Excess cost of care associated with sepsis in cancer patients: Results from a population-based case-control matched cohort

Background Cancer patients are at significant risk of developing sepsis due to underlying malignancy and necessary treatments. Little is known about the economic burden of sepsis in this high-risk population. We estimate the short- and long-term healthcare costs of care of cancer patients with and without sepsis using individual-level linked-administrative data. Methods We conducted a population-based matched cohort study of cancer patients aged ≥18, diagnosed between 2010 and 2017. Cases were identified if diagnosed with sepsis during the study period, and were matched 1:1 by age, sex, cancer type and other variables to controls without sepsis. Mean costs (2018 Canadian dollars) for patients with and without sepsis up to 5 years were estimated adjusted using survival probabilities at partitioned intervals. We estimated excess cost associated with sepsis presented as a cost difference between the two cohorts. Haematological and solid cancers were analysed separately. Results 77,483 cancer patients with sepsis were identified and matched. 64.3% of the cohort were aged ≥65, 46.3% female and 17.8% with haematological malignancies. Among solid tumour patients, the excess cost of care among patients who developed sepsis was $29,081 (95%CI, $28,404-$29,757) in the first year, rising to $60,714 (95%CI, $59,729-$61,698) over 5 years. This was higher for haematology patients; $46,154 (95%CI, $45,505-$46,804) in year 1, increasing to $75,931 (95%CI, $74,895-$76,968). Conclusions Sepsis imposes substantial economic burden and can result in a doubling of cancer care costs, particularly during the first year of cancer diagnosis. These estimates are helpful in improving our understanding of burden of sepsis along the cancer pathway and to deploy targeted strategies to alleviate this burden.

Bioremediation of polluted soil due to tsunami by using recycled waste glass

In this research, bioremediation of tsunami-affected polluted soil has been conducted by using collective microorganisms and recycled waste glass. The Tohoku earthquake, which was a mega earthquake in Japan triggered a huge tsunami on March 11th, 2011 that caused immeasurable damage to the geo-environmental conditions by polluting the soil with heavy metals and excessive salt content. Traditional methods to clean this polluted soil was not possible due to the excess cost and efforts. Laboratory experiments were conducted to examine the capability of bioremediation of saline soil by using recycled waste glass. Different collective microorganisms which were incubated inside the laboratory were used. The electrical conductivity (EC) was measured at different specified depths. It was noticed that the electrical conductivity decreased with the assist of the microbial metabolisms significantly. Collective microorganisms (CM2) were the highly capable to reduce salinity (up to 75%) while using recycled waste glass as their habitat.

Inefficiencies in Residency Matching Associated with Gale–Shapley Algorithms

Objective This study aimed to investigate emerging trends and increasing costs in the National Residency Matching Program (NRMP) and San Francisco Residency and Fellowship Match Services (SF Match) associated with the current applicant/program Gale–Shapley-type matching algorithms. Design A longitudinal observational study of behavioral trends in national residency matching systems with modeling of match results with alternative parameters. Patients and Methods We analyzed publicly available data from the SF Match and NRMP websites from 1985 to 2020 for trends in the total number of applicants and available positions, as well the average number of applications and interviews per applicant for multiple specialties. To understand these trends and the algorithms' effect on the residency programs and applicants, we analyzed anonymized rank list and match data for ophthalmology from the SF Match between 2011 and 2019. Match results using current match parameters, as well as under conditions in which applicant and/or program rank lists were truncated with finalized rank lists, were analyzed. Results Both the number of applications and length of programs' rank lists have increased steadily throughout residency programs, particularly those with competitive specialties. Capping student rank lists at seven programs, or less than 80% of the average 8.9 programs currently ranked, results in a 0.71% decrease in the total number of positions filled. Similarly, capping program rank lists at seven applicants per spot, or less than 60% of the average 11.5 applicants ranked per spot, results in a 5% decrease in the total number of positions filled. Conclusion While the number of ophthalmology positions in the United States has increased only modestly, the number of applications under consideration has increased substantially over the past two decades. The current study suggests that both programs and applicants rank more choices than are required for a nearly complete and stable match, creating excess cost and work for both applicants and programs. “Stable-marriage” type algorithms induce applicants and programs to rank as many counterparties as possible to maximize individual chances of optimizing the match.

The Application of Quality Control Circles to Reduce the Cost of Non-priced Consumables in Department of Oncology

Objective: To investigate the effectiveness of using quality control circle (QCC) techniques to reduce the cost of non-priced consumables in medical oncology. Methods: Analytic statistics were compiled on the performance appraisal form. Aiming at the key points of improvement with respect to the excess cost of non-valuable consumables, the reasons were analyzed, and corresponding measures were formulated to compare the cost before and after the improvement. Results: After the QCC activity, the cost of non-priced consumables decreased from RMB 6.57/bed day to RMB 3.96/bed day. Conclusion: QCC has effectively reduced the cost of non-priced consumables in the oncology department, and it is worthy of promotion.

Immune checkpoint inhibitor use, multimorbidity and healthcare expenditures among older adults with late-stage melanoma

Background: The objective of this study is to assess the impact of immune checkpoint inhibitors (ICIs) and multimorbidity on healthcare expenditures among older patients with late-stage melanoma. Materials & methods: A retrospective longitudinal cohort study using Surveillance, Epidemiology and End Results linked with Medicare claims was conducted. Generalized linear mixed models were used to analyze adjusted relationships of ICI, multimorbidity and ICI–multimorbidity interaction on average healthcare expenditures. Results: Patients who received ICI and those who had multimorbidity had significantly higher average total healthcare expenditures compared with ICI nonusers and no multimorbidity. In the fully adjusted model using ICI–multimorbidity interaction, no excess cost was added by multimorbidity. Conclusion: Use of ICIs, regardless of multimorbidity, is associated with increased healthcare expenditures.

