A Cost-Minimization Analysis of Paediatric Telehomecare Compared to Usual Care: the lower cost more than compensates a longer stay (Preprint)

2021 ◽  
Author(s):  
Cristina Adroher Mas ◽  
Candela Esposito ◽  
Astrid Batlle Boada ◽  
Ricard Casadevall ◽  
Marta Millet ◽  
...  
Keyword(s):  
Usual Care ◽  
User Satisfaction ◽  
Cost Minimization ◽  
Adult Population ◽  
Hospital Costs ◽  
Control Group ◽  
Hospital Perspective ◽  
Cost Minimization Analysis ◽  
Hospitalization Costs ◽  
The Cost

BACKGROUND While home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the paediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the healthcare model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. In addition to being the preferred option for families, previous experience suggest that paediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. OBJECTIVE To compare the average cost of a discharge by telehomecare with the usual care and to analyse the main drivers of the differential costs of both care models. METHODS Cost-minimization analysis conducted under a hospital’s perspective, based on observational data and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. RESULTS A 24h stay at the hospital costs € 503.68, while the in-home hospitalization costs € 264.66 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main savings drivers were the personnel costs (35.5% of the total), intermediate non-care costs (33.17%), and structural costs (19.04%). Home hospitalization involves a total stay 27.61% longer, but at a daily cost of almost half, represents a € 155 (9.01%) per 24h stay saving. CONCLUSIONS The cost analysis conducted under a hospital perspective shows that paediatric telehomecare is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

scholarly journals OP0198-HPR A STRUCTURED MODEL FOR OA CARE IN PRIMARY HEALTHCARE IS A COST-EFFECTIVE ALTERNATIVE COMPARED TO USUAL CARE FOR PEOPLE WITH HIP AND KNEE OA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 119-120
Author(s):  
N. Østerås ◽  
E. Aas ◽  
T. Moseng ◽  
L. Van Bodegom-Vos ◽  
K. Dziedzic ◽  
...  
Keyword(s):  
Usual Care ◽  
Primary Healthcare ◽  
Intervention Group ◽  
Cost Effective ◽  
Cost Utility ◽  
Control Group ◽  
Structured Model ◽  
Knee Oa ◽  
Cost Effective Alternative ◽  
The Cost

Background:To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international treatment recommendations. A previous analysis of a cluster RCT (cRCT) showed that compared to usual care, the intervention group reported higher quality of care and greater satisfaction with care. Also, more patients were treated according to international guidelines and fulfilled recommendations for physical activity at the 6-month follow-up.Objectives:To assess the cost-utility of a structured model for hip or knee OA care.Methods:A cRCT with stepped-wedge cohort design was conducted in 6 Norwegian municipalities (clusters) in 2015-17. The OA care model was implemented in one cluster at the time by switching from “usual care” to the structured model. The implementation of the model was facilitated by interactive workshops for general practitioners (GPs) and physiotherapists (PTs) with an update on OA treatment recommendations. The GPs explained the OA diagnosis and treatment alternatives, provided pharmacological treatment when appropriate, and suggested referral to physiotherapy. The PT-led patient OA education programme was group-based and lasted 3 hours followed by an 8–12-week individually tailored resistance exercise programme with twice weekly 1-hour supervised group sessions (5–10 patients per PT). An optional 10-hours Healthy Eating Program was available. Participants were ≥45 years with symptomatic hip or knee OA.Costs were measured from the healthcare perspective and collected from several sources. Patients self-reported visits in primary healthcare at 3, 6, 9 and 12 months. Secondary healthcare visits and joint surgery data were extracted from the Norwegian Patient Register. The health outcome, quality-adjusted life-year (QALY), was estimated based on the EQ-5D-5L scores at baseline, 3, 6, 9 and 12 months. The result of the cost-utility analysis was reported using the incremental cost-effectiveness ratio (ICER), defined as the incremental costs relative to incremental QALYs (QALYs gained). Based on Norwegian guidelines, the threshold is €27500. Sensitivity analyses were performed using bootstrapping to assess the robustness of reported results and presented in a cost-effectiveness plane (Figure 1).Results:The 393 patients’ mean age was 63 years (SD 9.6) and 74% were women. 109 patients were recruited during control periods (control group), and 284 patients were recruited during interventions periods (intervention group). Only the intervention group had a significant increase in EQ-5D-5L utility scores from baseline to 12 months follow-up (mean change 0.03; 95% CI 0.01, 0.05) with QALYs gained: 0.02 (95% CI -0.08, 0.12). The structured OA model cost approx. €301 p.p. with an additional €50 for the Healthy Eating Program. Total 12 months healthcare cost p.p. was €1281 in the intervention and €3147 in the control group, resulting in an incremental cost of -€1866 (95% CI -3147, -584) p.p. Costs related to surgical procedures had the largest impact on total healthcare costs in both groups. During the 12-months follow-up period, 5% (n=14) in the intervention compared to 12% (n=13) in the control group underwent joint surgery; resulting in a mean surgical procedure cost of €553 p.p. in the intervention as compared to €1624 p.p. in the control group. The ICER was -€93300, indicating that the OA care model resulted in QALYs gained and cost-savings. At a threshold of €27500, it is 99% likely that the OA care model is a cost-effective alternative.Conclusion:The results of the cost-utility analysis show that implementing a structured model for OA care in primary healthcare based on international guidelines is highly likely a cost-effective alternative compared to usual care for people with hip and knee OA. More studies are needed to confirm this finding, but this study results indicate that implementing structured OA care models in primary healthcare may be beneficial for the individual as well as for the society.Disclosure of Interests:None declared

