Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.

PubMed

Parissis, John; Athanasakis, Kostas; Farmakis, Dimitrios; Boubouchairopoulou, Nadia; Mareti, Christina; Bistola, Vasiliki; Ikonomidis, Ignatios; Kyriopoulos, John; Filippatos, Gerasimos; Lekakis, John

2015-02-01

Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Direct healthcare costs of selected diseases primarily or partially transmitted by water.

PubMed

Collier, S A; Stockman, L J; Hicks, L A; Garrison, L E; Zhou, F J; Beach, M J

2012-11-01

Despite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires' disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40 000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50 000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission.

Direct healthcare costs of selected diseases primarily or partially transmitted by water

PubMed Central

COLLIER, S. A.; STOCKMAN, L. J.; HICKS, L. A.; GARRISON, L. E.; ZHOU, F. J.; BEACH, M. J.

2015-01-01

SUMMARY Despite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires’ disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40 000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50 000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission. PMID:22233584

Direct Hospital Cost of Outcome Pathways in Implant-Based Reconstruction with Acellular Dermal Matrices.

PubMed

Qureshi, Ali A; Broderick, Kristen; Funk, Susan; Reaven, Nancy; Tenenbaum, Marissa M; Myckatyn, Terence M

2016-08-01

Current cost data on tissue expansion followed by exchange for permanent implant (TE/I) reconstruction lack a necessary assessment of the experience of a heterogenous breast cancer patient population and their multiple outcome pathways. We extend our previous analysis to that of direct hospital cost as bundling of payments is likely to follow the changing centralization of cancer care at the hospital level. We performed a retrospective analysis (2003-2009) of TE/I reconstructions with or without an acellular dermal matrix (ADM), namely Alloderm RTM. Postreconstructive events were analyzed and organized into outcome pathways as previously described. Aggregated and normalized inpatient and outpatient hospital direct costs and physician reimbursement were generated for each outcome pathway with or without ADM. Three hundred sixty-seven patients were analyzed. The average 2-year hospital direct cost per TE/I breast reconstruction patient was $11,862 in the +ADM and $12,319 in the -ADM groups (P > 0.05). Initial reconstructions were costlier in the +ADM ($6,868) than in the -ADM ($5,615) group, but the average cost of subsequent postreconstructive events within 2 years was significantly lower in +ADM ($5,176) than -ADM ($6,704) patients (P < 0.05). When a complication occurred, but reconstruction was still completed within 2 years, greater costs were incurred in the -ADM than in the +ADM group for most scenarios, leading to a net equalization of cost between study groups. Although direct hospital cost is an important factor for resource and fund allocation, it should not remain the sole factor when deciding to use ADM in TE/I reconstruction.

Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

PubMed

Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

2006-11-01

Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.

Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

PubMed

Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-09-01

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India.

PubMed

Sonkar, Kamlesh Kumar; Bhoi, Sanjeev Kumar; Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha Kant

2017-04-01

Myasthenia gravis (MG) requires lifelong treatment. The cost of management MG is very high in developed countries but there is no information on the cost of management of MG in the developing countries. This study reports the direct and indirect cost and predictors of cost of MG in a tertiary care teaching hospital in India. In a prospective hospital based study, from a tertiary hospital in India 66 consecutive patient during 2014-2015 were included. The age of the patients ranged between 6 and 75years. The severity of MG was assessed by myasthenia gravis foundation association (MGFA) class (MGFA) I-V. The patient data was collected s and their direct cost was calculated from the computerized Hospital information system. The indirect cost was calculated from patient's memory, checking the bills of transportation and wages loss by the patient or the care giver. Total annual cost of MG ranged between INR (4560-532227) with median INR 61390.5 (US$911.64). The median cost of outpatient department (OPD) consultation of 16 patients was INR 20439.9 (US$303.53), of 50 admitted patients was INR 44311.8 (US$658.03) and 21 intensive care unit (ICU) patients was INR 59574.3 (US$ 884.6) and the direct cost of thymectomy was INR 45000 (US$ 668.25). Direct cost was related to indirect cost (r=0.55; p=0.0001). Predictors of patient outcome were severity of MG, ICU admission, and thymectomy. The total median cost for management of myasthenia gravis was INR 61390.5 (4560-532227, US$911.64) per year, and the cost was mainly determined by the severity of MG. Copyright © 2016 Elsevier Ltd. All rights reserved.

Complementary effect of patient volume and quality of care on hospital cost efficiency.

PubMed

Choi, Jeong Hoon; Park, Imsu; Jung, Ilyoung; Dey, Asoke

2017-06-01

This study explores the direct effect of an increase in patient volume in a hospital and the complementary effect of quality of care on the cost efficiency of U.S. hospitals in terms of patient volume. The simultaneous equation model with three-stage least squares is used to measure the direct effect of patient volume and the complementary effect of quality of care and volume. Cost efficiency is measured with a data envelopment analysis method. Patient volume has a U-shaped relationship with hospital cost efficiency and an inverted U-shaped relationship with quality of care. Quality of care functions as a moderator for the relationship between patient volume and efficiency. This paper addresses the economically important question of the relationship of volume with quality of care and hospital cost efficiency. The three-stage least square simultaneous equation model captures the simultaneous effects of patient volume on hospital quality of care and cost efficiency.

Hospitalization costs associated with diarrhea among children during the period of rotavirus circulation in the Northwest region of Argentina.

PubMed

Giglio, Norberto D; Caruso, Martín; Castellano, Vanesa E; Choque, Liliana; Sandoval, Silvia; Micone, Paula; Gentile, Ángela

2017-12-01

To assess direct medical costs, outof-pocket expenses, and indirect costs in cases of hospitalizations for acute diarrhea among children <5 years of age at Hospital de Niños "Héctor Quintana" in the province of Jujuy during the period of rotavirus circulation in the Northwest region of Argentina. Cross-sectional study on diseaserelated costs. All children <5 years of age, hospitalized with the diagnosis of acute diarrhea and dehydration during the period of rotavirus circulation between May 1st and October 31st of 2013, were included. The assessment of direct medical costs was done by reviewing medical records whereas out-of-pocket expenses and indirect costs were determined using a survey. For the 95% confidence interval of the average cost per patient, a probabilistic bootstrapping analysis of 10 000 simulations by resampling was done. One hundred and five patients were enrolled. Their average age was 18 months (standard deviation: 12); 62 (59%) were boys. The average direct medical cost, out-of-pocket expense, and lost income per case was ARS 3413.6 (2856.35-3970.93) (USD 577.59), ARS 134.92 (85.95-213.57) (USD 22.82), and ARS 301 (223.28-380.02) (USD 50.93), respectively. The total cost per hospitalization event was ARS 3849.52 (3298-4402.25) (USD 651.35). The total cost per hospitalization event was within what is expected for Latin America. Costs are broken down into direct medical costs (significant share), compared to out-of-pocket expenses (3.5%) and indirect costs (7.8%). Sociedad Argentina de Pediatría

Healthcare costs, buyer alert.

PubMed

Brown, Melissa M; Brown, Gary C; Leiske, Heidi B; Lieske, P Alexander

2011-05-01

To assess the direct medical cost perspective versus the societal cost perspective associated with a vitreoretinal intervention. Most insurers, physicians, hospital administrators, legislators and the general public refer to direct medical costs when assessing the costs associated with healthcare interventions. The direct medical cost perspective, which is the same as the third-party insurer cost perspective, includes the costs an insurer might be expected to pay, including those for physicians, hospitals, drugs, durable goods, skilled nursing facilities and others. The societal cost perspective includes direct medical costs; direct nonmedical costs (caregiver, transportation, residence); and indirect medical costs (employment and salary). When assessing the costs associated with a healthcare intervention, the societal cost perspective generally yields a greater financial return-on-investment (ROI) to society and to the gross domestic product than does the utilization of direct medical costs alone. Consequently, the use of societal costs in cost-utility analysis typically results in more cost-effective interventions than when direct medical costs alone are employed. A societal cost perspective is more likely than the third-party insurer cost perspective to demonstrate a greater financial ROI to society.

Variation and outcomes associated with direct hospital admission among children with pneumonia in the United States.

PubMed

Leyenaar, JoAnna K; Shieh, Meng-Shiou; Lagu, Tara; Pekow, Penelope S; Lindenauer, Peter K

2014-09-01

Although the majority of children with an unplanned admission to the hospital are admitted through the emergency department (ED), direct admissions constitute a significant proportion of hospital admissions nationally. Despite this, past studies of children have not characterized direct admission practices or outcomes. Pneumonia is the leading cause of pediatric hospitalization in the United States, providing an ideal lens to examine variation and outcomes associated with direct admissions. To describe rates and patterns of direct admission in a large sample of US hospitals and to compare resource utilization and outcomes between children with pneumonia admitted directly to a hospital and those admitted from an ED. Retrospective cohort study of children 1 to 17 years of age with pneumonia who were admitted to hospitals contributing data to Perspective Data Warehouse. We developed hierarchical generalized linear models to examine associations between admission type and outcomes. Outcome measures included (1) length of stay, (2) high turnover hospitalization, (3) total hospital cost, (4) transfer to the intensive care unit, and (5) readmission within 30 days of hospital discharge. A total of 19,736 children from 278 hospitals met eligibility criteria, including 7100 (36.0%) who were admitted directly and 12,636 (64.0%) through the ED. Rates of direct admission varied considerably across hospitals, with a median direct admission rate of 33.3% (interquartile range, 11.1%-50.0%). Children admitted directly were more likely to be white, to have private health insurance, and to be admitted to small, general community hospitals. In adjusted models, children admitted directly had a 9% higher length of stay (risk ratio, 1.09 [95% CI, 1.07-1.11]), 39% lower odds of high turnover hospitalization (odds ratio [OR], 0.61 [95% CI, 0.56-0.66]), and 12% lower cost (risk ratio, 0.88 [95% CI, 0.87-0.90]) than those admitted through the ED, with no significant differences in transfers to the intensive care unit (OR, 1.29 [95% CI, 0.83-2.00]) or 30-day readmissions (OR, 0.80 [95% CI, 0.57-1.13]). Increasing rates of direct admission among children with access to outpatient care might be an effective strategy to reduce hospital costs and the volume of patients in the ED. Additional research is needed to establish direct admission policies and procedures that are safe and cost-effective.

The cost of hospital care for management of invasive group A streptococcal infections in England.

PubMed

Hughes, G J; VAN Hoek, A J; Sriskandan, S; Lamagni, T L

2015-06-01

The objective of this study was to estimate the direct financial costs of hospital care for management of invasive group A streptococcal (GAS) infections using hospital records for cases diagnosed in England. We linked laboratory-confirmed cases (n = 3696) identified through national surveillance to hospital episode statistics and reimbursement codes. From these codes we estimated the direct hospital costs of admissions. Almost all notified invasive GAS cases (92% of 3696) were successfully matched to a primary hospital admission. Of these, secondary admissions (within 30 days of primary admission) were further identified for 593 (17%). After exclusion of nosocomial cases (12%), the median costs of primary and secondary hospital admissions were estimated by subgroup analysis as £1984-£2212 per case, totalling £4·43-£6·34 million per year in England. With adjustment for unmatched cases this equated to £4·84-£6·93 million per year. Adults aged 16-64 years accounted for 48% of costs but only 40% of cases, largely due to an increased number of surgical procedures. The direct costs of hospital admissions for invasive GAS infection are substantial. These estimated costs will contribute to a full assessment of the total economic burden of invasive GAS infection as a means to assess potential savings through prevention measures.

Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010.

PubMed

Bhuiyan, Mejbah Uddin; Luby, Stephen P; Alamgir, Nadia Ishrat; Homaira, Nusrat; Sturm-Ramirez, Katharine; Gurley, Emily S; Abedin, Jaynal; Zaman, Rashid Uz; Alamgir, Asm; Rahman, Mahmudur; Ortega-Sanchez, Ismael R; Azziz-Baumgartner, Eduardo

2017-06-01

Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children <5 years and associated financial impact on households in Bangladesh. Data of this study could be useful for RSV vaccine development and also the value of various preventive strategies, including use of an RSV vaccine in children if one becomes available. From May through October 2010, children aged <5 years with laboratory-confirmed RSV were identified from a sentinel influenza program database at four tertiary hospitals. Research assistants visited case-patients' homes after hospital discharge and administered a structured questionnaire to record direct medical costs (physician consultation fee, costs for hospital bed, medicines and diagnostic tests); non-medical costs (costs for food, lodging and transportation); indirect costs (caregivers' productivity loss), and coping strategies used by families to pay for treatment. We used WHO-Choice estimates for routine health care service costs. We added direct, indirect and health care service costs to calculate cost-per-episode of severe RSV illness. We used Monte Carlo simulation to estimate annual economic burden for severe RSV illness. We interviewed caregivers of 39 persons hospitalized for RSV illness. The median direct cost for hospitalization was US$ 62 (interquartile range [IQR] = 43-101), indirect cost was US$ 19 (IQR = 11-29) and total cost was US$ 94 (IQR = 67-127). The median out-of-pocket cost was 24% of monthly household income of affected families (US$ 143), and >50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV-associated hospitalization in children aged <5 years in Bangladesh was US$ 10 million (IQR: US$ 7-16 million), the median indirect cost was US$ 3.0 million (IQR: 2-5 million) in 2010. RSV-associated hospitalization among children aged <5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship.

Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010

PubMed Central

Bhuiyan, Mejbah Uddin; Luby, Stephen P; Alamgir, Nadia Ishrat; Homaira, Nusrat; Sturm–Ramirez, Katharine; Gurley, Emily S.; Abedin, Jaynal; Zaman, Rashid Uz; Alamgir, ASM; Rahman, Mahmudur; Ortega–Sanchez, Ismael R.; Azziz–Baumgartner, Eduardo

2017-01-01

Background Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children <5 years and associated financial impact on households in Bangladesh. Data of this study could be useful for RSV vaccine development and also the value of various preventive strategies, including use of an RSV vaccine in children if one becomes available. Methods From May through October 2010, children aged <5 years with laboratory–confirmed RSV were identified from a sentinel influenza program database at four tertiary hospitals. Research assistants visited case–patients’ homes after hospital discharge and administered a structured questionnaire to record direct medical costs (physician consultation fee, costs for hospital bed, medicines and diagnostic tests); non–medical costs (costs for food, lodging and transportation); indirect costs (caregivers’ productivity loss), and coping strategies used by families to pay for treatment. We used WHO–Choice estimates for routine health care service costs. We added direct, indirect and health care service costs to calculate cost–per–episode of severe RSV illness. We used Monte Carlo simulation to estimate annual economic burden for severe RSV illness. Findings We interviewed caregivers of 39 persons hospitalized for RSV illness. The median direct cost for hospitalization was US$ 62 (interquartile range [IQR] = 43–101), indirect cost was US$ 19 (IQR = 11–29) and total cost was US$ 94 (IQR = 67–127). The median out–of–pocket cost was 24% of monthly household income of affected families (US$ 143), and >50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV–associated hospitalization in children aged <5 years in Bangladesh was US$ 10 million (IQR: US$ 7–16 million), the median indirect cost was US$ 3.0 million (IQR: 2–5 million) in 2010. Conclusion RSV–associated hospitalization among children aged <5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship. PMID:28702175

Management of leg and pressure ulcer in hospitalized patients: direct costs are lower than expected.

PubMed

Assadian, Ojan; Oswald, Joseph S; Leisten, Rainer; Hinz, Peter; Daeschlein, Georg; Kramer, Axel

2011-01-01

In Germany, cost calculations on the financial burden of wound treatment are scarce. Studies for attributable costs in hospitalized patients estimate for pressure ulcer additional costs of € 6,135.50 per patient, a calculation based on the assumption that pressure ulcers will lead to prolonged hospitalization averaging 2 months. The scant data available in this field prompted us to conduct a prospective economical study assessing the direct costs of treatment of chronic ulcers in hospitalized patients. The study was designed and conducted as an observational, prospective, multi-centre economical study over a period of 8 months in three community hospitals in Germany. Direct treatment costs for leg ulcer (n=77) and pressure ulcer (n=35) were determined observing 67 patients (average age: 75±12 years). 109 treatments representing 111 in-ward admissions and 62 outpatient visits were observed. During a total of 3,331 hospitalized and 867 outpatient wound therapies, 4,198 wound dressing changes were documented. Costs of material were calculated on a per item base. Direct costs of care and treatment, including materials used, surgical interventions, and personnel costs were determined. An average of € 1,342 per patient (€ 48/d) was spent for treatment of leg ulcer (staff costs € 581, consumables € 458, surgical procedures € 189, and diagnostic procedures € 114). On average, each wound dressing change caused additional costs of € 15. For pressure ulcer, € 991 per patient (€ 52/d) was spent on average (staff costs € 313, consumables € 618, and for surgical procedures € 60). Each wound dressing change resulted in additional costs of € 20 on average. When direct costs of chronic wounds are calculated on a prospective case-by-case basis for a treatment period over 3 months, these costs are lower than estimated to date. While reduction in prevalence of chronic wounds along with optimised patient care will result in substantial cost saving, this saving might be lower than expected. Our results, however, do not serve as basis for making any conclusions on cost-benefit analysis for both, the affected individual, as well as for the society.

Evaluating opportunities for direct contracting between employers and physician-hospital organizations.

PubMed

Straley, P F; Swaim, C R

1994-01-01

Employers seeking to reduce health care expenditures are turning to direct contracting as a way to control provider cost increases. In a direct contract, the participation of third parties is minimized. The health care provider and a corporate buyer directly negotiate a price agreement for the delivery of health care services. However, as managed care penetration increases, the ability of hospitals and physicians to assume risk while providing high quality, cost effective care will be paramount. Physicians and hospitals who choose to work together may find a physician-hospital organization an effective vehicle to meet the current and future market challenges of direct contracting.

The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada.

PubMed

Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo

2018-02-23

To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.

75 FR 60417 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

...-related groups (DRGs). The CHAMPUS DRG-based payment system, except for children's hospitals (whose capital and direct medical education costs are incorporated in the children's hospital differential), who... direct medical education costs. Respondents are institutional providers. Affected Public: Business or...

Limited Use of Price and Quality Advertising Among American Hospitals

PubMed Central

Wilks, Chrisanne E A; Richter, Jason P

2013-01-01

Background Consumer-directed policies, including health savings accounts, have been proposed and implemented to involve individuals more directly with the cost of their health care. The hope is this will ultimately encourage providers to compete for patients based on price or quality, resulting in lower health care costs and better health outcomes. Objective To evaluate American hospital websites to learn whether hospitals advertise directly to consumers using price or quality data. Methods Structured review of websites of 10% of American hospitals (N=474) to evaluate whether price or quality information is available to consumers and identify what hospitals advertise about to attract consumers. Results On their websites, 1.3% (6/474) of hospitals advertised about price and 19.0% (90/474) had some price information available; 5.7% (27/474) of hospitals advertised about quality outcomes information and 40.9% (194/474) had some quality outcome data available. Price and quality information that was available was limited and of minimal use to compare hospitals. Hospitals were more likely to advertise about service lines (56.5%, 268/474), access (49.6%, 235/474), awards (34.0%, 161/474), and amenities (30.8%, 146/474). Conclusions Insufficient information currently exists for consumers to choose hospitals on the basis of price or quality, making current consumer-directed policies unlikely to realize improved quality or lower costs. Consumers may be more interested in information not related to cost or clinical factors when choosing a hospital, so consumer-directed strategies may be better served before choosing a provider, such as when choosing a health plan. PMID:23988296

Limited use of price and quality advertising among American hospitals.

PubMed

Muhlestein, David B; Wilks, Chrisanne E A; Richter, Jason P

2013-08-29

Consumer-directed policies, including health savings accounts, have been proposed and implemented to involve individuals more directly with the cost of their health care. The hope is this will ultimately encourage providers to compete for patients based on price or quality, resulting in lower health care costs and better health outcomes. To evaluate American hospital websites to learn whether hospitals advertise directly to consumers using price or quality data. Structured review of websites of 10% of American hospitals (N=474) to evaluate whether price or quality information is available to consumers and identify what hospitals advertise about to attract consumers. On their websites, 1.3% (6/474) of hospitals advertised about price and 19.0% (90/474) had some price information available; 5.7% (27/474) of hospitals advertised about quality outcomes information and 40.9% (194/474) had some quality outcome data available. Price and quality information that was available was limited and of minimal use to compare hospitals. Hospitals were more likely to advertise about service lines (56.5%, 268/474), access (49.6%, 235/474), awards (34.0%, 161/474), and amenities (30.8%, 146/474). Insufficient information currently exists for consumers to choose hospitals on the basis of price or quality, making current consumer-directed policies unlikely to realize improved quality or lower costs. Consumers may be more interested in information not related to cost or clinical factors when choosing a hospital, so consumer-directed strategies may be better served before choosing a provider, such as when choosing a health plan.

Direct Costs of Dengue Hospitalization in Brazil: Public and Private Health Care Systems and Use of WHO Guidelines

PubMed Central

Vieira Machado, Alessandra A.; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-01-01

Background Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. Methods and Results To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). Conclusion The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care. PMID:25188295

Enhanced Recovery after Colorectal Surgery: Can We Afford Not to Use It?

PubMed

Jung, Andrew D; Dhar, Vikrom K; Hoehn, Richard S; Atkinson, Sarah J; Johnson, Bobby L; Rice, Teresa; Snyder, Jonathan R; Rafferty, Janice F; Edwards, Michael J; Paquette, Ian M

2018-04-01

Enhanced recovery pathways (ERPs) aim to reduce length of stay without adversely affecting short-term outcomes. High pharmaceutical costs associated with ERP regimens, however, remain a significant barrier to widespread implementation. We hypothesized that ERP would reduce hospital costs after elective colorectal resections, despite the use of more expensive pharmaceutical agents. An ERP was implemented in January 2016 at our institution. We collected data on consecutive colorectal resections for 1 year before adoption of ERP (traditional, n = 160) and compared them with consecutive resections after universal adoption of ERP (n = 146). Short-term surgical outcomes, total direct costs, and direct hospital pharmacy costs were compared between patients who received the ERP and those who did not. After implementation of the ERP, median length of stay decreased from 5.0 to 3.0 days (p < 0.01). There were no differences in 30-day complications (8.1% vs 8.9%) or hospital readmission (11.9% vs 11.0%). The ERP patients required significantly less narcotics during their index hospitalization (211.7 vs 720.2 morphine equivalence units; p < 0.01) and tolerated a regular diet 1 day sooner (p < 0.01). Despite a higher daily pharmacy cost ($477 per day vs $318 per day in the traditional cohort), the total direct pharmacy cost for the hospitalization was reduced in ERP patients ($1,534 vs $1,859; p = 0.016). Total direct cost was also lower in ERP patients ($9,791 vs $11,508; p = 0.004). Implementation of an ERP for patients undergoing elective colorectal resection substantially reduced length of stay, total hospital cost, and direct pharmacy cost without increasing complications or readmission rates. Enhanced recovery pathway after colorectal resection has both clinical and financial benefits. Widespread implementation has the potential for a dramatic impact on healthcare costs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The cost of acute respiratory infections in Northern India: a multi-site study.

PubMed

Peasah, Samuel K; Purakayastha, Debjani Ram; Koul, Parvaiz A; Dawood, Fatima S; Saha, Siddhartha; Amarchand, Ritvik; Broor, Shobha; Rastogi, Vaibhab; Assad, Romana; Kaul, Kaisar Ahmed; Widdowson, Marc-Alain; Lal, Renu B; Krishnan, Anand

2015-04-07

Despite the high mortality and morbidity resulting from acute respiratory infections (ARI) globally, there are few data from low-income countries on costs of ARI to inform public health policy decisions We conducted a prospective survey to assess costs of ARI episodes in selected primary, secondary, and tertiary healthcare facilities in north India where no respiratory pathogen vaccine is routinely recommended. Face-to-face interviews were conducted among a purposive sample of patients with ARI from healthcare facilities. Data were collected on out-of-pocket costs of hospitalization, medical consultations, medications, diagnostics, transportation, lodging, and missed work days. Telephone surveys were conducted two weeks after medical encounters to ask about subsequent missed work and costs incurred. Costs of prescriptions and diagnostics in public facilities were supplemented with WHO-CHOICE estimates of hospital bed costs. Missed work days were assigned cost based on the national annual per capita income (US$1,104). Non-medically attended ARI cases were identified from an ongoing community-based ARI surveillance project in Faridabad. During September 2012-March 2013, 1766 patients with ARI were enrolled, including 451 hospitalized patients, 1056 outpatients, and 259 non-medically attended patients. The total direct cost of an ARI episode requiring outpatient care was US$4- $6 for public and $3-$10 for private institutions based on age groups. The total direct cost of an ARI episode requiring hospitalized care was $54-$120 in public and $135-$355 in private institutions. The cost of ARI among those hospitalized was highest among persons aged > = 65 years and lowest among children aged < 5 years. Indirect costs due to missed work days were 16-25% of total costs. The direct out-of-pocket cost of hospitalized ARI was 34% of annual per capita income. The cost of hospitalized ARI episodes in India is high relative to median per capita income. Data from this study can inform evaluations of the cost effectiveness of proven ARI prevention strategies such as vaccination.

Direct costs associated with the appropriateness of hospital stay in elderly population

PubMed Central

Mould-Quevedo, Joaquín F; García-Peña, Carmen; Contreras-Hernández, Iris; Juárez-Cedillo, Teresa; Espinel-Bermúdez, Claudia; Morales-Cisneros, Gabriela; Sánchez-García, Sergio

2009-01-01

Background Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. Methods Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City. Results The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9–5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6 – 2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2 – US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7 – US$6,198.3), (p < 0.001). Conclusion Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management. PMID:19698130

The cost of open heart surgery in Nigeria.

PubMed

Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Ajose, Ifeoluwa; Idowu, Ariyo; Oke, David

2013-01-01

Open Heart Surgery (OHS) is not commonly practiced in Nigeria and most patients who require OHS are referred abroad. There has recently been a resurgence of interest in establishing OHS services in Nigeria but the cost is unknown. The aim of this study was to determine the direct cost of OHS procedures in Nigeria. The study was performed prospectively from November to December 2011. Three concurrent operations were selected as being representative of the scope of surgery offered at our institution. These procedures were Atrial Septal Defect (ASD) Repair, Off Pump Coronary Artery Bypass Grafting (OPCAB) and Mitral Valve Replacement (MVR). Cost categories contributing to direct costs of OHS (Investigations, Drugs, Perfusion, Theatre, Intensive Care, Honorarium and Hospital Stay) were tracked to determine the total direct cost for the 3 selected OHS procedures. ASD repair cost $ 6,230 (Drugs $600, Intensive Care $410, Investigations $955, Perfusion $1080, Theatre $1360, Honorarium $925, Hospital Stay $900). OPCAB cost $8,430 (Drugs $740, Intensive Care $625, Investigations $3,020, Perfusion $915, Theatre $1305, Honorarium $925, Hospital Stay $900). MVR with a bioprosthetic valve cost $11,200 (Drugs $1200, Intensive Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535, Honorarium $925, Hospital Stay $900). The direct cost of OHS in Nigeria currently ranges between $6,230 and $11,200. These costs compare favorably with the cost of OHS abroad and can serve as a financial incentive to patients, sponsors and stakeholders to have OHS procedures done in Nigeria.

Understanding Costs of Care in the Operating Room.

PubMed

Childers, Christopher P; Maggard-Gibbons, Melinda

2018-04-18

Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20.40; ambulatory, $14.35 of $20.90), with nonbillable supplies accounting for less than 10% of total expenses (inpatient, $2.55 of $37.37; ambulatory, $3.33 of $35.39). From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased. The mean cost of OR time is $36 to $37 per minute, using financial data from California's short-term general and specialty hospitals in FY2014. These statewide data provide a generalizable benchmark for the value of OR time. Furthermore, understanding the composition of costs will allow those interested in value improvement to identify high-yield targets.

Strategies for reducing implant costs in the revision total knee arthroplasty episode of care.

PubMed

Elbuluk, Ameer M; Old, Andrew B; Bosco, Joseph A; Schwarzkopf, Ran; Iorio, Richard

2017-12-01

Implant price has been identified as a significant contributing factor to high costs associated with revision total knee arthroplasty (rTKA). The goal of this study is to analyze the cost of implants used in rTKAs and to compare this pricing with 2 alternative pricing models. Using our institutional database, we identified 52 patients from January 1, 2014 to December 31, 2014. Average cost of components for each case was calculated and compared to the total hospital cost for that admission. Costs for an all-component revision were then compared to a proposed "direct to hospital" (DTH) standardized pricing model and a fixed price revision option. Potential savings were calculated from these figures. On average, 28% of the total hospital cost was spent on implants for rTKA. The average cost for revision of all components was $13,640 and ranged from $3000 to $28,000. On average, this represented 32.7% of the total hospital cost. Direct to hospital implant pricing could potentially save approximately $7000 per rTKA, and the fixed pricing model could provide a further $1000 reduction per rTKA-potentially saving $8000 per case on implants alone. Alternative implant pricing models could help lower the total cost of rTKA, which would allow hospitals to achieve significant cost containment.

Direct and indirect costs of surgically treated pelvic fractures.

PubMed

Aprato, Alessandro; Joeris, Alexander; Tosto, Ferdinando; Kalampoki, Vasiliki; Stucchi, Alessandro; Massè, Alessandro

2016-03-01

Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism). We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism. The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p < 0.001) and hospitalization in the surgical unit (p = 0.008). Pelvic fractures are associated with both high direct costs and substantial productivity loss.

Direct variable cost of the topical treatment of stages III and IV pressure injuries incurred in a public university hospital.

PubMed

Chacon, Julieta M F; Blanes, Leila; Borba, Luis G; Rocha, Luis R M; Ferreira, Lydia M

2017-05-01

to estimate the direct variable costs of the topical treatment of stages III and IV pressure injuries of hospitalized patients in a public university hospital, and assess the correlation between these costs and hospitalization time. Forty patients of both sexes who had been admitted to the São Paulo Hospital, São Paulo, SP, Brazil, from 2011 to 2012, with pressure injuries in the sacral, ischial or trochanteric region were included. The patients had a total of 57 pressure injuries in the selected regions, and the lesions were monitored daily until patient release, transfer or death. The quantities and types of materials, as well as the amount of professional labor time spent on each procedure and each patient were recorded. The unit costs of the materials and the hourly costs of the professional labor were obtained from the hospital's purchasing and human resources departments, respectively. Spearman's correlation coefficient and the Mann-Whitney and Kruskal-Wallis tests were used for the statistical analyses. The mean topical treatment costs for stages III and IV PIs were significantly different (US$ 854.82 versus US$ 1785.35; p = 0.004). The mean topical treatment cost of stages III and IV pressure injuries per patient was US$ 1426.37. The mean daily topical treatment cost per patient was US$ 40.83. There was a significant correlation between hospitalization time and the total costs of labor and materials (p < 0.05). There was no significant difference between hospitalization time periods for stages III and IV pressure injuries (40.80 days and 45.01 days, respectively; p = 0.834). The mean direct variable cost of the topical treatment for stages III and IV pressure injuries per patient in this public university hospital was US$ 1426.37. Copyright © 2016. Published by Elsevier Ltd.

Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

PubMed

Hoang, Van Minh; Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

2015-11-01

Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

The Economic and Social Burden of Traumatic Injuries: Evidence from a Trauma Hospital in Port-au-Prince, Haiti.

PubMed

Zuraik, Christopher; Sampalis, John; Brierre, Alexa

2018-06-01

The cost of traumatic injury is unknown in Haiti. This study aims to examine the burden of traumatic injury of patients treated and evaluated at a trauma hospital in the capital city of Port-au-Prince. A retrospective cross-sectional chart review study was conducted at the Hospital Bernard Mevs Project Medishare for all patients evaluated for traumatic injury from December 2015 to January 2016, as described elsewhere (Zuraik and Sampalis in World J Surg, https://doi.org/10.1007/s00268-017-4088-2 , 2017). Direct medical costs were obtained from patient hospital bills. Indirect and intangible costs were calculated using the human capital approach. A total of 410 patients were evaluated for traumatic injury during the study period. Total costs for all patients were $501,706 with a mean cost of $1224. Indirect costs represented 63% of all costs, direct medical costs 19%, and intangible costs 18%. Surgical costs accounted for the majority of direct medical costs (29%). Patients involved in road traffic accidents accounted for the largest number of injuries (41%) and the largest percentage of total costs (51%). Patients with gunshot wounds had the highest total mean costs ($1566). Mean costs by injury severity ranged from $62 for minor injuries, $1269 for serious injuries, to $13,675 for critical injuries. Injuries lead to a significant economic burden for individuals treated at a semi-private trauma hospital in the capital city of Port-au-Prince, Haiti. Programs aimed at reducing injuries, particularly road traffic accidents, would likely reduce the economic burden to the nation.

Determination of VA health care costs.

PubMed

Barnett, Paul G

2003-09-01

In the absence of billing data, alternative methods are used to estimate the cost of hospital stays, outpatient visits, and treatment innovations in the U.S. Department of Veterans Affairs (VA). The choice of method represents a trade-off between accuracy and research cost. The direct measurement method gathers information on staff activities, supplies, equipment, space, and workload. Since it is expensive, direct measurement should be reserved for finding short-run costs, evaluating provider efficiency, or determining the cost of treatments that are innovative or unique to VA. The pseudo-bill method combines utilization data with a non-VA reimbursement schedule. The cost regression method estimates the cost of VA hospital stays by applying the relationship between cost and characteristics of non-VA hospitalizations. The Health Economics Resource Center uses pseudo-bill and cost regression methods to create an encounter-level database of VA costs. Researchers are also beginning to use the VA activity-based cost allocation system.

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

PubMed Central

Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

2017-01-01

Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001). Conclusions Our study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department. PMID:28107366

Incidence and Costs of Clostridium difficile Infections in Canada.

PubMed

Levy, Adrian R; Szabo, Shelagh M; Lozano-Ortega, Greta; Lloyd-Smith, Elisa; Leung, Victor; Lawrence, Robin; Romney, Marc G

2015-09-01

Background.  Limited data are available on direct medical costs and lost productivity due to Clostridium difficile infection (CDI) in Canada. Methods.  We developed an economic model to estimate the costs of managing hospitalized and community-dwelling patients with CDI in Canada. The number of episodes was projected based on publicly available national rates of hospital-associated CDI and the estimate that 64% of all CDI is hospital-associated. Clostridium difficile infection recurrences were classified as relapses or reinfections. Resource utilization data came from published literature, clinician interviews, and Canadian CDI surveillance programs, and this included the following: hospital length of stay, contact with healthcare providers, pharmacotherapy, laboratory testing, and in-hospital procedures. Lost productivity was considered for those under 65 years of age, and the economic impact was quantified using publicly available labor statistics. Unit costs were obtained from published sources and presented in 2012 Canadian dollars. Results.  There were an estimated 37 900 CDI episodes in Canada in 2012; 7980 (21%) of these were relapses, out of a total of 10 900 (27%) episodes of recurrence. The total cost to society of CDI was estimated at $281 million; 92% ($260 million) was in-hospital costs, 4% ($12 million) was direct medical costs in the community, and 4% ($10 million) was due to lost productivity. Management of CDI relapses alone accounted for $65.1 million (23%). Conclusions.  The largest proportion of costs due to CDI in Canada arise from extra days of hospitalization. Interventions reducing the severity of infection and/or relapses leading to rehospitalizations are likely to have the largest absolute effect on direct medical costs.

Incidence and Costs of Clostridium difficile Infections in Canada

PubMed Central

Levy, Adrian R.; Szabo, Shelagh M.; Lozano-Ortega, Greta; Lloyd-Smith, Elisa; Leung, Victor; Lawrence, Robin; Romney, Marc G.

2015-01-01

Background. Limited data are available on direct medical costs and lost productivity due to Clostridium difficile infection (CDI) in Canada. Methods. We developed an economic model to estimate the costs of managing hospitalized and community-dwelling patients with CDI in Canada. The number of episodes was projected based on publicly available national rates of hospital-associated CDI and the estimate that 64% of all CDI is hospital-associated. Clostridium difficile infection recurrences were classified as relapses or reinfections. Resource utilization data came from published literature, clinician interviews, and Canadian CDI surveillance programs, and this included the following: hospital length of stay, contact with healthcare providers, pharmacotherapy, laboratory testing, and in-hospital procedures. Lost productivity was considered for those under 65 years of age, and the economic impact was quantified using publicly available labor statistics. Unit costs were obtained from published sources and presented in 2012 Canadian dollars. Results. There were an estimated 37 900 CDI episodes in Canada in 2012; 7980 (21%) of these were relapses, out of a total of 10 900 (27%) episodes of recurrence. The total cost to society of CDI was estimated at $281 million; 92% ($260 million) was in-hospital costs, 4% ($12 million) was direct medical costs in the community, and 4% ($10 million) was due to lost productivity. Management of CDI relapses alone accounted for $65.1 million (23%). Conclusions. The largest proportion of costs due to CDI in Canada arise from extra days of hospitalization. Interventions reducing the severity of infection and/or relapses leading to rehospitalizations are likely to have the largest absolute effect on direct medical costs. PMID:26191534

Chronic Hepatitis C-Related Cirrhosis Hospitalization Cost Analysis in Bulgaria.

