scholarly journals Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs

10.2196/13147 ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. e13147 ◽  
Author(s):  
Alistair Connell ◽  
Rosalind Raine ◽  
Peter Martin ◽  
Estela Capelas Barbosa ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiac Arrest ◽  
Clinical Outcomes ◽  
Health Care Costs ◽  
Primary Outcome ◽  
Care Pathway ◽  
Hospitalized Patients ◽  
Intervention Site ◽  
Arrest Rate ◽  
Care Costs

Background The development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response. Objective We sought to test this hypothesis by evaluating the impact of a digitally enabled intervention on clinical outcomes and health care costs associated with AKI in hospitalized patients. Methods We developed a care pathway comprising automated AKI detection, mobile clinician notification, in-app triage, and a protocolized specialist clinical response. We evaluated its impact by comparing data from pre- and postimplementation phases (May 2016 to January 2017 and May to September 2017, respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analyzed using segmented regression analysis. The primary outcome was recovery of renal function to ≤120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert, progression of AKI stage, transfer to renal/intensive care units, hospital re-admission within 30 days of discharge, dependence on renal replacement therapy 30 days after discharge, and hospital-wide cardiac arrest rate. Time taken for specialist review of AKI alerts was measured. Impact on health care costs as defined by Patient-Level Information and Costing System data was evaluated using difference-in-differences (DID) analysis. Results The median time to AKI alert review by a specialist was 14.0 min (interquartile range 1.0-60.0 min). There was no impact on the primary outcome (estimated odds ratio [OR] 1.00, 95% CI 0.58-1.71; P=.99). Although the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR 0.55, 95% CI 0.38-0.76; P<.001), DID analysis with the comparator site was not significant (OR 1.13, 95% CI 0.63-1.99; P=.69). There was no impact on other secondary clinical outcomes. Mean health care costs per patient were reduced by £2123 (95% CI −£4024 to −£222; P=.03), not including costs of providing the technology. Conclusions The digitally enabled clinical intervention to detect and treat AKI in hospitalized patients reduced health care costs and possibly reduced cardiac arrest rates. Its impact on other clinical outcomes and identification of the active components of the pathway requires clarification through evaluation across multiple sites.

scholarly journals Health Care Costs And Clinical Outcomes Associated With Rates Of Sulfonylurea Use By Physicians

2013 ◽  
Vol 16 (3) ◽  
pp. A173-A174
Author(s):  
K. Bognar ◽  
K. Bell ◽  
D.N. Lakdawalla ◽  
A. Shrestha ◽  
J.T. Snider ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Health Care Costs ◽  
Care Costs

scholarly journals Association Between Weight Change, Clinical Outcomes, and Health Care Costs in Patients with Type 2 Diabetes

2016 ◽  
Vol 22 (5) ◽  
pp. 449-466 ◽  
Author(s):  
Jayanti Mukherjee ◽  
Catarina Sternhufvud ◽  
Nancy Smith ◽  
Kelly Bell ◽  
Marni Stott-Miller ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Clinical Outcomes ◽  
Health Care Costs ◽  
Weight Change ◽  
Care Costs

scholarly journals Cost utility analysis of Remdesivir and Dexamethasone treatment for hospitalised COVID-19 patients - a hypothetical study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrea Carta ◽  
Claudio Conversano
Keyword(s):  
Health Care ◽  
Sensitivity Analysis ◽  
Health Care Costs ◽  
Cost Effective ◽  
Standard Of Care ◽  
Cost Utility ◽  
Hospitalized Patients ◽  
Model Parameters ◽  
The Cost ◽  
Care Costs

Abstract Background Sars-Cov-2 is a novel corona virus associated with significant morbidity and mortality. Remdesivir and Dexamethasone are two treatments that have shown to be effective against the Sars-Cov-2 associated disease. However, a cost-effectiveness analysis of the two treatments is still lacking. Objective The cost-utility of Remdesivir, Dexamethasone and a simultaneous use of the two drugs with respect to standard of care for treatment Covid-19 hospitalized patients is evaluated, together with the effect of Remdesivir compared to the base model but based on alernative assumptions. Methods A decision tree for an hypothetical cohort of Covid-19 hospitalized patients, from an health care perspective and a one year horizon is specified. Efficacy data are retrieved from a literature review of clinical trials, whilst costs and utility are obtained from other published studies. Results Remdesivir, if health care costs are related to the days of hospitalization, is a cost saving strategy. Dexamethasone is cost effective with an ICER of <DOLLAR/>5208/QALY, and the concurrent use of Remdesivir and Dexamethasone is the most favorable strategy for higher level of willingness to pay thresholds. Moreover, if Remdesivir has a positive effect on mortality the utility is three times higher respect to base case. Whereas, if health care costs are not related to the length of patient hospitalization Remdesivir has an ICER respect to standard of care of <DOLLAR/>384412.8/QALY gained, which is not cost effective. We also find that Dexaamethasone is cost effective respect to standard care if we compute the cost for live saved with an ICER of <DOLLAR/>313.79 for life saved. The uncertainty of the model parameters is also tested through both a one-way deterministic sensitivity analysis and a probabilistic sensitivity analysis. Conclusion We find that the use of Remdesivir and/or Dexamethasone is effective from an economic standpoint.