Financial and Mortality Modeling as a Tool to Present Infection Prevention Data: What a SIR of 1.2 Means for the Hospital

Background: Presenting to hospital leadership is an annual requirement of many infection prevention (IP) programs. Most presentations include current statistical data of hospital-acquired infections (HAIs) and whether the hospital has met its goals according to the National Healthcare Safety Network (NHSN) criteria. We presented HAI data in a novel way, with financial and mortality modeling, to show the impact of IP interventions to leadership not attuned to NHSN metrics. Method: We looked at 4 HAIs, their trends, and their effect on our hospital, Santa Clara Valley Medical Center (SCVMC). To estimate the impact of specific HAIs, we used 2 metrics derived from a meta-analysis by the US Department of Health and Human Services (HHS): excess mortality and excess cost. Excess mortality is defined as the difference between the underlying population mortality and the affected population mortality expressed as deaths per 1,000 population. Excess cost is defined as the additional cost introduced per patient with a specific HAI versus a similarly admitted patient without that HAI. HHS data were multiplied by the number of HAI events at SCVMC to generate estimates. Result: In our presentation, we elucidated a previously unseen cost savings and decreased mortality with 2 HAIs, central-line–associated blood stream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs), which were below NHSN targets due to IP-led interventions. We then showed 2 other HAIs, Clostridium difficile infection (CDI) and surgical site infections (SSIs), which did not meet our expected NHSN and institutional goals and were estimated to increase costs and potential mortalities in the upcoming year. We argued that proactive monies directed toward expanding our IP program and HAI mitigation efforts would cost a fraction of the impending healthcare expenditures as predicted by the model. Conclusion: By applying financial and mortality modeling, we helped our leadership perceive the concrete effect of IP-led interventions versus presenting abstract NHSN metrics. We also emphasized that without proactive leadership investment, we would continue to overspend healthcare dollars while not meeting our goals. This format of presentation gave us critical leverage to advocate for and successfully expand our IP department. Further SHEA-led cost-analysis modeling and education are needed to help IP departments promote their efforts in an effective manner.Funding: NoneDisclosures: None

Suboptimal prescribing behaviour associated with clinical software design features: a retrospective cohort study in English NHS primary care

BackgroundElectronic health record (EHR) systems are used by clinicians to record patients’ medical information, and support clinical activities such as prescribing. In England, healthcare professionals are advised to ‘prescribe generically’ because generic drugs are usually cheaper than branded alternatives, and have fixed reimbursement costs. ‘Ghost-branded generics’ are a new category of medicines savings, caused by prescribers specifying a manufacturer for a generic product, often resulting in a higher reimbursement price compared with the true generic.AimTo describe time trends and practice factors associated with excess medication costs from ghost-branded generic prescribing.Design and settingRetrospective cohort study of English GP prescribing data and EHR deployment data.MethodA retrospective cohort study was conducted, based on data from the OpenPrescribing.net database from May 2013 to May 2019. Total spending on ghost-branded generics across England was calculated, and excess spend on ghost-branded generics calculated as a percentage of all spending on generics for every CCG and general practice in England, for every month in the study period.ResultsThere were 31.8 million ghost-branded generic items and £9.5 million excess cost in 2018, compared with 7.45 million ghost-branded generic items and £1.3 million excess cost in 2014. Most excess costs were associated with one EHR, SystmOne, and it was identified that SystmOne offered ghost-branded generic options as the default. After informing the vendor, the authors monitored for subsequent change in costs, and report a rapid decrease in ghost-branded generic expenditure.ConclusionA design choice in a commonly used EHR has led to £9.5 million in avoidable excess prescribing costs for the NHS in 1 year. Notifying the vendor led to a change in user interface and a rapid, substantial spend reduction. This finding illustrates that EHR user interface design has a substantial impact on the quality, safety, and cost-effectiveness of clinical practice; this should be a priority for quantitative research.

The clinical and economic burden of systemic sclerosis related interstitial lung disease

Objective To quantify the burden of interstitial lung disease (ILD) in SSc. Methods Clinical data for SSc patients enrolled in the Australian Scleroderma Cohort Study were linked with healthcare databases for the period 2008–2015. ILD was defined by characteristic fibrotic changes on high-resolution CT (HRCT) lung, while severity was defined by the extent lung involvement on HRCT (mild <10%, moderate 10–30%, severe >30%). Determinants of healthcare cost were estimated using logistic regression. Results SSc-ILD patients utilized more healthcare resources, including hospitalization, emergency department presentation and ambulatory care services, than those without ILD with a total cost per patient of AUD$48 368 (26 230–93 615) vs AUD$33 657 (15 144–66 905), P<0.001) between 2008–2015. Healthcare utilization was associated with an annual median (25th–75th) excess cost per SSc-ILD patient compared with those without ILD of AUD$1192 (807–1212), P<0.001. Increasing ILD severity was associated with significantly more healthcare utilization and costs with an annual excess cost per patient with severe ILD compared with mild ILD of AUD$2321 (645–1846), P<0.001. ILD severity and the presence of coexistent PAH were the main determinants of overall healthcare cost above median for this SSc-ILD cohort (OR 5.1, P<0.001, and OR 2.6, P=0.01, respectively). Furthermore, SSc-ILD patients reported worse physical HRQoL compared with those without ILD [34.3 (10.5) vs 39.1 (10.8), P<0.001], with a progressive decline with increasing ILD severity (P=0.002). Conclusion SSc-ILD places a large burden on the healthcare system and the patient through poor HRQoL in addition to incremental healthcare resource utilization and associated direct cost.