PubMed

Dimitrova, Maria; Pavlov, Kaloyan; Mitov, Konstantin; Genov, Jordan; Petrova, Guenka Ivanova

2017-01-01

HCV infection is a leading cause of chronic liver disease with long-term complications-extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital "Queen Joanna-ISUL" for 3-year period (2012-2014). It is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital "Queen Joanna-ISUL" for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy) were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF), hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal-Wallis, and Friedman tests were used for statistical processing. 76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839) with an average cost per patient 4,577 BGN (€2,340). Statistically significant correlation was observed between the total cost per patient from the different payers' perspective and the Child-Pugh cirrhosis score. HCV-related cirrhosis is resource demanding and sets high direct medical costs as it is related with increased hospitalizations and complications acquiring additional treatment.

Neurologist adherence to clinical practice guidelines and costs in patients with newly diagnosed and chronic epilepsy in Germany.

PubMed

Strzelczyk, Adam; Bergmann, Arnfin; Biermann, Valeria; Braune, Stefan; Dieterle, Lienhard; Forth, Bernhard; Kortland, Lena-Marie; Lang, Michael; Peckmann, Thomas; Schöffski, Oliver; Sigel, Karl-Otto; Rosenow, Felix

2016-11-01

The aim of this study was to evaluate physician adherence to the German Neurological Society guidelines of 2008 regarding initial monotherapy and to determine the cost-of-illness in epilepsy. This was an observational cohort study using health data routinely collected at 55 outpatient neurology practices throughout Germany (NeuroTransData network). Data on socioeconomic status, course of epilepsy, anticonvulsive treatment, and direct and indirect costs were recorded using practice software-based questionnaires. One thousand five hundred eighty-four patients with epilepsy (785 male (49.6%); mean age: 51.3±18.1years) were enrolled, of whom 507 were newly diagnosed. Initial monotherapy was started according to authorization status in 85.9%, with nonenzyme-inducing drugs in 94.3% of all AEDs. Drugs of first choice by guideline recommendations were used in 66.5%. Total annual direct costs in the first year amounted to €2194 (SD: €4273; range: €55-43,896) per patient, with hospitalization (59% of total direct costs) and anticonvulsants (30%) as the main cost factors. Annual total direct costs decreased by 29% to €1572 in the second year, mainly because of a 59% decrease in hospitalization costs. The use of first choice AEDs did not influence costs. Chronic epilepsy was present in 1077 patients, and total annual direct costs amounted to €1847 per patient, with anticonvulsants (51.0%) and hospitalization (41.0%) as the main cost factors. Potential cost-driving factors in these patients were active epilepsy and focal epilepsy syndrome. This study shows excellent physician adherence to guidelines regarding initial monotherapy in adults with epilepsy. Newly diagnosed patients show higher total direct and hospital costs in the first year upon diagnosis, but these are not influenced by adherence to treatment guidelines. Copyright © 2016 Elsevier Inc. All rights reserved.

The relationship of hospital ownership and service composition to hospital charges

PubMed Central

Eskoz, Robin; Peddecord, K. Michael

1985-01-01

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals. PMID:10311161

The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals.

PubMed

Rispel, Laetitia C; Moorman, Julia

2015-01-01

Globally, flexible work arrangements - through the use of temporary nursing staff - are an important strategy for dealing with nursing shortages in hospitals. The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Hospital managers and policy-makers need to address the effective utilisation of agency nurses and quality of patient care in tandem.

Direct health costs of environmental tobacco smoke exposure and indirect health benefits due to smoking ban introduction.

PubMed

Hauri, Dimitri D; Lieb, Christoph M; Rajkumar, Sarah; Kooijman, Cornelis; Sommer, Heini L; Röösli, Martin

2011-06-01

Introducing comprehensive smoke-free policies to public places is expected to reduce health costs. This includes prevented health damages by avoiding environmental tobacco smoke (ETS) exposure as well as indirect health benefits from reduced tobacco consumption. The aim of this study was to estimate direct health costs of ETS exposure in public places and indirect health benefits from reduced tobacco consumption. We calculated attributable hospital days and years of life lost (YLL), based on the observed passive smoking and disease rates in Switzerland. The exposure-response associations of all relevant health outcomes were derived by meta-analysis from prospective cohort studies in order to calculate the direct health costs. To assess the indirect health benefits, a meta-analysis of smoking ban studies on hospital admissions for acute myocardial infarction was conducted. ETS exposure in public places in Switzerland causes 32,000 preventable hospital days (95% CI: 10,000-61,000), 3000 YLL (95% CI: 1000-5000), corresponding to health costs of 330 Mio CHF. The number of hospital days for ischaemic heart disease attributable to passive smoking is much larger if derived from smoking ban studies (41,000) than from prospective cohort studies (3200), resulting in additional health costs of 89 Mio CHF, which are attributed to the indirect health benefits of a smoking ban introduction. The example of smoking ban studies on ischaemic heart disease hospitalization rates suggests that total health costs that can be prevented with smoking bans are considerably larger than the costs arising from the direct health impact of ETS exposure in public places.

Service collaboration and hospital cost performance: direct and moderating effects.

PubMed

Proenca, E Jose; Rosko, Michael D; Dismuke, Clara E

2005-12-01

Growing reliance on service provision through systems and networks creates the need to better understand the nature of the relationship between service collaboration and hospital performance and the conditions that affect this relationship. We examine 1) the effects of service provision through health systems and health networks on hospital cost performance and 2) the moderating effects of market conditions and service differentiation on the collaboration-cost relationship. We used moderated regression analysis to test the direct and moderating effects. Data on 1368 private hospitals came from the 1998 AHA Annual Survey, Medicare Cost Reports, and Solucient. Service collaboration was measured as the proportion of hospital services provided at the system level and at the network level. Market conditions were measured by the levels of managed care penetration and competition in the hospital's market. The proportion of hospital services provided at the system level had a negative relationship with hospital cost. The relationship was curvilinear for network use. Degree of managed care penetration moderated the relationship between network-based collaboration and hospital cost. The benefits of service collaboration through systems and networks, as measured by reduced cost, depend on degree of collaboration rather than mere membership. In loosely structured collaborations such as networks, costs reduce initially but increase later as the extent of collaboration increases. The effect of network-based collaboration is also tempered by managed care penetration. These effects are not seen in more tightly integrated forms such as systems.

Physician Impact on the Total Cost of Care

PubMed Central

Taheri, Paul A.; Butz, David; Griffes, Louisa C.; Morlock, David R.; Greenfield, Lazar J.

2000-01-01

Background and Objectives Physicians’ efforts at cost containment focus on decreased resource utilization and reduced length of stay. Although these efforts appear to be appropriate, little data exist to gauge their success. As such, the goal of this study is to determine trauma service cost allocations and how this information can help physicians to contain costs. Materials and Methods The authors analyzed the costs for 696 trauma admissions at a level I trauma center for fiscal year 1997. Data were obtained from the hospital costing system. Costs analyzed were variable direct, fixed direct, and Indirect costs. Together, the fixed and indirect costs are referred to as “hospital overhead.” Total Cost equals variable direct plus fixed direct plus indirect costs. Results The mean variable, fixed, and indirect costs per patient were $7,998, $3,534, and $11,086, respectively. Mean total cost per patient was $22,618. Conclusion The 35% variable direct cost represents the percentage of total cost that is typically under the immediate influence of physicians, in contrast to the 65% of total cost over which physicians have little control. Physicians must gain a better understanding of cost drivers and must participate in the operations and allocations of institutional fixed direct and indirect costs if the overall cost of care is to be reduced. PMID:10714637

Has cost containment after the National Health Insurance system been successful? Determinants of Taiwan hospital costs.

PubMed

Hung, Jung-Hua; Chang, Li

2008-03-01

Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).

Cost accounting and public reimbursement schemes in Spanish hospitals.

PubMed

Sánchez-Martínez, Fernando; Abellán-Perpiñán, José-María; Martínez-Pérez, Jorge-Eduardo; Puig-Junoy, Jaume

2006-08-01

The objective of this paper is to provide a description and analysis of the main costing and pricing (reimbursement) systems employed by hospitals in the Spanish National Health System (NHS). Hospitals cost calculations are mostly based on a full costing approach as opposite to other systems like direct costing or activity based costing. Regional and hospital differences arise on the method used to allocate indirect costs to cost centres and also on the approach used to measure resource consumption. Costs are typically calculated by disaggregating expenditure and allocating it to cost centres, and then to patients and DRGs. Regarding public reimbursement systems, the impression is that unit costs are ignored, except for certain type of high technology processes and treatments.

Direct medical costs of hospitalizations for cardiovascular diseases in Shanghai, China: trends and projections.

PubMed

Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

2015-05-01

Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs.To develop a time series model using Box-Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai.Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030.From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04-4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05-1.19 billion) without additional government interventions.Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers.

Direct Medical Costs of Hospitalizations for Cardiovascular Diseases in Shanghai, China

PubMed Central

Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

2015-01-01

Abstract Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs. To develop a time series model using Box–Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai. Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030. From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04–4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05–1.19 billion) without additional government interventions. Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers. PMID:25997060

Direct costs associated with a nosocomial outbreak of Salmonella infection: an ounce of prevention is worth a pound of cure.

PubMed

Spearing, N M; Jensen, A; McCall, B J; Neill, A S; McCormack, J G

2000-02-01

Nosocomial outbreaks of Salmonella infections in Australia are an infrequent but significant source of morbidity and mortality. Such an outbreak results in direct, measurable expenses for acute care management, as well as numerous indirect (and less quantifiable) costs to those affected, the hospital, and the wider community. This article describes the significant direct costs incurred as a result of a nosocomial outbreak of Salmonella infection involving patients and staff. Information on costs incurred by the hospital was gathered from a number of sources. The data were grouped into 4 sections (medical costs, investigative costs, lost productivity costs, and miscellaneous) with use of an existing tool for calculating the economic impact of foodborne illness. The outbreak cost the hospital more than AU $120, 000. (US $95,000). This amount is independent of more substantial indirect costs. Salmonella infections are preventable. Measures to aid the prevention of costly outbreaks of nosocomial salmonellosis, although available, require an investment of both time and money. We suggest that dedication of limited resources toward such preventive strategies as education is a practical and cost-effective option for health care facilities.

An economic comparison of hospital-based and community-based glaucoma clinics

PubMed Central

Sharma, A; Jofre-Bonet, M; Panca, M; Lawrenson, J G; Murdoch, I

2012-01-01

Introduction We have established one model for community care of glaucoma clinic patients. Community optometrists received training and accreditation in glaucoma care. Once qualified they alternated between running half day glaucoma clinics in their own High Street practices and assisting in a hospital-based glaucoma clinic session. This paper reports the cost of this model. Methods Micro-costing was undertaken for the hospital clinic. A consensus meeting was held to agree costs for community clinics involving all optometrists in the project along with representatives of the multiple chain optometry practices who had participated. Costs to patients both indirect and direct were calculated following structured interviews of 197 patients attending hospital clinics and 194 attending community clinics. Results The estimated cost per patient attendance to the hospital clinic was £63.91 and the estimated cost per attendance to the community clinic was £145.62. For patients the combined direct and indirect cost to attend the hospital clinic was £6.15 and the cost to attend the community clinic £5.91. Discussion The principal reason for the higher cost in the community clinic was higher overhead costs in the community. Re-referral to the hospital system only occurred for 9% of patients and was not a large contribution to the increased cost. Time requested to next appointment was similar for the two clinics. Sensitivity analysis shows a strong effect of increasing patients seen per clinic. It would, however, require 25 patients to be seen per clinician per day in the community in order to make the costs comparable. PMID:22562188

The National Survey of Stroke. Economic impact.

PubMed

Adelman, S M

1981-01-01

The estimated economic costs of stroke in 1976 amounted to $7,363,784,000 (based on a 6 percent gross, or 4 percent net, discount rate). Almost half were direct costs, the majority of these were related to inpatient hospital and nursing facility care. Only about six percent of the total were morbidity costs, and the remaining fifty percent consisted of mortality costs, stated in terms of the present value of future earnings. Direct costs include charges by short-term hospitals, extended care facilities, physicians and other medical and allied health personnel, and the costs of aids and appliances. Indirect costs include both morbidity and mortality costs. These costs are distributed as follows. [Formula: see text].

AB064. Estimation of direct and indirect costs and quality of life of patients with chronic obstructive pulmonary disease and their burden on Greek Health System

PubMed Central

Zarogoulidou, Vasiliki; Arbanitidou-Bagiona, Maria; Papakosta, Despoina; Zarogoulidis, Paul; Porpodis, Konstantinos; Panagopoulou, Evaggelia; Chaidits, Athanasios Basileio; Kontakiotis, Theodore; Zarogoulidis, Konstantinos

2016-01-01

Background The aim of this study was to make an attempt to estimate the direct and indirect costs of chronic obstructive pulmonary disease since in Greece very few attempts have been done to measure these costs and data available are insufficient. Our research focused on evaluating these direct and indirect costs according to demographic factors, response to treatment, patient survival, quality of life and patient satisfaction from the health care services provided. Methods This study was performed in Pulmonary Department of Aristotle University of Thessaloniki, General Hospital “G. Papanikolaou” and 110 patients with chronic obstructive pulmonary disease were enrolled. The follow-up duration of the patients was two years from the time of diagnosis. First, for study purposes the calculation of direct and indirect costs were performed and their correlations with patients’ demographics (gender, age, profession, place of residence), number of exacerbations, response to treatment and survival. In parallel, every three months from the time of diagnosis patients’ quality of life was recorded, using questionnaires, which was also correlated with the direct and indirect costs of each disease under investigation. The exploration of patient satisfaction from the health services provided was performed once for each patient during the first hospital stay in the Pulmonary Department of Aristotle University of Thessaloniki, General Hospital “G. Papanikolaou”. Results The total mean costs per patient in a one year follow-up was: total mean direct cost: 3.889,08€, total mean indirect cost: 18.01€. In chronic obstructive pulmonary disease (COPD) higher costs were observed in patients over 70 years old, of secondary education and pensioners, while for bronchial asthma higher costs were observed mainly in women. The disease severity, the frequency of exacerbations and the need for hospitalization significantly increased the economic burden of Greek health care system. The increase of the medication and patients’ monitoring cost resulted in improved control of the disease. Patients with COPD showed stable or deteriorating quality of life during the 12 month period of time. At 24 months of follow-up, patients with COPD reported improved quality of life compared to diagnosis. Improved the quality of life was associated with increased direct and indirect costs. The increased costs that were partly the result of frequent examinations, treatments and visits to the doctor, seemed to have negatively affected the emotional state of patients. Improved quality of life in COPD patients was related with reduced direct and indirect costs. Patient satisfaction from the provided health services could not be assessed as there was no homogeneity among the questions of the questionnaire used for the study. Future research should be made for the development of a reliable tool for recording patient satisfaction from the provided health services in hospitals of our country. Conclusions The higher annual burden of COPD patients is probably due to the infectious exacerbations COPD patients experience, which usually leads them to hospitalization. Patients quality of life is influenced from a variety of factors and was correlated with direct or/and indirect hospitalisation and/or monitoring cost.

Cost and utilization outcomes of patients receiving hospital-based palliative care consultation.

PubMed

Penrod, Joan D; Deb, Partha; Luhrs, Carol; Dellenbaugh, Cornelia; Zhu, Carolyn W; Hochman, Tsivia; Maciejewski, Matthew L; Granieri, Evelyn; Morrison, R Sean

2006-08-01

To compare per diem total direct, ancillary (laboratory and radiology) and pharmacy costs of palliative care (PC) compared to usual care (UC) patients during a terminal hospitalization; to examine the association between PC and ICU admission. Retrospective, observational cost analysis using a VA (payer) perspective. Two urban VA medical centers. Demographic and health characteristics of 314 veterans admitted during two years were obtained from VA administrative data. Hospital costs came from the VA cost accounting system. Generalized linear models (GLM) were estimated for total direct, ancillary and pharmacy costs. Predictors included patient age, principal diagnosis, comorbidity, whether patient stay was medical or surgical, site and whether the patient was seen by the palliative care consultation team. A probit regression was used to analyze probability of ICU admission. Propensity score matching was used to improve balance in observed covariates. PC patients were 42 percentage points (95% CI, -56% [corrected] to -31%) less likely to be admitted to ICU. Total direct costs per day were $239 (95% CI, -387 to -122) lower and ancillary costs were $98 (95% CI, -133 to -57) lower than costs for UC patients. There was no difference in pharmacy costs. The results were similar using propensity score matching. PC was associated with significantly lower likelihood of ICU use and lower inpatient costs compared to UC. Our findings coupled with those indicating better patient and family outcomes with PC suggest both a cost and quality incentive for hospitals to develop PC programs.

Clinical characteristics and direct medical cost of respiratory syncytial virus infection in children hospitalized in Suzhou, China.

PubMed

Zhang, Tao; Zhu, Qiuli; Zhang, Xuelan; Ding, Yunfang; Steinhoff, Mark; Black, Steven; Zhao, Genming

2014-04-01

There have been few studies on children hospitalized with respiratory syncytial virus (RSV) published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven RSV children hospitalized in Suzhou, China. Testing is routine for RSV for children admitted to the respiratory ward at Suzhou University Children's Hospital. We performed a retrospective study on children with documented RSV infection hospitalized at Suzhou University Children Hospital during 2005-2009 using a structured chart review instrument. A total of 2721 hospitalized children (15.0% of those tested) were positive by immunofluorescent assay for RSV during 2005-2009, and 64.0% of them were male. Eighty-seven percentage of the RSV-infected children were 2 years old and younger, and 56.6% were ≤ 6 months of age. The median length of hospital stay was 8 days. Of the RSV-infected children, 92.5% developed pneumonia and 21.8% experienced wheezing. In total, 49 (5.1%) of RSV-positive children were transferred to the ICU. Children ≤ 6 months old and who had congenital heart disease had higher risk of severe RSV disease. The mean cost of each RSV-related hospitalization was US$571.8 (US$909.6 for children referred to ICU and US$565.4 for those cared for on the wards). Multivariable logistic regression showed that compared with the ≤ 6 months children, those aged >6 months old had higher hospitalization cost; children with respiratory distress or with chronic lung diseases tended to have higher hospitalization costs than others. RSV infections and severe RSV diseases mostly occurred in early infancy. The direct medical cost was high relative to family income. Effective strategies of RSV immunization of young children in China may be beneficial in addressing this disease burden.

Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome

PubMed Central

2011-01-01

Background Controlled trials have found therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) infusion therapy to be equally efficacious in treating Guillain-Barré syndrome (GBS). Due to increases in the price of IVIg compared to human serum albumin (HSA), used as a replacement fluid in TPE, we examined direct hospital-level expenditures for TPE and IVIg for meaningful cost-differences between these treatments. Methods Using financial data from our two institutions, hospital cost profiles for IVIg and 5% albumin were established. Reimbursement amounts were obtained from publicly available Medicare data resources to determine payment rates for TPE, non-tunneled central catheter line placement, and drug infusion therapy. A model was developed which allows hospitals to input cost and reimbursement amounts for both IVIg and TPE with HSA that results in real-time valuations of these interventions. Results The direct cost of five IVIg infusion sessions totaling 2.0 grams per kilogram (g/kg) body weight was $10,329.85 compared to a series of five TPE procedures, which had direct costs of $4,638.16. Conclusions In GBS patients, direct costs of IVIg therapy are more than twice that of TPE. Given equivalent efficacy and similar severity and frequencies of adverse events, TPE appears to be a less expensive first-line therapy option for treatment of patients with GBS. PMID:21575219

The role and timing of palliative medicine consultation for women with gynecologic malignancies: association with end of life interventions and direct hospital costs.

PubMed

Nevadunsky, Nicole S; Gordon, Sharon; Spoozak, Lori; Van Arsdale, Anne; Hou, Yijuan; Klobocista, Merieme; Eti, Serife; Rapkin, Bruce; Goldberg, Gary L

2014-01-01

Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies. A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥ 30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission <3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher's Exact, Mann-Whitney U, Kaplan-Meier, and Student's T testing. 49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0-3) versus 2 (range 0-6) p=0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0-28,019) versus untimely, $7729 (0-52,720), p=0.01. Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs. © 2013. Published by Elsevier Inc. All rights reserved.

Direct treatment costs of HIV/AIDS in Portugal.

PubMed

Perelman, Julian; Alves, Joana; Miranda, Ana Cláudia; Mateus, Céu; Mansinho, Kamal; Antunes, Francisco; Oliveira, Joaquim; Poças, José; Doroana, Manuela; Marques, Rui; Teófilo, Eugénio; Pereira, João

2013-10-01

To analyze the direct medical costs of HIV/AIDS in Portugal from the perspective of the National Health Service. A retrospective analysis of medical records was conducted for 150 patients from five specialized centers in Portugal in 2008. Data on utilization of medical resources during 12 months and patients' characteristics were collected. A unit cost was applied to each care component using official sources and accounting data from National Health Service hospitals. The average cost of treatment was 14,277 €/patient/year. The main cost-driver was antiretroviral treatment (€ 9,598), followed by hospitalization costs (€ 1,323). Treatment costs increased with the severity of disease from € 11,901 (> 500 CD4 cells/µl) to € 23,351 (CD4 count ≤ 50 cells/ µl). Cost progression was mainly due to the increase in hospitalization costs, while antiretroviral treatment costs remained stable over disease stages. The high burden related to antiretroviral treatment is counterbalanced by relatively low hospitalization costs, which, however, increase with severity of disease. The relatively modest progression of total costs highlights that alternative public health strategies that do not affect transmission of disease may only have a limited impact on expenditure, since treatment costs are largely dominated by constant antiretroviral treatment costs.

Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis.

PubMed

Moodie, Marj; Lal, Anita; Vidmar, Suzanna; Armstrong, David S; Byrnes, Catherine A; Carlin, John B; Cheney, Joyce; Cooper, Peter J; Grimwood, Keith; Robertson, Colin F; Tiddens, Harm A; Wainwright, Claire E

2014-09-01

To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions. Costs were assessed in a randomized controlled trial conducted in Australia and New Zealand on infants diagnosed with CF after newborn screening and assigned to receive either BAL-directed or standard therapy until they reached 5 years of age. A health care funder perspective was adopted. Resource use measurement was based on standardized data collection forms administered for patients across all sites. Unit costs were obtained primarily from government schedules. Mean costs per child during the study period were Australian dollars (AUD)92 860 in BAL-directed therapy group and AUD90 958 in standard therapy group (mean difference AUD1902, 95% CI AUD-27 782 to 31 586, P = .90). Mean hospital costs per child during the study period were AUD57 302 in the BAL-directed therapy group and AUD66 590 in the standard therapy group (mean difference AUD-9288; 95% CI AUD-35 252 to 16 676, P = .48). BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years, flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings. Copyright © 2014 Elsevier Inc. All rights reserved.

Cost of Osteoporotic Fractures in Singapore.

PubMed

Ng, Charmaine Shuyu; Lau, Tang Ching; Ko, Yu

2017-05-01

To estimate the 3-month direct and indirect costs associated with osteoporotic fractures from both the hospital's and patient's perspectives in Singapore and to compare the cost between acute and prevalent osteoporotic fractures. Resource use and expenditure data were collected using interviewer-administered questionnaires at baseline and at a 3-month follow-up between July 2013 and January 2014. Estimated osteoporotic fracture-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, medications, transportation, health care and community services, special equipment and home/car modifications, and productivity loss. A total of 67 patients agreed to participate, giving a response rate of 64.4%. The mean (median) 3-month direct medical cost from the hospital's perspective was found to be SGD 3,886.90 (SGD 413.10), of which 74.2% was accounted for by inpatient services, 25.2% by outpatient services, and 0.6% by accident and emergency services. Moreover, considerable variation (SD = SGD 2,615.40) was observed in the costs of outpatient rehabilitation services. Findings were similar when the patient's perspective was taken. The total costs, with both direct and indirect costs included, were SGD 11,438.70 (acute) and SGD 1,015.40 (prevalent), of which 34.7% and 8.0%, respectively, were accounted for by inpatient services. Hospitalization was associated with the highest cost borne by both the hospital and the patient, and informal care dominated indirect costs. Better knowledge of the financial consequences of fragility fractures could enable proactive and preventive measures to be undertaken, especially at sites of care with high cost drivers. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

PubMed

Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

2015-01-01

Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Cost-benefit analysis of craniocerebral surgical site infection control in tertiary hospitals in China.

PubMed

Zhou, Jiong; Ma, Xiaojun

2015-02-19

Surgical site infection (SSI) is one of the most common postoperative complications. This study aimed to determine the cost of SSIs and to evaluate whether SSI control can reduce medical costs under the current medical payment system and wage rates in China. Prospective surveillance of craniocerebral surgery was conducted between July 2009 and June 2012. SSI patients and non-SSI patients were matched with a ratio of 1:2. Terms such as medical costs and length of hospital stay were compared between the two groups. Based on the economic loss of hospital infection, which causes additional expenditures and a reduction in the number of patients treated, the benefits of hospital infection control were estimated. The costs of human resources and materials of hospital infection surveillance and control were also estimated. Finally, the cost-benefit rates in different medical contexts and with different SSI-case ratios were calculated. The incidence of SSIs in this study was 4%. SSIs significantly prolonged hospital stay by 11.75 days (95% CI: 6.24-22.52), increased medical costs by US $3,412.48 (95% CI: $1,680.65-$5,879.89). The direct economic loss was $114,903 in a 40-bed ward. The cost of implementing infection control in such a unit was calculated to be approximately $5,555.47 CONCLUSIONS: Under the current fee-for-service healthcare model in China, the control of SSIs can hardly yield direct economic benefits, but can yield social benefits. With the implementation of a total medical cost pre-payment system, SSI control will present a remarkable benefit-cost ratio for hospitals.

The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

PubMed Central

Rispel, Laetitia C.; Moorman, Julia

2015-01-01

Background Globally, flexible work arrangements – through the use of temporary nursing staff – are an important strategy for dealing with nursing shortages in hospitals. Objective The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Methods Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). Results In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Conclusion Hospital managers and policy-makers need to address the effective utilisation of agency nurses and quality of patient care in tandem. PMID:25971399

Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany.

PubMed

Zeidler, J; Mittendorf, T; Vahldiek, G; Zeidler, H; Merkesdal, S

2008-10-01

To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany. A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of euro2047 and euro1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were euro2067 (euro1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation. Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

Perineal tap water burns in the elderly: at what cost?

PubMed

Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David

2017-11-01

Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.

Acute care costs of patients admitted for management of chronic obstructive pulmonary disease exacerbations: contribution of disease severity, infection and chronic heart failure.

PubMed

Hutchinson, A; Brand, C; Irving, L; Roberts, C; Thompson, P; Campbell, D

2010-05-01

In 2003, chronic obstructive pulmonary disease (COPD) accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65-74-year-old age group, COPD was the sixth leading cause of disability for men and the seventh for women. To measure the influence of disease severity, COPD phenotype and comorbidities on acute health service utilization and direct acute care costs in patients admitted with COPD. Prospective cohort study of 80 patients admitted to the Royal Melbourne Hospital in 2001-2002 for an exacerbation of COPD. Patients were followed for 12 months and data were collected on acute care utilization. Direct hospital costs were derived using Transition II, an activity-based costing system. Individual patient costs were then modelled to ascertain which patient factors influenced total direct hospital costs. Direct costs were calculated for 225 episodes of care, the median cost per admission was AU$3124 (interquartile range $1393 to $5045). The median direct cost of acute care management per patient per year was AU$7273 (interquartile range $3957 to $14 448). In a multivariate analysis using linear regression modelling, factors predictive of higher annual costs were increasing age (P= 0.041), use of domiciliary oxygen (P= 0.008) and the presence of chronic heart failure (P= 0.006). This model has identified a number of patient factors that predict higher acute care costs and awareness of these can be used for service planning to meet the needs of patients admitted with COPD.

Costs optimization in anaesthesia.

PubMed

Martelli, Alessandra

2015-04-27

The aim of this study is to analyze the direct cost of different anaesthetic techniques used within the Author's hospital setting and compare with costs reported in the literature. Mean cost of drugs and devices used in our local Department of Anaesthesia was considered in the present study. All drugs were supplied by the in-house Pharmacy Service of Parma's General Hospital. All calculation have been made using an hypothetical ASA1 patient weighting 70 kg. The quality of consumption and cost of inhalation anaesthesia with sevoflurane or desflurane at different fresh gas flow were analyzed, and the cost of total venous anaesthesia (TIVA) using propofol and remifentanil with balanced anaesthesia were also analyzed. In addition, direct costs of general, spinal and sciatic-femoral nerve block anaesthesia used for common plastic surgery procedures were assessed. The results of our study show that the cost of inhalational anaesthesia decreases using fresh gas flow below 1L, and the use of desflurane is more expensive. In our Hospital, the cost of TIVA is more or less equivalent to the costs of balanced anaesthesia with sevoflurane in surgical procedure lasting more than five hours. The direct cost was lower for the spinal anaesthesia compared with general anaesthesia and sciatic- femoral nerve block for some surgical procedures. (www.actabiomedica.it).

[Direct medical costs of hospital treatment of fractures of the upper extremity of the femur].

PubMed

El Ayoubi, Abdelghani; Bouhelo, Kevin Parfait Bienvenu; Chafik, Hachem; Nasri, Mohammed; El Idrissi, Mohammed; Shimi, Mohammed; El Ibrahimi, Abdelhalim; Elmrini, Abdelmajid

2017-01-01

Fractures of the upper extremity of the femur are serious because of their morbidity and social and/or economic consequences. They have been the subject of several studies of world literature concerning their hospital treatment, evolution and prevention. The increase in the incidence of this pathology seems unavoidable due to population ageing and to the lengthening life expectancy; it is posing a real long-term public health problem whose importance will be further increased by the need to control health care costs. The results of this study show that the average age of onset of fracture of the proximal extremity of the femur is 68,13 ± 16.9 years, with a male predominance and a sex ratio of 1.14. In our study pertrochanterian fractures represented 69.4% of cases. Direct medical costs of the hospital treatment of fractures of the upper extremity of the femur at the Hassan II University Hospital were £387 714,38 in 222 cases, with an average cost of £1757,4 , including costs for patient's stay in hospital, which represented the majority of expenses ( 77% of total costs). It is desirable to raise staff awareness of the costs of consumables in order to reduce treatment costs and to adopt cost-oriented behaviour. Length of stay should be limited to the maximum extent because it only allows to reduce staff and accommodation costs.

Economic credentialing: the propriety of managing physician costs through privileging.

PubMed

Dahl, B A

1999-01-01

Hospital executives face the unique task of managing the costs of an institution in which they have no direct managerial authority over the primary cost drivers, namely, the physicians who practice in the hospital. Perhaps the most controversial method of controlling physician costs consists of the application of economic factors to the credentialing process. Using the credentialing process as a technique to exert fiscal control over physicians affords hospital executives and their governing boards a tremendous cost-management opportunity. The legal propriety of economic credentialing remains unsettled. Many commentators, relying on limited case law, conclude that hospitals can engage in economic credentialing. Nevertheless, hospitals should exercise care when employing an economic rationale to restrict privileges lest they stir up legal challenges. Moreover, if hospitals use economic credentialing to limit medicaid patients' access to hospitals by excluding these patients' physicians from the hospital, the federal government may have the last word on the propriety of the practice.

Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands.

PubMed

Kik, Sandra V; Olthof, Sandra P J; de Vries, Jonie T N; Menzies, Dick; Kincler, Naomi; van Loenhout-Rooyakkers, Joke; Burdo, Conny; Verver, Suzanne

2009-08-05

In low tuberculosis (TB) incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1-6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted euro353. Most costs were spent when being hospitalized. Time loss (mean 81 days) was mainly due to hospitalization (19 days) and additional work days lost (60 days), and corresponded with a cost estimation of euro2603. Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

PubMed

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

An 8-year follow-up study of 221 consecutive hip fracture patients in Finland: analysis of reoperations and their direct medical costs.

PubMed

Lüthje, P; Helkamaa, T; Nurmi-Lüthje, I; Kaukonen, J-P; Kataja, M

2014-03-01

Some hip fracture patients need one or more reoperations because of complications following initial operative treatment. The aim of this study was to identify all further surgical interventions in a cohort of patients with hip fractures over a period of 8 years after index fracture. Immediate direct costs of these reoperations were also calculated. This retrospective study investigated 221 consecutive patients with hip fractures operated on at two different hospitals in southeastern Finland. The study period in hospital A was from 1 February 2003 to 31 January 2004, and in hospital B from 1 February 2003 to 30 April 2004. About 50% were femoral neck fractures, 41% trochanteric fractures, and 9% subtrochanteric fractures. Patients' medical records were checked from the hospital records and confirmed manually. Short- and long-term complications were recorded. Survival analysis was performed using a life-table method. The actual costs for reoperations and other further procedures for each patient were calculated using diagnosis-related groups-based costs for both hospitals in 2012. A total of 20 patients (9%) needed reoperations. Overall, 10 patients (8.9%) with a femoral neck fracture (n = 112), 8 patients (8.7%) with trochanteric fracture (n = 92), and 2 patients (10.5%) with subtrochanteric fracture (n = 19) were reoperated on. The median interval between the primary operation of the acute hip fracture (n = 20) and the first reoperation was about 300 days (range: 2 weeks to 82 months). Among the women reoperated on, the excess mortality was lower than among those undergoing a single operation. The median costs of treatment per patient with one or more reoperations were €13,422 in hospital A (range: €1616-€61,755), €11,076 in hospital B (range: €1540-€17,866), and €12,850 in the total study group (p = 0.43). In the case of infections (3 patients), the mean costs per patient were €28,751 (range: €11,076-€61,755). Almost 10% of hip fracture patients required reoperations, and these reoperations caused significant direct costs to health care. However, direct costs account for only approximately 25% of the first year's total costs. These costs should be taken into account when evaluating the economics of hip fractures and the burden of health care.

Hospital costs of acute pulmonary embolism.

PubMed

Fanikos, John; Rao, Amanda; Seger, Andrew C; Carter, Danielle; Piazza, Gregory; Goldhaber, Samuel Z

2013-02-01

Pulmonary embolism places a heavy economic burden on health care systems, but the components of hospital cost have not been elucidated. We evaluated hospitalized patients with the primary diagnosis of pulmonary embolism. Our goal was to determine the total and component costs associated with their hospital care. We included patients hospitalized at Brigham and Women's Hospital from September 2003 to May 2010. Patient demographics, characteristics, comorbidities, interventions, and treatments were obtained from the electronic medical record. Costs were obtained using the hospital's accounting software and categorized into the areas providing direct patient supplies or care. We identified 991 hospitalized patients with acute pulmonary embolism. In-hospital mortality was 4.2%, and 90-day mortality after hospital discharge was 13.8%. The median length of hospital stay was 3 days, and the mean length of hospital stay was 4 days. The mean total hospitalization cost per patient was $8764. Nursing costs, which included room and board, were $5102. Pharmacy ($966) and radiology ($963) costs were similar. Pharmacy costs ($966) were dominated by the use of low-molecular-weight heparin ($232). Radiology costs ($963) were dominated by the use of diagnostic imaging examinations ($672). During the observation period, an average of 160 patients with pulmonary embolism were admitted each year, requiring an annual hospital expense ranging from $884,814 to $1,866,489. Pulmonary embolism has a high case fatality rate and remains an expensive illness to diagnose and treat. Nursing costs comprise the largest component of costs. Copyright © 2013 Elsevier Inc. All rights reserved.

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

PubMed

Levine, David M; Ouchi, Kei; Blanchfield, Bonnie; Diamond, Keren; Licurse, Adam; Pu, Charles T; Schnipper, Jeffrey L

2018-05-01

Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. Randomized controlled trial. Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma. Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing. Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience. Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p < 0.01) and less often received consultations (0% vs. 27%; p = 0.04). Home patients were more physically active (median minutes, 209 vs. 78; p < 0.01), with a trend toward more sleep. No adverse events occurred in home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p < 0.01) lower, with trends toward less use of home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups. The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial. Trial Registration NCT02864420.

Quantifying the direct public health care cost of systemic sclerosis

PubMed Central

Morrisroe, Kathleen; Stevens, Wendy; Sahhar, Joanne; Ngian, Gene-Siew; Rabusa, Candice; Ferdowsi, Nava; Hill, Catherine; Proudman, Susanna; Nikpour, Mandana

2017-01-01

Abstract To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement. PMID:29310332

Quantifying the direct public health care cost of systemic sclerosis: A comprehensive data linkage study.

PubMed

Morrisroe, Kathleen; Stevens, Wendy; Sahhar, Joanne; Ngian, Gene-Siew; Rabusa, Candice; Ferdowsi, Nava; Hill, Catherine; Proudman, Susanna; Nikpour, Mandana

2017-12-01

To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement.

[Costs of serious adverse events in a community teaching hospital, in Mexico].

PubMed

Gutiérrez-Mendoza, Luis Meave; Torres-Montes, Abraham; Soria-Orozco, Manuel; Padrón-Salas, Aldanely; Ramírez-Hernández, María Elizabeth

2015-01-01

Serious adverse events during hospital care are a worldwide reality and threaten the safety of the hospitalised patient. To identify serious adverse events related to healthcare and direct hospital costs in a Teaching Hospital in México. A study was conducted in a 250-bed Teaching Hospital in San Luis Potosi, Mexico. Data were obtained from the Quality and Patient Safety Department based on 2012 incidents report. Every event was reviewed and analysed by an expert team using the "fish bone" tool. The costs were calculated since the event took place until discharge or death of the patient. A total of 34 serious adverse events were identified. The average cost was $117,440.89 Mexican pesos (approx. €7,000). The great majority (82.35%) were largely preventable and related to the process of care. Undergraduate medical staff were involved in 58.82%, and 14.7% of patients had suffered adverse events in other hospitals. Serious adverse events in a Teaching Hospital setting need to be analysed to learn and deploy interventions to prevent and improve patient safety. The direct costs of these events are similar to those reported in developed countries. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery.

