULTS Within 90 d, achieving TICI 3 results in a cost-saving of $5,258 per patient and health benefit of 7.3 d in perfect health as compared to TICI 2b. In the long-term, for the 3 ages groups (55, 65, and 75 yr old), achieving TICI 3 results in cost savings of $82,965, $51,155, and $31,034 respectively, and health benefits of 2.42 QALYs, 1.92 QALYs, and 1.36 QALYs. Every 1% increase in TICI 3 in 55-yr-old patients at a nation-wide level results in a cost saving of nearly $6.1 million and a health benefit of 176 QALYs. Among 65-yr-old patients, the corresponding cost savings and health benefit are $3.7 million and 176 QALYs, and $2.3 million and 99 QALYS for 75-yr-old patients. CONCLUSION There are substantial cost and health implications of achieving complete vs incomplete reperfusion after EVT. Our study reinforces the need for a more conservative definition of therapy success and treatment approaches to achieve TICI 3 reperfusion.

scholarly journals Measles CEA

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S64-S65
Author(s):  
Emily Hyle
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Economic Value ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
International Travel ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Cost Effectiveness Ratio ◽  
The Impact

Abstract Background Most measles importations are due to returning US travelers infected during international travel. We projected clinical outcomes and assessed cost-effectiveness of pretravel evaluation for measles immunity and MMR vaccination among eligible adult US international travelers. Methods We designed a decision tree to investigate pretravel evaluation compared with no evaluation from the societal perspective. Data from the Global TravEpiNet Consortium and published literature informed input parameters (Figure 1). Outcomes included measles cases averted per 10 million travelers, costs, and the incremental cost-effectiveness ratio (ICER, Δcosts/Δmeasles cases averted); we considered ICERs < $100,000/measles case averted to be cost-effective. We performed sensitivity analyses to assess the impact of varying the probability of exposure based on travel destination, and the percentage of travelers with pre-existing measles immunity. Results In the base case, departure after pretravel evaluation resulted in 16 measles importations and 46 transmissions per 10 million travelers and cost $132 million, vs without pretravel evaluation (26 importations and 87 transmissions per 10 million travelers, costing $22 million). Pretravel evaluation averted 51 measles cases per 10 million travelers with an ICER of $2.2 million per case averted. Results were most sensitive to the probability of measles exposure and the traveler’s pre-existing immunity (Figure 2). Pretravel evaluation was cost-effective for travelers to Asia if pre-existing measles immunity was <80%. Evaluation was always cost-effective for travelers to Africa when pre-existing immunity was less than 100% and became cost saving when the percentage of immune travelers was lower (<70%). Travelers who were more likely to be non-immune and were visiting destinations with higher probabilities of exposure were most likely to benefit from pretravel evaluation for measles immunity at excellent economic value. Conclusion As risk of measles exposure increases and likelihood of travelers’ pre-existing immunity decreases, it can be cost-effective or cost saving to assess US international travelers’ measles immunity status and vaccinate with MMR prior to departure. Disclosures All authors: No reported disclosures.

scholarly journals Cost-effectiveness of rivaroxaban compared with enoxaparin plus warfarin for the treatment of hospitalised acute deep vein thrombosis in China

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038433
Author(s):  
Li Yang ◽  
Jingjing Wu
Keyword(s):  
Deep Vein Thrombosis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Transition Probabilities ◽  
Sensitivity Analyses ◽  
Vein Thrombosis ◽  
Life Years ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein ◽  
The Impact

ObjectiveLimited economic evaluation data for rivaroxaban compared with standard of care (SoC) exists in China. The objective of this analysis was to evaluate the cost-effectiveness of rivaroxaban compared with current SoC (enoxaparin overlapped with warfarin) for the treatment of acute deep vein thrombosis (DVT) in China.MethodsA Markov model was adapted from a payer’s perspective to evaluate the costs and quality-adjusted life years (QALYs) of patients with DVT treated with rivaroxaban or enoxaparin/warfarin. Clinical data from the EINSTEIN-DVT trial were obtained to estimate the transition probabilities. Data on Chinese health resource use, unit costs and utility parameters were collected from previously published literature and used to estimate the total costs and QALYs. The time horizon was set at 5 years and a 3-month cycle length was used in the model. A 5% discount rate was applied to the projected costs. One-way sensitivity analyses and probabilistic sensitivity analyses were undertaken to assess the impact of uncertainty on results.ResultsRivaroxaban therapy resulted in an increase of 0.008 QALYs and was associated with lower total costs compared with enoxaparin/warfarin (US$4744.4 vs US$5572.4, respectively), demonstrating it to be a cost-saving treatment strategy. The results were mainly sensitive to length of hospitalisation due to DVT on enoxaparin/warfarin, cost per day of hospitalisation and the difference in length of stay of rivaroxaban-treated and enoxaparin/warfarin-treated patients.ConclusionRivaroxaban therapy resulted in a cost saving compared with enoxaparin/warfarin for the anticoagulation treatment of patients with hospitalised acute DVT in China.Trial registration numberNCT00440193; Post-results.