scholarly journals The Effectiveness of Sterile Wound Drapes in the Prevention of Surgical Site Infection in Thoracic Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Kemal Karapınar ◽  
Celalettin İbrahim Kocatürk
Keyword(s):  
Thoracic Surgery ◽  
Surgical Site Infection ◽  
Operation Time ◽  
Surgical Site Infections ◽  
Control Group ◽  
Site Infection ◽  
Wound Debridement ◽  
Thoracic Surgical Procedures ◽  
Hospitalization Costs ◽  
The Cost

Background. The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. Methods. Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015–2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. Results. Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). Conclusion. The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.

Cost-Minimization Analysis of Piperacillin/Tazobactam versus Imipenem/Cilastatin for the Treatment of Serious Infections: A Canadian Hospital Perspective

1999 ◽  
Vol 33 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Fawziah O Marra ◽  
Luciana O Frighetto ◽  
Carlo A Marra ◽  
Kenna M Sleigh ◽  
H Grant Stiver ◽  
...  
Keyword(s):  
Cost Minimization ◽  
Canadian Hospital ◽  
Hospital Perspective ◽  
Cost Minimization Analysis ◽  
Serious Infections

scholarly journals A Cost-Minimization Analysis of Paediatric Telehomecare Compared to Usual Care: the lower cost more than compensates a longer stay (Preprint)

10.2196/31628 ◽  
2021 ◽  
Author(s):  
Cristina Adroher Mas ◽  
Candela Esposito ◽  
Astrid Batlle Boada ◽  
Ricard Casadevall ◽  
Marta Millet ◽  
...  
Keyword(s):  
Usual Care ◽  
Lower Cost ◽  
Cost Minimization ◽  
Cost Minimization Analysis

Cost Analysis Comparing Computed Tomographic Pulmonary Angiography (CTPA) and Ventilation-Perfusion (V/Q) Scanning for the Diagnosis of Pulmonary Embolism

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 567-567
Author(s):  
Alastair Dorreen ◽  
Chris Skedgel ◽  
Marc A. Rodger ◽  
Susan R. Kahn ◽  
Michael J. Kovacs ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cost Effectiveness ◽  
Cost Analysis ◽  
Incremental Cost ◽  
Cost Minimization ◽  
Imaging Modality ◽  
Sensitivity Analyses ◽  
Pulmonary Emboli ◽  
Cost Minimization Analysis ◽  
The Cost