PubMed

Bailey, Jonathan G; Davis, Philip J B; Levy, Adrian R; Molinari, Michele; Johnson, Paul M

2016-06-01

Postoperative complications have been identified as an important and potentially preventable cause of increased hospital costs. While older adults are at increased risk of experiencing complications and other adverse events, very little research has specifically examined how these events impact inpatient costs. We sought to examine the association between postoperative complications, hospital mortality and loss of independence and direct inpatient health care costs in patients 70 years or older who underwent nonelective abdominal surgery. We prospectively enrolled consecutive patients 70 years or older who underwent nonelective abdominal surgery between July 1, 2011, and Sept. 30, 2012. Detailed patient-level data were collected regarding demographics, diagnosis, treatment and outcomes. Patient-level resource tracking was used to calculate direct hospital costs (2012 $CDN). We examined the association between complications, hospital mortality and loss of independence cost using multiple linear regression. During the study period 212 patients underwent surgery. Overall, 51.9% of patients experienced a nonfatal complication (32.5% minor and 19.4% major), 6.6% died in hospital and 22.6% experienced a loss of independence. On multivariate analysis nonfatal complications (p < 0.001), hospital mortality (p = 0.021) and loss of independence at discharge (p < 0.001) were independently associated with health care costs. These adverse events respectively accounted for 30%, 4% and 10% of the total costs of hospital care. Adverse events were common after abdominal surgery in older adults and accounted for 44% of overall costs. This represents a substantial opportunity for better patient outcomes and cost savings with quality improvement strategies tailored to the needs of this high-risk surgical population.

A hospital-specific template for benchmarking its cost and quality.

PubMed

Silber, Jeffrey H; Rosenbaum, Paul R; Ross, Richard N; Ludwig, Justin M; Wang, Wei; Niknam, Bijan A; Saynisch, Philip A; Even-Shoshan, Orit; Kelz, Rachel R; Fleisher, Lee A

2014-10-01

Develop an improved method for auditing hospital cost and quality tailored to a specific hospital's patient population. Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, New York, and Texas between 2004 and 2006. A template of 300 representative patients from a single index hospital was constructed and used to match 300 patients at 43 hospitals that had a minimum of 500 patients over a 3-year study period. From each of 43 hospitals we chose 300 patients most resembling the template using multivariate matching. We found close matches on procedures and patient characteristics, far more balanced than would be expected in a randomized trial. There were little to no differences between the index hospital's template and the 43 hospitals on most patient characteristics yet large and significant differences in mortality, failure-to-rescue, and cost. Matching can produce fair, directly standardized audits. From the perspective of the index hospital, "hospital-specific" template matching provides the fairness of direct standardization with the specific institutional relevance of indirect standardization. Using this approach, hospitals will be better able to examine their performance, and better determine why they are achieving the results they observe. © Health Research and Educational Trust.

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico.

PubMed

Bhattarai, Rachana; Carabin, Hélène; Flores-Rivera, Jose; Corona, Teresa; Proaño, Jefferson V; Flisser, Ana; Budke, Christine M

2018-01-01

The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC) during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 - 329) and US$ 2,576 (95% CI: 2,244 - 2,908), respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 - 527), US$ 228 (95% CI: 167 - 288), US$ 157 (95% CI: 111 - 202), US$ 150 (95% CI: 106 - 204), and US$ 91 (95% CI: 27 - 154), respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

PubMed

Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

2017-09-01

To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P < .001. Length of acute hospital stay was significantly shorter in patients discharged to home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P < .001]. The hospital-at-home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

A Cost Analysis of Colonoscopy using Microcosting and Time-and-motion Techniques

PubMed Central

Ness, Reid M.; Stiles, Renée A.; Shintani, Ayumi K.; Dittus, Robert S.

2007-01-01

Background The cost of an individual colonoscopy is an important determinant of the overall cost and cost-effectiveness of colorectal cancer screening. Published cost estimates vary widely and typically report institutional costs derived from gross-costing methods. Objective Perform a cost analysis of colonoscopy using micro-costing and time-and-motion techniques to determine the total societal cost of colonoscopy, which includes direct health care costs as well as direct non-health care costs and costs related to patients’ time. The design is prospective cohort. The participants were 276 contacted, eligible patients who underwent colonoscopy between July 2001 and June 2002, at either a Veterans’ Affairs Medical Center or a University Hospital in the Southeastern United States. Major results The median direct health care cost for colonoscopy was $379 (25%, 75%; $343, $433). The median direct non-health care and patient time costs were $226 (25%, 75%; $187, $323) and $274 (25%, 75%; $186, $368), respectively. The median total societal cost of colonoscopy was $923 (25%, 75%; $805, $1047). The median direct health care, direct non-health care, patient time costs, and total costs at the VA were $391, $288, $274, and $958, respectively; analogous costs at the University Hospital were $376, $189, $368, and $905, respectively. Conclusion Microcosting techniques and time-and-motion studies can produce accurate, detailed cost estimates for complex medical interventions. Cost estimates that inform health policy decisions or cost-effectiveness analyses should use total costs from the societal perspective. Societal cost estimates, which include patient and caregiver time costs, may affect colonoscopy screening rates. PMID:17665271

[Direct service costs of diabetes mellitus hospitalisations in the Mexican Institute of Social Security].

PubMed

Salas-Zapata, Leonardo; Palacio-Mejía, Lina Sofía; Aracena-Genao, Belkis; Hernández-Ávila, Juan Eugenio; Nieto-López, Emmanuel Salvador

To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security METHODS: The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The immediate economic impact of maternal deaths on rural Chinese households.

PubMed

Ye, Fang; Wang, Haijun; Huntington, Dale; Zhou, Hong; Li, Yan; You, Fengzhi; Li, Jinhua; Cui, Wenlong; Yao, Meiling; Wang, Yan

2012-01-01

To identify the immediate economic impact of maternal death on rural Chinese households. Results are reported from a study that matched 195 households who had suffered a maternal death to 384 households that experienced a childbirth without maternal death in rural areas of three provinces in China, using quantitative questionnaire to compare differences of direct and indirect costs between two groups. The direct costs of a maternal death were significantly higher than the costs of a childbirth without a maternal death (US$4,119 vs. $370, p<0.001). More than 40% of the direct costs were attributed to funeral expenses. Hospitalization and emergency care expenses were the largest proportion of non-funeral direct costs and were higher in households with maternal death than the comparison group (US$2,248 vs. $305, p<0.001). To cover most of the high direct costs, 44.1% of affected households utilized compensation from hospitals, and the rest affected households (55.9%) utilized borrowing money or taking loans as major source of money to offset direct costs. The median economic burden of the direct (and non-reimbursed) costs of a maternal death was quite high--37.0% of the household's annual income, which was approximately 4 times as high as the threshold for an expense being considered catastrophic. The immediate direct costs of maternal deaths are extremely catastrophic for the rural Chinese households in three provinces studied.

Economic burden of Clostridium difficile in five hospitals of the Florence health care system in Italy.

PubMed

Poli, Anna; Di Matteo, Sergio; Bruno, Giacomo M; Fornai, Enrica; Valentino, Maria Chiara; Colombo, Giorgio L

2015-01-01

Despite the awareness about the increasing rates of Clostridium difficile infection (CDI) and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation), few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication. We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI. We enrolled 69 patients (19 males and 50 females), with a mean age of 82.16 years (minimum 46 to maximum 98). The total number of hospitalization days observed was 886 (12.8 per patient on average). The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature. The economic impact of CDI is most evident in the extension of the duration of hospitalization and emergency recurrences requiring new therapeutic options with the need to develop and implement new diagnostic and therapeutic algorithms in clinical practice.

Economic burden of Clostridium difficile in five hospitals of the Florence health care system in Italy

PubMed Central

Poli, Anna; Di Matteo, Sergio; Bruno, Giacomo M; Fornai, Enrica; Valentino, Maria Chiara; Colombo, Giorgio L

2015-01-01

Introduction Despite the awareness about the increasing rates of Clostridium difficile infection (CDI) and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation), few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication. Methods We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI. Results We enrolled 69 patients (19 males and 50 females), with a mean age of 82.16 years (minimum 46 to maximum 98). The total number of hospitalization days observed was 886 (12.8 per patient on average). The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature. Conclusion The economic impact of CDI is most evident in the extension of the duration of hospitalization and emergency recurrences requiring new therapeutic options with the need to develop and implement new diagnostic and therapeutic algorithms in clinical practice. PMID:26604846

Tuberculosis Costs in Spain and Related Factors.

PubMed

Gullón, José Antonio; García-García, José María; Villanueva, Manuel Ángel; Álvarez-Navascues, Fernando; Rodrigo, Teresa; Casals, Martí; Anibarro, Luis; García-Clemente, Marta María; Jiménez, María Ángeles; Bustamante, Ana; Penas, Antón; Caminero, José Antonio; Caylà, Joan

2016-12-01

To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. 319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost. Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Annual costs of rheumatoid arthritis in Turkey.

PubMed

Malhan, Simten; Akbulut, Lale Aktekin; Bodur, Hatice; Tulunay, Cankat F

2010-03-01

Objective of the present study is aimed to determine costs of rheumatoid arthritis (RA) based on reimbursement agencies perspective [Social Security Institution (SSI)] in Turkey. The international clinical guidelines for RA are followed for analysing the direct costs. Data were collected from hospital bills, social security institution price lists, and Ministry of Health drug price list. Direct costs of RA patients were estimated as euro 2,669.14 patient/year. Outpatient costs were found to be euro 240.40. Routine tests during the year were calculated as euro 98.85. Ten percent of patients are hospitalized per year, and 0.62% of these patients received arthroplasty and/or other interventions. The cost during hospital stay was euro 87.76. euro 2,238 was determined as being paid per year for medication alone (including anti-TNF) and euro 4 is spent on auxiliary materials annually. Our data show a remarkable economic impact of RA over society. We hope that the cost of RA studies will help package price practices for reimbursement agencies.

Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations.

PubMed

Rottenkolber, Dominik; Schmiedl, Sven; Rottenkolber, Marietta; Farker, Katrin; Saljé, Karen; Mueller, Silke; Hippius, Marion; Thuermann, Petra A; Hasford, Joerg

2011-06-01

German hospital reimbursement modalities changed as a result of the introduction of Diagnosis Related Groups (DRG) in 2004. Therefore, no data on the direct costs of adverse drug reactions (ADRs) resulting in admissions to departments of internal medicine are available. The objective was to quantify the ADR-related economic burden (direct costs) of hospitalizations in internal medicine wards in Germany. Record-based study analyzing the patient records of about 57,000 hospitalizations between 2006 and 2007 of the Net of Regional Pharmacovigilance Centers (Germany). All ADRs were evaluated by a team of experts in pharmacovigilance for severity, causality, and preventability. The calculation of accurate person-related costs for ADRs relied on the German DRG system (G-DRG 2009). Descriptive and bootstrap statistical methods were applied for data analysis. The incidence of hospitalization due to at least 'possible' serious outpatient ADRs was estimated to be approximately 3.25%. Mean age of the 1834 patients was 71.0 years (SD 14.7). Most frequent ADRs were gastrointestinal hemorrhage (n = 336) and drug-induced hypoglycemia (n = 270). Average inpatient length-of-stay was 9.3 days (SD 7.1). Average treatment costs of a single ADR were estimated to be approximately €2250. The total costs sum to €434 million per year for Germany. Considering the proportion of preventable cases (20.1%), this equals a saving potential of €87 million per year. Preventing ADRs is advisable in order to realize significant nationwide savings potential. Our cost estimates provide a reliable benchmark as they were calculated based on an intensified ADR surveillance and an accurate person-related cost application. Copyright © 2011 John Wiley & Sons, Ltd.

Cost analysis of Omega-3 supplementation in critically ill patients with sepsis.

PubMed

Kyeremanteng, Kwadwo; Shen, Jennifer; Thavorn, Kednapa; Fernando, Shannon M; Herritt, Brent; Chaudhuri, Dipayan; Tanuseputro, Peter

2018-06-01

Nutritional supplement of omega-3 fatty acids have been proposed to improve clinical outcomes in critically ill patients. While previous work have demonstrated that omega-3 supplementation in patients with sepsis is associated with reduced ICU and hospital length of stay, the financial impact of this intervention is unknown. Perform a cost analysis to evaluate the impact of omega-3 supplementation on ICU and hospital costs. We extracted data related to ICU and hospital length of stay from the individual studies reported in a recent systematic review. The Cochrane Collaboration tool was used to assess the risk of bias in these studies. Average daily ICU and hospital costs per patient were obtained from a cost study by Kahn et al. We estimated the ICU and hospital costs by multiplying the mean length of stay by the average daily cost per patient in ICU or Hospital. Adjustments for inflation were made according to the USD annual consumer price index. We calculated the difference between the direct variable cost of patients with omega-3 supplementation and patients without omega-3 supplementation. 95% confidence intervals were estimated using bootstrap re-sampling procedures with 1000 iterations. A total of 12 RCT involving 925 patients were included in this cost analysis. Septic patients supplemented with omega-3 had both lower mean ICU costs ($15,274 vs. $18,172) resulting in $2897 in ICU savings per patient and overall hospital costs ($17,088 vs. $19,778), resulting in $2690 in hospital savings per patient. Sensitivity analyses were conducted to investigate the impact of different study methods on the LOS. The results were still consistent with the overall findings. Patients with sepsis who received omega-3 supplementation had significantly shorter LOS in the ICU and hospital, and were associated with lower direct variable costs than control patients. The 12 RCTs used in this analysis had a high risk of bias. Large-scaled, high-quality, multi-centered RCTs on the effectiveness of this intervention is recommended to improve the quality of the existing evidence. Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Economic cost analysis of malaria case management at the household level during the malaria elimination phase in The People's Republic of China.

PubMed

Xia, Shang; Ma, Jin-Xiang; Wang, Duo-Quan; Li, Shi-Zhu; Rollinson, David; Zhou, Shui-Sen; Zhou, Xiao-Nong

2016-06-03

In China, malaria has been posing a significant economic burden on households. To evaluate malaria economic burden in terms of both direct and indirect costs has its meaning in improving the effectiveness of malaria elimination program in China. A number of study sites (eight counties in five provinces) were selected from the malaria endemic area in China, representing the different levels of malaria incidence, risk classification, economic development. A number of households with malaria cases (n = 923) were surveyed during the May to December in 2012 to collect information on malaria economic burden. Descriptive statistics were used to characterize the basic profiles of selected malaria cases in terms of their gender, age group, occupation and malaria type. The malaria economic costs were evaluated by direct and indirect costs. Comparisons were carried out by using the chi-square test (or Z-test) and the Mann-Whitney U test among malaria cases with reference to local/imported malaria patients, hospitalized/out patients, and treatment hospitals. The average cost of malaria per case was 1 691.23 CNY (direct cost was 735.41 CNY and indirect cost was 955.82 CNY), which accounted for 11.1 % of a household's total income. The average costs per case for local and imported malaria were 1 087.58 CNY and 4271.93 CNY, respectively. The average cost of a malaria patient being diagnosed and treated in a hospital at the county level or above (3 975.43 CNY) was 4.23 times higher than that of malaria patient being diagnosed and treated at a village or township hospital (938.80 CNY). This study found that malaria has been posing a significant economic burden on households in terms of direct and indirect costs. There is a need to improve the effectiveness of interventions in order to reduce the impact costs of malaria, especially of imported infections, in order to eliminate the disease in China.

Primary prevention of pediatric abusive head trauma: a cost audit and cost-utility analysis.

PubMed

Friedman, Joshua; Reed, Peter; Sharplin, Peter; Kelly, Patrick

2012-01-01

To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program. A 5 year cohort of infants with abusive head trauma admitted to hospital in Auckland, New Zealand was reviewed. We determined the direct costs of hospital care (from hospital and Ministry of Health financial records), community rehabilitation (from the Accident Compensation Corporation), special education (from the Ministry of Education), investigation and child protection (from the Police and Child Protective Services), criminal trials (from the Police, prosecution and defence), punishment of offenders (from the Department of Corrections) and life-time care for moderate or severe disability (from the Accident Compensation Corporation). Analysis of the possible cost-utility of a national primary prevention program was undertaken, using the costs established in our cohort, recent New Zealand national data on the incidence of pediatric abusive head trauma, international data on quality of life after head trauma, and published international literature on prevention programs. There were 52 cases of abusive head trauma in the sample. Hospital costs totaled $NZ2,433,340, child protection $NZ1,560,123, police investigation $NZ1,842,237, criminal trials $NZ3,214,020, punishment of offenders $NZ4,411,852 and community rehabilitation $NZ2,895,848. Projected education costs for disabled survivors were $NZ2,452,148, and the cost of projected lifetime care was $NZ33,624,297. Total costs were $NZ52,433,864, averaging $NZ1,008,344 per child. Cost-utility analysis resulted in a strongly positive economic argument for primary prevention, with expected case scenarios showing lowered net costs with improved health outcomes. Pediatric abusive head trauma is very expensive, and on a conservative estimate the costs of acute hospitalization represent no more than 4% of lifetime direct costs. If shaken baby prevention programs are effective, there is likely to be a strong economic argument for their implementation. This study also provides robust data for future cost-benefit analysis in the field of abusive head trauma prevention. Copyright © 2012 Elsevier Ltd. All rights reserved.

The direct hospitalization cost of care for acute burns in Lagos, Nigeria: a one-year prospective study

PubMed Central

Ahachi, C.N.; Fadeyibi, I.O.; Abikoye, F.O.; Chira, M.K.; Ugburo, A.O.; Ademiluyi, S.A.

2011-01-01

Summary Objective. We conducted a prospective study to identify the direct hospitalization cost of managing major acute burns in Lagos, Nigeria, and to determine the factors that influence the cost. Method. All consecutive and consenting patients seen and managed for major burns at the National Orthopaedic Hospital, Igbobi, Lagos, between 1 June 2007 and 31 May 2008 were recruited for the study. A special form designed for the study was used to collect the necessary data. Results. Fifty-two patients were seen during the study period (27 males and 25 females). The ages ranged from 2 months to 69 yr with a mean of 25.4 ± 17.1 yr. The length of hospital stay ranged from 0.3-12 months (mean, 3.2 ± 3.1 months). The average daily cost of treating a patient was ₦ (naira) 8,855 (₦1000 = €4.44) and the average overall cost was ₦209,303.70, with the costs of wound dressings, hospital admission, and surgery constituting respectively 29.5%, 25.7%, and 19.1% of the total amount spent. Conclusion. The length of hospital stay was prolonged in many patients and management methods should be reviewed to reduce this. The cost of managing burns is prohibitive for an average Nigerian. Efforts should be intensified to prevent burn injury and a Special Health Insurance policy should be established to finance burns management. PMID:22262967

Systematic Review of the Economic Burden of Overt Hepatic Encephalopathy and Pharmacoeconomic Impact of Rifaximin.

PubMed

Neff, Guy; Iii, Woodie Zachry

2018-04-12

Hepatic encephalopathy (HE), a common neurologic complication in cirrhosis, is associated with substantial disease and economic burden. Rifaximin is a non-systemic antibiotic that reduces the risk of overt HE recurrence and overt HE-related hospitalizations. Our objective was to provide an overview of the direct HE-related costs and cost benefits of rifaximin, lactulose, and rifaximin plus lactulose. A systematic review of PubMed and relevant meeting abstracts was conducted to identify publications since 1 January 2007 reporting economic data related to HE and rifaximin and/or lactulose. Further, a public database and published literature were used to estimate current costs of hospitalization for overt HE, and potential cost savings of HE-related hospitalizations with rifaximin. The methodological quality of included studies was evaluated using the Drummond checklist. A total of 16 reports were identified for inclusion in the systematic review. Globally, HE-related direct costs ranged from $US5370 to $US50,120 annually per patient. Rifaximin was associated with shorter hospital stays and reduced healthcare costs. Rifaximin also has the potential to reduce overt HE-related hospitalization risk by 50% compared with lactulose. Rifaximin was shown to have a favourable pharmacoeconomic profile compared with lactulose (based on the incremental cost-effectiveness ratio). In addition to its clinical benefits (e.g. reduction in the risk of recurrence of overt HE, overt HE-related hospitalizations, favourable adverse event profile), economic data are favourable for the use of rifaximin in patients with a history of overt HE.

Counting Costs under Severe Financial Constraints: A Cost-of-Illness Analysis of Spondyloarthropathies in a Tertiary Hospital in Greece.

PubMed

Tsifetaki, Niki; Migkos, Michail P; Papagoras, Charalampos; Voulgari, Paraskevi V; Athanasakis, Kostas; Drosos, Alexandros A

2015-06-01

To investigate the total annual direct cost of patients with spondyloarthritis (SpA) in Greece. Retrospective study with 156 patients diagnosed and followed up in the rheumatology clinic of the University Hospital of Ioannina. Sixty-four had ankylosing spondylitis (AS) and 92 had psoriatic arthritis (PsA). Health resource use for each patient was elicited through a retrospective chart review that documented the use of monitoring visits, medications, laboratory/diagnostic tests, and inpatient stays for the previous year from the date that the review took place. Costs were calculated from a third-party payer perspective and are reported in 2014 euros. The mean ± SD annual direct cost for the patients with SpA reached €8680 ± 6627. For the patients with PsA and AS, the cost was estimated to be €8097 ± 6802 and €9531 ± 6322, respectively. The major cost was medication, which represented 88.9%, 88.2%, and 89.3% of the mean total direct cost for SpA, AS, and PsA, respectively. The annual amount of the scheduled tests for all patients corresponded to 7.5%, and for those performed on an emergency basis, 1.1%. Further, the cost for scheduled and emergency hospitalization, as well as the cost of scheduled visits to an outpatient clinic, corresponded to 2.5% of the mean total annual direct cost for the patients with SpA. SpA carries substantial financial cost, especially in the era of new treatment options. Adequate access and treatment for patients with SpA remains a necessity, even in times of fiscal constraint. Thus, the recommendations of the international scientific organizations should be considered when administering high-cost drugs such as biological treatments.

Reliability and Validity in Hospital Case-Mix Measurement

PubMed Central

Pettengill, Julian; Vertrees, James

1982-01-01

There is widespread interest in the development of a measure of hospital output. This paper describes the problem of measuring the expected cost of the mix of inpatient cases treated in a hospital (hospital case-mix) and a general approach to its solution. The solution is based on a set of homogenous groups of patients, defined by a patient classification system, and a set of estimated relative cost weights corresponding to the patient categories. This approach is applied to develop a summary measure of the expected relative costliness of the mix of Medicare patients treated in 5,576 participating hospitals. The Medicare case-mix index is evaluated by estimating a hospital average cost function. This provides a direct test of the hypothesis that the relationship between Medicare case-mix and Medicare cost per case is proportional. The cost function analysis also provides a means of simulating the effects of classification error on our estimate of this relationship. Our results indicate that this general approach to measuring hospital case-mix provides a valid and robust measure of the expected cost of a hospital's case-mix. PMID:10309909

The Chikungunya Epidemic on La Réunion Island in 2005–2006: A Cost-of-Illness Study

PubMed Central

Soumahoro, Man-Koumba; Boelle, Pierre-Yves; Gaüzere, Bernard-Alex; Atsou, Kokuvi; Pelat, Camille; Lambert, Bruno; La Ruche, Guy; Gastellu-Etchegorry, Marc; Renault, Philippe; Sarazin, Marianne; Yazdanpanah, Yazdan; Flahault, Antoine; Malvy, Denis; Hanslik, Thomas

2011-01-01

Background This study was conducted to assess the impact of chikungunya on health costs during the epidemic that occurred on La Réunion in 2005–2006. Methodology/Principal Findings From data collected from health agencies, the additional costs incurred by chikungunya in terms of consultations, drug consumption and absence from work were determined by a comparison with the expected costs outside the epidemic period. The cost of hospitalization was estimated from data provided by the national hospitalization database for short-term care by considering all hospital stays in which the ICD-10 code A92.0 appeared. A cost-of-illness study was conducted from the perspective of the third-party payer. Direct medical costs per outpatient and inpatient case were evaluated. The costs were estimated in Euros at 2006 values. Additional reimbursements for consultations with general practitioners and drugs were estimated as €12.4 million (range: €7.7 million–€17.1 million) and €5 million (€1.9 million–€8.1 million), respectively, while the cost of hospitalization for chikungunya was estimated to be €8.5 million (€5.8 million–€8.7 million). Productivity costs were estimated as €17.4 million (€6 million–€28.9 million). The medical cost of the chikungunya epidemic was estimated as €43.9 million, 60% due to direct medical costs and 40% to indirect costs (€26.5 million and €17.4 million, respectively). The direct medical cost was assessed as €90 for each outpatient and €2,000 for each inpatient. Conclusions/Significance The medical management of chikungunya during the epidemic on La Réunion Island was associated with an important economic burden. The estimated cost of the reported disease can be used to evaluate the cost/efficacy and cost/benefit ratios for prevention and control programmes of emerging arboviruses. PMID:21695162

Induction-related cost of patients with acute myeloid leukaemia in France.

PubMed

Nerich, Virginie; Lioure, Bruno; Rave, Maryline; Recher, Christian; Pigneux, Arnaud; Witz, Brigitte; Escoffre-Barbe, Martine; Moles, Marie-Pierre; Jourdan, Eric; Cahn, Jean Yves; Woronoff-Lemsi, Marie-Christine

2011-04-01

The economic profile of acute myeloid leukaemia (AML) is badly known. The few studies published on this disease are now relatively old and include small numbers of patients. The purpose of this retrospective study was to evaluate the induction-related cost of 500 patients included in the AML 2001 trial, and to determine the explanatory factors of cost. "Induction" patient's hospital stay from admission for "induction" to discharge after induction. The study was performed from the French Public Health insurance perspective, restrictive to hospital institution costs. The average management of a hospital stay for "induction" was evaluated according to the analytical accounting of Besançon University Teaching Hospital and the French public Diagnosis-Related Group database. Multiple linear regression was used to search for explanatory factors. Only direct medical costs were included: treatment and hospitalisation. Mean induction-related direct medical cost was estimated at €41,852 ± 6,037, with a mean length of hospital stay estimated at 36.2 ± 10.7 days. After adjustment for age, sex and performance status, only two explanatory factors were found: an additional induction course and salvage course increased induction-related cost by 38% (± 4) and 15% (± 1) respectively, in comparison to one induction. These explanatory factors were associated with a significant increase in the mean length of hospital stay: 45.8 ± 11.6 days for 2 inductions and 38.5 ± 15.5 if the patient had a salvage course, in comparison to 32.9 ± 7.7 for one induction (P < 10⁻⁴). This result is robust and was confirmed by sensitivity analysis. Consideration of economic constraints in health care is now a reality. Only the control of length of hospital stay may lead to a decrease in induction-related cost for patients with AML.

Rationale and design of the health economics evaluation registry for remote follow-up: TARIFF.

PubMed

Ricci, Renato P; D'Onofrio, Antonio; Padeletti, Luigi; Sagone, Antonio; Vicentini, Alfredo; Vincenti, Antonio; Morichelli, Loredana; Cavallaro, Ciro; Ricciardi, Giuseppe; Lombardi, Leonida; Fusco, Antonio; Rovaris, Giovanni; Silvestri, Paolo; Guidotto, Tiziana; Pollastrelli, Annalisa; Santini, Massimo

2012-11-01

The aims of the study are to develop a cost-minimization analysis from the hospital perspective and a cost-effectiveness analysis from the third payer standpoint, based on direct estimates of costs and QOL associated with remote follow-ups, using Merlin@home and Merlin.net, compared with standard ambulatory follow-ups, in the management of ICD and CRT-D recipients. Remote monitoring systems can replace ambulatory follow-ups, sparing human and economic resources, and increasing patient safety. TARIFF is a prospective, controlled, observational study aimed at measuring the direct and indirect costs and quality of life (QOL) of all participants by a 1-year economic evaluation. A detailed set of hospitalized and ambulatory healthcare costs and losses of productivity that could be directly influenced by the different means of follow-ups will be collected. The study consists of two phases, each including 100 patients, to measure the economic resources consumed during the first phase, associated with standard ambulatory follow-ups, vs. the second phase, associated with remote follow-ups. Remote monitoring systems enable caregivers to better ensure patient safety and the healthcare to limit costs. TARIFF will allow defining the economic value of remote ICD follow-ups for Italian hospitals, third payers, and patients. The TARIFF study, based on a cost-minimization analysis, directly comparing remote follow-up with standard ambulatory visits, will validate the cost effectiveness of the Merlin.net technology, and define a proper reimbursement schedule applicable for the Italian healthcare system. NCT01075516.

Direct, indirect, and intangible costs after severe trauma up to occupational reintegration - an empirical analysis of 113 seriously injured patients.

PubMed

Anders, Benjamin; Ommen, Oliver; Pfaff, Holger; Lüngen, Markus; Lefering, Rolf; Thüm, Sonja; Janssen, Christian

2013-01-01

Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients. This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients' sociodemographic and socioeconomic characteristics was performed. At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4). The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies.

Direct, indirect, and intangible costs after severe trauma up to occupational reintegration – an empirical analysis of 113 seriously injured patients

PubMed Central

Anders, Benjamin; Ommen, Oliver; Pfaff, Holger; Lüngen, Markus; Lefering, Rolf; Thüm, Sonja; Janssen, Christian

2013-01-01

Aim: Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients. Methods: This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients’ sociodemographic and socioeconomic characteristics was performed. Results: At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4). Conclusions: The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies. PMID:23798979

Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience.

PubMed

Mouraviev, Vladimir; Nosnik, Israel; Sun, Leon; Robertson, Cary N; Walther, Philip; Albala, David; Moul, Judd W; Polascik, Thomas J

2007-02-01

To evaluate the financial implications of how the costs of new minimally invasive surgery such as laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of the prostate (CAP) technologies compare with those of conventional surgery. From January 2002 to July 2005, 452 consecutive patients underwent surgical treatment for clinically localized (Stage T1-T2) prostate cancer. The distribution of patients among the surgical procedures was as follows: group 1, radical retropubic prostatectomy (RRP) (n = 197); group 2, radical perineal prostatectomy (RPP) (n = 60); group 3, LRP (n = 137); and group 4, CAP (n = 58). The total direct hospital costs and grand total hospital costs were analyzed for each type of surgery. The mean length of stay in the CAP group was significantly lower (0.16 +/- 0.14 days) than that for RRP (2.79 +/- 1.46 days), RPP (2.87 +/- 1.43 days), and LRP (2.15 +/- 1.48 days; P <0.0005). The direct surgical costs were less for the RRP (2471 dollars +/- 636 dollars) and RPP (2788 dollars +/- 762 dollars) groups than for the technology-dependent procedures: LRP (3441 dollars +/- 545 dollars) and CAP (5702 dollars +/- 1606 dollars; P <0.0005). The total hospital cost differences, including pathologic assessment costs, were less for LRP (10,047 dollars +/- 107 dollars, median 9343 dollars) and CAP (9195 dollars +/- 1511 dollars, median 8796 dollars) than for RRP (10,704 dollars +/- 3468 dollars, median 9724 dollars) or RPP (10,536 dollars +/- 3088 dollars, median 9251 dollars), with significant differences (P <0.05) between the minimally invasive technique and open surgery groups. In our study, despite the relatively increased surgical expense of CAP compared with conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs were offset by the significantly lower nonoperative hospital costs. The cost advantages associated with CAP included a shorter length of stay in the hospital and the absence of pathologic costs and the need for blood transfusion.

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique

PubMed Central

Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

2015-01-01

Background: Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. Objectives: The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). Materials and Methods: We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Results: Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. Conclusion: As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs. PMID:26715979

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.

PubMed

Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

2015-10-01

Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs.

Are cost differences between specialist and general hospitals compensated by the prospective payment system?

PubMed

Longo, Francesco; Siciliani, Luigi; Street, Andrew

2017-10-23

Prospective payment systems fund hospitals based on a fixed-price regime that does not directly distinguish between specialist and general hospitals. We investigate whether current prospective payments in England compensate for differences in costs between specialist orthopaedic hospitals and trauma and orthopaedics departments in general hospitals. We employ reference cost data for a sample of hospitals providing services in the trauma and orthopaedics specialty. Our regression results suggest that specialist orthopaedic hospitals have on average 13% lower profit margins. Under the assumption of break-even for the average trauma and orthopaedics department, two of the three specialist orthopaedic hospitals appear to make a loss on their activity. The same holds true for 33% of departments in our sample. Patient age and severity are the main drivers of such differences.

Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis.

PubMed

May, Peter; Normand, Charles; Cassel, J Brian; Del Fabbro, Egidio; Fine, Robert L; Menz, Reagan; Morrison, Corey A; Penrod, Joan D; Robinson, Chessie; Morrison, R Sean

2018-06-01

Economics of care for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations. To estimate the association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness. Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation. For Embase, PsycINFO, and CENTRAL, we searched without a time limitation. For PubMed, CINAHL, and EconLit, we searched for articles published after August 1, 2013. Data analysis was performed from April 8, 2017, to September 16, 2017. Economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only, controlling for a minimum list of confounders. Eight eligible studies were identified, all cohort studies, of which 6 provided sufficient information for inclusion. The study estimated the association of PCC within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting. Treatment effect estimates were pooled in the meta-analysis. Total direct hospital costs. This study included 6 samples with a total 133 118 patients (range, 1020-82 273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%). Mean Elixhauser index scores ranged from 2.2 to 3.5 among the studies. When patients were pooled irrespective of diagnosis, there was a statistically significant reduction in costs (-$3237; 95% CI, -$3581 to -$2893; P < .001). In the stratified analyses, there was a reduction in costs for the cancer (-$4251; 95% CI, -$4664 to -$3837; P < .001) and noncancer (-$2105; 95% CI, -$2698 to -$1511; P < .001) subsamples. The reduction in cost was greater in those with 4 or more comorbidities than for those with 2 or fewer. The estimated association of early hospital PCC with hospital costs may vary according to baseline clinical factors. Estimates may be larger for primary diagnosis of cancer and more comorbidities compared with primary diagnosis of noncancer and fewer comorbidities. Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.

Cost of illness due to typhoid Fever in pemba, zanzibar, East Africa.

PubMed

Riewpaiboon, Arthorn; Piatti, Moritz; Ley, Benedikt; Deen, Jacqueline; Thriemer, Kamala; von Seidlein, Lorenz; Salehjiddawi, Mohammad; Busch, Clara Jana-Lui; Schmied, Wolfgang H; Ali, Said Mohammed; The Typhoid Economic Study Group GiDeok Pak Leon R Ochiai Mahesh K Puri Na Yoon Chang Thomas F Wierzba And John D Clemens

2014-09-01

The aim of this study was to estimate the economic burden of typhoid fever in Pemba, Zanzibar, East Africa. This study was an incidence-based cost-of-illness analysis from a societal perspective. It covered new episodes of blood culture-confirmed typhoid fever in patients presenting at the outpatient or inpatient departments of three district hospitals between May 2010 and December 2010. Cost of illness was the sum of direct costs and costs for productivity loss. Direct costs covered treatment, travel, and meals. Productivity costs were loss of income by patients and caregivers. The analysis included 17 episodes. The mean age of the patients, was 23 years (range=5-65, median=22). Thirty-five percent were inpatients, with a mean of 4.75 days of hospital stay (range=3-7, median=4.50). The mean cost for treatment alone during hospital care was US$ 21.97 at 2010 prices (US$ 1=1,430.50 Tanzanian Shilling─TSH). The average societal cost was US$ 154.47 per typhoid episode. The major expenditure was productivity cost due to lost wages of US$ 128.02 (83%). Our results contribute to the further economic evaluation of typhoid fever vaccination in Zanzibar and other sub-Saharan African countries.

Cost analysis of microtia treatment in the Netherlands.

PubMed

Kolodzynski, M N; van Hövell Tot Westerflier, C V A; Kon, M; Breugem, C C

2017-09-01

Ear reconstruction for microtia is a challenging procedure. Although analyzing esthetic outcome is crucial, there is a paucity of information with regard to financial aspects of microtia reconstruction. This study was conducted to analyze the costs associated with ear reconstruction with costal cartilage in patients with microtia. Ten consecutive children with autologous ear reconstruction of a unilateral microtia were included in this analysis. All patients had completed their treatment protocol for ear reconstruction. Direct costs (admission to hospital, diagnostics, and surgery) and indirect cost (travel expenses and absence from work) were obtained retrospectively. The overall mean cumulative cost per patient was €14,753. Direct and indirect costs were €13,907 and €846, respectively. Hospital admission and surgery cover 55% and 32% of all the costs, respectively. This study analyzes the costs for autologous ear reconstruction. Hospital admission and surgery are the most important factors of the total costs. Total costs could be decreased by possibly decreasing admission days and surgical time. These data can be used for choosing and developing future treatment strategies. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Analysis of hospital costs as a basis for pricing services in Mali.

PubMed

Audibert, Martine; Mathonnat, Jacky; Pareil, Delphine; Kabamba, Raymond

2007-01-01

In a move to achieve a better equity in the funding of access to health care, particularly for the poor, a better efficiency of hospital functioning and a better financial balance, the analysis of hospital costs in Mali brings several key elements to improve the pricing of medical services. The method utilized is the classical step-down process which takes into consideration the entire set of direct and indirect costs borne by the hospital. Although this approach does not allow to estimate the economic cost of consultations, it is a useful contribution to assess the financial activity of the hospital and improve its performance, financially speaking, through a more relevant user fees policy. The study shows that there are possibilities of cross-subsidies within the hospital or within services which improve the recovery of some of the current costs. It also leads to several proposals of pricing care while taking into account the constraints, the level of the hospital its specific conditions and equity. Copyright (c) 2007 John Wiley & Sons, Ltd.