scholarly journals Estimating the Impact of Novel Digital Therapeutics in Type 2 Diabetes and Hypertension: Health Economic Analysis

10.2196/15814 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e15814 ◽  
Author(s):  
Robert J Nordyke ◽  
Kevin Appelbaum ◽  
Mark A Berman
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cohort Studies ◽  
Cost Savings ◽  
Economic Benefits ◽  
Sensitivity Analyses ◽  
Clinical Inertia ◽  
Health Resource ◽  
The Impact

Background Behavioral interventions can meaningfully improve cardiometabolic conditions. Digital therapeutics (DTxs) delivering these interventions may provide benefits comparable to pharmacologic therapies, displacing medications for some patients. Objective Our objective was to estimate the economic impact of a digital behavioral intervention in type 2 diabetes mellitus (T2DM) and hypertension (HTN) and estimate the impact of clinical inertia on deprescribing medications. Methods Decision analytic models estimated health resource savings and cost effectiveness from a US commercial payer perspective. A 3-year time horizon was most relevant to the intervention and payer. Effectiveness of the DTx in improving clinical outcomes was based on cohort studies and published literature. Health resource utilization (HRU), health state utilities, and costs were drawn from the literature with costs adjusted to 2018 dollars. Future costs and quality-adjusted life years (QALYs) were discounted at 3%. Sensitivity analyses assessed uncertainty. Results Average HRU savings ranged from $97 to $145 per patient per month, with higher potential benefits in T2DM. Cost-effectiveness acceptability analyses using a willingness-to-pay of $50,000/QALY indicated that the intervention would be cost effective at total 3-year program costs of $6468 and $6620 for T2DM and HTN, respectively. Sensitivity analyses showed that reduced medication costs are a primary driver of potential HRU savings, and the results were robust within values tested. A resistance to deprescribe medications when a patient’s clinical outcomes improve can substantially reduce the estimated economic benefits. Our models rely on estimates of clinical effectiveness drawn from limited cohort studies with DTxs and cannot account for other disease management programs that may be implemented. Performance of DTxs in real-world settings is required to further validate their economic benefits. Conclusions The DTxs studied may provide substantial cost savings, in part by reducing the use of conventional medications. Clinical inertia may limit the full cost savings of DTxs.

Potential Medicare beneficiary out-of-pocket cost reductions through use of biosimilar filgrastim-sndz over reference filgrastim among patients with lung cancer: A simulation model analysis.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 140-140
Author(s):  
Sanjeev Balu ◽  
Gary Puckrein ◽  
Liou Xu ◽  
Alan Ryan ◽  
Kim Campbell
Keyword(s):  
Lung Cancer ◽  
Cost Saving ◽  
Simulation Model ◽  
Simulation Analysis ◽  
Medicare Beneficiary ◽  
Cost Savings ◽  
Limited Data ◽  
Data Set ◽  
Model Average ◽  
The Impact