Abstract Abstract 567 Background: Accurate diagnosis of a pulmonary embolism remains problematic due to the nonspecific findings of the clinical presentation and the limitations of radiographic imaging. Computed tomography pulmonary angiography (CTPA) has surpassed ventilation-perfusion (V/Q) scanning as the primary imaging modality in the investigation of patients with suspected pulmonary emboli due to its superior diagnostic accuracy. Data from a large randomized controlled trial has indicated that while strategies using both CTPA and V/Q are equally safe at excluding the diagnosis, CTPA detects significantly more pulmonary emboli (1). The purpose of this study was to perform a cost analysis comparing CTPA and V/Q scanning for the investigation of patients with suspected pulmonary emboli based upon this large trial. Methods: A cost analysis was performed using a decision-analysis model. The costs and outcomes of CTPA and V/Q scanning in detecting or ruling out pulmonary embolism over a 90 day analysis horizon were incorporated into a decision tree where the probabilities for each outcome were taken from (1) and a systematic literature review. The decision tree incorporated the thromboembolic and major bleeding complications associated with the diagnosis and treatment of pulmonary embolism in 100,000 patients. Outcomes in the model were measured in terms of quality-adjusted life years (QALYs). The economic model took a direct-payer perspective, considering direct costs to the health care system and patients. All costs were based on 2009 Canadian dollars. The primary economic evaluation was conducted within a deterministic cost-effectiveness analysis framework in terms of incremental cost per QALY. If the clinical benefits were found to be statistically insignificant the primary evaluation would be collapsed to a cost-minimization analysis and a secondary analysis would be performed to using probabilistic methods to estimate the expected incremental costs and outcomes based upon probability distributions around mean point estimates. Sensitivity analyses around key parameters were also performed. Results: The primary deterministic analysis collapsed to a cost-minimization analysis on the grounds that no statistically differences in the proportion of false negative results or mortality were observed in the randomized trial comparing CTPA with VQ scanning for the diagnosis of pulmonary embolism (1). The cost minimization analysis demonstrated a strategy using V/Q scanning as the primary imaging modality was less costly. CTPA was associated with an incremental cost of $11.3 million per 100,000 patients compared to V/Q scanning. CTPA was associated with an additional 3760 additional diagnoses of pulmonary embolism and 111 major bleeding episodes compared to V/Q scanning. The secondary probabilistic cost-effectiveness analysis revealed that CTPA was associated with an incremental cost of $4.8 million per 100,000-person cohort and 3134 QALYs gained relative to V/Q scanning for a cost-effectiveness of $1543 per QALY gained. Furthermore, the cost-effectiveness acceptability curve demonstrated CTPA had an 89% likelihood of being cost-effective relative to the threshold of $50,000 per QALY gained. Sensitivity analyses demonstrated cost-effectiveness ratio was most impacted by varying prevalence of pulmonary embolism and the relative and absolute differences in the proportions of fatal pulmonary embolism from falsely negative scans between the two tests. Conclusions: The results of the cost-minimization analysis imply that V/Q scanning is a less costly alternative to CTPA resulting from less pulmonary emboli diagnosed while maintaining similar 3-month rate of thromboembolic complications relative to CTPA. Secondary analysis, however, concluded that diagnostic algorithms incorporating CTPA may be cost-effective under defined circumstances. (1) Anderson et al. JAMA 2007; 298:2743-2753 Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cost minimization analysis of two chemotherapy regimens in the treatment of colorectal cancer in a public reimbursement hospital in Brazil

2021 ◽  
Vol 12 (2) ◽  
pp. 544
Author(s):  
Sara C. BOSCATO ◽  
Márcia R. GODOY ◽  
Isabela HEINECK
Keyword(s):  
Colorectal Cancer ◽  
Sensitivity Analysis ◽  
Palliative Treatment ◽  
Cost Minimization ◽  
Pharmacoeconomic Evaluation ◽  
Cost Minimization Analysis ◽  
The Individual ◽  
The Cost ◽  
Daily Hospitalization ◽  
Treatment Sensitivity

Objective: To conduct a pharmacoeconomic evaluation between XELOX and mFOLFOX6 in the adjuvant and metastatic treatment of colorectal cancer from the perspective of a public reimbursement hospital. Methods: The cost minimization analysis was conducted for patients who started treatment in 2013 and 2014. The micro-costing technique was used to verify expenditures on drugs, materials, laboratory and imaging tests, ambulatory and daily hospitalization, human and administrative resources and determine the individual cost of each alternative, per patient. To evaluate the robustness of the economic analysis, multivariate sensitivity analysis was performed in six different scenarios. Results: There was an average cost for XELOX of U$ 4,637.14 in adjuvant and U$ 3,831.48 for palliative treatment, and a cost for mFOLFOX6 of U$ 5,474.89 in adjuvant and U$ 4,432.95 in palliative treatment. Sensitivity analysis maintained the dominance of XELOX. Material and drug costs accounted for about 85% of the total cost of XELOX; for mFOLFOX6 this cost was around 36%. On the other hand, the cost of hospitalization and placement of a catheter occured exclusively for mFOLFOX6, which also presented a higher cost with human resources. Conclusion: From the perspective of the hospital, XELOX proved to be the least costly alternative on the treatment of colorectal cancer.

Cost-Minimization Analysis of Anti-D Immune Globulin Versus Intravenous Immune Globulin for the Initial Treatment of Immune Thrombocytopenic Purpura.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3305-3305
Author(s):  
David A. Wetzel ◽  
Michael D. Tarantino
Keyword(s):  
Immune Globulin ◽  
Immune Thrombocytopenic Purpura ◽  
Initial Dose ◽  
Initial Treatment ◽  
Cost Minimization ◽  
Treatment Options ◽  
Healthcare Payer ◽  
Thrombocytopenic Purpura ◽  
Cost Minimization Analysis ◽  
The Cost