Impact of comorbidities on hospitalization costs following hip fracture.

PubMed

Nikkel, Lucas E; Fox, Edward J; Black, Kevin P; Davis, Charles; Andersen, Lucille; Hollenbeak, Christopher S

2012-01-04

Hip fractures are common in the elderly, and patients with hip fractures frequently have comorbid illnesses. Little is known about the relationship between comorbid illness and hospital costs or length of stay following the treatment of hip fracture in the United States. We hypothesized that specific individual comorbid illnesses and multiple comorbid illnesses would be directly related to the hospitalization costs and the length of stay for older patients following hip fracture. With use of discharge data from the 2007 Nationwide Inpatient Sample, 32,440 patients who were fifty-five years or older with an isolated, closed hip fracture were identified. Using generalized linear models, we estimated the impact of comorbidities on hospitalization costs and length of stay, controlling for patient, hospital, and procedure characteristics. Hypertension, deficiency anemias, and fluid and electrolyte disorders were the most common comorbidities. The patients had a mean of three comorbidities. Only 4.9% of patients presented without comorbidities. The average estimated cost in our reference patient was $13,805. The comorbidity with the largest increased hospitalization cost was weight loss or malnutrition, followed by pulmonary circulation disorders. Most other comorbidities significantly increased the cost of hospitalization. Compared with internal fixation of the hip fracture, hip arthroplasty increased hospitalization costs significantly. Comorbidities significantly affect the cost of hospitalization and length of stay following hip fracture in older Americans, even while controlling for other variables.

The economics of treatment for infants with respiratory distress syndrome.

PubMed

Neil, N; Sullivan, S D; Lessler, D S

1998-01-01

To define clinical outcomes and prevailing patterns of care for the initial hospitalization of infants at greatest risk for respiratory distress syndrome (RDS); to estimate direct medical care costs associated with the initial hospitalization; and to introduce and demonstrate a simulation technique for the economic evaluation of health care technologies. Clinical outcomes and usual-care algorithms were determined for infants with RDS in three birthweight categories (500-1,000g; >1,000-1,500g; and >1,500g) using literature- and expert-panel-based data. The experts were practitioners from major U.S. hospitals who were directly involved in the clinical care of such infants. Using the framework derived from the usual care patterns and outcomes, the authors developed an itemized "micro-costing" economic model to simulate the costs associated with the initial hospitalization of a hypothetical RDS patient. The model is computerized and dynamic; unit costs, frequencies, number of days, probabilities and population multipliers are all variable and can be modified on the basis of new information or local conditions. Aggregated unit costs are used to estimate the expected medical costs of treatment per patient. Expected costs of initial hospitalization per uncomplicated surviving infant with RDS were estimated to be $101,867 for 500-1,000g infants; $64,524 for >1,000-1,500g infants; and $27,224 for >1,500g infants. Incremental costs of complications among survivors were estimated to be $22,155 (500-1,000g); $11,041 (>1,000-1,500g); and $2,448 (>1,500 g). Expected costs of initial hospitalization per case (including non-survivors) were $100,603; $72,353; and $28,756, respectively. An itemized model such as the one developed here serves as a benchmark for the economic assessment of treatment costs and utilization. Moreover, it offers a powerful tool for the prospective evaluation of new technologies or procedures designed to reduce the incidence of, severity of, and/or total hospital resource use ascribed to RDS.

A new costing model in hospital management: time-driven activity-based costing system.

PubMed

Öker, Figen; Özyapıcı, Hasan

2013-01-01

Traditional cost systems cause cost distortions because they cannot meet the requirements of today's businesses. Therefore, a new and more effective cost system is needed. Consequently, time-driven activity-based costing system has emerged. The unit cost of supplying capacity and the time needed to perform an activity are the only 2 factors considered by the system. Furthermore, this system determines unused capacity by considering practical capacity. The purpose of this article is to emphasize the efficiency of the time-driven activity-based costing system and to display how it can be applied in a health care institution. A case study was conducted in a private hospital in Cyprus. Interviews and direct observations were used to collect the data. The case study revealed that the cost of unused capacity is allocated to both open and laparoscopic (closed) surgeries. Thus, by using the time-driven activity-based costing system, managers should eliminate the cost of unused capacity so as to obtain better results. Based on the results of the study, hospital management is better able to understand the costs of different surgeries. In addition, managers can easily notice the cost of unused capacity and decide how many employees to be dismissed or directed to other productive areas.

Legionnaire's disease avoidance planning.

PubMed

Broadbent, Clive

2007-09-01

Hospital-acquired infection is the cause of about 5,000 deaths a year in the UK. In New Zealand, there are more than three times as many such deaths as from the annual road toll. The costs in loss of income, in pain and suffering and in direct costs to hospitals are staggering.

Seizure Correlates with Prolonged Hospital Stay, Increased Costs, and Increased Mortality in Nontraumatic Subdural Hematoma.

PubMed

Joseph, Jacob R; Smith, Brandon W; Williamson, Craig A; Park, Paul

2016-08-01

Nontraumatic subdural hematoma (NTSDH) is a common neurosurgical disease process, with mortality reported as high as 13%. Seizure has a known association with NTSDH, although patient outcomes have not previously been well studied in this population. The purpose of this study was to examine the relationship between in-hospital seizure and inpatient outcomes in NTSDH. Using the University HealthSystem Consortium (UHC) database, we performed a retrospective cohort study of adults with a principal diagnosis of NTSDH (International Classification of Diseases, Ninth Revision code 43.21) between 2011 and 2015. Patients with in-hospital seizure (International Classification of Diseases, Ninth Revision codes 34500-34591, 78033, 78039) were compared with those without. Patients with a history of seizure before arrival were excluded. Patient demographics, hospital length of stay (LOS), intensive care unit stay, in-hospital mortality, and direct costs were recorded. A total 16,928 patients with NTSDH were identified. Mean age was 69.2 years, and 64.7% were male. In-hospital seizure was documented in 744 (4.40%) patients. Hospital LOS was 17.64 days in patients with seizure and 6.26 days in those without (P < 0.0001). Mean intensive care unit stay increased from 3.36 days without seizure to 9.36 days with seizure. In-hospital mortality was 9.19% in patients without seizure and 16.13% in those with seizure (P < 0.0001). Direct costs were $12,781 in patients without seizure and $38,110 in those with seizure (P < 0.0001). Seizure in patients with NTSDH correlates with significantly increased total LOS and increased mortality. Direct costs are similarly increased. Further studies accounting for effects of illness severity are necessary to validate these results. Copyright © 2016 Elsevier Inc. All rights reserved.

Economic costs of outbreaks of acute viral gastroenteritis due to norovirus in Catalonia (Spain), 2010-2011.

PubMed

Navas, Encarna; Torner, Nuria; Broner, Sonia; Godoy, Pere; Martínez, Ana; Bartolomé, Rosa; Domínguez, Angela

2015-10-01

To determine the direct and indirect costs of outbreaks of acute viral gastroenteritis (AVG) due to norovirus in closed institutions (hospitals, social health centers or nursing homes) and the community in Catalonia in 2010-11. Information on outbreaks were gathered from the reports made by epidemiological surveillance units. Direct costs (medical visits, hospital stays, drug treatment, sample processing, transport, diagnostic tests, monitoring and control of the outbreaks investigated) and indirect costs (lost productivity due to work absenteeism, caregivers time and working hours lost due to medical visits) were calculated. Twenty-seven outbreaks affecting 816 people in closed institutions and 74 outbreaks affecting 1,940 people in the community were detected. The direct and indirect costs of outbreaks were € 131,997.36 (€ 4,888.79 per outbreak) in closed institutions and € 260,557.16 (€ 3,521.04 per outbreak) in community outbreaks. The cost per case was € 161.76 in outbreaks in closed institutions and € 134.31 in community outbreaks. The main costs were surveillance unit monitoring (€ 116,652.93), laboratory diagnoses (€ 119,950.95), transport of samples (€ 69,970.90), medical visits (€ 25,250.50) and hospitalization (€ 13,400.00). The cost of outbreaks of acute viral gastroenteritis due to norovirus obtained in this study was influenced by the number of people affected and the severity of the outbreak, which determined hospitalizations and work absenteeism. Urgent reporting of outbreaks would allow the implementation of control measures that could reduce the numbers affected and the duration of the illness and thus the costs derived from them.

Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA.

PubMed

Wagner, Todd H; Chen, Shuo; Barnett, Paul G

2003-09-01

The U.S. Department of Veterans Affairs (VA) maintains discharge abstracts, but these do not include cost information. This article describes the methods the authors used to estimate the costs of VA medical-surgical hospitalizations in fiscal years 1998 to 2000. They estimated a cost regression with 1996 Medicare data restricted to veterans receiving VA care in an earlier year. The regression accounted for approximately 74 percent of the variance in cost-adjusted charges, and it proved to be robust to outliers and the year of input data. The beta coefficients from the cost regression were used to impute costs of VA medical-surgical hospital discharges. The estimated aggregate costs were reconciled with VA budget allocations. In addition to the direct medical costs, their cost estimates include indirect costs and physician services; both of these were allocated in proportion to direct costs. They discuss the method's limitations and application in other health care systems.

The Cost of Morbidities in Very Low Birth Weight Infants

PubMed Central

Johnson, Tricia J.; Patel, Aloka L.; Jegier, Briana; Engstrom, Janet L.; Meier, Paula

2013-01-01

Objective The objective of this study was to determine the association between direct costs for the initial neonatal intensive care unit (NICU) hospitalization and four potentially preventable morbidities in a retrospective cohort of very low birth weight infants (VLBW; <1500g birth weight). Methods The sample included 425 VLBW infants born alive between July 2005 and June 2009 at Rush University Medical Center. Morbidities included brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and late onset sepsis. Clinical and economic data were retrieved from the institution’s system-wide data warehouse and cost accounting system. A general linear regression model was fit to determine incremental direct costs associated with each morbidity. Results After controlling for birth weight, gestational age, and socio-demographic characteristics, the presence of brain injury was associated with a $12,048 (p=0.005) increase in direct costs; necrotizing enterocolitis with a $15,440 (p=0.005) increase; bronchopulmonary dysplasia with a $31,565 (p<0.001) increase; and late onset sepsis with a $10,055 (p<0.001) increase in direct costs. The absolute number of morbidities was also associated with significantly higher costs. Conclusions This study provides the first collective estimates of the direct costs during the NICU hospitalization for these four morbidities in VLBW infants. The incremental costs associated with these morbidities were high, and these data can inform future studies evaluating interventions to prevent or reduce these costly morbidities. PMID:22910099

The cost of chronic pain: an analysis of a regional pain management service in Ireland.

PubMed

Gannon, Brenda; Finn, David P; O'Gorman, David; Ruane, Nancy; McGuire, Brian E

2013-10-01

The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden. Wiley Periodicals, Inc.

Cost-effectiveness of rotavirus vaccination in Bolivia from the state perspective.

PubMed

Smith, Emily R; Rowlinson, Emily E; Iniguez, Volga; Etienne, Kizee A; Rivera, Rosario; Mamani, Nataniel; Rheingans, Rick; Patzi, Maritza; Halkyer, Percy; Leon, Juan S

2011-09-02

In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state's policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program. To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia. Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness. Our data will guide Bolivia's funding allocation for RV as international subsidies change. Copyright © 2011 Elsevier Ltd. All rights reserved.

Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain

PubMed Central

2010-01-01

Background Although some studies indicate that bipolar disorder causes high health care resources consumption, no study is available addressing a cost estimation of bipolar disorder in Spain. The aim of this observational study was to evaluate healthcare resource utilization and the associated direct cost in patients with manic episodes in the Spanish setting. Methods Retrospective descriptive study was carried out in a consecutive sample of patients with a DSM-IV diagnosis of bipolar type I disorder with or without psychotic symptoms, aged 18 years or older, and who were having an active manic episode at the time of inclusion. Information regarding the current manic episode was collected retrospectively from the medical record and patient interview. Results Seven hundred and eighty-four evaluable patients, recruited by 182 psychiatrists, were included in the study. The direct cost associated with healthcare resource utilization during the manic episode was high, with a mean cost of nearly €4,500 per patient, of which approximately 55% corresponded to the cost of hospitalization, 30% to the cost of psychopharmacological treatment and 10% to the cost of specialized care. Conclusions Our results show the high cost of management of the patient with a manic episode, which is mainly due to hospitalizations. In this regard, any intervention on the management of the manic patient that could reduce the need for hospitalization would have a significant impact on the costs of the disease. PMID:20426814

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

2016-03-01

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

Specialty hospitals emulating focused factories: a case study.

PubMed

Kumar, Sameer

2010-01-01

For 15 years general hospital managers faced new competition from for-profit specialty hospitals that operate on a "focused factory" model, which threaten to siphon-off the most profitable patients. This paper aims to discuss North American specialty hospitals and to review rising costs impact on general hospital operations. The focus is to discover whether specialty hospitals are more efficient than general hospitals; if so, how significant is the difference and also what can general hospitals do in light of the rising specialty hospitals. The case study involves stochastic frontier regression analysis using Cobb-Douglas and Translog cost functions to compare Minnesota general and specialty hospital efficiency. Analysis is based on data from 117 general and 19 specialty hospitals. The results suggest that specialty hospitals are significantly more efficient than general hospitals. Overall, general hospitals were found to be more than twice as inefficient compared with specialty hospitals in the sample. Some cost-cutting factors highlighted can be implemented to trim rising costs. The case study highlights some managerial levers that general hospital operational managers might use to control rising costs. This also helps them compete with specialty hospitals by reducing overheads and other major costs. The study is based on empirical modeling for an important healthcare operational challenge and provides additional in-depth information that has health policy implications. The analysis and findings enable healthcare managers to guide their institutions in a new direction during a time of change within the industry.

A Hospital-Specific Template for Benchmarking its Cost and Quality

PubMed Central

Silber, Jeffrey H; Rosenbaum, Paul R; Ross, Richard N; Ludwig, Justin M; Wang, Wei; Niknam, Bijan A; Saynisch, Philip A; Even-Shoshan, Orit; Kelz, Rachel R; Fleisher, Lee A

2014-01-01

Objective Develop an improved method for auditing hospital cost and quality tailored to a specific hospital’s patient population. Data Sources/Setting Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, New York, and Texas between 2004 and 2006. Study Design A template of 300 representative patients from a single index hospital was constructed and used to match 300 patients at 43 hospitals that had a minimum of 500 patients over a 3-year study period. Data Collection/Extraction Methods From each of 43 hospitals we chose 300 patients most resembling the template using multivariate matching. Principal Findings We found close matches on procedures and patient characteristics, far more balanced than would be expected in a randomized trial. There were little to no differences between the index hospital’s template and the 43 hospitals on most patient characteristics yet large and significant differences in mortality, failure-to-rescue, and cost. Conclusion Matching can produce fair, directly standardized audits. From the perspective of the index hospital, “hospital-specific” template matching provides the fairness of direct standardization with the specific institutional relevance of indirect standardization. Using this approach, hospitals will be better able to examine their performance, and better determine why they are achieving the results they observe. PMID:25201167

Profile and costs of secondary conditions resulting in emergency department presentations and readmission to hospital following traumatic spinal cord injury.

PubMed

Gabbe, Belinda J; Nunn, Andrew

2016-08-01

People with traumatic spinal cord injury (SCI) face complex challenges in their care, recovery and life. Secondary conditions can develop to involve many body systems and can impact health, function, quality of life, and community participation. These secondary conditions can be costly, and many are preventable. The aim of this study was to describe the type and direct costs of secondary conditions requiring readmission to hospital, or visit to an emergency department (ED), within the first two years following traumatic spinal cord injury (SCI). A retrospective cohort study using population-level linked data from hospital ED and admission datasets was undertaken in Victoria, Australia. The incidence and direct treatment costs of readmission to hospital and ED visit within 2-years post-injury for secondary conditions related to SCI were measured for the 356 persons with traumatic SCI with a date of injury from 2008 to 2011. Of the 356 cases, 141 (40%) experienced 366 (median 2, range 1-11) readmissions to hospital for secondary conditions. 95 (27%) visited an ED at least once, within two years of injury for a secondary condition. The cost of hospital readmissions was AUD$5,553,004 and AUD$87,790 for ED visits. The mean±SD cost was AUD$15,172±$20,957 per readmission and AUD$670±$198 per ED visit. Urological conditions (e.g. urinary tract infection) were most common, followed by pressure areas/ulcers for readmissions, and fractures in the ED. Hospitalisation for complications within two years of traumatic SCI was common and costly in Victoria, Australia. Improved bladder and pressure area management could result in substantial morbidity and cost savings following SCI. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China.

PubMed

He, Xiaoning; Wu, Jing; Jiang, Yawen; Liu, Li; Ye, Wenyu; Xue, Haibo; Montgomery, William

2015-04-09

It is uncertain whether the extra acquisition costs of atypical antipsychotics over typical antipsychotics are offset by their other reduced resource use especially in hospital services in China. This study compared the psychiatric-related health care resource utilization and direct medical costs for patients with schizophrenia initiating atypical or typical antipsychotics in Tianjin, China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2008-2010). Adult patients with schizophrenia with ≥1 prescription for antipsychotics after ≥90-day washout and 12-month continuous enrollment after first prescription was included. Psychiatric-related resource utilization and direct medical costs of the atypical and typical cohorts were estimated during the 12-month follow-up period. Logistic regressions, ordinary least square (OLS), and generalized linear models (GLM) were employed to estimate differences of resource utilization and costs between the two cohorts. One-to-one propensity score matching was conducted as a sensitivity analysis. 1131 patients initiating either atypical (N = 648) or typical antipsychotics (N = 483) were identified. Compared with the typical cohort, the atypical cohort had a lower likelihood of hospitalization (45.8% vs. 56.7%, P < 0.001; adjusted OR: 0.58, P < 0.001) over the follow-up period. Medication costs for the atypical cohort were higher than the typical cohort ($438 vs. $187, P < 0.001); however, their non-medication medical costs were significantly lower ($1223 vs. $1704, P < 0.001). The total direct medical costs were similar between the atypical and typical cohorts before ($1661 vs. $1892, P = 0.100) and after matching ($1711 vs. 1868, P = 0.341), consistent with the results from OLS and GLM models for matched cohorts. The atypical cohort had similar total direct medical costs compared to the typical cohort. Higher medication costs associated with atypical antipsychotics were offset by a reduction in non-medication medical costs, driven by fewer hospitalizations.

Total hip arthroplasty revision due to infection: a cost analysis approach.

PubMed

Klouche, S; Sariali, E; Mamoudy, P

2010-04-01

The treatment of total hip arthroplasty (THA) infections is long and costly. However,the number of studies in the literature analysing the real cost of THA revision in relation to their etiology, including infection, is limited. The aim of this retrospective study was to determine the cost of revision of infected THA and to compare these costs to those of primary THA and revision of non-infected THA. We performed a retrospective cost analysis for the year 2006 using an identical analytic accounting system in each hospital department (according to internal criteria) based on allotment of direct costs and receipts for each department. From January to December 2006, 424 primary THA, 57 non-infected THA revisions and 40 THA revisions due to infection were performed. The different cost areas of the patient's treatment were identified.This included preoperative medical work-up, medicosurgical management during hospital stay,a second stay in an orthopedic rehabilitation hospital (ORH) and post-hospitalisation antibiotic therapy after revision due to infection, as well as home-based hospitalisation (HH) costs, if this was the selected alternative option. We used the national health insurance fee schedule found in the "Common classification of medical procedures" and the "General nomenclature of professional procedures" applicable in France since September 1, 2005. Hospital costs included direct costs (hospital overhead costs) and indirect costs, (medical, surgical, technical settings and net general service expenses). The calculation of HH costs and ORH costs were based on the average daily charge of these departments. The cost of primary THA was used as the reference.We then compared our surgical costs with those found for the corresponding comparable hospital stay groups (Groupes homogènes de séjour). The average hospital stay (AHS) was 7.5 +/- 1.8 days for primary THA, 8.9 +/- 2.2 days for non-infected revisions and 30.6 +/- 14.9 days for revisions due to infection. The rate of transfer to a rehabilitation hospital (ORH) was 55% for primary THA, 77% in non infected revision cases and 65% in revisions due to infection. Moreover, 30% of these infected THA were prescribed HH. Non-infected THA revisions cost 1.4 times more than primary THA. THA revisions due to infection cost 3.6 times more than primary THA. The economic impact of THA infections is considerable. The extra costs are mainly due to an extended hospital stay and to longer rehabilitation consuming significant substantial human and material resources. The cost of treating infected THA is high. Treatment strategies should therefore be optimised to increase the success rate and minimise total costs. Level IV. Economic and decision analyses, retrospective study 2010 Elsevier Masson SAS. All rights reserved.

The economic burden of depression in Switzerland.

PubMed

Tomonaga, Yuki; Haettenschwiler, Josef; Hatzinger, Martin; Holsboer-Trachsler, Edith; Rufer, Michael; Hepp, Urs; Szucs, Thomas D

2013-03-01

Despite the high prevalence of depression, information about the burden of this disease in Switzerland is scarce. A better knowledge of the costs of depression may provide important information for future national preventive programmes, optimizing cost-effective budgeting. The estimates of national costs may improve the public's awareness of depression and depression-related costs, breaking down the taboo of depression as an illness. The aims of this study were to analyse the annual cost for different levels of depression and to investigate the annual economic burden of depression in Switzerland. A retrospective, multicentre, non-interventional study in psychiatrist practices was carried out. Outpatients who had been diagnosed with depression in the last 3 years were included. Patient demographics and information on clinical characteristics and resource utilization in the first 12 months after diagnosis were collected. Costs analysis, subdivided into direct and indirect costs, was performed for three depression severity classes (mild, moderate and severe), according to the 17-item Hamilton Depression Rating Scale (HDRS-17). Costs were also extrapolated to a national level. Regression analysis was performed to control for factors that may have an impact on the cost of depression. A total of 556 patients were included. Hospitalization and hospitalization days were directly correlated with disease severity (p < 0.001). Medical resource utilization linked to depression and antidepressant treatments was also correlated to the disease status. Severely depressed patients reported a significantly higher number of workdays lost and were significantly more often on disability insurance. The mean total direct costs per person per year, mainly due to hospitalization costs, were 3,561 for mild, 9,744 for moderate and 16,240 for severe depression. The mean indirect costs per person per year, mainly due to workdays lost, were 8,730 for mild, 12,675 for moderate and 16,669 for severe depression (year 2007/2008 values). Regression analysis showed that hospitalization days, psychiatrist visits in hospital, disability insurance, workdays lost and the HDRS-17 score were significantly correlated to the total costs. Extrapolation at a national level resulted in a total burden of about 8.1-8.3 billion per year. The burden of depression in Switzerland was estimated to be about 8 billion per year. The costs of depression were directly related to disease severity. However, since many cases of depression remain unreported and since this analysis only included individuals between 18 and 65 years of age, it is reasonable to suppose that the total burden of depression may be even higher.

[Hip fracture in older adults: prevalence and costs in two hospitals. Tabasco, Mexico, 2009].

PubMed

Quevedo-Tejero, Elsy del Carmen; Zavala-González, Marco Antonio; Hernández-Gamas, Arianna del Carmen; Hernández-Ortega, Hilda María

2011-01-01

To determine hip fracture prevalence and direct healthcare costs in elderly users of the reference hospitals of the Mexican Institute of Social Insurance (IMSS by spanish initials) and Mexican Oils (PEMEX by spanish initials), from Villahermosa, Tabasco, Mexico, during 2009. This is a cross-sectional study. The information was based on the registers of surgical interventions and institutional reports of the elderly inpatients who had a registered attention in their institution. Descriptive statistical analysis was performed considering the following variables: age, gender, hip fracture type, occurrence month, direct healthcare cost. Out of 10,765 records of hospitalized elderly, 57 hip fracture cases were found (33 in the IMSS and 24 in PEMEX). Hip fracture prevalence was 0.5%, (IMSS 1.1% and PEMEX 0.3%), being more frequent in women and older than 69. The most frequent fracture type was the femur neck one (78.9%). The estimated cost of healthcare in the hospital per patient was USD 5,803 in the IMSS and USD 11,800 in PEMEX. The hip fracture prevalence was higher in the IMSS users. Estimated healthcare costs per patient were higher than the reported in other institutions of the of the mexican health national system.

[Financial burden of hepatitis B-related diseases and factors influencing the costs in Shenzhen, China].

PubMed

Liang, Sen; Zhang, Shun-xiang; Ma, Qi-shan; Xiao, He-wei; Lü, Qiu-ying; Xie, Xu; Mei, Shu-jiang; Hu, Dong-sheng; Zhou, Bo-ping; Li, Bing; Chen, Jing-fang; Cui, Fu-qiang; Wang, Fu-zhen; Liang, Xiao-feng

2010-12-01

To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the sum total was 16:1. The proportions of total annual cost per patient with hepatitis B-related diseases accounted for annual patient income were 285.3%, and 75.4% for annual household income. Furthermore, proportions of direct costs accounted for annual patient income and annual household income were 108.1% and 28.6%. The total annual indirect cost per person was 8123.38 Yuan for patients of all hepatitis B-related diseases, while 7134.63 Yuan for caregivers. Corresponding work-loss days were 55.74 days for patients and 19.83 days for caregivers. Based on multiple linear stepwise regression analysis, age of patients was a common influencing factor to all kinds of costs. Other factors were as follows: complicated with other diseases, antiviral medication, monthly household income and self-medications. The economic burden of hepatitis B-related diseases was substantial for patients and their families. All costs tended to increase with the severity of disease. The direct costs were larger than the indirect costs. And the direct medical costs were more than the direct ones. Indirect costs based on patients were larger than the ones of caregivers.

34 CFR 76.560 - General indirect cost rates; exceptions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... rates; exceptions. (a) The differences between direct and indirect costs and the principles for... in the cost principles for— (1) Institutions of higher education, at 34 CFR 74.27; (2) Hospitals, at...

Effects of Per-diem payment on the duration of hospitalization and medical expenses according to the palliative care demonstration project in Korea.

PubMed

Shin, J Y; Yoon, S J; Ahn, H S; Yun, Y H

2017-04-01

The aim of this study was to examine the impacts of a government-directed palliative care demonstration (PCD) project, Per-diem Payment System (PDPS), on length of stay (LOS), hospital costs, resource usage and healthcare quality during the searched period from January in 2009 to December in 2010. A retrospective claim data review. Individuals who had been eligible for the palliative care payment policy, PDPS, during 2 years (from 2009 to 2010) were assigned to the case group including seven hospitals (n = 3117). Those (seven hospitals) who were not come eligible for the palliative care payment policy were assigned to the control group (n = 2347) with fee for service. The data used in this study were electronically submitted requests of payment to the Health Insurance Review Agency during the period January 2009 to December 2010. After the PCD project, the length of stay for palliative patients with cancer diseases decreased by 2.56% (β = -0.026; p-value = 0.0001) among patients hospitalized in a PCD project compared with patients hospitalized in seven hospitals that was not designed as a PCD project. Compared with costs before the PCD project, costs decreased by 0.76% (β = 0.013; p-value = 0.0001). We provided evidence regarding the change in the societal burden due to palliative care. Although there was a reduction of direct medical costs reported in limited number of hospitals, in the long term, we can anticipate an expanding impact on medical costs in all palliative hospitals. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study.

PubMed

Clarke, A E; Zowall, H; Levinton, C; Assimakopoulos, H; Sibley, J T; Haga, M; Shiroky, J; Neville, C; Lubeck, D P; Grover, S A; Esdaile, J M

1997-06-01

To perform the first prospective longitudinal study of direct (health services utilized) and indirect costs (diminished productivity represented by income loss) incurred by patients with rheumatoid arthritis (RA) in Saskatoon and Montreal, followed for up to 12 and 4 years, respectively. 1063 patients reported on health status, health services utilization, and diminished productivity every 6 months. Annual direct costs were $3788 (1994 Canadian dollars) in the late 1980s and $4656 in the early 1990s. Given that the average age exceeded 60 years, few participated in labor force activities or considered themselves disabled from the labor force and their indirect costs were substantially less, $2165 in the late 1980s and $1597 in the early 1990s. Institutional stays and medications made up at least 80% of total direct costs. Lengths of stay in acute care facilities remained constant, but the rate of hospitalization increased in the early 1990s, increasing average hospital costs per patient from $1563 in the late 1980s to $2023 in the early 1990s. For nonacute care facilities, rate of admission as well as length of stay increased over time, increasing costs per patient in Saskatoon 5-fold, from $291 to $1605. Those with greater functional disability incurred substantially higher direct and those under 65 years incurred higher indirect costs. Direct costs are higher than indirect costs. The major component is due to institutional stays that, in contrast to other direct cost components, is increased in the older and more disabled. Measures to reduce longterm disability by earlier, more aggressive intervention have the potential to produce considerable cost savings. However, it is unknown which strategies will have the greatest effect on outcome and accordingly, how resources can be optimally allocated.

The current cost of angina pectoris to the National Health Service in the UK

PubMed Central

Stewart, S; Murphy, N; Walker, A; McGuire, A; McMurray, J J V

2003-01-01

Objective: To calculate the cost of angina pectoris to the UK National Health Service (NHS) in the year 2000. Methods: Calculation of the cost of hospital admissions, revascularisation procedures, hospital outpatient consultations, general practice (GP) consultations, and prescribed drug treatment. Results: 634 000 individuals (1.1% of the UK population) consulted GPs 2.35 million times, costing £60.5 million. They required 16.0 million prescriptions (cost £80.7 million) and 254 000 hospital outpatient referrals (cost £30.4 million). There were 149 000 hospital admissions, 117 000 coronary angiograms, 21 400 coronary artery bypass operations, 17 700 percutaneous coronary interventions, and 516 000 outpatient visits, at a cost of £208.4 million, £69.9 million, £106.2 million, £60.7 million, and £52.2 million, respectively. The direct cost of angina was therefore £669 million (1.3% of total NHS expenditure), with hospital bed occupancy and procedures accounting for 32% and 35% of this total, respectively. Conclusions: Angina is a common and costly public health problem. It consumed over 1% of all NHS expenditure in the year 2000, mainly because of hospital bed occupancy and revascularisation procedures. This is likely to be a conservative estimate of its true cost. PMID:12860855

The cost of nurse-sensitive adverse events.

PubMed

Pappas, Sharon Holcombe

2008-05-01

The aim of this study was to describe the methodology for nursing leaders to determine the cost of adverse events and effective levels of nurse staffing. The growing transparency of quality and cost outcomes motivates healthcare leaders to optimize the effectiveness of nurse staffing. Most hospitals have robust cost accounting systems that provide actual patient-level direct costs. These systems allow an analysis of the cost consumed by patients during a hospital stay. By knowing the cost of complications, leaders have the ability to justify the cost of improved staffing when quality evidence shows that higher nurse staffing improves quality. An analysis was performed on financial and clinical data from hospital databases of 3,200 inpatients. The purpose was to establish a methodology to determine actual cost per case. Three diagnosis-related groups were the focus of the analysis. Five adverse events were analyzed along with the costs. A regression analysis reported that the actual direct cost of an adverse event was dollars 1,029 per case in the congestive heart failure cases and dollars 903 in the surgical cases. There was a significant increase in the cost per case in medical patients with urinary tract infection and pressure ulcers and in surgical patients with urinary tract infection and pneumonia. The odds of pneumonia occurring in surgical patients decreased with additional registered nurse hours per patient day. Hospital cost accounting systems are useful in determining the cost of adverse events and can aid in decision making about nurse staffing. Adverse events add costs to patient care and should be measured at the unit level to adjust staffing to reduce adverse events and avoid costs.

[Cost of assisted reproduction technology in a public hospital].

PubMed

Navarro Espigares, José Luis; Martínez Navarro, Luis; Castilla Alcalá, José Antonio; Hernández Torres, Elisa

2006-01-01

Most studies on the costs of assisted reproductive technologies (ART) identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998. Data from the Human Reproduction Unit of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998 and 2003 were analyzed. Since the total costs of the unit were known, the cost of the distinct ART procedures performed in the hospital was calculated by means of a methodology for cost distribution. Between 1998 and 2003, the activity and costs of the Human Reproduction Unit analyzed evolved differently. Analysis of activity showed that some techniques, such as intracytoplasmic sperm injection, were consolidated while others, such as stimulation without assisted reproduction or intracervical insemination were abandoned. In all procedures, unit costs per cycle and per delivery decreased in the period analyzed. Important changes took place in the structure of costs of ART in the Human Reproduction Unit of the Virgen de las Nieves University Hospital between 1998 and 2003. Some techniques were discontinued, while others gained importance. Technological advances and structural innovations, together with a "learning effect," modified the structure of ART-related costs.

Comparing methodologies for the allocation of overhead and capital costs to hospital services.

PubMed

Tan, Siok Swan; van Ineveld, Bastianus Martinus; Redekop, William Ken; Hakkaart-van Roijen, Leona

2009-06-01

Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.

Influenza-related healthcare visits, hospital admissions, and direct medical costs for all children aged 2 to 17 years in a defined Swedish region, monitored for 7 years.

PubMed

Rahmqvist, Mikael; Gjessing, Kristian; Faresjö, Tomas

2016-08-01

The seasonal variation of influenza and influenza-like illness (ILI) is well known. However, studies assessing the factual direct costs of ILI for an entire population are rare. In this register study, we analyzed the seasonal variation of ILI-related healthcare visits and hospital admissions for children aged 2 to 17 years, and the resultant parental absence from work, for the period 2005 to 2012. The study population comprised an open cohort of about 78,000 children per year from a defined region. ILI was defined as ICD-10 codes: J00-J06; J09-J15, J20; H65-H67. Overall, the odds of visiting a primary care center for an ILI was 1.64-times higher during the peak influenza season, compared to the preinfluenza season. The corresponding OR among children aged 2 to 4 years was 1.96. On average, an estimated 20% of all healthcare visits for children aged 2 to 17 years, and 10% of the total healthcare costs, were attributable to seasonal ILI. In primary care, the costs per week and 10,000 person years for ILI varied - by season - from &OV0556;3500 to &OV0556;7400. The total ILI cost per year, including all physical healthcare forms, was &OV0556;400,400 per 10,000 children aged 2 to 17 years. The costs for prescribed and purchased drugs related to ILI symptoms constituted 52% of all medicine costs, and added 5.8% to the direct healthcare costs.The use of temporary parental employment benefits for caring of ill child followed the seasonal pattern of ILI (r = 0.91, P < 0.001). Parental absence from work was estimated to generate indirect costs, through loss of productivity of 5.2 to 6.2 times the direct costs. Direct healthcare costs increased significantly during the influenza season for children aged 2 to 17 years, both in primary and hospital outpatient care, but not in hospital inpatient care. Primary care manages the majority of visits for influenza and ILI. Children 2 to 4 years have a larger portion of their total healthcare encounters related to ILI compared with older children. There is a clear correlation between ILI visits across the years and parental absence from work.

Healthcare Costs of Rotavirus and Other Types of Gastroenteritis in Children in Norway.

PubMed

Shin, Minkyung; Salamanca, Beatriz Valcarcel; Kristiansen, Ivar S; Flem, Elmira

2016-04-01

Norway has initiated a publicly funded rotavirus immunization program for all age-eligible children in 2014. We aimed to estimate the healthcare costs of rotavirus gastroenteritis in children younger than 5 years old. We identified all gastroenteritis cases in children younger than 5 years old treated during 2009-2013 through the national claims database for primary care and the national hospital registry. We estimated direct medical costs of rotavirus-associated primary care consultations and hospital encounters (inpatient admission, outpatient visit and ambulatory care). We performed a range of one-way sensitivity analyses to explore uncertainty in the cost estimates. Before vaccine introduction, the mean healthcare cost of rotavirus gastroenteritis in children younger than 5 years old was €4,440,337 per year. Among rotavirus-associated costs, 92% were hospital costs and the remaining 8% were primary care costs. The mean annual cost of rotavirus-associated hospital encounters was €4,083,691, of which 95% were costs of inpatient hospital admissions. The average healthcare cost of medically attended gastroenteritis in children younger than 5 years old was approximately €8 million per year, of which rotavirus-related costs represented 56%. Healthcare costs of rotavirus gastroenteritis in Norway are substantial. The cost-effectiveness of ongoing rotavirus immunization program should be reassessed.

Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices.

PubMed

Sardiwalla, Yaeesh; Jufas, Nicholas; Morris, David P

2017-06-12

Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.

Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial.

PubMed

Waaler Bjørnelv, G M; Frihagen, F; Madsen, J E; Nordsletten, L; Aas, E

2012-06-01

We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2 years, patients treated with hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective. Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly. A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82 years were randomized to either internal fixation (n = 86) or hemiarthroplasty (n = 80). Patients were followed up at 4, 12, and 24 months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients' quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios. Over the 2-year period, patients treated with hemiarthroplasty gained 0.15-0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (p = 0.81), €2,474 (p = 0.80), and €14,160 (p = 0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings. Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.

Economic evaluation of pressure ulcer care: a cost minimization analysis of preventive strategies.