scholarly journals Health Care Costs After Cardiac Arrest in the United States

2018 ◽  
Vol 11 (4) ◽  
Author(s):  
Abdulla A. Damluji ◽  
Mohammed S. Al-Damluji ◽  
Sydney Pomenti ◽  
Tony J. Zhang ◽  
Mauricio G. Cohen ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cardiac Arrest ◽  
Health Care Costs ◽  
The United States ◽  
Care Costs

scholarly journals An evaluation of a digital pain management programme: clinical effectiveness and cost savings

2019 ◽  
Vol 14 (4) ◽  
pp. 238-249 ◽  
Author(s):  
Theo John Pimm ◽  
Laura Juliette Williams ◽  
Megan Reay ◽  
Stephen Pickering ◽  
Ranjeeta Lota ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Clinical Outcomes ◽  
Health Care Costs ◽  
Clinical Effectiveness ◽  
Management Programme ◽  
Web Based ◽  
Digital Interventions ◽  
Care Costs

Introduction: Chronic pain is one of the most prevalent causes of disability worldwide, and digital interventions may be one of the ways to meet this need. Randomised controlled trials have demonstrated that digital interventions can be effective in treating chronic pain. This study aimed to establish the clinical effectiveness of a web-based pain management programme (PMP), specifically whether it would lead to improved clinical outcomes and reduced health care costs in a real-world clinical setting. Methods: Of 738 participants, 438 engaged with the programme and 300 did not. Two analyses were conducted: a within-subjects pre–post comparison of clinical outcomes for participants who completed the programme and a between-groups comparison of health care usage for those who engaged and those who did not. Results: Participants who completed the programme made significant improvements with regard to their perceived health status, level of disability, mood, confidence managing pain, problems in life due to pain and level of pain. Around one-third of participants made reliable changes in their levels of disability, depression and anxiety. There was no relationship between gender or age and engagement with the programme. Those who engaged with the programme demonstrated reduced health care costs in the year following referral, whereas health care costs of non-engagers increased. Limitations of the study include a high drop-out rate and a non-randomised comparison group. Results must therefore be interpreted with some caution. Conclusion: A web-based pain management programme can be clinically effective and may be a useful addition to the treatments offered by pain management services.

Economic and Social Burden of Multiple Myeloma in Italy: The Co.Mi.M. Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2393-2393
Author(s):  
Maria Teresa Petrucci ◽  
Elisabetta Calabrese ◽  
Anna Levi ◽  
Vincenzo Federico ◽  
Michela Ceccolini ◽  
...  
Keyword(s):  
Health Care ◽  
Multiple Myeloma ◽  
Clinical Outcomes ◽  
Resource Utilization ◽  
Health Care Costs ◽  
Indirect Costs ◽  
Sample Distribution ◽  
Clinical Records ◽  
The Impact ◽  
Care Costs

Abstract Background. Few data are available on the impact of multiple myeloma (MM) on Italian healthcare expenditure and society broadly. This is especially important because of the increased prevalence of MM in Italy. Aim and methods. The Co.Mi.M. study is a cross-sectional retrospective, prevalence-based study (Tarricone, Health Policy, 2006) that involved 5 Italian hematologic institutions and designed to measure resource utilization associated with MM management in terms of direct and indirect costs in a societal perspective. A specific questionnaire was administered to obtain anonymous, subject-level data on health-care utilization and costs in 236 subjects with MM. Quality of Life (QoL) data collection was included in the protocol. Data sources included clinical records and interviews with physicians and patients. Four disease-phases were considered in a stratified distribution that reflects real clinical practice: asymptomatic (“watch and wait”); symptomatic, receiving an autotransplant; symptomatic, receiving drugs; and plateau/remission. Costs were identified over 1 year of disease management with regard to: drugs; visits; laboratory tests; hospital admissions; support devices; home assistance; travel; and reduced productivity of patients and caregivers. Costs for lost working days were derived according to the human capital method using national average earnings per working category. No clinical outcomes were collected. Health-related QoL was measured using the EORTC QLQ-C30. Results. The sample distribution was as follows: 16.5% asymptomatic; 12.3% symptomatic, receiving an autotransplant; 44.5% symptomatic, receiving drugs; and 26.7% plateau/remission. The average social costs per subject per year were €20,868. Direct health-care costs (hospitalizations, drugs, diagnostics, visits, etc) were €16,867 per subject per year; direct non-health care costs (transportation, hotels, paid care, etc.) were €1,776 per patient per year; indirect costs (productivity loss) were €2,225 per subject per year. The average direct health care costs per subject per year in the different subgroups were: €755, €53,102; €18,882; €6,803. The groups with the highest resource utilization were (b) the autotransplanted and (c) those receiving drugs. Specifically, 95% of total hospitalizations were related to autotransplant. Conclusion. The main resource utilization comes for direct medical costs. MM treatment strategy has changed dramatically in the last years. In particular, transplant and pharmacological treatments represent the most relevant costs, although counterbalanced by the highly increased clinical outcomes reported in the literature. After year 2000 the post-relapse survival has steadily improved. In particular, an improvement in survival amongst patients who had access to one or more innovative drugs has been demonstrated (Shaji Kumar, Blood, 2007).

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