Abstract Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder in which opsonized platelets are prematurely destroyed within the spleen. At this time both anti-D immune globulin (anti-D) and intravenous immune globulin (IVIG) are established treatment options for the management of ITP in children and adults. Due to the tremendous increase in demand for IVIG products in the past decade and the subsequent lack of sufficient production a national shortage has emerged. As a consequence, the direct cost and resulting burden on the healthcare payer has risen dramatically for this treatment option. We performed a cost-minimization analysis (CMA) to compare the cost of using anti-D versus IVIG for the initial treatment of non emergent ITP in appropriate patients. A CMA was employed for this economic evaluation because clinical evidence supports the supposition that the efficacies of the treatment options in question are similar. The perspective used for this study was that of the healthcare payer. The study population includes children and adults with non emergent forms of ITP who are both Rh positive and nonsplenectomized. This CMA did not include the cost to the healthcare payer for treatment administration or the incidence and cost of subsequent treatments for each product. The incidence of severe adverse events when using IVIG or anti-D are rare and therefore were not included in this CMA. In this analysis the cost for the non emergent initial treatment of ITP using [Immune Globulin Intravenous (Human)] 10% (Gammagard Liquid 10%) 1gm/kg × 2 days was compared to anti-D (WinRho® SDF Liquid) 50μg/kg × 1 day respectively. We performed a CMA using the same initial dose and duration of IVIG and anti-D dosed at 75μg/kg. And finally we performed a CMA using one day of treatment for both IVIG and anti-D dosed at 75μg/kg. An average patient weight of 75kg was used for initial dose calculations for each product. The average wholesale price (AWP) for each product was used for cost calculations. Gammagard Liquid 10% was selected as the product for IVIG therapy because this product currently holds a large portion of market share for IVIG products in the US. An example CMA calculation was; Gammagard Liquid 10% 1g/kg × 75kg × 2 days × $101.25 – WinRho® SDF 50μg/kg × 75kg × $1.10/μg. The results of these three CMAs when using anti-D versus IVIG for the initial treatment of ITP yielded a cost savings of $11,063.00, $9,000.50 and $1,406.25 respectively. When the CMA calculations were adjusted to use the actual number of vials needed to dispense the final dose of IVIG and anti-D dosed at 75μg/kg, the savings realized was $1,213.75 per dose dispensed. These CMAs have demonstrated the cost benefit of using anti-D for the initial treatment of non emergent ITP in appropriate patients.

Cost-Minimization Analysis of Intravenous Adenosine and Dipyridamole in Thallous Chloride ti 201 Spect Myocardial Perfusion Imaging

1997 ◽  
Vol 31 (9) ◽  
pp. 974-979 ◽  
Author(s):  
Daniel E Hilleman ◽  
B Daniel Lucas ◽  
Syed M Mohiuddin ◽  
M Jeffrey Holmberg
Keyword(s):  
Myocardial Perfusion Imaging ◽  
Myocardial Perfusion ◽  
Adverse Effects ◽  
Perfusion Imaging ◽  
Acquisition Cost ◽  
Cost Minimization ◽  
Spect Myocardial Perfusion Imaging ◽  
Cost Minimization Analysis ◽  
Spect Myocardial Perfusion ◽  
The Cost

Objective To conduct a cost-minimization analysis of intravenous adenosine and intravenous dipyridamole in thallous chloride TI 201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. Design A retrospective, open-label, cost-minimization analysis. Setting University hospital, outpatient nuclear medicine department. Patients Eighty-three patients undergoing dipyridamole TI 201 SPECT and 166 patients undergoing adenosine TI 201 SPECT. Main outcome Measures A cost-minimization analysis was conducted using a direct cost accounting approach estimating institutional costs. For the purpose of this study, sensitivity and specificity between adenosine SPECT and dipyridamole SPECT were assumed to be identical. Key costs evaluated included acquisition, administration, monitoring, treatment of adverse effects, follow-up care, and repeat tests. Results Adenosine increased heart rate and lowered blood pressure to a significantly greater extent than dipyridamole. The frequency of adverse reactions was not significantly different (p = 0.103) between adenosine (1.64 ± 1.32 per patient) and dipyridamole (1.36 ± 1.23 per patient). The frequency of prolonged and late-onset adverse effects was significantly greater for dipyridamole than for adenosine (p < 0.001). The frequency of adverse events requiring medical intervention was statistically greater for dipyridamole (24%) compared with adenosine (5%) (p < 0.00001). Total cost was significantly less for adenosine ($378.50 ± $128.20 per patient) compared with dipyridamole ($485.60 ± $230.40). Although adenosine had a significantly greater acquisition cost than dipyridamole (p < 0.0001), administration, monitoring, and adverse reaction costs were significantly less for adenosine than for dipyridamole. Conclusions The cost of using dipyridamole is significantly greater than the cost of using adenosine despite adenosine's high acquisition cost. Adenosine is less expensive to use because of lower administration costs, monitoring costs, and adverse effect costs. Adenosine should be the agent of choice for pharmacologic vasodilation in the setting of myocardial perfusion imaging.

Sign in / Sign up

Export Citation Format

Share Document