PubMed

Schuurman, Jaap-Peter; Schoonhoven, Lisette; Defloor, Tom; van Engelshoven, Ilse; van Ramshorst, Bert; Buskens, Erik

2009-01-01

The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was carried out alongside a prospective cohort study on the incidence and risk factors for pressure ulcers. Two large teaching hospitals in the Netherlands with (partly) opposing approaches in prevention, a technological versus a human approach, were analyzed. The main outcome measures were resource use, costs of preventive measures and treatment, and pressure ulcer incidence in both hospitals. Pressure ulcer prevention through a predominantly technical approach resulted in a similar incidence rate as prevention through a predominantly human approach. However, the technical approach was considerably less expensive.

Hospital costs estimation and prediction as a function of patient and admission characteristics.

PubMed

Ramiarina, Robert; Almeida, Renan Mvr; Pereira, Wagner Ca

2008-01-01

The present work analyzed the association between hospital costs and patient admission characteristics in a general public hospital in the city of Rio de Janeiro, Brazil. The unit costs method was used to estimate inpatient day costs associated to specific hospital clinics. With this aim, three "cost centers" were defined in order to group direct and indirect expenses pertaining to the clinics. After the costs were estimated, a standard linear regression model was developed for correlating cost units and their putative predictors (the patients gender and age, the admission type (urgency/elective), ICU admission (yes/no), blood transfusion (yes/no), the admission outcome (death/no death), the complexity of the medical procedures performed, and a risk-adjustment index). Data were collected for 3100 patients, January 2001-January 2003. Average inpatient costs across clinics ranged from (US$) 1135 [Orthopedics] to 3101 [Cardiology]. Costs increased according to increases in the risk-adjustment index in all clinics, and the index was statistically significant in all clinics except Urology, General surgery, and Clinical medicine. The occupation rate was inversely correlated to costs, and age had no association with costs. The (adjusted) per cent of explained variance varied between 36.3% [Clinical medicine] and 55.1% [Thoracic surgery clinic]. The estimates are an important step towards the standardization of hospital costs calculation, especially for countries that lack formal hospital accounting systems.

Cost comparative study of autologous peripheral blood progenitor cells (PBPC) and bone marrow (ABM) transplantations for non-Hodgkin's lymphoma patients.

PubMed

Woronoff-Lemsi, M C; Arveux, P; Limat, S; Deconinck, E; Morel, P; Cahn, J Y

1997-12-01

Intensive high-dose chemotherapy with autologous stem-cell support has become a common treatment strategy for non-Hodgkin's lymphomas. A cost-identification analysis was conducted comparing 10 patients autografted with PBSC to 10 others autografted with BM. The analysis included harvest and graft until graft day +100 and was carried out from the point of view of the hospital setting. Resources used, logistic and direct medical costs per patient were identified, and sensitivity analyses performed. The cost distribution was different. Stem cell harvest was more expensive for PBPC ($9030) and BM ($4745); on the other hand, hospitalization from graft to discharge from hospital cost savings with PBSC were about $10666. After discharge from hospital, costs were similar and cheaper in both groups. For the overall study the PBPC procedure was less expensive than ABMT, $35381 and $41759 respectively, with cost savings of $6378. The number of days spent in hospital and blood bank costs were the major cost factors. This study was based on a single pathology, non-Hodgkin's lymphoma, and the actual hospital records for each patient situation as opposed to a clinical trial, and our results were consistent with different previous studies carried out in different health care systems.

Trends in Costs of Thyroid Disease Treatment in Denmark during 1995-2015.

PubMed

Møllehave, Line Tang; Linneberg, Allan; Skaaby, Tea; Knudsen, Nils; Ehlers, Lars; Jørgensen, Torben; Thuesen, Betina Heinsbæk

2018-03-01

Iodine fortification (IF) may contribute to changes in costs of thyroid disease treatment through changes in disease patterns. From a health economic perspective, assessment of the development in costs of thyroid disease treatment in the population is pertinent. To assess the trends in annual medicine and hospital costs of thyroid disease treatment during 1995-2015 in Denmark, i.e., before and after the introduction of mandatory IF in 2000. Information on treatments for thyroid disease (antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment) was obtained from nationwide registers. Costs were valued at 2015 prices using sales prices for medicines and the Danish Diagnosis-Related Group (DRG) and Danish Ambulatory Grouping System (DAGS) tariffs of surgeries/radioiodine treatments. Results were adjusted for changes in population size and age and sex distribution. The total direct medicine and hospital costs of thyroid disease treatment increased from EUR ∼190,000 per 100,000 persons in 1995 to EUR ∼270,000 per 100,000 persons in 2015. This was mainly due to linearly increased costs of thyroid hormone therapy and increased costs of thyroid surgery since 2008. Costs of antithyroid medication increased slightly and transiently after IF, while costs of radioiodine treatment remained constant. Costs of thyroid hormone therapy and thyroid surgery did not follow the development in the prevalence of hypothyroidism and structural thyroid diseases observed in concurrent studies. The costs of total direct medicine and hospital costs for thyroid disease treatment in Denmark increased from 1995 to 2015. This is possibly due to several factors, e.g., changes in treatment practices, and the direct effect of IF alone remains to be estimated.

[Cost-effectiveness of two hospital care schemes for psychiatric disorders].

PubMed

Nevárez-Sida, Armando; Valencia-Huarte, Enrique; Escobedo-Islas, Octavio; Constantino-Casas, Patricia; Verduzco-Fragoso, Wázcar; León-González, Guillermo

2013-01-01

In Mexico, six of every twenty Mexicans suffer psychiatric disorders at some time in their lives. This disease ranks fifth in the country. The objective was to determine and compare the cost-effectiveness of two models for hospital care (partial and traditional) at a psychiatric hospital of Instituto Mexicano del Seguro Social (IMSS). a multicenter study with a prospective cohort of 374 patients was performed. We made a cost-effectiveness analysis from an institutional viewpoint with a six-month follow-up. Direct medical costs were analyzed, with quality of life gains as outcome measurement. A decision tree and a probabilistic sensitivity analysis were used. patient care in the partial model had a cost 50 % lower than the traditional one, with similar results in quality of life. The cost per successful unit in partial hospitalization was 3359 Mexican pesos while in the traditional it increased to 5470 Mexican pesos. treating patients in the partial hospitalization model is a cost-effective alternative compared with the traditional model. Therefore, the IMSS should promote the infrastructure that delivers the psychiatric services to the patient attending to who requires it.

Economic Benefits and Costs of Human Milk Feedings: A Strategy to Reduce the Risk of Prematurity-Related Morbidities in Very-Low-Birth-Weight Infants123

PubMed Central

Johnson, Tricia J.; Patel, Aloka L.; Bigger, Harold R.; Engstrom, Janet L.; Meier, Paula P.

2014-01-01

Infants born at very low birth weight (VLBW; birth weight <1500 g) are at high risk of mortality and are some of the most expensive patients in the hospital. Additionally, VLBW infants are susceptible to prematurity-related morbidities, including late-onset sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and retinopathy of prematurity, which have short- and long-term economic consequences. The incremental cost of these morbidities during the neonatal intensive care unit (NICU) hospitalization is high, ranging from $10,055 (in 2009 US$) for late-onset sepsis to $31,565 for BPD. Human milk has been shown to reduce both the incidence and severity of some of these morbidities and, therefore, has an indirect impact on the cost of the NICU hospitalization. Furthermore, human milk may also directly reduce NICU hospitalization costs, independent of the indirect impact on the incidence and/or severity of these morbidities. Although there is an economic cost to both the mother and institution for providing human milk during the NICU hospitalization, these costs are relatively low. This review describes the total cost of the initial NICU hospitalization, the incremental cost associated with these prematurity-related morbidities, and the incremental benefits and costs of human milk feedings during critical periods of the NICU hospitalization as a strategy to reduce the incidence and severity of these morbidities. PMID:24618763

Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants.

PubMed

Johnson, Tricia J; Patel, Aloka L; Bigger, Harold R; Engstrom, Janet L; Meier, Paula P

2014-03-01

Infants born at very low birth weight (VLBW; birth weight <1500 g) are at high risk of mortality and are some of the most expensive patients in the hospital. Additionally, VLBW infants are susceptible to prematurity-related morbidities, including late-onset sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and retinopathy of prematurity, which have short- and long-term economic consequences. The incremental cost of these morbidities during the neonatal intensive care unit (NICU) hospitalization is high, ranging from $10,055 (in 2009 US$) for late-onset sepsis to $31,565 for BPD. Human milk has been shown to reduce both the incidence and severity of some of these morbidities and, therefore, has an indirect impact on the cost of the NICU hospitalization. Furthermore, human milk may also directly reduce NICU hospitalization costs, independent of the indirect impact on the incidence and/or severity of these morbidities. Although there is an economic cost to both the mother and institution for providing human milk during the NICU hospitalization, these costs are relatively low. This review describes the total cost of the initial NICU hospitalization, the incremental cost associated with these prematurity-related morbidities, and the incremental benefits and costs of human milk feedings during critical periods of the NICU hospitalization as a strategy to reduce the incidence and severity of these morbidities.

The economic cost of road traffic crashes in an urban setting

PubMed Central

García‐Altés, A; Pérez, K

2007-01-01

The objective of this article is to assess the total economic costs of road traffic crashes in Barcelona, a metropolitan city located in Southern Europe. A cost‐of‐illness study was conducted using a prevalence approximation, a societal and healthcare system perspective, and a 1‐year time horizon. Results were measured in terms of Euros in 2003. Total costs of road traffic crashes in Barcelona in 2003 were €367 million. Direct costs equalled €329 million (89.8% of total costs), including property damage costs, insurance administration costs and hospital costs. Police, emergency costs and transportation costs had a minimum effect on total direct costs. Indirect costs were €37 million, including lost productivity due to hospitalization and mortality. The results of the sensitivity analysis showed the upper limit of total economic cost of road traffic crashes in Barcelona to be €782 million. This is the first study to estimate the costs of road traffic crashes for a city in a developed country. The importance of the problem calls for further interventions to reduce road traffic crashes. PMID:17296693

Cost inefficiency in Washington hospitals: a stochastic frontier approach using panel data.

PubMed

Li, T; Rosenman, R

2001-06-01

We analyze a sample of Washington State hospitals with a stochastic frontier panel data model, specifying the cost function as a generalized Leontief function which, according to a Hausman test, performs better in this case than the translog form. A one-stage FGLS estimation procedure which directly models the inefficiency effects improves the efficiency of our estimates. We find that hospitals with higher casemix indices or more beds are less efficient while for-profit hospitals and those with higher proportion of Medicare patient days are more efficient. Relative to the most efficient hospital, the average hospital is only about 67% efficient.

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil.

PubMed

Cavassini, Ana Claudia Molina; Lima, Silvana Andréa Molina; Calderon, Iracema Mattos Paranhos; Rudge, Marilza Vieira Cunha

2012-01-01

Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp). Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.

Direct medical costs of accidental falls for adults with transfemoral amputations.

PubMed

Mundell, Benjamin; Maradit Kremers, Hilal; Visscher, Sue; Hoppe, Kurtis; Kaufman, Kenton

2017-12-01

Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. We describe the direct medical costs of falls in adults with a transfemoral amputation. This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US$25,652 (US$10,468, US$38,872). The mean costs for the 10 adults admitted to the emergency department was US$18,091 (US$-7,820, US$57,368). Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.

[Financial cost of early rheumatoid arthritis in the first year of medical attention: three clinical scenarios in a third-tier university hospital in Colombia].

PubMed

Mora, Claudia; González, Andrés; Díaz, Jorge; Quintana, Gerardo

2009-03-01

In Colombia, the cost burden of chronic diseases is not well known, either globally or in localized areas of the health system. Rheumatoid arthritis is one of most common chronic diseases, and represents a high cost for the health system. The direct medical costs were estimated for rheumatoid arthritis patients in the in the first year of diagnosis at a level 3 university hospital in Colombia. Three therapy settings for early rheumatoid arthritis patients were established in the first year of diagnosis according to national and international guidelines. Each setting included treatment with disease-modifying anti-rheumatic drugs or biologic therapy based on disease severity as measured by Disease Activity Score 28. All direct medical costs were included: specialized medical care, diagnostic tests and drugs. Cost information was obtained from the Central Military Hospital finance department in Bogotá and the national manual of drug prices based on the "Farmaprecios" 2007 guide, a reference in general use by health institutions. Results. The average of cost of medical care in patients with mild, moderate and severe disease was US $1689, $1805 and $23,441 respectively. The recommended retail prices of the medicines published in "Farmaprecios" was US $1418, $1821 and $31,931. When the charges levied by several major health institutions were compared, substantial increases were noted, US $4936, $7716 and $123,661, respectively. Drug costs represented 86% of total cost, laboratory costs were 10% and medical attention was only 4%. Drugs costs were the principal component of the total direct medical cost, and it increased 40 times when a biological therapy is used. Complete economic evaluation studies are necesary to estimate the viability and clinical relevance of biological therapy for early rheumatoid arthritis.

The cost savings of newer oral anticoagulants in atrial fibrillation-related stroke prevention
.

PubMed

Masbah, Norliana; Macleod, Mary Joan

2017-03-01

Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fibrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Hospitalization records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospitalizations. Only 254 patients (39.4%) with confirmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically insignificant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction. AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin.
.

Cost savings in a hospital clinical laboratory with a pay-for-performance incentive program for supervisors.

PubMed

Winkelman, J W; Aitken, J L; Wybenga, D R

1991-01-01

A pay-for-performance incentive program for clinical laboratory supervisors was developed and implemented at Brigham and Women's Hospital (Boston, Mass). It provides monetary rewards to personnel who directly produce cost savings in their area of responsibility. This reward system is new to the hospital laboratory but is commonly used in industry. Substantial true cost savings over and above previously established stringent budgets were achieved, 11% of which was returned to first-line supervisors in the form of a bonus. The program expanded the scope of professionalism for supervisors to include fiscal management.

The business case for nursing in long-term care.

PubMed

Horn, Susan D

2008-05-01

Lower nurse staffing in hospitals has been associated with adverse patient outcomes; results in nursing homes (NHs) are less clear. We examined the association between nurses' direct care time and outcomes in long-stay NH residents and potential cost savings from decreased adverse outcomes versus additional wages for adequate nurse staffing. Data were from the National Pressure Ulcer Long-Term Care Study of 1,376 at-risk residents from 82 NHs. Primary data came from medical records. Hospital, pressure ulcer (PrU) treatment, and urinary tract infection (UTI) costs were from national statistics or cost-identification studies. Time horizon was 1 year. More registered nurse (RN) direct care time/resident/day was associated with fewer PrUs, hospitalizations, and UTIs. Annual net societal benefit was $3,191/resident/year in high-risk NH units with 30-40 min of RN time/resident/day versus units with <10 min. Thus, after controlling for important variables, more RN time/day was strongly associated with better outcomes and lower societal cost.

A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.

PubMed

Lanbeck, Peter; Ragnarson Tennvall, Gunnel; Resman, Fredrik

2016-07-27

Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.

Burden of rheumatoid arthritis from a societal perspective: A prevalence-based study on cost of illness for patients with rheumatoid arthritis in China.

PubMed

Hu, Hao; Luan, Luan; Yang, Keqin; Li, Shu-Chuen

2017-02-17

To provide a comprehensive estimation of the economic burden of rheumatoid arthritis (RA) in China, especially for patients from less developed areas, and to explore the cost transferability between regions to assist healthcare decision-making. The study was conducted in south and north China from May 2013 to December 2013. The burden of RA was investigated by interviewing participants with a questionnaire battery containing socio-demographic, cost of illness (COI) and medical treatments. The COI questionnaire captured direct, indirect and intangible costs. Direct costs included hospitalizations, outpatient visits and medications. Indirect costs were estimated using the human capital approach, and intangible costs valued through the willingness-to-pay approach. All cost data were converted to 2013 US dollars by purchasing power parity, and then summarized descriptively and analyzed with mixed models. Questionnaires were administered to 133 RA patients. The average direct costs were $1917.21 ± $2559.06 per patient year, with medications at $1283.89 ± $1898.15 comprising more than 50% of the total. The average indirect costs were $492.88 ± $1739.74 per patient year, while intangible costs were $20396.30 ± $31145.10. There was no significant difference detected between regions. Recent hospitalization was tested as a significant predictor of the direct costs. Age and income were significantly associated with indirect and intangible costs. Besides the substantial burden in terms of direct medical costs and productivity lost, there were notable intangible costs, especially among older patients. This conclusion could be potentially expanded to other provinces in China or even other countries through the adjustments for transferability. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China.

PubMed

Wu, Jing; He, Xiaoning; Liu, Li; Ye, Wenyu; Montgomery, William; Xue, Haibo; McCombs, Jeffery S

2015-01-01

Information concerning the treatment costs of schizophrenia is scarce in People's Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated. A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median) length of stay of 112.1 (71) days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median) number of visits of 6.2 (4) and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication treatment costs were the most important element (45.7%) of schizophrenia-related costs, followed by laboratory and diagnostic costs (19.9%), medication costs (15.4%), and bed fees (13.3%). The costs related to the treatment of patients with schizophrenia were considerable in Tianjin, People's Republic of China, driven mainly by schizophrenia-related hospitalizations. Efforts focusing on community-based treatment programs and appropriate choice of drug treatment have the potential to reduce the use of inpatient services and may lead to better clinical and economic outcomes in the management of patients with schizophrenia in People's Republic of China.

Estimated cost of overactive bladder in Thailand.

PubMed

Prasopsanti, Kriangsak; Santi-Ngamkun, Apirak; Pornprasit, Kanokwan

2007-11-01

To estimate the annual direct and indirect costs of overactive bladder (OAB) in indigenous Thai people aged 18 years and over in the year 2005. Economically based models using diagnostic and treatment algorithms from clinical practice guidelines and current disease prevalence data were used to estimate direct and indirect costs of OAB. Prevalence and event probability estimates were obtained from the literature, national data sets, and expert opinion. Costs were estimated from a small survey using a cost questionnaire and from unit costs of King Chulalongkorn Memorial Hospital. The annual cost of OAB in Thailand is estimated as 1.9 billion USD. It is estimated to consume 1.14% of national GDP The cost includes 0.33 billion USD for direct medical costs, 1.3 billion USD for direct, nonmedical costs and 0.29 billion USD for indirect costs of lost productivity. The largest costs category was direct treatment costs of comorbidities associated with OAB. Costs of OAB medication accountedfor 14% of the total costs ofOAB.

Cost and quality trends in direct contracting arrangements.

PubMed

Lyles, Alan; Weiner, Jonathan P; Shore, Andrew D; Christianson, Jon; Solberg, Leif I; Drury, Patricia

2002-01-01

This paper presents the first empirical analysis of a 1997 initiative of the Buyers Health Care Action Group (BHCAG) known as Choice Plus. This initiative entailed direct contracts with provider-controlled delivery systems; annual care system bidding; public reports of consumer satisfaction and quality; uniform benefits; and risk-adjusted payment. After case-mix adjustment, hospital costs decreased, ambulatory care costs rose modestly, and pharmacy costs increased substantially. Process-oriented quality indicators were stable or improved. The BHCAG employer-to-provider direct contracting and consumer choice model appeared to perform reasonably well in containing costs, without measurable adverse effects on quality.

[Direct costs of complicated chicken pox in a Colombian pediatric population].

PubMed

Alvis-Guzmán, Nelson; Paternina-Caicedo, Angel; Alvis-Estrada, Luis; De la Hoz-Restrepo, Fernando

2011-12-01

Estimating the cost of chicken pox in a Colombian pediatric population. This was a retrospective case study which searched for all diagnosed chicken pox cases in the Napoleón Franco Pareja children's hospital (Cartagena, Colombia), during 2005-2008. The hospital's records/perspective was used. Cost related to health personnel, lab, diagnostic images and drugs were searched. The micro-costing was made at Colombian peso prices for 2010. An adjustment was made for inflation. Mean hospital costs were $ 898,766 (Q1: $ 197,348; Q3: $ 1,195,262). Mean hospital cost per day was $ 221,777 (Q1: $ 97,027; Q3: $ 293,740). Mean cost <1 year-old patients was $ 980,742 (Q1: $ 905,708; Q3: $ 1,026,031). Mean cost was $ 105,833 in 5-12 year-old patients (Q1: $ 39,568; Q3: $ 891,824). The results were similar to those of previous studies (in Panama and some developed countries) highlighting relatively high illness costs in Colombia. These results increase the evidence in favor of vaccination and invite Colombian public health officials to consider introducing a chicken pox vaccine into Colombia.

[Operational costs and control of performance in surgical clinics between marketing and planning economics. Risk or perhaps quadrature of the circle].

PubMed

Kraus, T W; Weber, W; Mieth, M; Funk, H; Klar, E; Herfarth, C

2000-03-01

Surgical hospitals can be seen as operational or even industrial production systems. Doctors have a major impact on both medical performance and costs. For active participation in the management process, knowledge of industrial controlling mechanisms is required. German hospitals currently receive no procedure-related financial revenues, such as prices or tariffs for defined medical treatment activities. Maximum clinical revenues are, furthermore, limited by principles of planned economy and can be increased only slightly by greater medical performance. Costs are the only target that can be autonomously influenced by the management. Operative controlling in hospitals aims at horizontal and vertical coordination of subunits and decentralization of process regulations. Hospital medical performance is not clearly defined, its quantitative measurement very problematic. Process-orientated clinical activities are not taken into account. A high percentage of hospital costs are fixed and can be influenced only by major structural interventions in the long term. Variable costs are primarily dependent on the quantity of clinical activities, but also heavily influenced by patient structure (comorbidity and risk profile). The various forms of industrial cost calculations, such as internal budgeting, internal markets or flexible plan-cost balancing, cannot be directly applied in hospital management. Based on these analyses, current operational concepts and strategic trends are listed to describe cost-management options in hospitals with focus on the German health reforms.

Cost analysis of chronic obstructive pulmonary disease in a tertiary care setting in Taiwan.

PubMed

Chiang, Chi-Huei

2008-09-01

The prevalence of COPD in the Western Pacific is increasing. The present study determined the total direct health-care costs for the management of COPD patients with differing degrees of disease severity. The study also aimed to find the key cost drivers in the management of COPD. COPD patients were recruited from a tertiary care hospital during April 2002 and March 2003. One-year costs were identified by applying cost data to medical information obtained by review of medical records. Costs included those for medications, oxygen therapy, laboratory and diagnostic tests, clinic visits, emergency room visits and hospital stays. There were 160 patients recruited. Patients were categorized by COPD severity: moderate A COPD (50

Analysis of direct medical and nonmedical costs for care of rheumatoid arthritis patients using the large cohort database, IORRA.

PubMed

Tanaka, Eiichi; Hoshi, Daisuke; Igarashi, Ataru; Inoue, Eisuke; Shidara, Kumi; Sugimoto, Naoki; Sato, Eri; Seto, Yohei; Nakajima, Ayako; Momohara, Shigeki; Taniguchi, Atsuo; Tsutani, Kiichiro; Yamanaka, Hisashi

2013-07-01

Our goal was to determine the annual direct medical and nonmedical costs for the care of patients with rheumatoid arthritis (RA) using data from a large cohort database in Japan. Direct medical costs [out of pocket to hospitals and pharmacies and for complementary and alternative medicine (CAM)] and nonmedical costs (caregiving, transportation, self-help devices, house modifications) were determined for RA patients who were participants in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) studies conducted in October 2007 and April 2008. Correlations between these costs and RA disease activity, disability level, and quality of life (QOL) were assessed. Data were analyzed from 5,204 and 5,265 RA patients in October 2007 and April 2008, respectively. The annual direct medical costs were JPY132,000 [out of pocket to hospital (US$1 = JPY90 in 2007)], JPY84,000 (out of pocket to pharmacy), and JPY146,000 (CAM). Annual direct nonmedical costs were JPY105,000 (caregiving), JPY22,000 (transportation), JPY30,000 (self-help devices), and JPY188,000 (house modifications). Based on the utilization rate for each cost component, the annual medical and nonmedical costs for each RA patient were JPY262,136 and JPY61,441, respectively. Costs increased with increasing RA disease activity and disability level or worsening quality of life (QOL). Based on the IORRA database, patients with RA bear heavy economic burdens that increase as the disease is exacerbated. The results also suggest that the increase in medical and nonmedical costs may be ameliorated by the proactive control of disease activity.

Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany.

PubMed

Strzelczyk, Adam; Haag, Anja; Reese, Jens P; Nickolay, Tanja; Oertel, Wolfgang H; Dodel, Richard; Knake, Susanne; Rosenow, Felix; Hamer, Hajo M

2013-06-01

This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires. We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of € 2955 in 2003 and € 3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2008. Indirect costs of € 1689 and € 1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%). This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of 'newer' AEDs. The amount and distribution of indirect cost components remained unchanged. Copyright © 2013 Elsevier Inc. All rights reserved.

[Costs of chronic obstructive pulmonary disease in patients treated in ambulatory care in Poland].

PubMed

Jahnz-Różyk, Karina; Targowski, Tomasz; From, Sławomir; Faluta, Tomasz; Borowiec, Lukasz

2011-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. A cost-of-illness study aims to determine the total economic impact of a disease or health condition on society through the identification, measurement, and valuation of all direct and indirect costs. Exacerbations are believed to be a major cost driver in COPD. The aim of this study was to examine direct, mean costs of COPD in Poland under usual clinical practice form societal perspective. It was an observational bottom-up-cost-of-illness study, based on a retrospective sample of patients presenting with COPD in pulmonary ambulatory care facilities in Poland. Total medical resources consumption of a sample were collected in 2007/2008 year by physician - lung specialists. Direct costs of COPD were evaluated based on data from different populations of five clinical hospitals and eight out-patient clinics. Resources utilisation and cost data are summarised as mean values per patient per year. 95% confidence intervals were derived using percentile bootstrapping. Total medicals resources consumption of a COPD patient per year was 1007 EURO (EUR 1 = PLN 4.0; year 2008). Among this cost 606 EURO was directly related to COPD follow up, 105 EURO was related to ambulatory exacerbation, and 296 EURO was related to exacerbation treated in hospital. The burden of COPD itself appeared to be considerable magnitude for society in Poland.

Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy.

PubMed

Landais, Alain; Morel, Morgane; Goldstein, Jacques; Loriau, Jerôme; Fresnel, Annie; Chevalier, Corinne; Rejasse, Gilles; Alfonsi, Pascal; Ecoffey, Claude

2017-06-01

Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P<0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P<0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures. Copyright © 2017. Published by Elsevier Masson SAS.

Impact of radio-frequency identification (RFID) technologies on the hospital supply chain: a literature review.

PubMed

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives.

Impact of Radio-Frequency Identification (RFID) Technologies on the Hospital Supply Chain: A Literature Review

PubMed Central

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives. PMID:24159272

Hospitalization costs of lung cancer diagnosis in Turkey: Is there a difference between histological types and stages?

PubMed

Türk, Murat; Yıldırım, Fatma; Yurdakul, Ahmet Selim; Öztürk, Can

2016-12-01

To establish the direct costs of diagnosing lung cancer in hospitalized patients. Hospital data of patients who were hospitalized and diagnosed as lung cancer between September 2013 and August 2014 were retrospectively analyzed. Patients who underwent surgery for diagnosis and who were initiated with cancer treatment during the same hospital stay were excluded from study. Histological types and stages of lung cancer were determined. Expenses were grouped as laboratory costs, pathology costs, diagnostic imaging costs, overnight room charges, medication costs, blood center costs, consumable expenditures' costs and inpatient service charges (including consultants' service, electrocardiogram, follow-up, nursing services, diagnostic interventions). Of the 68 patients, 55 (81%) had non-small cell lung cancer (NSCLC), 13 (19%) had small cell lung cancer (SCLC). 47% of patients with NSCLC had stage 4 disease and 86% of patients with SCLC had extensive stage disease. Median total cost per patient was 910 (95% CI= 832-1291) Euros (€). Of all costs, 37% were due to inpatient service charges and 22% were medication costs. Median total cost per patient was 912 (95% CI= 783-1213) € in NSCLC patients and 908 (95% CI= 456-2203) € in SCLC patients (p> 0.05). In NSCLC group, total cost per patient was 873 (95% CI= 591-1143) € in stage 1-2-3 diseases and 975 (95% CI= 847-1536) € in stage 4 disease (p> 0.05). In SCLC group total cost per patient was 937 € in limited stage and 502 (95% CI= 452-2508) € in extensive stage (p> 0.05). There is no significant difference between costs related to diagnosis of different lung cancer types and stages in patients hospitalized in a university hospital.

Antibiotic pharmacoeconomics: an attempt to find the real cost of hospital antibiotic prescribing.

PubMed Central

Kerr, J. R.; Barr, J. G.; Smyth, E. T.; O'Hare, J.; Bell, P. M.; Callender, M. E.

1993-01-01

Antibiotics account for a large part of all hospital pharmacy budgets, but the actual cost of their prescription is unknown. These costs include intravenous administration, labour, serum antibiotic assay, monitoring of haematological and biochemical indices, disposal of sharps and adverse effects. An in-house method of costing antibiotic therapy is presented, to quantify these hidden expenses. Since not only an awareness, but an accurate quantification, of hidden costs is required, a study of various hospital procedures relating directly to antibiotic therapy was undertaken in an acute medical ward; this involved the identification of particular staff members performing various procedures, consumables used and time taken. The cost of five-day courses of gentamicin, penicillin G, ampicillin, flucloxacillin, cefuroxime, ceftotaxime and erythromycin has been calculated; drug and hidden costs for each are presented graphically for comparison. The breakdown cost for gentamicin is presented to illustrate the method. The costing of adverse effects has not been attempted. We suggest that costings of this sort are used in cost-benefit analysis of antibiotic use. These calculations have been incorporated into a computer spreadsheet and this costing service will be offered to clinical areas of our hospital. PMID:8516976

Tying supply chain costs to patient care.

PubMed

Parkinson, Rosalind C

2014-05-01

In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality.

Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study.

PubMed

Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

2017-02-01

Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

A pharmacoeconomic study of traditional anticoagulation versus direct oral anticoagulation for the treatment of venous thromboembolism in the emergency department.

PubMed

Law, Stephanie; Ghag, Daljit; Grafstein, Eric; Stenstrom, Robert; Harris, Devin

2016-09-01

Patients with venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]) are commonly treated as outpatients. Traditionally, patients are anticoagulated with low-molecular-weight heparin (LMWH) and warfarin, resulting in return visits to the ED. The direct oral anticoagulant (DOAC) medications do not require therapeutic monitoring or repeat visits; however, they are more expensive. This study compared health costs, from the hospital and patient perspectives, between traditional versus DOAC therapy. A chart review of VTE cases at two tertiary, urban hospitals from January 1, 2010 to December 31, 2012 was performed to capture historical practice in VTE management, using LMWH/warfarin. This historical data were compared against data derived from clinical trials, where a DOAC was used. Cost minimization analyses comparing the two modes of anticoagulation were completed from hospital and patient perspectives. Of the 207 cases in the cohort, only 130 (63.2%) were therapeutically anticoagulated (international normalized ratio 2.0-3.0) at emergency department (ED) discharge; patients returned for a mean of 7.18 (range: 1-21) visits. Twenty-one (10%) were admitted to the hospital; 4 (1.9%) were related to VTE or anticoagulation complications. From a hospital perspective, a DOAC (in this case, rivaroxaban) had a total cost avoidance of $1,488.04 per VTE event, per patient. From a patient perspective, it would cost an additional $204.10 to $349.04 over 6 months, assuming no reimbursement. VTE management in the ED has opportunities for improvement. A DOAC is a viable and cost-effective strategy for VTE treatment from a hospital perspective and, depending on patient characteristics and values, may also be an appropriate and cost-effective option from a patient perspective.

Using Length of Stay to Control for Unobserved Heterogeneity When Estimating Treatment Effect on Hospital Costs with Observational Data: Issues of Reliability, Robustness, and Usefulness.

PubMed

May, Peter; Garrido, Melissa M; Cassel, J Brian; Morrison, R Sean; Normand, Charles

2016-10-01

To evaluate the sensitivity of treatment effect estimates when length of stay (LOS) is used to control for unobserved heterogeneity when estimating treatment effect on cost of hospital admission with observational data. We used data from a prospective cohort study on the impact of palliative care consultation teams (PCCTs) on direct cost of hospital care. Adult patients with an advanced cancer diagnosis admitted to five large medical and cancer centers in the United States between 2007 and 2011 were eligible for this study. Costs were modeled using generalized linear models with a gamma distribution and a log link. We compared variability in estimates of PCCT impact on hospitalization costs when LOS was used as a covariate, as a sample parameter, and as an outcome denominator. We used propensity scores to account for patient characteristics associated with both PCCT use and total direct hospitalization costs. We analyzed data from hospital cost databases, medical records, and questionnaires. Our propensity score weighted sample included 969 patients who were discharged alive. In analyses of hospitalization costs, treatment effect estimates are highly sensitive to methods that control for LOS, complicating interpretation. Both the magnitude and significance of results varied widely with the method of controlling for LOS. When we incorporated intervention timing into our analyses, results were robust to LOS-controls. Treatment effect estimates using LOS-controls are not only suboptimal in terms of reliability (given concerns over endogeneity and bias) and usefulness (given the need to validate the cost-effectiveness of an intervention using overall resource use for a sample defined at baseline) but also in terms of robustness (results depend on the approach taken, and there is little evidence to guide this choice). To derive results that minimize endogeneity concerns and maximize external validity, investigators should match and analyze treatment and comparison arms on baseline factors only. Incorporating intervention timing may deliver results that are more reliable, more robust, and more useful than those derived using LOS-controls. © Health Research and Educational Trust.

Healthcare Resource Uses and Out-of-Pocket Expenses Associated with Pulmonary TB Treatment in Thailand.

PubMed

Tanvejsilp, Pimwara; Loeb, Mark; Dushoff, Jonathan; Xie, Feng

2017-08-22

In Thailand, pharmaceutical care has been recently introduced to a tertiary hospital as an approach to improve adherence to tuberculosis (TB) treatment in addition to home visit and modified directly observed therapy (DOT). However, the economic impact of pharmaceutical care is not known. The aim of this study was to estimate healthcare resource uses and costs associated with pharmaceutical care compared with home visit and modified DOT in pulmonary TB patients in Thailand from a healthcare sector perspective inclusive of out-of-pocket expenditures. We conducted a retrospective study using data abstracted from the hospital billing database associated with pulmonary TB patients who began treatment between 2010 and 2013 in three hospitals in Thailand. We used generalized linear models to compare the costs by accounting for baseline characteristics. All costs were converted to international dollars (Intl$) RESULTS: The mean direct healthcare costs to the public payer were $519.96 (95%confidence interval [CI] 437.31-625.58) associated with pharmaceutical care, $1020.39 (95% CI 911.13-1154.11) for home visit, and $887.79 (95% CI 824.28-955.91) for modified DOT. The mean costs to patients were $175.45 (95% CI 130.26-230.48) for those receiving pharmaceutical care, $53.77 (95% CI 33.25-79.44) for home visit, and $49.33 (95% CI 34.03-69.30) for modified DOT. After adjustment for baseline characteristics, pharmaceutical care was associated with lower total direct costs compared with home visit (-$354.95; 95% CI -285.67 to -424.23) and modified DOT (-$264.61; 95% CI -198.76 to -330.46). After adjustment for baseline characteristics, pharmaceutical care was associated with lower direct costs compared with home visit and modified DOT.

In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery

PubMed Central

Mishra, Vinod; Lewandowska, Milena; Andersen, Jack Gunnar; Andersen, Marit Helen; Lindberg, Harald; Døhlen, Gaute; Fosse, Erik

2017-01-01

Abstract OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared. METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs). RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P≤ 0.001). CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device. PMID:28007875

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.

PubMed

Toscano, Cristiana M; Sugita, Tatiana H; Rosa, Michelle Q M; Pedrosa, Hermelinda C; Rosa, Roger Dos S; Bahia, Luciana R

2018-01-08

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.

The direct and indirect costs of Dravet Syndrome.

PubMed

Whittington, Melanie D; Knupp, Kelly G; Vanderveen, Gina; Kim, Chong; Gammaitoni, Arnold; Campbell, Jonathan D

2018-03-01

The objective of this study was to estimate the annual direct and indirect costs associated with Dravet Syndrome (DS). A survey was electronically administered to the caregivers of patients with DS treated at Children's Hospital Colorado. Survey domains included healthcare utilization of the patient with DS and DS caregiver work productivity and activity impairment. Patient healthcare utilization was measured using modified questions from the National Health Interview Survey; caregiver work productivity and activity impairment were measured using modified questions from the Work Productivity and Activity Impairment questionnaire. Direct costs were calculated by multiplying the caregiver-reported healthcare utilization rates by the mean unit cost for each healthcare utilization category. Indirect costs included lost productivity, income loss, and lost leisure time. The indirect costs were a function of caregiver-reported hours spent caregiving and an hourly unit cost. The survey was emailed to 60 DS caregivers, of which 34 (57% response rate) responded. Direct costs on average were $27,276 (95% interval: $15,757, $41,904) per patient with DS. Hospitalizations ($11,565 a year) and in-home medical care visits ($9894 a year) were substantial cost drivers. Additionally, caregivers reported extensive time spent providing care to an individual with DS. This caregiver time resulted in average annual indirect costs of $81,582 (95% interval: $57,253, $110,151), resulting in an average total annual financial burden of $106,378 (95% interval: $78,894, $137,906). Dravet Syndrome results in substantial healthcare utilization, financial burden, and time commitment. Establishing evidence on the financial burden of DS is essential to understanding the overall impact of DS, identifying potential areas for support needs, and assessing the impact of novel treatments as they become available. Based on the study findings, in-home visits, hospitalizations, and lost productivity and leisure time of caregivers are key domains for DS economic evaluations. Future research should extend these estimates to include the potential additional healthcare utilization of the DS caregiver. Copyright © 2018 Elsevier Inc. All rights reserved.