140 Background: G-CSFs are utilized to lower the incidence of febrile neutropenia (FN) in patients with cancers treated with chemotherapy. In 2015 filgrastim-sndz was the first biosimilar to be approved and launched in the US. Limited data exists on the impact of biosimilars on patient out-of-pocket (OOP) expenditures. The objective of this simulation model is to estimate potential OOP cost savings through use of filgrastim-sndz (FIL-S) over reference filgrastim (FIL-REF) from a Medicare lung cancer patient perspective. Methods: An Excel simulation analysis was conducted among lung cancer patients treated with biosimilar FIL-S or FIL-REF (identified through HCPCS codes). Data from the 2016 Medicare Limited Data Set was used to populate the model. Average Medicare payment to the provider and beneficiary OOP responsibility per claim of either FIL-S or FIL-REF were calculated. The average OOP reduction per claim for a FIL-S beneficiary relative to a FIL-REF beneficiary was multiplied to a hypothetical FN prevalent population of 100,000 beneficiaries (average of 10 claims per beneficiary) to estimate the potential OOP savings. Results: Data from 525 FIL-S and 621 FIL-REF claims were analyzed. The average Medicare allowed charge amount per claim for a FIL-S beneficiary was $381.7 versus $419.1 for a FIL-REF beneficiary, while corresponding average Medicare payments to the provider were $299.3 and $327.4, respectively. On an average, OOP responsibility for a FIL-S beneficiary was lower compared to a FIL-REF beneficiary ($76.4 vs. $85.0) leading to a cost saving per claim of approximately $8.60. When extrapolated to 100,000 beneficiaries (1,000,000 claims), the overall cost saving was projected to be around $8.6 million. Conclusions: Our simulation model estimated potential OOP Medicare lung cancer beneficiary savings of around $8.6 million, based on a hypothetical population of 100,000 FN beneficiaries, with the use of biosimilar FIL-S over FIL-REF. Further real-world analyses are required to evaluate the true cost savings potential with the use of biosimilars over reference biologics.

Efficient Energy Management System Based on GA and Classical Boolean Approach

2016 ◽  
Vol 15 (03) ◽  
pp. 1650012
Author(s):  
Musbah Abdulgader ◽  
Cheng Yang ◽  
Devinder Kaur
Keyword(s):  
Cost Saving ◽  
Energy Management ◽  
Cost Savings ◽  
Department Of Energy ◽  
Time Data ◽  
Storage Unit ◽  
Energy Storage Unit ◽  
Load Demand ◽  
The Cost ◽  
The Impact

In this paper, two intelligent strategies for energy management unit for a home integrated with smart grid are proposed. The strategies are based on classical Boolean and genetic algorithm (GA). The objective is to optimize the cost saving for the end consumer. The price of energy varies by the hour depending on the load on the grid. The two strategies predict when and by how much the storage unit installed in the house should charge and release for 24 h of the day, satisfying the constraint that the load demand of the house at any particular hour should always be met. The strategies were tested by real time data collected by the Department of Energy for a typical house in the Chicago, Illinois region for the year 2013. Both the strategies achieve cost savings; however, it has been found that GA-based strategy results in higher cost saving. The impact of the capacity of the energy storage unit (ESU) on the cost saving has been analyzed for a GA strategy and cost saving obtained when the capacity of ESU is 1.5 times and 2 times the house hold load at any given hour is presented.

scholarly journals Associations between Australian clinical medical practitioner exposure to workplace aggression and workforce participation intentions

2016 ◽  
Vol 40 (1) ◽  
pp. 36 ◽  
Author(s):  
Danny J. Hills
Keyword(s):  
Patient Care ◽  
Medical Practitioner ◽  
Well Being ◽  
Workplace Aggression ◽  
Cross Sectional Survey ◽  
Workforce Participation ◽  
Cross Sectional ◽  
Medical Practitioners ◽  
The Impact ◽  
Clinical Workload

Objective The aim of the present study was to determine the association between clinician exposure to workplace aggression from any source in the previous 12 months and workforce participation intentions. Methods A cross-sectional survey, in the third wave of the Medicine in Australia: Balancing Employment and Life (MABEL) study, was conducted between March 2010 and June 2011. Respondents were a representative sample of 9449 Australian general practitioners (GPs) and GP registrars (n = 3515), specialists (n = 3875), hospital non-specialists (n = 1171) and specialists in training (n = 888). Associations between aggression exposure and workforce participation intentions were determined using logistic regression modelling. Results In adjusted models, aggression exposure was positively associated with a greater likelihood of intending to reduce clinical workload in the next 5 years (odds ratio (OR) = 1.15, 95% confidence interval (CI) 1.02–1.29) and intending to leave patient care within 5 years (OR = 1.20, 95% CI 1.07–1.35). When also accounting for well being factors, aggression exposure remained positively associated with intending to leave patient care within 5 years (OR = 1.13, 95% CI 1.00–1.27). Conclusions Exposure to workplace aggression presents a risk to the retention of medical practitioners in clinical practice and a potential risk to community access to quality medical care. More concerted efforts in preventing and minimising workplace aggression in clinical medical practice are required. What is known about the topic? Very few studies have addressed the impact of workplace aggression on workforce participation intentions of medical practitioners. What does this paper add? This paper provides evidence that exposure to workplace aggression from any source is associated with intentions to reduce clinical workload or leave patient care. What are the implications for practitioners? There is a need to prevent or minimise the risk of exposure to workplace aggression from any source because the impacts may extend beyond the known psychological or physical effects to practitioner decisions about ongoing participation in the provision of clinical services.