Annual Cost of U.S. Hospital Visits for Pediatric Abusive Head Trauma.

PubMed

Peterson, Cora; Xu, Likang; Florence, Curtis; Parks, Sharyn E

2015-08-01

We estimated the frequency and direct medical cost from the provider perspective of U.S. hospital visits for pediatric abusive head trauma (AHT). We identified treat-and-release hospital emergency department (ED) visits and admissions for AHT among patients aged 0-4 years in the Nationwide Emergency Department Sample and Nationwide Inpatient Sample (NIS), 2006-2011. We applied cost-to-charge ratios and estimated professional fee ratios from Truven Health MarketScan(®) to estimate per-visit and total population costs of AHT ED visits and admissions. Regression models assessed cost differences associated with selected patient and hospital characteristics. AHT was diagnosed during 6,827 (95% confidence interval [CI] [6,072, 7,582]) ED visits and 12,533 (95% CI [10,395, 14,671]) admissions (28% originating in the same hospital's ED) nationwide over the study period. The average medical cost per ED visit and admission were US$2,612 (error bound: 1,644-3,581) and US$31,901 (error bound: 29,266-34,536), respectively (2012 USD). The average total annual nationwide medical cost of AHT hospital visits was US$69.6 million (error bound: 56.9-82.3 million) over the study period. Factors associated with higher per-visit costs included patient age <1 year, males, coexisting chronic conditions, discharge to another facility, death, higher household income, public insurance payer, hospital trauma level, and teaching hospitals in urban locations. Study findings emphasize the importance of focused interventions to reduce this type of high-cost child abuse. © The Author(s) 2015.

Enhanced ABC costing for hospitals: directed expense costing.

PubMed

Ryan, J

1997-10-01

Space limitations do not allow a complete discussion of all the topics and many of the obvious questions that the preceding brief introduction to directed expense costing probably raised in the reader's mind. These include how errors in accounting practices like posting expenses to the wrong period are handled; and how the system automatically adjusts costs for expenses benefiting several periods but posted to the acquisition month. As was mentioned above, underlying this overtly simple costing method are a number of sophisticated and sometimes complex processes that are hidden from the normal user and designed to automatically protect the integrity and accuracy of the costing process. From a user's viewpoint, the system is straightforward, understandable, and easy to use and audit. From a software development perspective, it is not quite that effortless. By using a system that is understood by all users at all levels, these users can now communicate with each other in a new and effective way. This new communication channel only occurs after each user is satisfied as to the overall costing quality achieved by the process. However, not all managers or physicians are always happy that the institution is using this "understandable" cost accounting system. During one of the weekly meetings of a hospital's administrative council, complaints from several powerful department heads concerning the impact that the use of cost data was having on them were brought up for discussion. In defending the continued use of the system, one vice president stated to the group that cost accounting does not get any easier than this, or any less expensive, or any more accurate. The directed expense process works and works very well. Our department heads and physicians will have to come to grips with the accountably it provides us to assess their value to the hospital.

Hospital-based glaucoma clinics: what are the costs to patients?

PubMed

Sharma, A; Jofre-Bonet, M; Panca, M; Lawrenson, J G; Murdoch, I

2010-06-01

To investigate the costs to patients attending hospital-based glaucoma clinics. A patient-based costs questionnaire was developed and completed for patients attending six ophthalmology units across London (Ealing General Hospital, St Georges Hospital, Mile End Hospital, Upney Centre Barking, St Ann's Hospital and the Royal London Hospital). The questionnaire considered age, sex, ethnicity as well as patient-based costs, opportunity costs, and companion costs. All patients visiting for review or appointments were approached non-selectively. A total of 100 patients were sampled from each unit. The mean age of the full sample was 69.6 years (SD 12.6), with little variation between sites (68.5-71.8 years). There was an almost equal sex distribution (male (298 (50.6%)). There was no major difference in occupational distribution between sites. The majority of people came to hospital by bus (40%) or car (26%). Female patients went slightly more by cab or car, whereas male patients went slightly more by foot or train. There was some variability in transport method by site. The data showed that the Royal London hospital had the highest mean cost per visit (pound16.20), whereas St Georges had the lowest (pound12.90). Upney had the second highest mean cost per visit (pound15.20), whereas Ealing and St Ann's had similar mean costs of (pound13.25) and (pound13), respectively. Travel costs accounted for about one-fifth of the total patient's costs. For all glaucoma clinics, total societal costs were higher than the sum of patients' costs because of the high frequency of companions. A surprising finding was that two-thirds of the population (392 or 66.6%) reported no qualification-considerably higher than the national census statistics for the same population. To our knowledge this paper presents direct and indirect patient costs in attending hospital glaucoma units for the first time. It highlights the significance of opportunity costs when considering health-care interventions as they amount to a third or more of the total costs of patient attendances to clinics.

Cost-benefit and effectiveness analysis of rapid testing for MRSA carriage in a hospital setting.

PubMed

Henson, Gay; Ghonim, Elham; Swiatlo, Andrea; King, Shelia; Moore, Kimberly S; King, S Travis; Sullivan, Donna

2014-01-01

A cost-effectiveness analysis was conducted comparing the polymerase chain reaction assay and traditional microbiological culture as screening tools for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to the pediatric and surgical intensive care units (PICU and SICU) at a 722 bed academic medical center. In addition, the cost benefits of identification of colonized MRSA patients were determined. The cost-effectiveness analysis employed actual hospital and laboratory costs, not patient costs. The actual cost of the PCR assay was higher than the microbiological culture identification of MRSA ($602.95 versus $364.30 per positive carrier identified). However, this did not include the decreased turn-around time of PCR assays compared to traditional culture techniques. Patient costs were determined indirectly in the cost-benefit analysis of clinical outcome. There was a reduction in MRSA hospital-acquired infection (3.5 MRSA HAI/month without screening versus 0.6/month with screening by PCR). A cost-benefit analysis based on differences in length of stay suggests an associated savings in hospitalization costs: MRSA HAI with 29.5 day median LOS at $63,810 versus MRSA identified on admission with 6 day median LOS at $14,561, a difference of $49,249 per hospitalization. Although this pilot study was small and it is not possible to directly relate the cost-effectiveness and cost-benefit analysis due to confounding factors such as patient underlying morbidity and mortality, a reduction of 2.9 MRSA HAI/month associated with PCR screening suggests potential savings in hospitalization costs of $142,822 per month.

Service use and costs of incident femoral fractures in nursing home residents in Germany: the Bavarian Fall and Fracture Prevention Project (BF2P2).

PubMed

Heinrich, Sven; Rapp, Kilian; Rissmann, Ulrich; Becker, Clemens; König, Hans-Helmut

2011-07-01

Hip fractures are one of the most costly consequences of falls in the elderly. Despite their increased risk of falls and fractures, nursing home residents are often neglected in service utilization and costing studies. The purpose of this study was to determine service use, initial and long-term direct costs of incident femoral fractures in nursing home residents 65 years or older in Germany. An incidence-based, bottom-up cost-of-illness study aiming at measuring fracture-related direct costs from a payer perspective was conducted. Nursing homes The retrospective dataset included all insurants of a sickness fund (Allgemeine Ortskrankenkasse Bavaria), who were 65 years or older, resided in a nursing home, and had a level of care of at least one in the statutory long-term care insurance (n = 60,091). Incident femoral fractures (ICD-10, S72) in 2006 were followed until the end of 2008, incorporating service use and costs of inpatient care (up to 12 months after the initial hospitalization episode), nursing home care (until death or the end of 2008), and ambulatory care (pharmaceuticals, nonphysician providers, and medical supply within 3 months after the initial hospitalization episode). Additional costs for nursing home and ambulatory care were determined with a before/after design. Costs beyond the year 2006 were discounted with a rate of 5%. Sensitivity analyses on key parameters were performed. Overall mean direct costs of 9488 USD (SD ± 4453 USD, 2006) occurred for incident femoral fractures (n = 1525). This included inpatient care (90.2%), additional costs for nursing home care (7.1%), and ambulatory care (2.7%). Eighty-seven percent of the costs occurred for the initial hospitalization episode and 13% for long-term costs. After the index admission, 12.1% were admitted to a rehabilitation facility, 4.1% were rehospitalized within a year, and in 17.7% the level of care increased within 90 days after the end of the initial hospital episode. The share of residents with incident femoral fractures rehospitalized was significantly higher and costs for nonphysician providers were significantly lower for male residents. Residents with femoral fractures used a wide range of health services. Our study underestimates the true costs to society in Germany. Efforts should be directed to economic evaluations of fall-prevention programs aiming at reducing fall-related fractures including femoral fractures. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

"Factors associated with non-small cell lung cancer treatment costs in a Brazilian public hospital".

PubMed

de Barros Reis, Carla; Knust, Renata Erthal; de Aguiar Pereira, Claudia Cristina; Portela, Margareth Crisóstomo

2018-02-17

The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time. Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution. The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R 2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%. Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.

Hospital and Community Characteristics Associated With Pediatric Direct Admission to Hospital.

PubMed

Leyenaar, JoAnna K; Shieh, Meng-Shiou; Lagu, Tara; Pekow, Penelope S; Lindenauer, Peter K

2017-10-27

One quarter of pediatric hospitalizations begin as direct admissions, defined as hospitalization without receiving care in the hospital's emergency department (ED). Direct admission rates are highly variable across hospitals, yet previous studies have not examined reasons for this variation. We aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates. We conducted a cross-sectional study of the Healthcare Cost and Utilization Project's Kids Inpatient Database, American Hospital Association Database, and Area Health Resource File, including children <18 years of age who were admitted for a medical hospitalization in states contributing data to all data sets. Using hierarchical generalized linear modeling, we generated risk-adjusted direct admission rates and used generalized linear models to assess the association of hospital and community characteristics with these risk-adjusted rates. We included 211,458 children discharged from 933 hospitals and 26 states; 20.2% were admitted directly. One-fifth of the variance in risk-adjusted direct admission rates was attributed to observed hospital and community factors. The greatest proportion of this explained variance was related to ED volume (37%), volume of pediatric hospitalizations (27%), and size of the pediatrician workforce (12%). Direct admission rates were associated with several hospital and community characteristics, but the majority of variation in hospitals' direct admission rates was not explained by these factors. These findings suggest opportunities for diverse hospital types to develop the infrastructure and communication systems necessary to support pediatric direct admissions. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Economic Burden of Hepatitis C Virus Infection in Different Stages of Disease: A Report From Southern Iran.

PubMed

Zare, Fatemeh; Fattahi, Mohammad Reza; Sepehrimanesh, Masood; Safarpour, Ali Reza

2016-04-01

Hepatitis C virus (HCV) infection is a major blood-borne infection which imposes high economic cost on the patients. The current study aimed to evaluate the total annual cost due to chronic HCV related diseases imposed on each patient and their family in Southern Iran. Economic burden of chronic hepatitis C-related liver diseases (chronic hepatitis C, cirrhosis and hepatocellular carcinoma) were examined. The current retrospective study evaluated 200 Iranian patients for their socioeconomic status, utilization (direct and indirect costs) and treatment costs and work days lost due to illness by a structured questionnaire in 2015. Costs of hospital admissions were extracted from databases of Nemazee hospital, Shiraz, Iran. The outpatient expenditure per patient was measured through the rate of outpatient visits and average cost per visit reported by the patients; while the inpatient costs were calculated through annual rate of hospital admissions and average expenditure. Self-medication and direct non-medical costs were also reported. The human capital approach was used to measure the work loss cost. The total annual cost per patient for chronic hepatitis C, cirrhosis and hepatocellular carcinoma (HCC) based on purchasing power parity (PPP) were USD 1625.50, USD 6117.2, and USD 11047.2 in 2015, respectively. Chronic hepatitis C-related liver diseases impose a substantial economic burden on patients, families and the society. The current study provides useful information on cost of treatment and work loss for different disease states, which can be further used in cost-effectiveness evaluations.

The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock.

PubMed

Khwannimit, Bodin; Bhurayanontachai, Rungsun

2015-10-01

The costs of severe sepsis care from middle-income countries are lacking. This study investigated direct intensive care unit (ICU) costs and factors that could affect the financial outcomes. A prospective cohort study was conducted in the medical ICU of a tertiary referral university teaching hospital in Thailand. A total of 897 patients were enrolled in the study, with 683 (76.1%) having septic shock. Community-, nosocomial, and ICU-acquired infections were documented in 574, 282, and 41 patients, respectively. The median ICU costs per patient were $2716.5 ($1296.1-$5367.6) and $599.9 ($414.3-$948.6) per day. The ICU costs accounted for 64.7% of the hospital costs. In 2008 to 2011, the ICU costs significantly decreased by 40% from $3542.5 to $2124.9, whereas, the daily ICU costs decreased only 3.3% from $609.7 to $589.7. By multivariate logistic regression analysis, age, nosocomial or ICU infection, admission from the emergency department, number of organ failures, ICU length of stay, and fluid balance the first 72 hours were independently associated with ICU costs. The ICU costs of severe sepsis management significantly declined in our study. However, the ICU costs were a financial burden accounting for two thirds of the hospital costs. It is essential for intensivists to contribute a high standard of care within a restricted budget. Copyright © 2015 Elsevier Inc. All rights reserved.

Cost analysis of surgically treated pressure sores stage III and IV.

PubMed

Filius, A; Damen, T H C; Schuijer-Maaskant, K P; Polinder, S; Hovius, S E R; Walbeehm, E T

2013-11-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study

PubMed Central

Saperi, Bin Sulong; Ramli, Roszalina; Ahmed, Zafar; Muhd Nur, Amrizal; Ibrahim, Mohd Ismail; Rashdi, Muhd Fazlynizam; Nordin, Rifqah; Rahman, Normastura Abd; Yusoff, Azizah; Nazimi, Abd Jabar; Abdul Rahman, Roselinda; Abdul Razak, Noorhayati; Mohamed, Norlen

2017-01-01

Objective Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma. Materials and methods A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed. Results A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia. Conclusion Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia. PMID:28223831

Economic Burden of Smoking in Iran: A Prevalence-Based Annual Cost Approach

PubMed Central

Rezaei, Satar; Matin, Behzad Karami; Hajizadeh, Mohammad; Bazyar, Mohammad; Sari, Ali Akbari

2017-01-01

Objectives: The burden of smoking on the health system and society is significant. The current study aimed to estimate the annual direct and indirect costs of smoking in Iran for the year 2014. Methods: A prevalence-based disease-specific approach was used to determine costs associated with the three most common smoking-related diseases: lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). Data on healthcare utilization were obtained from an original survey, hospital records and questionnaires. The number of deaths was extracted from the global burden diseases study (GBD). The human capital approach was applied to estimate the costs of morbidity and mortality due to smoking-related diseases, classified as direct (hospitalization, outpatients and non-medical costs) and indirect (mortality and morbidity). Results: The total economic cost of the three most common smoking-attributable diseases in Iran was US$1.46 billion in 2014, including US$1.05 billion (71.7%) in indirect and US$0.41 billion (28.3%) in direct costs. Direct costs of the three smoking-related diseases accounted for 1.6% of total healthcare expenditures and total costs were about 0.26% of Iran’s gross domestic product (GDP) in 2014. Conclusions: Our study indicated that smoking places a substantial economic burden on Iranian society. Therefore, sustained smoking cessation interventions and tobacco control policies are required to reduce the magnitude and extent of smoking-attributable costs in Iran. PMID:29072438

Predictors of direct cost of diabetes care in pediatric patients with type 1 diabetes

USDA-ARS?s Scientific Manuscript database

This study examines factors that predict elevated direct costs of pediatric patients with type 1 diabetes. Methods: A cohort of 784 children with type 1 diabetes at least 6 months postdiagnosis and managed by pediatric endocrinologists at Texas Children's Hospital were included in this study. Actual...

42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

Code of Federal Regulations, 2010 CFR

2010-10-01

... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.160 Election of reasonable cost payment for direct medical and surgical services of physicians in teaching...

Cost analysis in a clinical microbiology laboratory.

PubMed

Brezmes, M F; Ochoa, C; Eiros, J M

2002-08-01

The use of models for business management and cost control in public hospitals has led to a need for microbiology laboratories to know the real cost of the different products they offer. For this reason, a catalogue of microbiological products was prepared, and the costs (direct and indirect) for each product were analysed, along with estimated profitability. All tests performed in the microbiology laboratory of the "Virgen de la Concha" Hospital in Zamora over a 2-year period (73192 tests) were studied. The microbiological product catalogue was designed using homogeneity criteria with respect to procedures used, workloads and costs. For each product, the direct personnel costs (estimated from workloads following the method of the College of American Pathologists, 1992 version), the indirect personnel costs, the direct and indirect material costs and the portion of costs corresponding to the remaining laboratory costs (capital and structural costs) were calculated. The average product cost was 16.05 euros. The average cost of a urine culture (considered, for purposes of this study, as a relative value unit) reached 13.59 euros, with a significant difference observed between positive and negative cultures (negative urine culture, 10.72 euros; positive culture, 29.65 euros). Significant heterogeneity exists, both in the costs of different products and especially in the cost per positive test. The application of a detailed methodology of cost analysis facilitates the calculation of the real cost of microbiological products. This information provides a basic tool for establishing clinical management strategies.

Economic evaluation of uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial.

PubMed

Volkers, Nicole A; Hehenkamp, Wouter J K; Smit, Patrick; Ankum, Willem M; Reekers, Jim A; Birnie, Erwin

2008-07-01

To investigate whether uterine artery embolization (UAE) is a cost-effective alternative to hysterectomy for patients with symptomatic uterine fibroids, the authors performed an economic evaluation alongside the multicenter randomized EMMY (EMbolization versus hysterectoMY) trial. Between February 2002 and February 2004, 177 patients were randomized to undergo UAE (n = 88) or hysterectomy (n = 89) and followed up until 24 months after initial treatment allocation. Conditional on the equivalence of clinical outcome, a cost minimization analysis was performed according to the intention to treat principle. Costs included health care costs inside and outside the hospital as well as costs related to absence from work (societal perspective). Cumulative standardized costs were estimated as volumes multiplied with prices. The nonparametric bootstrap method was used to quantify differences in mean (95% confidence interval [CI]) costs between the strategies. In total, 81 patients underwent UAE and 75 underwent hysterectomy. In the UAE group, 19 patients (23%) underwent secondary hysterectomies. The mean total costs per patient in the UAE group were significantly lower than those in the hysterectomy group ($11,626 vs $18,563; mean difference, -$6,936 [-37%], 95% CI: -$9,548, $4,281). The direct medical in-hospital costs were significantly lower in the UAE group: $6,688 vs $8,313 (mean difference, -$1,624 [-20%], 95% CI: -$2,605, -$586). Direct medical out-of-hospital and direct nonmedical costs were low in both groups (mean cost difference, $156 in favor of hysterectomy). The costs related to absence from work differed significantly between the treatment strategies in favor of UAE (mean difference, -$5,453; 95% CI: -$7,718, -$3,107). The costs of absence from work accounted for 79% of the difference in total costs. The 24-month cumulative cost of UAE is lower than that of hysterectomy. From a societal economic perspective, UAE is the superior treatment strategy in women with symptomatic uterine fibroids.

Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change.

PubMed

Lin, Shao; Hsu, Wan-Hsiang; Van Zutphen, Alissa R; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-11-01

Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. The estimated respiratory disease burden attributable to extreme heat at baseline (1991-2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080-2099 based on three different climate scenarios ranged from 206-607 excess hospital admissions, US$26-$76 million in hospitalization costs, and 1,299-3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080-2099 than in 1991-2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.

42 CFR 413.77 - Direct GME payments: Determination of per resident amounts.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., research and other nonreimbursable cost centers, and hospital-based providers that are not participating in... hospital's per resident amount is updated using the methodology specified under paragraph (c)(1) of this... hospital's per resident amount is adjusted using the methodology specified in paragraph (c)(1) of this...

42 CFR 413.77 - Direct GME payments: Determination of per resident amounts.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., research and other nonreimbursable cost centers, and hospital-based providers that are not participating in... hospital's per resident amount is updated using the methodology specified under paragraph (c)(1) of this... hospital's per resident amount is adjusted using the methodology specified in paragraph (c)(1) of this...

Direct Diabetes-Related Costs in Young Patients with Early-Onset, Long-Lasting Type 1 Diabetes

PubMed Central

Straßburger, Klaus; Flechtner-Mors, Marion; Hungele, Andreas; Beyer, Peter; Placzek, Kerstin; Hermann, Ulrich; Schumacher, Andrea; Freff, Markus; Stahl-Pehe, Anna

2013-01-01

Objective To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. Research Design and Methods Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0–4 years of age within the years 1993–1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. Results Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943–4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. Conclusions Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group. PMID:23967077

The cost of fall related presentations to the ED: a prospective, in-person, patient-tracking analysis of health resource utilization.

PubMed

Woolcott, J C; Khan, K M; Mitrovic, S; Anis, A H; Marra, C A

2012-05-01

We prospectively collected data on elderly fallers to estimate the total cost of a fall requiring an Emergency Department presentation. Using data collected on 102 falls, we found the average cost per fall causing an Emergency Department presentation of $11,408. When hospitalization was required, the average cost per fall was $29,363. For elderly persons, falls are a major source of mortality, morbidity, and disability. Previous Canadian cost estimates of seniors' falls were based upon administrative data that has been shown to underestimate the incidence of falls. Our objective was to use a labor-intensive, direct observation patient-tracking method to accurately estimate the total cost of falls among seniors who presented to a major urban Emergency Department (ED) in Canada. We prospectively collected data from seniors (>70 years) presenting to the Vancouver General Hospital ED after a fall. We excluded individuals who where cognitively impaired or unable to read/write English. Data were collected on the care provided including physician assessments/consultations, radiology and laboratory tests, ED/hospital time, rehabilitation facility time, and in-hospital procedures. Unit costs of health resources were taken from a fully allocated hospital cost model. Data were collected on 101 fall-related ED presentations. The most common diagnoses were fractures (n = 33) and lacerations (n = 11). The mean cost of a fall causing ED presentation was $11,408 (SD: $19,655). Thirty-eight fallers had injuries requiring hospital admission with an average total cost of $29,363 (SD: $22,661). Hip fractures cost $39,507 (SD: $17,932). Among the 62 individuals not admitted to the hospital, the average cost of their ED visit was $674 (SD: $429). Among the growing population of Canadian seniors, falls have substantial costs. With the cost of a fall-related hospitalization approaching $30,000, there is an increased need for fall prevention programs.

Economic outcomes of influenza in hospitalized elderly with and without ICU admission.

PubMed

Chan, Yik-Kei; Wong, Rity Yk; Ip, Margaret; Lee, Nelson Ls; You, Joyce Hs

2017-01-01

To describe direct medical costs of influenza in hospitalized elderly, with and without intensive care unit (ICU) admission, during the 2014-2015 season in Hong Kong. A retrospective study was conducted in 110 inpatients aged ≥65 years with laboratory-confirmed influenza treated by antiviral therapy during season 2014-2015 in a tertiary hospital. Resource utilization of influenza-related diagnostic and laboratory tests, medications for influenza treatment, usage of general medical ward and ICU during the influenza-related length of hospital stay (IR-LOS) were collected. There were 18 (16.4%) and 92 (83.4%) cases with and without ICU admission, respectively. The difference in influenza-related mortality rates between patients with (11.1%) and without ICU admission (2.2%) was not statistically significant (P=0.064). Patients with ICU admission reported longer IR-LOS (12.7 ±6.0 days versus 5.5 ±2.7 days; P<0.001) and higher direct costs (36,588 USD ±21,482 versus 5,773 USD ±2,017; P<0.001; 1 USD=7.8 HKD). Male gender (OR=14.50; 95% CI 1.68, 125.07) and respiratory complications (OR=9.61; 95% CI 1.90, 48.50) were positive predictors of ICU admission. Age ≥70 years (OR=0.09; 95% CI 0.02, 0.46) and antiviral therapy initiation within 7 days (OR=0.05; 95% CI 0.003, 0.79) were negative predictors of ICU admission. Influenza B was a positive predictor of high-cost hospitalization in non-ICU survivors (OR=7.33; 95% CI 1.24, 43.29). No predictor of mortality was identified. Hospitalization cost in elderly for seasonal influenza was substantial in Hong Kong. The cost in patients with ICU admission was significantly higher than those without ICU care. Respiratory complications and male gender predicted ICU admission. Influenza B infection predicted high-cost hospitalization in non-ICU survivors.

The economic burden of incisional ventral hernia repair: a multicentric cost analysis.

PubMed

Gillion, J-F; Sanders, D; Miserez, M; Muysoms, F

2016-12-01

A systematic review of literature led us to take note that little was known about the costs of incisional ventral hernia repair (IVHR). Therefore we wanted to assess the actual costs of IVHR. The total costs are the sum of direct (hospital costs) and indirect (sick leave) costs. The direct costs were retrieved from a multi-centric cost analysis done among a large panel of 51 French public hospitals, involving 3239 IVHR. One hundred and thirty-two unitary expenditure items were thoroughly evaluated by the accountants of a specialized public agency (ATIH) dedicated to investigate the costs of the French Health Care system. The indirect costs (costs of the post-operative inability to work and loss of profit due to the disruption in the ongoing work) were estimated from the data the Hernia Club registry, involving 790 patients, and over a large panel of different Collective Agreements. The mean total cost for an IVHR in France in 2011 was estimated to be 6451€, ranging from 4731€ for unemployed patients to 10,107€ for employed patients whose indirect costs (5376€) were slightly higher than the direct costs. Reducing the incidence of incisional hernia after abdominal surgery with 5 % for instance by implementation of the European Hernia Society Guidelines on closure of abdominal wall incisions, or maybe even by use of prophylactic mesh augmentation in high risk patients could result in a national cost savings of 4 million Euros.

Societal burden of cluster headache in the United States: a descriptive economic analysis.

PubMed

Ford, Janet H; Nero, Damion; Kim, Gilwan; Chu, Bong Chul; Fowler, Robert; Ahl, Jonna; Martinez, James M

2018-01-01

To estimate direct and indirect costs in patients with a diagnosis of cluster headache in the US. Adult patients (18-64 years of age) enrolled in the Marketscan Commercial and Medicare Databases with ≥2 non-diagnostic outpatient (≥30 days apart between the two outpatient claims) or ≥1 inpatient diagnoses of cluster headache (ICD-9-CM code 339.00, 339.01, or 339.02) between January 1, 2009 and June 30, 2014, were included in the analyses. Patients had ≥6 months of continuous enrollment with medical and pharmacy coverage before and after the index date (first cluster headache diagnosis). Three outcomes were evaluated: (1) healthcare resource utilization, (2) direct healthcare costs, and (3) indirect costs associated with work days lost due to absenteeism and short-term disability. Direct costs included costs of all-cause and cluster headache-related outpatient, inpatient hospitalization, surgery, and pharmacy claims. Indirect costs were based on an average daily wage, which was estimated from the 2014 US Bureau of Labor Statistics and inflated to 2015 dollars. There were 9,328 patients with cluster headache claims included in the analysis. Cluster headache-related total direct costs (mean [standard deviation]) were $3,132 [$13,396] per patient per year (PPPY), accounting for 17.8% of the all-cause total direct cost. Cluster headache-related inpatient hospitalizations ($1,604) and pharmacy ($809) together ($2,413) contributed over 75% of the cluster headache-related direct healthcare cost. There were three sub-groups of patients with claims associated with indirect costs that included absenteeism, short-term disability, and absenteeism + short-term disability. Indirect costs PPPY were $4,928 [$4,860] for absenteeism, $803 [$2,621] for short-term disability, and $3,374 [$3,198] for absenteeism + disability. Patients with cluster headache have high healthcare costs that are associated with inpatient admissions and pharmacy fulfillments, and high indirect costs associated with absenteeism and short-term disability.

[An evaluation of costs in nephrology by means of analytical accounting system].

PubMed

Hernández-Jaras, J; García Pérez, H; Pons, R; Calvo, C

2005-01-01

The analytical accounting is a countable technique directed to the evaluation, by means of pre-established criteria of distribution, of the internal economy of the hospital, in order to know the effectiveness and efficiency of Clinical Units. The aim of this study was to analyze the activity and costs of the Nephrology Department of General Hospital of Castellón. Activity of Hospitalization and Ambulatory Care, during 2003 was analysed. Hospitalization discharges were grouped in DGR and the costs per DGR were determinated. Total costs Hospitalisation and Ambulatory Care were 560.434,9 and 146.317,8 Euros, respectively. And the costs of one stay, one first outpatient visit and maintenance visit were 200, 63, and 31,6 Euros, respectively. Eighty per cent of the discharges were grouped in 9 DGR and DRG number 316 (Renal Failure) represented 30% of the total productivity. Costs of DGR 316 were 3.178,2 Euros and 16% represented laboratory cost and costs of diagnostic or therapeutic procedures. With introduction of analytical accounting and DGR system, the Nephrology Departments can acquire more full information on the results and costs of treatment. These techniques permits to improve the financial and economic performance.

Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions

PubMed Central

Benkeser, David; Coe, Norma B.; Engelberg, Ruth A.; Teno, Joan M.; Curtis, J. Randall

2016-01-01

Abstract Background: Terminal intensive care unit (ICU) stays represent an important target to increase value of care. Objective: To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. Design: Secondary analysis of an intervention study to improve quality of care for critically ill patients. Setting/Patients: 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center. Methods: Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models. Main Results: Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics. Conclusions: Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models. PMID:27813724

[Cost-effectiveness of laparoscopic versus open cholecystectomy].

PubMed

Fajardo, Roosevelt; Valenzuela, José Ignacio; Olaya, Sandra Catalina; Quintero, Gustavo; Carrasquilla, Gabriel; Pinzón, Carlos Eduardo; López, Catalina; Ramírez, Juan Camilo

2011-01-01

Cholecystectomy has been the subject of several clinical and cost comparison studies. The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of health care institutions and from that of the patients. The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected--156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy. The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios. Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p<0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p<0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomy and laparoscopic cholecystectomy was more cost-effective than open cholecystectomy (US$ 995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero. The open laparoscopy procedure was associated with longer hospital stays, where as the cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was lower for both for the health care institution and patients. The cost-effectiveness for both procedures was comparable.

Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women.

PubMed

Bessette, L; Jean, S; Lapointe-Garant, M-P; Belzile, E L; Davison, K S; Ste-Marie, L G; Brown, J P

2012-06-01

This study determined the cost of treating fractures at osteoporotic sites (except spine fractures) for the year following fracture. While the average cost of treating a hip fracture was the highest of all fractures ($46,664 CAD per fracture), treating other fractures also accounted for significant expenditures ($5,253 to $10,410 CAD per fracture). This study aims to determine the mean direct medical cost of treating fractures at peripheral osteoporotic sites in the year post-fracture (through 2 years post-hip fracture). Health administrative databases from the province of Quebec, Canada were used to estimate the cost of treating peripheral fractures at osteoporotic sites for the year following fracture (through 2 years for hip fractures). Included in costs analyses were physician claims, emergency and outpatient clinic costs, hospitalization costs, and subsequent costs for treatment of complications. A total of 15,827 patients (mean age 72 years) who suffered one fracture at an osteoporotic site had data for analyses. Hip/femur fractures had the highest rate of hospital stays related to fracture (91%) and the highest rate of hospital stays associated with a post-fracture complication (8%). In the year following fracture, the mean (SD) costs (2009 Canadian dollars) of treating acute fractures and post-fracture complications were: hip/femur fracture $46,664 ($43,198), wrist fracture $5,253 ($18,982), and fractures at other peripheral sites $10,410 ($27,641). The average (SD) cost of treating post-fracture complications at the hip/femur in the second year post-fracture was $1,698 ($12,462). Hospitalizations associated with the fracture accounted for 88% of the total cost of fracture treatment. The treatment of hip fractures accounts for a significant proportion of the costs associated with the treatment of peripheral osteoporotic fractures. Interventions to reduce the incidence of fractures, particularly hip fractures, would result in significant cost savings to the health care system and would preserve quality of life in many patients.

Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States.

PubMed

Adam, E A; Collier, S A; Fullerton, K E; Gargano, J W; Beach, M J

2017-10-01

National emergency department (ED) visit prevalence and costs for selected diseases that can be transmitted by water were estimated using large healthcare databases (acute otitis externa, campylobacteriosis, cryptosporidiosis, Escherichia coli infection, free-living ameba infection, giardiasis, hepatitis A virus (HAV) infection, Legionnaires' disease, nontuberculous mycobacterial (NTM) infection, Pseudomonas-related pneumonia or septicemia, salmonellosis, shigellosis, and vibriosis or cholera). An estimated 477,000 annual ED visits (95% CI: 459,000-494,000) were documented, with 21% (n = 101,000, 95% CI: 97,000-105,000) resulting in immediate hospital admission. The remaining 376,000 annual treat-and-release ED visits (95% CI: 361,000-390,000) resulted in $194 million in annual direct costs. Most treat-and-release ED visits (97%) and costs ($178 million/year) were associated with acute otitis externa. HAV ($5.5 million), NTM ($2.3 million), and salmonellosis ($2.2 million) were associated with next highest total costs. Cryptosporidiosis ($2,035), campylobacteriosis ($1,783), and NTM ($1,709) had the highest mean costs per treat-and-release ED visit. Overall, the annual hospitalization and treat-and-release ED visit costs associated with the selected diseases totaled $3.8 billion. As most of these diseases are not solely transmitted by water, an attribution process is needed as a next step to determine the proportion of these visits and costs attributable to waterborne transmission.

Considering Value in Rectal Cancer Surgery: An Analysis of Costs and Outcomes Based on the Open, Laparoscopic, and Robotic Approach for Proctectomy.

PubMed

Silva-Velazco, Jorge; Dietz, David W; Stocchi, Luca; Costedio, Meagan; Gorgun, Emre; Kalady, Matthew F; Kessler, Hermann; Lavery, Ian C; Remzi, Feza H

2017-05-01

The aim of the study was to compare value (outcomes/costs) of proctectomy in patients with rectal cancer by 3 approaches: open, laparoscopic, and robotic. The role of minimally invasive proctectomy in rectal cancer is controversial. In the era of value-based medicine, costs must be considered along with outcomes. Primary rectal cancer patients undergoing curative intent proctectomy at our institution between 2010 and 2014 were included. Patients were grouped by approach [open surgery, laparoscopic surgery, and robotic surgery (RS)] on an intent-to-treat basis. Groups were compared by direct costs of hospitalization for the primary resection, 30-day readmissions, and ileostomy closure and for short-term outcomes. A total of 488 patients were evaluated; 327 were men (67%), median age was 59 (27-93) years, and restorative procedures were performed in 333 (68.2%). Groups were similar in demographics, tumor characteristics, and treatment details. Significant outcome differences between groups were found in operative and anesthesia times (longer in the RS group), and in estimated blood loss, intraoperative transfusion, length of stay, and postoperative complications (all higher in the open surgery group). No significant differences were found in short-term oncologic outcomes. Direct cost of the hospitalization for primary resection and total direct cost (including readmission/ileostomy closure hospitalizations) were significantly greater in the RS group. The laparoscopic and open approaches to proctectomy in patients with rectal cancer provide similar value. If robotic proctectomy is to be widely applied in the future, the costs of the procedure must be reduced.

Household costs among patients hospitalized with malaria: evidence from a national survey in Malawi, 2012.

PubMed

Hennessee, Ian; Chinkhumba, Jobiba; Briggs-Hagen, Melissa; Bauleni, Andy; Shah, Monica P; Chalira, Alfred; Moyo, Dubulao; Dodoli, Wilfred; Luhanga, Misheck; Sande, John; Ali, Doreen; Gutman, Julie; Lindblade, Kim A; Njau, Joseph; Mathanga, Don P

2017-10-02

With 71% of Malawians living on < $1.90 a day, high household costs associated with severe malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi. A cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June-August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level. Out of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs. Although malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect households from potentially catastrophic health expenditures.

Healthcare resource utilization and costs of outpatient follow-up after liver transplantation in a university hospital in São Paulo, Brazil: cost description study.

PubMed

Soárez, Patricia Coelho de; Lara, Amanda Nazareth; Sartori, Ana Marli Christovam; Abdala, Edson; Haddad, Luciana Bertocco de Paiva; D'Albuquerque, Luiz Augusto Carneiro; Novaes, Hillegonda Maria Dutilh

2015-01-01

Data on the costs of outpatient follow-up after liver transplantation are scarce in Brazil. The purpose of the present study was to estimate the direct medical costs of the outpatient follow-up after liver transplantation, from the first outpatient visit after transplantation to five years after transplantation. Cost description study conducted in a university hospital in São Paulo, Brazil. Cost data were available for 20 adults who underwent liver transplantation due to acute liver failure (ALF) from 2005 to 2009. The data were retrospectively retrieved from medical records and the hospital accounting information system from December 2010 to January 2011. Mean cost per patient/year was R$ 13,569 (US$ 5,824). The first year of follow-up was the most expensive (R$ 32,546 or US$ 13,968), and medication was the main driver of total costs, accounting for 85% of the total costs over the five-year period and 71.9% of the first-year total costs. In the second year after transplantation, the mean total costs were about half of the amount of the first-year costs (R$ 15,165 or US$ 6,509). Medication was the largest contributor to the costs followed by hospitalization, over the five-year period. In the fourth year, the costs of diagnostic tests exceeded the hospitalization costs. This analysis provides significant insight into the costs of outpatient follow-up after liver transplantation due to ALF and the participation of each cost component in the Brazilian setting.

Academic health systems management: the rationale behind capitated contracts.

PubMed

Taheri, P A; Butz, D A; Greenfield, L J

2000-06-01

To determine why hospitals enter into "capitated" contracts, which often generate accounting losses. The authors' hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital's capitated health maintenance organization (HMO) patients made up 16. 0% of the total admissions but only 9.4% of the total patient days. Both the mean LOS of 3.4 days and the mean ICU LOS of 0.3 days were significantly different from the overall values of 5.8 days and 1 day, respectively, for the noncapitated population. For patients classified with a DRG with complication who traveled from more than 60 miles away, the mean LOS was 10.7 days and the mean total cost was $21,658. This is in contrast to all patients who traveled greater than 60 miles, who had an LOS of 7.2 days and a mean total cost of $12,569. The capitated payor directed the bulk of its subscribers to one hospital (other payors transferred their sicker patients). This was reflected in the capitated group's lower costs and LOS. This stable stream of relatively low-acuity patients enhanced capacity utilization. For capitated patients, the hospital still benefits by recovering the incremental cost (VDC) of treating these patients, and only a portion of the assigned overhead. Thus, in the short run, capitated patients provide a positive economic benefit. Other payors' higher-acuity patients arrive more randomly, place greater strains on capacity, and generate higher overhead costs. This results in differential reimbursement to cover this incremental overhead. Having a portfolio of contracts allows the hospital to optimize capacity both in terms of patient flows and acuity. One risk of operating near capacity is that capitated patients could displace other higher-paying patients.

Hysteroscopic Endometrial Polypectomy: Clinical and Economic Data in Decision Making.

PubMed

Franchini, Mario; Lippi, Giuseppe; Calzolari, Stefano; Giarrè, Giovanna; Gubbini, Giampietro; Catena, Ursula; Di Spiezio Sardo, Attilio; Florio, Pasquale

To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary referral hospital and center for gynecologic care. Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016. Hysteroscopic endometrial polypectomy performed in the same-day hospital setting or office setting using one of the following: bipolar electrode, loop electrode, mechanical device, or hysteroscopic tissue removal system. The various costs associated with the 2 clinical settings at Palagi Hospital, Florence, Italy were compiled, and a direct cost comparison was made using an activity-based cost-management system. The costs for using reusable loop electrode resection-16 or loop electrode resection-26 were significantly less expensive than using disposable loop electrode resection-27, the tissue removal system, or bipolar electrode resection (p = .0002). Total hospital costs for polypectomy with all systems were significantly less expensive in an office setting compared with same-day surgery in the hospital setting (p = .0001). Office-based hysteroscopic tissue removal was associated with shorter operative time compared with the other procedures (p = .0002) CONCLUSION: The total cost of hysteroscopic polypectomy is markedly higher when using disposable equipment compared with reusable equipment, both in the hospital operating room and the office setting. Same-day hospital or office-based surgery with reusable loop electrode resection is the most cost-effective approach in each settings, but requires experienced surgeons. Finally, the shorter surgical time should be taken into consideration for patients undergoing vaginal polypectomy in the office setting, owing more to patient comfort than to cost savings. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States.

PubMed

Sun, Shawn X; Liu, Gordon G; Christensen, Dale B; Fu, Alex Z

2007-10-01

To review the literature addressing the economic outcomes of nonadherence in the treatment of schizophrenia, and to utilize the review results to provide an update on the economic impact of hospitalizations among schizophrenia patients related to antipsychotic nonadherence. A structured search of EMBASE, Ovid MEDLINE, PubMed and PsycINFO for years 1995-2007 was conducted to identify published English-language articles addressing the economic impact of antipsychotic nonadherence in schizophrenia. The following key words were used in the search: compliance, noncompliance, adherence, nonadherence, relapse, economic, cost, and schizophrenia. A bibliographic search of retrieved articles was performed to identify additional studies. For a study to be included, the date of publication had to be from 1/1/1995 to 6/1/2007, and the impact of nonadherence had to be measured in terms of direct healthcare costs or inpatient days. Subsequently, an estimate of incremental hospitalization costs related to antipsychotic non adherence was extrapolated at the US national level based on the reviewed studies (nonadherence rate and hospitalization rate) and the National Inpatient Sample of Healthcare Cost and Utilization Project (average daily hospitalization costs). Seven studies were identified and reviewed based on the study design, measurement of medication nonadherence, study setting, and cost outcome results. Despite the varied adherence measures across studies, all articles reviewed showed that antipsychotic nonadherence was related to an increase in hospitalization rate, hospital days or hospital costs. We also estimated that the national rehospitalization costs related to antipsychotic nonadherence was $1479 million, ranging from $1392 million to $1826 million in the US in 2005. The estimate of rehospitalization costs was restricted to schizophrenia patients from the Medicaid program. Additionally, the studies we reviewed did not capture the newer antipsychotic drugs (ziprasidone, aripiprazole and paliperidone). Thus, the nonadherence rates or rehospitalization rates might have changed after these new drugs came to the market, which could limit our cost estimation. Poor adherence to antipsychotic medications was consistently associated with higher risk of relapse and rehospitalization and higher hospitalization costs. To reduce the cost of hospitalizations among schizophrenia patients, it seems clear that efforts to increase medication adherence should be undertaken.

The Economic Burden of Autonomic Dysreflexia during Hospitalization for Individuals with Spinal Cord Injury.

PubMed

Squair, Jordan W; White, Barry A B; Bravo, Grace I; Martin Ginis, Kathleen A; Krassioukov, Andrei V

2016-08-01

We sought to determine the economic burden of autonomic dysreflexia (AD) from the perspective of the Canadian healthcare system in a case series of individuals with spinal cord injury (SCI) presenting to emergency care. In doing so, we sought to illustrate the potential return on investments in the translation of evidence-informed practices and developments in the prevention, diagnosis, and management of AD. Activity-based costing methodology was employed to estimate the direct healthcare or hospitalization costs of AD following presentation to the emergency department. Differences in trends were noted between patients who were promptly diagnosed, managed, and discharged, and patients whose experience followed a less direct or ideal path to discharge. We recorded 29 emergency room visits for conditions ultimately diagnosed as AD. Overall, median length of stay was 3 days (interquartile range [IQR] = 1.25-5.75), but extended up to 103 consecutive days. Cost analysis revealed median healthcare costs of $5029 (IQR = $2397-9522) for hospital admissions for AD, with the highest estimated hospital cost for a single admission > $190,000. Emergency room admissions resulting from AD can result in dramatic healthcare costs. Delayed diagnosis and inefficient management of AD may lead to further complications, adding to the strain on already limited healthcare resources. Prompt recognition of AD; broader translation of evidence-informed practices; and novel diagnosis, self-management, and/or therapeutic/pharmaceutical applications may prove to mitigate the burden of AD and improve patient well-being.

The economics of recovery after pancreatic surgery: detailed cost minimization analysis of an enhanced recovery program.

PubMed

Kagedan, Daniel J; Devitt, Katharine S; Tremblay St-Germain, Amélie; Ramjaun, Aliya; Cleary, Sean P; Wei, Alice C

2017-11-01

Clinical pathways (CPW) are considered safe and effective at decreasing postoperative length of stay (LoS), but the effect on economic costs is uncertain. This study sought to elucidate the effect of a CPW on direct hospitalization costs for patients undergoing pancreaticoduodenectomy (PD). A CPW for PD patients at a single Canadian institution was implemented. Outcomes included LoS, 30-day readmissions, and direct costs of hospital care. A retrospective cost minimization analysis compared patients undergoing PD prior to and following CPW implementation, using a bootstrapped t test and deviation-based cost modeling. 121 patients undergoing PD after CPW implementation were compared to 74 controls. Index LoS was decreased following CPW implementation (9 vs. 11 days, p = 0.005), as was total LoS (10 vs. 11 days, p = 0.003). The mean total cost of postoperative hospitalization per patient decreased in the CPW group ($15,678.45 CAD vs. $25,732.85 CAD, p = 0.024), as was the mean 30-day cost including readmissions ($16,627.15 CAD vs. $29,872.72 CAD, p = 0.016). Areas of significant cost savings included laboratory tests and imaging investigations. CPWs may generate cost savings by reducing unnecessary investigations, and improve quality of care through process standardization and decreasing practice variation. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

High cost of stage IV pressure ulcers.

PubMed

Brem, Harold; Maggi, Jason; Nierman, David; Rolnitzky, Linda; Bell, David; Rennert, Robert; Golinko, Michael; Yan, Alan; Lyder, Courtney; Vladeck, Bruce

2010-10-01

The aim of this study was to calculate and analyze the cost of treatment for stage IV pressure ulcers. A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed up for a maximum of 29 months and analyzed. Costs directly related to the treatment of pressure ulcers and their associated complications were calculated. Nineteen patients with stage IV pressure ulcers (11 hospital-acquired and 8 community-acquired) were identified and their charts were reviewed. The average hospital treatment cost associated with stage IV pressure ulcers and related complications was $129,248 for hospital-acquired ulcers during 1 admission, and $124,327 for community-acquired ulcers over an average of 4 admissions. The costs incurred from stage IV pressure ulcers are much greater than previously estimated. Halting the progression of early stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce health care expenditures by millions of dollars. Copyright © 2010 Elsevier Inc. All rights reserved.

Direct medical costs for partial refractory epilepsy in Mexico.

PubMed

García-Contreras, Fernando; Constantino-Casas, Patricia; Castro-Ríos, Angélica; Nevárez-Sida, Armando; Estrada Correa, Gloria del Carmen; Carlos Rivera, Fernando; Guzmán-Caniupan, Jorge; Torres-Arreola, Laura del Pilar; Contreras-Hernández, Iris; Mould-Quevedo, Joaquin; Garduño-Espinosa, Juan

2006-04-01

The aim was to determine the direct medical costs in patients with partial refractory epilepsy at the Mexican Institute of Social Security (IMSS) in Mexico. We carried out a multicenter, retrospective-cohort partial-economic evaluation study of partial refractory epilepsy (PRE) diagnosed patients and analyzed patient files from four secondary- and tertiary-level hospitals. PRE patients >12 years of age with two or more antiepileptic drugs and follow-up for at least 1 year were included. The perspective was institutional (IMSS). Only direct healthcare costs were considered, and the timeline was 1 year. Cost techniques were microcosting, average per-service cost, and per-day cost, all costs expressed in U.S. dollars (USD, 2004). We reviewed 813 files of PRE patients: 133 had a correct diagnosis, and only 72 met study inclusion criteria. Fifty eight percent were females, 64% were <35 years of age, 47% were students, in 73% maximum academic level achieved was high school, and 53% were single. Fifty one percent of cases experienced simple partial seizures and 94% had more than one monthly seizure. Annual healthcare cost of the 72 patients was 190,486 USD, ambulatory healthcare contributing 76% and hospital healthcare with 24%. Annual mean healthcare cost per PRE patient was 2,646 USD; time of disease evolution and severity of the patient's illness did not affect costs significantly.

34 CFR 75.560 - General indirect cost rates; exceptions.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) The differences between direct and indirect costs and the principles for determining the general... principles for— (1) Institutions of higher education, at 34 CFR 74.27; (2) Hospitals, at 34 CFR 74.27; (3...

The burden of acute myocardial infarction after a regional cardiovascular center project in Korea.

PubMed

Kim, Arim; Yoon, Seok-Jun; Kim, Young-Ae; Kim, Eun Jung

2015-10-01

The aim of this study was to examine the impact of a government-directed regional cardiovascular center (RCVC) project on the length of stay (LOS) and medical costs due to acute myocardial infarction (AMI). A retrospective claim data review. Forty hospitals including four RCVCs in Korea. A total of 1469 AMI patients who visited a RCVC in two regions between February 2009 and December 2011. RCVC project has been fostering specialized center by region for management of cardiovascular disease. It has built a system that could receive intensive care quickly within 3 h when disease occurred. Changes in the LOS and cost were evaluated using the difference-in-differences (DIDs) method combined with propensity score matching (1:1) and multilevel analysis with adjustment for patient's and institutional factors. The net effect of RCVC project implementation showed decline of LOS (-0.71 days) and total medical costs (-797 US dollars) by DID. After the RCVC project, the LOS for patients with AMI hospitalized in a RCVC was decreased by 8.9% (β = -0.094, P = 0.041) compared with patients hospitalized in a hospital not designed as a RCVC. Compared with costs before the RCVC project, they were decreased by 11.5% (β = -0.122, P = 0.004). We provided evidence regarding the change in the societal burden due to AMI after regionalization. Although there was a reduction of LOS and direct medical costs reported in limited number of regionalized hospitals, in the long term we can anticipate an expanding impact in all regionalized hospitals. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

A cost-effective interdisciplinary approach to microbiologic send-out test use.

PubMed

Aesif, Scott W; Parenti, David M; Lesky, Linda; Keiser, John F

2015-02-01

Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.

A Cost Analysis Study of the Radiography Program at Middlesex Hospital Using Shock's Analysis Model.

ERIC Educational Resources Information Center

Spence, Weymouth

Federal and state governments want to decrease payments for medical education, and other payers are trying to restrict payouts to direct and necessary patient care services. Teaching hospitals are increasing tuition and fees, reducing education budgets and, in many instances, closing education programs. Hospital administrators are examining the…

Risk-Assessment Score and Patient Optimization as Cost Predictors for Ventral Hernia Repair.

PubMed

Saleh, Sherif; Plymale, Margaret A; Davenport, Daniel L; Roth, John Scott

2018-04-01

Ventral hernia repair (VHR) is associated with complications that significantly increase healthcare costs. This study explores the associations between hospital costs for VHR and surgical complication risk-assessment scores, need for cardiac or pulmonary evaluation, and smoking or obesity counseling. An IRB-approved retrospective study of patients having undergone open VHR over 3 years was performed. Ventral Hernia Risk Score (VHRS) for surgical site occurrence and surgical site infection, and the Ventral Hernia Working Group grade were calculated for each case. Also recorded were preoperative cardiology or pulmonary evaluations, smoking cessation and weight reduction counseling, and patient goal achievement. Hospital costs were obtained from the cost accounting system for the VHR hospitalization stratified by major clinical cost drivers. Univariate regression analyses were used to compare the predictive power of the risk scores. Multivariable analysis was performed to develop a cost prediction model. The mean cost of index VHR hospitalization was $20,700. Total and operating room costs correlated with increasing CDC wound class, VHRS surgical site infection score, VHRS surgical site occurrence score, American Society of Anesthesiologists class, and Ventral Hernia Working Group (all p < 0.01). The VHRS surgical site infection scores correlated negatively with contribution margin (-280; p < 0.01). Multivariable predictors of total hospital costs for the index hospitalization included wound class, hernia defect size, age, American Society of Anesthesiologists class 3 or 4, use of biologic mesh, and 2+ mesh pieces; explaining 73% of the variance in costs (p < 0.001). Weight optimization significantly reduced direct and operating room costs (p < 0.05). Cardiac evaluation was associated with increased costs. Ventral hernia repair hospital costs are more accurately predicted by CDC wound class than VHR risk scores. A straightforward 6-factor model predicted most cost variation for VHR. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

[Impact of the chemotherapy protocols for metastatic breast cancer on the treatment cost and the survival time of 371 patients treated in three hospitals of the Rhone-Alpes region].

PubMed

Paviot, B Trombert; Bachelot, T; Clavreul, G; Jacquin, J-P; Mille, D; Rodrigues, J-M

2009-10-01

The chemotherapy of the metastatic breast cancer is characterized by the diversity of the treatment protocols and the utilisation of new expensive molecules posing the double problem of outcomes for the patients and financial effects for the hospitals. This survey describes the different chemotherapy treatments prescribed in the metastatic breast cancer and the direct costs supported by the hospitals according to the patient survival time. A cohort of 371 patients treated for a metastatic breast cancer was followed in three hospitals of the Rhone-Alpes region between 2001 and 2006. The detail of their different antineoplasic treatments, as well as the purchase cost of the drugs and their cost of hospital administration, the cost of the other hospital stays are presented in relation with the survival. The median survival time (35,8 months; CI 95%: [31.7-39.1]) since the first metastasis does not differ significantly according to the hospital. Ninety-three different chemotherapy protocols are observed combining from one to five molecules. Thirty-two different molecules are identified. In first line treatment, there is a significant difference in the use of the new molecules according to hospital (Chi(2) test; P < 10(-3)). The average cost of a chemotherapy treatment is 3,919 euro (+/- 8,069 euro), the higher cost is observed for trastuzumab (23,443 euro). The average time period before the beginning of a new chemotherapy line is 212 days (+/- 237 days) and the mean cost of hospital stay during this period is 3,903 euro (+/- 4,097 euro). If no impact of the chemotherapy treatment strategy is observed on the survival time of the patient, it is the opposite for the hospital treatment cost. These results are asking for a better control system of the authorization procedure of new molecules marketing and the harmonization of the practices.

Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center.

PubMed

Stone, Alexander B; Grant, Michael C; Pio Roda, Claro; Hobson, Deborah; Pawlik, Timothy; Wu, Christopher L; Wick, Elizabeth C

2016-03-01

Despite positive results from several international Enhanced Recovery After Surgery (ERAS) protocols, the United States has been slow to adopt ERAS protocols, in part due to concern regarding the expenses of such a program. We sought to evaluate the potential annual net cost savings of implementing a US-based ERAS program. Using data from existing publications and experience with an ERAS program, a model of net financial costs was developed for surgical groups of escalating numbers of annual cases. Our example scenario provided a financial analysis of the implementation of an ERAS program at a United States academic institution based on data from the ERAS Program for Colorectal Surgery at The Johns Hopkins Hospital. Based on available data from the United States, ERAS programs lead to reductions in lengths of hospital stay that range from 0.7 to 2.7 days and substantial direct cost savings. Using example data from a quaternary hospital, the considerable cost of $552,783 associated with implementation of an ERAS program was offset by even greater savings in the first year of nearly $948,500, yielding a net savings of $395,717. Sensitivity analysis across several caseload and direct cost scenarios yielded similar savings in 20 of the 27 projections. Enhanced Recovery After Surgery protocols have repeatedly led to reduction in length of hospital stay and improved surgical outcomes. A financial model, based on published data and experience, projects that investment in an ERAS program can also lead to net financial savings for US hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain.

PubMed

Ribed-Sánchez, Borja; González-Gaya, Cristina; Varea-Díaz, Sara; Corbacho-Fabregat, Carlos; Bule-Farto, Isabel; Pérez de-Oteyza, Jaime

To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€) and social costs due to hospitalization (200,724€). Three adverse reactions resulted in patient death (at a social cost of 1,364,805€). In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91M€; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42%) and the social cost of hospitalization (110 vs 200M€; +83%). Mortality costs decreased (2.65 vs. 1.36M€; -48%). This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Economic Burden of Hepatitis C Virus Infection in Different Stages of Disease: A Report From Southern Iran

PubMed Central

Zare, Fatemeh; Fattahi, Mohammad Reza; Sepehrimanesh, Masood; Safarpour, Ali Reza

2016-01-01

Background Hepatitis C virus (HCV) infection is a major blood-borne infection which imposes high economic cost on the patients. Objectives The current study aimed to evaluate the total annual cost due to chronic HCV related diseases imposed on each patient and their family in Southern Iran. Patients and Methods Economic burden of chronic hepatitis C-related liver diseases (chronic hepatitis C, cirrhosis and hepatocellular carcinoma) were examined. The current retrospective study evaluated 200 Iranian patients for their socioeconomic status, utilization (direct and indirect costs) and treatment costs and work days lost due to illness by a structured questionnaire in 2015. Costs of hospital admissions were extracted from databases of Nemazee hospital, Shiraz, Iran. The outpatient expenditure per patient was measured through the rate of outpatient visits and average cost per visit reported by the patients; while the inpatient costs were calculated through annual rate of hospital admissions and average expenditure. Self-medication and direct non-medical costs were also reported. The human capital approach was used to measure the work loss cost. Results The total annual cost per patient for chronic hepatitis C, cirrhosis and hepatocellular carcinoma (HCC) based on purchasing power parity (PPP) were USD 1625.50, USD 6117.2, and USD 11047.2 in 2015, respectively. Conclusions Chronic hepatitis C-related liver diseases impose a substantial economic burden on patients, families and the society. The current study provides useful information on cost of treatment and work loss for different disease states, which can be further used in cost-effectiveness evaluations. PMID:27257424

Nursing home case-mix reimbursement in Mississippi and South Dakota.

PubMed

Arling, Greg; Daneman, Barry

2002-04-01

To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

The economic impact of chronic prostatitis.

PubMed

Calhoun, Elizabeth A; McNaughton Collins, Mary; Pontari, Michel A; O'Leary, Michael; Leiby, Benjamin E; Landis, J Richard; Kusek, John W; Litwin, Mark S

2004-06-14

Little information exists on the economic impact of chronic prostatitis. The objective of this study was to determine the direct and indirect costs associated with chronic prostatitis. Outcomes were assessed using a questionnaire designed to capture health care resource utilization. Resource estimates were converted into unit costs with direct medical cost estimates based on hospital cost-accounting data and indirect costs based on modified labor force, employment, and earnings data from the US Census Bureau. The total direct costs for the 3 months prior to entry into the cohort, excluding hospitalization, were $126 915 for the 167 study participants for an average of $954 per person among the 133 consumers. Of the men, 26% reported work loss valued at an average of $551. The average total costs (direct and indirect) for the 3 months was $1099 per person for those 137 men who had resource consumption with an expected annual total cost per person of $4397. For those study participants with any incurred costs, tests for association revealed that the National Institutes of Health Chronic Prostatitis Symptom Index (P<.001) and each of the 3 subcategories of pain (P =.003), urinary function (P =.03), and quality-of-life (P =.002) were significantly associated with resource use, although the quality-of-life subscale score from the National Institutes of Health Chronic Prostatitis Symptom Index was the only predictor of resource consumption. Chronic prostatitis is associated with substantial costs and lower quality-of-life scores, which predicted resource consumption. The economic impact of chronic prostatitis warrants increased medical attention and resources to identify and test effective treatment strategies.

Academic Health Systems Management: The Rationale Behind Capitated Contracts

PubMed Central

Taheri, Paul A.; Butz, David A.; Greenfield, Lazar J.

2000-01-01

Objective To determine why hospitals enter into “capitated” contracts, which often generate accounting losses. The authors’ hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. Summary Background Data In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. Methods The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. Results The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital’s capitated health maintenance organization (HMO) patients made up 16.0% of the total admissions but only 9.4% of the total patient days. Both the mean LOS of 3.4 days and the mean ICU LOS of 0.3 days were significantly different from the overall values of 5.8 days and 1 day, respectively, for the noncapitated population. For patients classified with a DRG with complication who traveled from more than 60 miles away, the mean LOS was 10.7 days and the mean total cost was $21,658. This is in contrast to all patients who traveled greater than 60 miles, who had an LOS of 7.2 days and a mean total cost of $12,569. Conclusion The capitated payor directed the bulk of its subscribers to one hospital (other payors transferred their sicker patients). This was reflected in the capitated group’s lower costs and LOS. This stable stream of relatively low-acuity patients enhanced capacity utilization. For capitated patients, the hospital still benefits by recovering the incremental cost (VDC) of treating these patients, and only a portion of the assigned overhead. Thus, in the short run, capitated patients provide a positive economic benefit. Other payors’ higher-acuity patients arrive more randomly, place greater strains on capacity, and generate higher overhead costs. This results in differential reimbursement to cover this incremental overhead. Having a portfolio of contracts allows the hospital to optimize capacity both in terms of patient flows and acuity. One risk of operating near capacity is that capitated patients could displace other higher-paying patients. PMID:10816628

Impact of hospitalizations for bronchiolitis in preterm infants on long-term health care costs in Italy: a retrospective case-control study.

PubMed

Roggeri, Daniela Paola; Roggeri, Alessandro; Rossi, Elisa; Cataudella, Salvatore; Martini, Nello

2016-01-01

Bronchiolitis is an acute inflammatory injury of the bronchioles, and is the most frequent cause of hospitalization for lower respiratory tract infections in preterm infants. This was a retrospective, observational, case-control study conducted in Italy, based on administrative database analysis. The aim of this study was to evaluate differences in health care costs of preterm infants with and without early hospitalization for bronchiolitis. Preterm infants born in the period between January 1, 2009 and December 31, 2010 and hospitalized for bronchiolitis in the first year of life were selected from the ARNO Observatory database and observed for the first 4 years of life. These preterm infants were compared (paired 1-3) with preterm infants who were not hospitalized for bronchiolitis in the first year of life and with similar characteristics. Only direct health care costs reimbursed by the Italian National Health Service were considered for this study (drugs, hospitalizations, and diagnostic/therapeutic procedures). Of 40,823 newborns in the accrual period, 863 were preterm with no evidence of prophylaxis, and 22 preterm infants were hospitalized for bronchiolitis (cases) and paired with 62 controls. Overall, cases had 74% higher average cost per infant in the first 4 years of life than controls (18,624€ versus 10,189€, respectively). The major cost drivers were hospitalizations, accounting for >90% in both the populations. The increase in total yearly health care cost between cases and controls remained substantial even in the fourth year of life for all cost items. A relevant increase in hospitalizations and drug consumption linked to respiratory tract diseases was noted in infants hospitalized for bronchiolitis during the entire follow-up period. Preterm infants hospitalized for bronchiolitis in the first year of life were associated with increased resource consumption and costs throughout the entire period of observation; even in the fourth year, the difference versus paired controls was relevant.

Direct Medical Costs of Dengue Fever in Vietnam: A Retrospective Study in a Tertiary Hospital

PubMed Central

VO, Nhung Thi Tuyet; PHAN, Trang Ngo Diem; VO, Trung Quang

2017-01-01

Background In Vietnam, dengue fever is a major health concern, yet comprehensive information on its economic costs is lacking. The present study investigated treatment costs associated with dengue fever from the perspective of health care provision. Methods This retrospective study was conducted between January 2013 and December 2015 in Cu Chi General Hospital. The following dengue-related treatment costs were calculated: hospitalisation, diagnosis, specialised services, drug usage and medical supplies. Average cost per case and treatment cost across different age was calculated. Results In the study period, 1672 patients with dengue fever were hospitalised. The average age was 24.98 (SD = 14.10) years, and 47.5% were males (795 patients). Across age groups, the average cost per episode was USD 48.10 (SD = 3.22). The highest costs (USD 56.61, SD = 48.84) were incurred in the adult age group (> 15 years), and the lowest costs (USD 30.10, SD = 17.27) were incurred in the paediatric age group (< 15 years). Conclusion The direct medical costs of dengue-related hospitalisation place a severe economic burden on patients and their families. The probable economic value of dengue management in Vietnam is significant. PMID:28814934

The cost of harm and savings through safety: using simulated patients for leadership decision support.

PubMed

Denham, Charles R; Guilloteau, Franck R

2012-09-01

The ultimate objective of this program is to provide an approach to understanding and communicating health-care harm and cost to compel health-care provider leadership teams to vote "yes" to investments in patient safety initiatives, with the confidence that clinical, financial, and operational performance will be improved by such programs. Through a coordinated combination of literature evaluations, careful mapping of high impact scenarios using simulated patients and consensus review of clinical, operational, and financial factors, we confirmed value in such approaches to decision support information for hospital leadership teams to invest in patient safety projects. The study resulted in the following preliminary findings: ·Communication between hospital quality and finance departments can be much improved by direct collaborative relationships through regular meetings to help both clarify direct costs, indirect costs, and the savings of waste and harm to patients by avoidance of infections. ·Governance leaders and the professional administrative leaders should consider establishing the structures and systems necessary to act on risks and hazards as they evolve to deploy resources to areas of harm and risk. ·Quality and Infection Control Professionals can best wage their war on healthcare waste and harm by keeping abreast of the latest literature regarding the latest measures, standards, and safe practices for healthcare-acquired infections and hospital-acquired conditions. ·Regular reviews of patients with health-careYassociated infections, with direct attention to the attributable cost of treatment and how financial waste and harm to patients may be avoided, may provide hospital leaders with new insights for improvement. ·If hospitals developed their own risk scenarios to determine impact of harm and waste from hospital-acquired conditions in addition to impact scenarios for specific processes through technology and process innovations, they would have more clear guidance for improvement efforts. ·Tools such as impact calculators, performance models, and simulated patient trajectories are no more tied to the reality of running a hospital or treating a patient as jet simulator metrics are to taking a real flight with real weather and real aircraftVthey provide a view to enhance decision making but do NOT provide the answers. The final result of this project was to demonstrate a prototype leadership decision-support investment model approach that addresses clinical, operational, and financial performance for typical hospitals.

Shifting from inpatient to outpatient treatment of deep vein thrombosis in a tertiary care center: a cost-minimization analysis.

PubMed

Boucher, Michel; Rodger, Marc; Johnson, Jeffrey A; Tierney, Mike

2003-03-01

To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults. Prospective, observational study with historical inpatient cases as controls. Ambulatory thrombosis clinic of a tertiary care teaching center in Canada. Forty-nine inpatients with DVT from a previous study in 1996 at the same institution who would have been eligible for outpatient therapy if this option had been available, and 51 consecutive patients referred to the ambulatory thrombosis clinic for treatment of DVT between March 2000 and January 2001. The 49 inpatients received unfractionated heparin, and the 51 outpatients received low-molecular-weight heparin (LMWH). A cost-minimization analysis restricted to the hospital perspective was conducted. This design was justified based on the clinical equivalence of the two treatment strategies. All direct hospital costs for treating the 51 consecutive outpatients with LMWH were measured. These data were compared with the cost of treating the inpatients with unfractionated heparin. The analysis horizon was limited to 7 days, based on the duration of hospitalization and length of heparin therapy for DVT before conversion to oral warfarin. The mean cost (in Canadian dollars) per outpatient case was 248 Canadian dollars (95% confidence interval 216-280 Canadian dollars) and was significantly different from the mean cost/inpatient case of 2826 Canadian dollars (adjusted for the difference in fiscal years) (p<0.0005). A breakdown of the outpatient cost showed that nursing time contributed to 51% of the cost, monitoring laboratory tests 5%, drugs 2%, and other costs (diagnostic laboratory tests and medical imaging) 42%. Converting from inpatient to outpatient treatment of proximal DVT was associated with a significant cost savings for our institution. Accordingly, it is financially advantageous for hospitals to offer this service as it reduces direct costs and does not appear to compromise patient care.

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis.

PubMed

Legrand, Guillaume; Ruscio, Laura; Benhamou, Dan; Pelletier-Fleury, Nathalie

2015-07-01

Several minimally invasive techniques for cardiac output monitoring such as the esophageal Doppler (ED) and arterial pulse pressure waveform analysis (APPWA) have been shown to improve surgical outcomes compared with conventional clinical assessment (CCA). To evaluate the cost-effectiveness of these techniques in high-risk abdominal surgery from the perspective of the French public health insurance fund. An analytical decision model was constructed to compare the cost-effectiveness of ED, APPWA, and CCA. Effectiveness data were defined from meta-analyses of randomized clinical trials. The clinical end points were avoidance of hospital mortality and avoidance of major complications. Hospital costs were estimated by the cost of corresponding diagnosis-related groups. Both goal-directed therapy strategies evaluated were more effective and less costly than CCA. Perioperative mortality and the rate of major complications were reduced by the use of ED and APPWA. Cost reduction was mainly due to the decrease in the rate of major complications. APPWA was dominant compared with ED in 71.6% and 27.6% and dominated in 23.8% and 20.8% of the cases when the end point considered was "major complications avoided" and "death avoided," respectively. Regarding cost per death avoided, APPWA was more likely to be cost-effective than ED in a wide range of willingness to pay. Cardiac output monitoring during high-risk abdominal surgery is cost-effective and is associated with a reduced rate of hospital mortality and major complications, whatever the device used. The two devices evaluated had negligible costs compared with the observed reduction in hospital costs. Our comparative studies suggest a larger effect with APPWA that needs to be confirmed by further studies. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

PubMed Central

Hsu, Wan-Hsiang; Van Zutphen, Alissa R.; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-01-01

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial. PMID:22922791

Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

PubMed Central

Burge, Russel; Yang, Yicheng; Du, Fen; Lu, Tie; Huang, Qiang; Ye, Wenyu; Xu, Weihua

2015-01-01

Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123) who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%), followed by vertebral fracture (34.2%). The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients' ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture. PMID:26221563

Estimation of the costs of cervical cancer screening, diagnosis and treatment in rural Shanxi Province, China: a micro-costing study

PubMed Central

2012-01-01

Background Cost estimation is a central feature of health economic analyses. The aim of this study was to use a micro-costing approach and a societal perspective to estimate aggregated costs associated with cervical cancer screening, diagnosis and treatment in rural China. Methods We assumed that future screening programs will be organized at a county level (population ~250,000), and related treatments will be performed at county or prefecture hospitals; therefore, this study was conducted in a county and a prefecture hospital in Shanxi during 2008–9. Direct medical costs were estimated by gathering information on quantities and prices of drugs, supplies, equipment and labour. Direct non-medical costs were estimated via structured patient interviews and expert opinion. Results Under the base case assumption of a high-volume screening initiative (11,475 women screened annually per county), the aggregated direct medical costs of visual inspection, self-sampled careHPV (Qiagen USA) screening, clinician-sampled careHPV, colposcopy and biopsy were estimated as US$2.64,$7.49,$7.95,$3.90 and $5.76, respectively. Screening costs were robust to screening volume (<5% variation if 2,000 women screened annually), but costs of colposcopy/biopsy tripled at the lower volume. Direct medical costs of Loop Excision, Cold-Knife Conization and Simple and Radical Hysterectomy varied from $61–544, depending on the procedure and whether conducted at county or prefecture level. Direct non-medical expenditure varied from $0.68–$3.09 for screening/diagnosis and $83–$494 for pre-cancer/cancer treatment. Conclusions Diagnostic costs were comparable to screening costs for high-volume screening but were greatly increased in lower-volume situations, which is a key consideration for the scale-up phase of new programs. The study’s findings will facilitate cost-effectiveness evaluation and budget planning for cervical cancer prevention initiatives in China. PMID:22624619

The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion.

PubMed

Leone, Tiziana; Coast, Ernestina; Parmar, Divya; Vwalika, Bellington

2016-09-01

Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n = 112) with women who had an abortion. Three treatment routes are identified: (1) safe abortion at the hospital, (2) unsafe clandestine medical abortion initiated elsewhere with post-abortion care at the hospital and (3) unsafe abortion initiated elsewhere with post-abortion care at the hospital. Based on these three typologies, we use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample. Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. When accounting for uncertainty this figure increases dramatically. For safe and unsafe abortions, unofficial provider payments represent a major cost to women.This study demonstrates that despite a liberal legislation, Zambia still needs better dissemination of the law to women and providers and resources to ensure abortion service access. The policy implications of this study include: the role of pharmacists and mid-level providers in the provision of medical abortion services; increased access to contraception, especially for adolescents; and elimination of demands for unofficial provider payments. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Home-based care after a shortened hospital stay versus hospital-based care postpartum: an economic evaluation.

PubMed

Petrou, Stavros; Boulvain, Michel; Simon, Judit; Maricot, Patrice; Borst, François; Perneger, Thomas; Irion, Olivier

2004-08-01

To compare the cost effectiveness of early postnatal discharge and home midwifery support with a traditional postnatal hospital stay. Cost minimisation analysis within a pragmatic randomised controlled trial. The University Hospital of Geneva and its catchment area. Four hundred and fifty-nine deliveries of a single infant at term following an uncomplicated pregnancy. Prospective economic evaluation alongside a randomised controlled trial in which women were allocated to either early postnatal discharge combined with home midwifery support (n= 228) or a traditional postnatal hospital stay (n= 231). Costs (Swiss francs, 2000 prices) to the health service, social services, patients, carers and society accrued between delivery and 28 days postpartum. Clinical and psychosocial outcomes were similar in the two trial arms. Early postnatal discharge combined with home midwifery support resulted in a significant reduction in postnatal hospital care costs (bootstrap mean difference 1524 francs, 95% confidence interval [CI] 675 to 2403) and a significant increase in community care costs (bootstrap mean difference 295 francs, 95% CI 245 to 343). There were no significant differences in average hospital readmission, hospital outpatient care, direct non-medical and indirect costs between the two trial groups. Overall, early postnatal discharge combined with home midwifery support resulted in a significant cost saving of 1221 francs per mother-infant dyad (bootstrap mean difference 1209 francs, 95% CI 202 to 2155). This finding remained relatively robust following variations in the values of key economic parameters performed as part of a comprehensive sensitivity analysis. A policy of early postnatal discharge combined with home midwifery support exhibits weak economic dominance over traditional postnatal care, that is, it significantly reduces costs without compromising the health and wellbeing of the mother and infant.

Prostate Vaporization Techniques in Canadian Hospital

ClinicalTrials.gov

2018-04-11

Direct Costs Excluding Capital Equipment Purchase; Operator (Surgeon) Completed Questionnaire; Operative Parameters (Time, Bleeding Etc); Complications (Post-op Retention, Bleeding, Re-admission to Hospital, Infection Etc); 3 Month Efficacy Evaluation (Compared to Baseline) Using Validated Symptom Assessment Tools (See Outcome Metrics for Details)

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo.