scholarly journals Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Sheena Xin Liu ◽  
Rui Xiang ◽  
Charles Lagor ◽  
Nan Liu ◽  
Kathleen Sullivan
Keyword(s):  
Heart Failure ◽  
Cost Saving ◽  
Hospital Admissions ◽  
Clinical Performance ◽  
Cost Savings ◽  
Time Frame ◽  
Economic Modeling ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Year Gain

Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from$2832 to$5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in$2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.

The introduction of a targeted user-pays approach to funding high-level residential aged care in Australia: an empirical investigation of the impact on price

2010 ◽  
Vol 5 (4) ◽  
pp. 481-508 ◽  
Author(s):  
Susan Gargett
Keyword(s):  
Cost Savings ◽  
Aged Care ◽  
Residential Aged Care ◽  
Average Price ◽  
Age Related ◽  
Rate Of Increase ◽  
The Government ◽  
High Level ◽  
The Cost ◽  
The Impact

AbstractIn response to predictions that population ageing will increase government spending over the coming decades, in 1997–98, the Australian Government introduced means-tested income fees and accommodation charges for those admitted to nursing homes with income and assets above set threshold levels. Immediately prior, all residents paid the same price for their care and were not required to contribute towards the cost of their accommodation. In addition, in relation to those eligible to pay a higher price, the Government reduced its subsidisation of the cost of their care. The Government anticipated that the initiative would more equitably share the cost of age-related services across the public and private sectors, and result in some cost savings for itself. The purpose of this study is to assess the impact of the policy on the average price paid by residents. The findings suggest that the policy may have contributed to an increase in the average price paid, but statistical evidence is limited due to a number of data issues. Results also indicate that the rate of increase in the price was greater after theResidential Aged Care Structural Reformpackage was introduced. The study contributes to the economic analysis of the sector by evaluating time series estimates of prices paid by residents since the early 1970s.

scholarly journals Varenicline treatment for smoking cessation in high risk patients: a budget impact analysis

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Federico Spandonaro ◽  
Letizia Mancusi ◽  
Barbara Polistena
Keyword(s):  
Smoking Cessation ◽  
High Risk ◽  
Cost Saving ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
High Risk Patients ◽  
Italian National Health Service ◽  
Risk Patients

INTRODUCTION: The promotion of smoking cessation is a worldwide Public Health priority.OBJECTIVE: To estimate the budget impact on the Italian National Health Service (NHS) of the access to reimbursement of varenicline for the treatment of high risk patients with bronchopulmonary, diabetic and cardiovascular diseases.METHODS: A closed-group Markov model was developed in order to compare the costs incurred by the NHS to promote smoking cessation with cessation-related savings, using an alternative scenario in which aids to cessation are not reimbursed by the NHS. The analysis was conducted over a 5-year time horizon, in the perspective of the Italian NHS. Efficacy was expressed in terms of smoke abstinence for at least one year, and data was derived from clinical trials; the savings associated with smoking cessation were derived from cost-of-illness studies.RESULTS: The results show how costs would concentrate in the first year: they are estimated at € 200.6 million, of which € 162.4 million for drug therapy and € 38.2 million for counseling. Average annual savings over the first five years are estimated at € 77.7 million, with a cumulative net impact at 5 years of € -188.0 million (cost-saving). The analysis appears to be robust: sensitivity analyses show that the covering of initial costs occurs in any case between the third and fourth year, and that the treatment remains cost-saving at 5 years.CONCLUSIONS: The financial impact on the Italian NHS of the reimbursement of varenicline for the treatment of high risk smoking population would be a sustainable healthcare policy, resulting in cost savings starting from the fourth year.

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