PubMed

Leitão, Raquel Jales; Ferraz, Marcos Bosi; Chaves, Ana Cristina; Mari, Jair J

2006-04-01

To estimate the direct costs of schizophrenia for the public sector. A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

An analysis of the health service efficiency and patient experience with two different intravenous iron preparations in a UK anaemia clinic.

PubMed

Wilson, Paul D; Hutchings, Adam; Jeans, Aruna; Macdougall, Iain C

2013-01-01

Historically, the Renal Unit at King's College Hospital used intravenous (IV) iron sucrose (IS) to treat iron deficiency anaemia in patients with chronic kidney disease who were not on dialysis (CKD-ND). As part of a service initiative to improve patient experience, new products were considered as alternatives. This study investigated the potential impact on patient experience and service costs by switching from IS to ferric carboxymaltose (FCM). A decision analytical model was used to calculate the impact of switching from IS to FCM for a cohort of CKD-ND patients. Service provision data were collected for 365 patients who received 600 mg IS within a 12 month period, creating the IS data set. The service provision data, along with a clinically relevant FCM administration protocol (stipulating total doses of 500 mg FCM), were used to calculate a corresponding theoretical data set for FCM for the same cohort of patients. The FCM protocol saved each patient two hospital visits and 2.66 hours of time (equating to approximately a saving of £36.21 in loss of earnings) and £19 in travel costs. Direct attributable costs for iron administration (which included drug, disposables, nursing staff, and hospital-provided patient transport costs) were £58,646 for IS vs £46,473 for FCM. Direct overhead costs (which included nursing preparation time, administration staff, clinic space, and consultant time costs) were £40,172 for the IS service vs £15,174 for the FCM service. Based on clinical experience with the products, this analysis assumes that 500 mg FCM is therapeutically equivalent to 600 mg IS. Consultant time costs are assumed to be the same between the two treatment groups. IV iron administration protocols and data are specific to King's College Hospital. The design is retrospective and changes to the management of the clinic, including service delivery optimization, may also affect real costs. FCM was associated with fewer hospital visits and reduced transport costs for CKD-ND patients receiving IV iron and has the potential to save 19-37% in service costs. Owing to increased administration efficiency, FCM can improve the overall patient experience while reducing the total cost of the King's College Hospital IV iron service for CKD-ND patients, compared with treatment with IS.

Service provision and outcome for deliberate self-poisoning in adults--results from a six centre descriptive study.

PubMed

Kapur, Navneet; House, Allan; May, Chris; Creed, Francis

2003-07-01

The aim of the study was to compare the hospital management and direct costs of self-poisoning in six United Kingdom hospitals and to investigate whether hospital management influences outcome. This was a prospective descriptive study carried out at three teaching hospitals and three district general hospitals in North West England on adults (aged 16 or over) presenting to the study centres with deliberate self-poisoning over a 5-month period. Data were based on demographic and clinical characteristics, management of the current episode, direct costs and repetition of self-poisoning within 12 weeks of index episode. There were 1778 episodes of self-poisoning during the study period. There were marked differences in management between centres. There was a fivefold difference in the rate of admission to a medical bed (16.5%-81.3%), and a twofold difference in the rate of psychosocial assessment (28.5%-57.7%). These differences remained after adjustment for demographic and clinical factors. Hospital costs per episode varied from pound 228 to pound 422 and repetition rate ranged from 10% to 16%. Psychosocial assessment was associated with a twofold reduction in the risk of repetition. The marked variability of services for self-poisoning continue. It seems likely that this is having a detrimental effect on patient outcomes. Large scale intervention studies are required to inform both clinical practice and service provision.

Cost of breast cancer based on real-world data: a cancer registry study in Italy.

PubMed

Capri, Stefano; Russo, Antonio

2017-01-26

In European countries, it is difficult for local health organizations to determine the resources allocated to different hospitals for breast cancer. The aim of the current study was to examine the costs of breast cancer during the different phases of the diagnostictherapeutic sequence based on real world data. To identify breast cancer cases diagnosed between 2007 and 2011, we used the cancer registry of the Agency for Health Protection of the Province of Milan (3.2 million inhabitants). A generalized linear model controlling for patient age, cancer stage and Charlson co-morbidity index was used to calculate the adjusted mean costs for each hospital and for each study phase. Regression analyses were based on dependent variables of individual costs (diagnosis, treatment, follow-up and total cost were logtransformed. The following independent variables were included as covariates: age at diagnosis, hospital volume, stage, job category, educational level, marital status, comorbidities, deprivation index. Total and mean costs were computed for several variables and for each phase. On average for each subject, the costs were collected over 2.5 years. A total of 12,580 breast cancer cases were studied. The mean cost of diagnosis was €414, the mean cost of treatment was €8,780, the mean overall cost of follow-up was approximately €2,351, and the mean total direct medical cost was €10,970. The age of the patients, stage of tumor and employment level of the patient were significantly correlated with the variability of the costs. The highest variability in costs was observed for the follow-up costs, in which 38% of hospitals fell outside the 95% confidence interval. In the overspending-hospitals, patients received an intensive follow-up regimen with scintigraphy and thoracic CAT (computerized axial tomography). In this study, which represents the first population-level study of its kind in Italy, we estimated all direct medical costs for the 6-month period before the diagnosis of breast cancer and the first two years after diagnosis. Patients were identified from the local cancer registry. The analysis offers insight into the utilization of resources incurred by one major area of interest of cancer care in Italy.

Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals.

PubMed

Le Monnier, A; Duburcq, A; Zahar, J-R; Corvec, S; Guillard, T; Cattoir, V; Woerther, P-L; Fihman, V; Lalande, V; Jacquier, H; Mizrahi, A; Farfour, E; Morand, P; Marcadé, G; Coulomb, S; Torreton, E; Fagnani, F; Barbut, F

2015-10-01

The impact of Clostridium difficile infection (CDI) on healthcare costs is significant due to the extra costs of associated inpatient care. However, the specific contribution of recurrences has rarely been studied. The aim of this study was to estimate the hospital costs of CDI and the fraction attributable to recurrences in French acute-care hospitals. A retrospective study was performed for 2011 on a sample of 12 large acute-care hospitals. CDI costs were estimated from both hospital and public insurance perspectives. For each stay, CDI additional costs were estimated by comparison to controls without CDI extracted from the national DRG (diagnosis-related group) database and matched on DRG, age and sex. When CDI was the primary diagnosis, the full cost of stay was used. A total of 1067 bacteriological cases of CDI were identified corresponding to 979 stays involving 906 different patients. Recurrence(s) were identified in 118 (12%) of these stays with 51.7% of them having occurred within the same stay as the index episode. Their mean length of stay was 63.8 days compared to 25.1 days for stays with an index case only. The mean extra cost per stay with CDI was estimated at €9,575 (median: €7,514). The extra cost of CDI in public acute-care hospitals was extrapolated to €163.1 million at the national level, of which 12.5% was attributable to recurrences. The economic burden of CDI is substantial and directly impacts healthcare systems in France. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

[Direct hospitalization costs associated with chronic Hepatitis C in the Valencian Community in 2013].

PubMed

Barrachina Martínez, Isabel; Giner Durán, Remedios; Vivas-Consuelo, David; López Rodado, Antonio; Maldonado Segura, José Alberto

2018-04-23

Hospital costs associated with Chronic Hepatitis C (HCC) arise in the final stages of the disease. Its quantification is very helpful in order to estimate and check the burden of the disease and to make financial decisions for new antivirals. The highest costs are due to the decompensation of cirrosis. Cross-sectional observational study of hospital costs of HCC diagnoses in the Valencian Community in 2013 (n= 4,486 hospital discharges). Information source: Minimum basic set of data/ Basic Minimum Data Set. The costs were considered according to the rates established for the DRG (Diagnosis related group) associated with the episodes with diagnosis of hepatitis C. The average survival of patients since the onset of the decom- pensation of their cirrhosis was estimated by a Markov model, according to the probabilities of evolution of the disease existing in Literatura. There were 4,486 hospital episodes, 1,108 due to complications of HCC, which generated 6,713 stays, readmission rate of 28.2% and mortality of 10.2%. The hospital cost amounted to 8,788,593EUR: 3,306,333EUR corresponded to Cirrhosis (5,273EUR/patient); 1,060,521EUR to Carcinoma (6,350EUR/ patient) and 2,962,873EUR to transplantation (70,544EUR/paciente. Comorbidity was 1,458,866EUR. These costs are maintai- ned for an average of 4 years once the cirrhosis decompensation begins. Cirrhosis due to HCC generates a very high hospitalization's costs. The methodology used in the estimation of these costs from the DRG can be very useful to evaluate the trend and economic impact of this disease.

Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy.

PubMed

Tomaszewski, Jeffrey J; Matchett, Jarred C; Davies, Benjamin J; Jackman, Stephen V; Hrebinko, Ronald L; Nelson, Joel B

2012-07-01

To perform a contemporary comparative cost-analysis of robotic-assisted laparoscopic radical prostatectomy (RARP) and open radical retropubic prostatectomy (RRP). All patients undergoing RARP (n = 115) or RRP (n = 358) by 1 of 4 surgeons at a single institution during a 15-month period were retrospectively reviewed. The hospital length of stay (LOS), operative time, hospital charges, reimbursement, and direct and indirect hospital costs were analyzed and compared. The mean LOS between patients undergoing RARP (1.2 ± 0.6 days) and RRP (1.4 ± 0.8 days) was not significantly different. The operating room supply costs per case were almost 7 times greater for RARP ($2852 ± $528) than for RRP ($417 ± $59; P < .05). The ancillary, cardiology, imaging, administrative, laboratory, and pharmacy costs were not significantly different between the 2 approaches. The mean total costs per case for RARP exceeded the total costs for RRP by 62% ($14 006 ± $1641 vs $8686 ± $1989; P < .05). Payment to the hospital from all sources was nearly equivalent: $10 011 for RRP and $9993 for RARP. Therefore, the average profit for each RRP was $1325 and each RARP lost $4013. In the present single-institution analysis, the total actual costs associated with RARP were significantly greater than those for RRP and were attributable to the robotic equipment and supplies. Copyright © 2012 Elsevier Inc. All rights reserved.

The economic burden of chronic obstructive pulmonary disease from 2004 to 2013.

PubMed

Kim, Jinhyun; Lee, Tae Jin; Kim, Sungjae; Lee, Eunhee

2016-01-01

This study examines the epidemiology and economic impact of chronic obstructive pulmonary disease (COPD) at a nationwide level in South Korea. This retrospective analysis used the societal cost-of-illness framework, consisting of direct medical costs, direct non-medical costs, and indirect costs. In order to analyze the societal costs of patients with COPD, this study used a data mining and a macro-costing method on data from a South Korean national-level health survey and a national health insurance claims database from 2004-2013. The total societal cost of COPD in 2013 was estimated to be $439.9 million for 1,419,914 patients. The direct medical cost for COPD was $214.3 million, which included a hospitalization cost of $96.3 million, an outpatient cost of $76.4 million, and a pharmaceutical cost of $41.6 million. The direct non-medical cost was estimated at $43.5 million. The indirect overall cost associated with the morbidity and mortality of COPD was $182.2 million in 2013. This study showed that COPD has a major effect on healthcare costs, particularly direct medical costs. Thus, appropriate long-term interventions are recommended to lower the economic burden of COPD in South Korea.

Financial implications of ventral hernia repair: a hospital cost analysis.

PubMed

Reynolds, Drew; Davenport, Daniel L; Korosec, Ryan L; Roth, J Scott

2013-01-01

Complicated ventral hernias are often referred to tertiary care centers. Hospital costs associated with these repairs include direct costs (mesh materials, supplies, and nonsurgeon labor costs) and indirect costs (facility fees, equipment depreciation, and unallocated labor). Operative supplies represent a significant component of direct costs, especially in an era of proprietary synthetic meshes and biologic grafts. We aim to evaluate the cost-effectiveness of complex abdominal wall hernia repair at a tertiary care referral facility. Cost data on all consecutive open ventral hernia repairs (CPT codes 49560, 49561, 49565, and 49566) performed between 1 July 2008 and 31 May 2011 were analyzed. Cases were analyzed based upon hospital status (inpatient vs. outpatient) and whether the hernia repair was a primary or secondary procedure. We examined median net revenue, direct costs, contribution margin, indirect costs, and net profit/loss. Among primary hernia repairs, cost data were further analyzed based upon mesh utilization (no mesh, synthetic, or biologic). Four-hundred and fifteen patients underwent ventral hernia repair (353 inpatients and 62 outpatients); 173 inpatients underwent ventral hernia repair as the primary procedure; 180 inpatients underwent hernia repair as a secondary procedure. Median net revenue ($17,310 vs. 10,360, p < 0.001) and net losses (3,430 vs. 1,700, p < 0.025) were significantly greater for those who underwent hernia repair as a secondary procedure. Among inpatients undergoing ventral hernia repair as the primary procedure, 46 were repaired without mesh; 79 were repaired with synthetic mesh and 48 with biologic mesh. Median direct costs for cases performed without mesh were $5,432; median direct costs for those using synthetic and biologic mesh were $7,590 and 16,970, respectively (p < .01). Median net losses for repairs without mesh were $500. Median net profit of $60 was observed for synthetic mesh-based repairs. The median contribution margin for cases utilizing biologic mesh was -$4,560, and the median net financial loss was $8,370. Outpatient ventral hernia repairs, with and without synthetic mesh, resulted in median net losses of $1,560 and 230, respectively. Ventral hernia repair is associated with overall financial losses. Inpatient synthetic mesh repairs are essentially budget neutral. Outpatient and inpatient repairs without mesh result in net financial losses. Inpatient biologic mesh repairs result in a negative contribution margin and striking net financial losses. Cost-effective strategies for managing ventral hernias in a tertiary care environment need to be developed in light of the financial implications of this patient population.

The cost implications of an early versus delayed invasive strategy in Acute Coronary Syndromes: the TIMACS study.

PubMed

Bainey, Kevin R; Gafni, Amiram; Rao-Melacini, Purnima; Tong, Wesley; Steg, Philippe G; Faxon, David P; Lamy, Andre; Granger, Christopher B; Yusuf, Salim; Mehta, Shamir R

2014-06-01

The Timing of Intervention in Acute Coronary Syndromes (TIMACS) trial demonstrated that early invasive intervention (within 24 hours) was similar to a delayed approach (after 36 hours) overall but improved outcomes were seen in patients at high risk. However, the cost implications of an early versus delayed invasive strategy are unknown. A third-party perspective of direct cost was chosen and United States Medicare costs were calculated using average diagnosis related grouping (DRG) units. Direct medical costs included those of the index hospitalization (including clinical, procedural and hospital stay costs) as well as major adverse cardiac events during 6 months of follow-up. Sensitivity and sub-group analyses were performed. The average total cost per patient in the early intervention group was lower compared with the delayed intervention group (-$1170; 95% CI -$2542 to $202). From the bootstrap analysis (5000 replications), the early invasive approach was associated with both lower costs and better clinical outcomes regarding death/myocardial infarction (MI)/stroke in 95.1% of the cases (dominant strategy). In high-risk patients (GRACE score ≥141), the net reduction in cost was greatest (-$3720; 95% CI -$6270 to -$1170). Bootstrap analysis revealed 99.8% of cases were associated with both lower costs and better clinical outcomes (death/MI/stroke). We were unable to evaluate the effect of community care and investigations without hospitalization (office visits, non-invasive testing, etc). Medication costs were not captured. Indirect costs such as loss of productivity and family care were not included. An early invasive management strategy is as effective as a delayed approach and is likely to be less costly in most patients with acute coronary syndromes.

Cost-minimization analysis of piperacillin/tazobactam versus imipenem/cilastatin for the treatment of serious infections: a Canadian hospital perspective.

PubMed

Marra, F O; Frighetto, L O; Marra, C A; Sleigh, K M; Stiver, H G; Bryce, E A; Reynolds, R P; Jewesson, P J

1999-02-01

In 1998 we reported the first Canadian double-blind, randomized, clinical trial involving a comparison of piperacillin/tazobactam (P/T) with imipenem/cilastatin (I/C). The present study was conducted to determine the feasibility of replacing I/C at our institution. To describe the outcome of a pharmacoeconomic analysis of the clinical trial from the perspective of a tertiary acute-care institution. A total of 150 consenting adults originally prescribed I/C were randomly assigned to receive either P/T 4.5 g i.v. (n = 75) or I/C 500 mg i.v. (n = 75) every six hours. Actual direct medical resources used in relation to the treatment of bacterial infections were prospectively assessed during a clinical trial; these included cost of study and ancillary antibiotics, hospitalization, diagnostic testing (radiology, laboratory assessments), and labor, as well as treatment of adverse drug reactions, antibiotic failures, and superinfections. While costs for successful treatment courses were similar across treatment arms, hospitalization costs for treatment course failures were higher for P/T recipients. Direct medical costs for treatment courses associated with a superinfection were also higher in the P/T arm. Overall costs for treatment failures with either study drug were at least twofold those observed for successful treatment courses. Mean total management cost per patient in the P/T group was $15,211 ($ CDN throughout) (95% CI $11,429 to $18,993), compared with $14,232 (95% CI $11,421 to $17,043) in the I/C group (p = 0.32), resulting in a mean cost difference of $979. Sensitivity analyses revealed that the superiority of I/C over P/T for successful treatment of serious infections was sensitive to changes in the cost of hospitalization and drug efficacy for either drug. Based on the results of the clinical trial, P/T and I/C offer similar clinical, microbiologic, and toxicity outcomes in hospitalized patients with serious infections. Under base-case conditions, our pharmacoeconomic analysis showed that I/C was a cost-effective alternative to P/T at the dosage regimens studied. However, this finding was sensitive to plausible changes in both clinical and economic parameters.

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.

PubMed

Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K

2013-01-01

Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

Hospitalization costs of severe bacterial pneumonia in children: comparative analysis considering different costing methods

PubMed Central

Nunes, Sheila Elke Araujo; Minamisava, Ruth; Vieira, Maria Aparecida da Silva; Itria, Alexander; Pessoa, Vicente Porfirio; de Andrade, Ana Lúcia Sampaio Sgambatti; Toscano, Cristiana Maria

2017-01-01

ABSTRACT Objective To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Methods Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Results Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (p<0.001) or record review (p=0.006). Conclusion Brazilian Public Unified Health System costs estimated via different costing methods differ significantly, with gross-costing yielding lower cost estimates. Given costs estimated by different micro-costing methods are similar and costing methods based on therapeutic guidelines are easier to apply and less expensive, this method may be a valuable alternative for estimation of hospitalization costs of bacterial community-acquired pneumonia in children. PMID:28767921

Prescription for concern.

PubMed

Haugh, Richard; Thrall, Terese Hudson; Scalise, Dagmara

2002-02-01

As U.S. medical care relies more heavily on prescription drugs, hospitals are caught in an increasingly painful situation. Shortages of critical pharmaceuticals often leave hospitals empty-handed and, according to clinicians, endanger patient safety. Soaring drug costs account for a huge proportion of burgeoning health care spending, and strategies to control costs, including pharmacy benefit managers and drug discount cards for seniors, so far have had limited or negligible success. Direct-to-consumer advertising has increased demand for expensive--and according to some experts, unnecessary or inappropriate--prescription drugs. In this special report H&HN examines the pressures that these factors put on hospitals.

Implementation of the affordable care act: a case study of a service line co-management company.

PubMed

Lanese, Bethany

2016-09-19

Purpose The purpose of this paper is to test and measure the outcome of a community hospital in implementing the Affordable Care Act (ACA) through a co-management arrangement. RQ1: do the benefits of a co-management arrangement outweigh the costs? RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? Design/methodology/approach A case study of a 350-bed non-profit community hospital co-management company. The quantitative data are eight quarters of quality metrics prior and eight quarters post establishment of the co-management company. The quality metrics are all based on standardized national requirements from the Joint Commission and Centers for Medicare and Medicaid Services guidelines. These measures directly impact the quality initiatives under the ACA that are applicable to all healthcare facilities. Qualitative data include survey results from hospital employees of the perceived effectiveness of the co-management company. A paired samples difference of means t-test was conducted to compare the timeframe before co-management and post co-management. Findings The findings indicate that the benefits of a co-management arrangement do outweigh the costs for both the physicians and the hospital ( RQ1). The physicians benefit through actual dollar payout, but also with improved communication and greater input in running the service line. The hospital benefits from reduced cost - or reduced penalties under the ACA - as well as better communication and greater physician involvement in administration of the service line. RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? The hospital improved in every quality metric under the co-management company. A paired sample difference of means t-test showed a statistically significant improvement in five of the six quality metrics in the study. Originality/value Previous research indicates the potential effectiveness of co-management companies in improving healthcare delivery and hospital-physician relations (Sowers et al., 2013). The current research takes this a step further to show that the data do in fact support these concepts. The hospital and the physicians carrying out the day-to-day actions have shared goals, better communication, and improved quality metrics under the co-management company. As the number of co-management companies increases across the USA, more research can be directed at determining their overall impact on quality care.

Template matching for auditing hospital cost and quality.

PubMed

Silber, Jeffrey H; Rosenbaum, Paul R; Ross, Richard N; Ludwig, Justin M; Wang, Wei; Niknam, Bijan A; Mukherjee, Nabanita; Saynisch, Philip A; Even-Shoshan, Orit; Kelz, Rachel R; Fleisher, Lee A

2014-10-01

Develop an improved method for auditing hospital cost and quality. Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006. A template of 300 representative patients was constructed and then used to match 300 patients at hospitals that had a minimum of 500 patients over a 3-year study period. From each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching. The matching algorithm found close matches on procedures and patient characteristics, far more balanced than measured covariates would be in a randomized clinical trial. These matched samples displayed little to no differences across hospitals in common patient characteristics yet found large and statistically significant hospital variation in mortality, complications, failure-to-rescue, readmissions, length of stay, ICU days, cost, and surgical procedure length. Similar patients at different hospitals had substantially different outcomes. The template-matched sample can produce fair, directly standardized audits that evaluate hospitals on patients with similar characteristics, thereby making benchmarking more believable. Through examining matched samples of individual patients, administrators can better detect poor performance at their hospitals and better understand why these problems are occurring. © Health Research and Educational Trust.

[Direct costs and clinical aspects of adverse drug reactions in patients admitted to a level 3 hospital internal medicine ward].

PubMed

Tribiño, Gabriel; Maldonado, Carlos; Segura, Omar; Díaz, Jorge

2006-03-01

Adverse drug reactions (ADRs) occur frequently in hospitals and increase costs of health care; however, few studies have quantified the clinical and economic impact of ADRs in Colombia. These impacts were evaluated by calculating costs associated with ADRs in patients hospitalized in the internal medicine ward of a Level 3 hospital located in Bogotá, Colombia. In addition, salient clinical features of ADRs were identified and characterized. Intensive follow-ups for a cohort of patients were conducted for a five month period in order to detect ADRs; different ways to classify them, according to literature, were considered as well. Information was collected using the INVIMA reporting format, and causal probability was evaluated with the Naranjo algorithm. Direct costs were calculated from the perspective of payer, based on the following costs: additional hospital stay, medications, paraclinical tests, additional procedures, patient displacement to intermediate or intensive care units, and other costs. Of 836 patients admitted to the service, 268 adverse drug reactions were detected in 208 patients (incidence proportion 25.1%, occurence rate 0.32). About the ADRs found, 74.3% were classified as probable, 92.5% were type A, and 81.3% were moderate. The body system most often affected was the circulatory system (33.9%). Drugs acting on the blood were most frequently those ones associated with adverse reactions (37.6%). The costs resulting from medical care of adverse drug reactions varied from COL dollar 93,633,422 (USD dollar 35,014.92) to COL dollar 122,155,406 (USD dollar 45,680.94), according to insurance type, during the study period. Adverse drug reactions have a significant negative health and financial impact on patient welfare. Because of the substantial resources required for their medical care and the significant proportion of preventable adverse reactions, active programs of institutional pharmacovigilance are highly recommended.

Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled Trials

PubMed Central

Bijen, Claudia B. M.; Vermeulen, Karin M.; Mourits, Marian J. E.; de Bock, Geertruida H.

2009-01-01

Objective Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Data sources Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. Selection of studies Twelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. Methods The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. Findings Analysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored ≥10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1% higher than the AH group ($60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750. Conclusions The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival. PMID:19806210

Primary Prevention of Pediatric Abusive Head Trauma: A Cost Audit and Cost-Utility Analysis

ERIC Educational Resources Information Center

Friedman, Joshua; Reed, Peter; Sharplin, Peter; Kelly, Patrick

2012-01-01

Objectives: To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program. Methods: A 5 year cohort of infants with abusive head trauma admitted to hospital in Auckland, New Zealand was reviewed. We…

[The impact on costs and care of two approaches to reduce employees' dental plan expenses in a private company].

PubMed

Costa Filho, Luiz Cesar da; Duncan, Bruce Bartholow; Polanczyk, Carisi Anne; Sória, Marina Lara; Habekost, Ana Paula; Costa, Carolina Covolo da

2008-05-01

The present study evaluated the dental care plan offered to 4,000 employees of a private hospital and their respective families. The analysis covered three stages: (1) baseline (control), when dental care was provided by an outsourced company with a network of dentists paid for services, (2) a renegotiation of costs with the original dental care provider, and (3) provision of dental care by the hospital itself, through directly hired dentists on regular salaries. Monthly economic and clinical data were collected for this research. The dental plan renegotiation reduced costs by 37% in relation to baseline, and the hospital's own dental service reduced costs by 50%. Renegotiation led to a 31% reduction in clinical procedures, without altering the dental care profile; the hospital's own dental service did not reduce the total number of clinical procedures, but modified the profile of dental care, since procedures related to the causes of diseases increased and surgical/restorative procedures decreased.

The psychiatric nurse specialist: a valuable asset in the general hospital.

PubMed

Fife, B; Lemler, S

1983-04-01

In summary, what are the ways in which the psychiatric/mental clinical specialist contributes to cost-effectiveness, the professional growth of nursing staff, and quality patient care in the general hospital setting? All services of the psychiatric/mental health clinical specialist are ultimately directed toward increasing the effectiveness with which staff can deliver care. This goal is accomplished by helping staff nurses maximize their knowledge, by providing needed educational opportunities, by promoting the use of a holistic model of care, and by helping staff cope with their own stress. In our experience, high quality care that meets the physiological, psychological, and sociological needs of patients decreases the length of the hospital stay, prevents repeated hospitalizations, and minimizes the development of psychosocial problems secondary to the illness. With the necessary support and cooperation from administration, this clinical specialist role reduces health care costs, promotes a higher level of functioning in patients and their families, and increases the level of job satisfaction for the staff who provide direct bedside care.

Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery.

PubMed

Akhavan, Sina; Ward, Lorrayne; Bozic, Kevin J

2016-01-01

Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery. The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA). Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system. Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost categories with the most variability between TA and TDABC estimates were operating room services and room and board. Traditional hospital cost accounting systems overestimate the costs associated with many surgical procedures, including primary TJA. TDABC provides a more accurate measure of true resource use associated with TJAs and can be used to identify high-cost/high-variability processes that can be targeted for process/quality improvement. Level III, therapeutic study.

Appropriate VTE prophylaxis is associated with lower direct medical costs.

PubMed

Amin, Alpesh; Hussein, Mohamed; Battleman, David; Lin, Jay; Stemkowski, Stephen; Merli, Geno J

2010-11-01

To calculate and compare the direct medical costs of guideline-recommended prophylaxis with prophylaxis that does not fully adhere with guideline recommendations in a large, real-world population. Discharge records were retrieved from the US Premier Perspective™ database (January 2003-December 2003) for patients aged≥40 years with a primary diagnosis of cancer, chronic heart failure, lung disease, or severe infectious disease who received some form of thromboprophylaxis. Univariate analysis and multivariate regression modeling were performed to compare direct medical costs between discharges who received appropriate prophylaxis (correct type, dose, and duration based on sixth edition American College of Chest Physicians [ACCP] recommendations) and partial prophylaxis (not in full accordance with ACCP recommendations). Market segmentation analysis was used to compare costs stratified by hospital and patient characteristics. Of the 683 005 discharges included, 148,171 (21.7%) received appropriate prophylaxis and 534,834 (78.3%) received partial prophylaxis. The total direct unadjusted costs were $15,439 in the appropriate prophylaxis group and $17,763 in the partial prophylaxis group. After adjustment, mean adjusted total costs per discharge were lower for those receiving appropriate prophylaxis ($11,713; 95% confidence interval [CI], $11,675-$11,753) compared with partial prophylaxis ($13,369; 95% CI, $13,332-$13 406; P<0.01). Appropriate prophylaxis appeared to be associated with numerically lower unadjusted costs than partial prophylaxis, regardless of hospital size, rural/urban location, teaching status, and patient age and gender. This large, real-world analysis suggests that appropriate prophylaxis, in adherence with ACCP guidelines, is potentially cost-saving compared with partial prophylaxis in at-risk medical patients.

Activity-based costs of blood transfusions in surgical patients at four hospitals.

PubMed

Shander, Aryeh; Hofmann, Axel; Ozawa, Sherri; Theusinger, Oliver M; Gombotz, Hans; Spahn, Donat R

2010-04-01

Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse. To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model. All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate. Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.

High direct costs of medical care in patients with Type 1 diabetes attending a referral clinic in a government-funded hospital in Northern India.

PubMed

Katam, Kishore K; Bhatia, Vijayalakshmi; Dabadghao, Preeti; Bhatia, Eesh

2016-01-01

There is little information regarding costs of managing type 1 diabetes mellitus (T1DM) from low- and middle-income countries. We estimated direct costs of T1DM in patients attending a referral diabetes clinic in a governmentfunded hospital in northern India. We prospectively enrolled 88 consecutive T1DM patients (mean [SD] age 15.3 [8] years) with age at onset <18 years presenting to the endocrine clinic of our institution. Data on direct costs were collected for a 12 months-6 months retrospectively followed by 6 months prospectively. Patients belonged predominantly (77%) to the middle socioeconomic strata (SES); 81% had no access to government subsidy or health insurance. The mean direct cost per patient-year of T1DM was `27 915 (inter-quartile range [IQR] `19 852-32 856), which was 18.6% (7.1%-30.1%) of the total family income. A greater proportion of income was spent by families of lower compared to middle SES (32.6% v. 6.6%, p<0.001). The mean out-of-pocket payment for diabetes care ranged from 2% to 100% (mean 87%) of the total costs. The largest expenditure was on home blood glucose monitoring (40%) and insulin (39.5%). On multivariate analysis, total direct cost was associated with annual family income (β=0.223, p=0.033), frequency of home blood glucose monitoring (β=0.249, p=0.016) and use of analogue insulin (β=0.225, p=0.016). Direct costs of T1DM were high; in proportion to their income the costs were greater in the lower SES. The largest expenditure was on home blood glucose monitoring and insulin. Support for insulin and glucose testing strips for T1DM care is urgently required.

The influence of procedure delay on resource use: a national study of patients with open tibial fracture.

PubMed

Sears, Erika Davis; Burke, James F; Davis, Matthew M; Chung, Kevin C

2013-03-01

The purpose of this study was to (1) understand national variation in delay of emergency procedures in patients with open tibial fracture at the hospital level and (2) compare length of stay and cost in patients cared for at the best- and worst-performing hospitals for delay. The authors retrospectively analyzed the 2003 to 2009 Nationwide Inpatient Sample. Adult patients with open tibial fracture were included. Hospital probability of delay in performing emergency procedures beyond the day of admission was calculated. Multilevel linear regression random-effects models were created to evaluate the relationship between the treating hospital's tendency for delay (in quartiles) and the log-transformed outcomes of length of stay and cost. The final sample included 7029 patients from 332 hospitals. Patients treated at hospitals in the fourth (worst) quartile for delay were estimated to have 12 percent (95 percent CI, 2 to 21 percent) higher cost compared with patients treated at hospitals in the first quartile. In addition, patients treated at hospitals in the fourth quartile had an estimated 11 percent (95 percent CI, 4 to 17 percent) longer length of stay compared with patients treated at hospitals in the first quartile. Patients with open tibial fracture treated at hospitals with more timely initiation of surgical care had lower cost and shorter length of stay than patients treated at hospitals with less timely initiation of care. Policies directed toward mitigating variation in care may reduce unnecessary waste.

Costs of diarrheal disease and the cost-effectiveness of a rotavirus vaccination program in kyrgyzstan.

PubMed

Flem, Elmira T; Latipov, Renat; Nurmatov, Zuridin S; Xue, Yiting; Kasymbekova, Kaliya T; Rheingans, Richard D

2009-11-01

We examined the cost-effectiveness of a rotavirus immunization program in Kyrgyzstan, a country eligible for vaccine funding from the GAVI Alliance. We estimated the burden of rotavirus disease and its economic consequences by using national and international data. A cost-effectiveness analysis was conducted from government and societal perspectives, along with a range of 1-way sensitivity analyses. Rotavirus-related hospitalizations and outpatient visits cost US$580,864 annually, of which $421,658 (73%) is direct medical costs and $159,206 (27%) is nonmedical and indirect costs. With 95% coverage, vaccination could prevent 75% of rotavirus-related hospitalizations and deaths and 56% of outpatient visits and could avert $386,193 (66%) in total costs annually. The medical break-even price at which averted direct medical costs equal vaccination costs is $0.65/dose; the societal break-even price is $1.14/dose for a 2-dose regimen. At the current GAVI Alliance-subsidized vaccine price of $0.60/course, rotavirus vaccination is cost-saving for the government. Vaccination is cost-effective at a vaccine price $9.41/dose, according to the cost-effectiveness standard set by the 2002 World Health Report. Addition of rotavirus vaccines to childhood immunization in Kyrgyzstan could substantially reduce disease burden and associated costs. Vaccination would be cost-effective from the national perspective at a vaccine price $9.41 per dose.

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka.

PubMed

Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S; Tozan, Yeşim

2016-02-01

Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health's perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216-609 for pediatric cases and between US$196-866 for adult cases according to disease severity and treatment setting. This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

PubMed Central

Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S.; Tozan, Yeşim

2016-01-01

Background Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. Methods We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. Results The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. Conclusions This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka. PMID:26910907

Target-controlled inhalation anaesthesia: A cost-benefit analysis based on the cost per minute of anaesthesia by inhalation.

PubMed

Ponsonnard, Sébastien; Galy, Antoine; Cros, Jérôme; Daragon, Armelle Marie; Nathan, Nathalie

2017-02-01

End-tidal target-controlled inhalational anaesthesia (TCIA) with halogenated agents (HA) provides a faster and more accurately titrated anaesthesia as compared to manually-controlled anaesthesia. This study aimed to measure the macro-economic cost-benefit ratio of TCIA as compared to manually-controlled anaesthesia. This retrospective and descriptive study compared direct drug spending between two hospitals before 2011 and then after the replacement of three of six anaesthesia machines with TCIA mode machines in 2012 (Aisys carestation ® , GE). The direct costs were obtained from the pharmacy department and the number and duration of the anaesthesia procedures from the computerized files of the hospital. The cost of halogenated agents was reduced in the hospital equipped with an Aisys carestation ® by 13% as was the cost of one minute of anaesthesia by inhalation (€0.138 and €0.121/min between 2011 and 2012). The extra cost of the implementation of the 3 anaesthesia machines could be paid off with the resulting savings over 6 years. TCIA appears to have a favourable cost-benefit ratio. Despite a number of factors, which would tend to minimise the saving and increase costs, we still managed to observe a 13% savings. Shorter duration of surgery, type of induction as well as the way HA concentration is targeted may influence the savings results obtained. Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Cost of treatment for breast cancer in central Vietnam

PubMed Central

Hoang Lan, Nguyen; Laohasiriwong, Wongsa; Stewart, John Frederick; Tung, Nguyen Dinh; Coyte, Peter C.

2013-01-01

Background In recent years, cases of breast cancer have been on the rise in Vietnam. To date, there has been no study on the financial burden of the disease. This study estimates the direct medical cost of a 5-year treatment course for women with primary breast cancer in central Vietnam. Methods Retrospective patient-level data from medical records at the Hue Central Hospital between 2001 and 2006 were analyzed. Cost analysis was conducted from the health care payers’ perspective. Various direct medical cost categories were computed for a 5-year treatment course for patients with breast cancer. Costs, in US dollars, discounted at a 3% rate, were converted to 2010 after adjusting for inflation. For each cost category, the mean, standard deviation, median, and cost range were estimated. Median regression was used to investigate the relationship between costs and the stage, age at diagnosis, and the health insurance coverage of the patients. Results The total direct medical cost for a 5-year treatment course for breast cancer in central Vietnam was estimated at $975 per patient (range: $11.7–$3,955). The initial treatment cost, particularly the cost of chemotherapy, was found to account for the greatest proportion of total costs (64.9%). Among the patient characteristics studied, stage at diagnosis was significantly associated with total treatment costs. Patients at later stages of breast cancer did not differ significantly in their total costs from those at earlier stages however, but their survival time was much shorter. The absence of health insurance was the main factor limiting service uptake. Conclusion From the health care payers’ perspective, the Government subsidization of public hospital charges lowered the direct medical costs of a 5-year treatment course for primary breast cancer in central Vietnam. However, the long treatment course was significantly influenced by out-of-pocket payments for patients without health insurance. PMID:23394855

How much does care in palliative care wards cost in Poland?

PubMed Central

Pokropska, Wieslawa; Łuczak, Jacek; Kaptacz, Anna; Stachowiak, Andrzej; Hurich, Krystyna; Koszela, Monika

2016-01-01

Introduction The main task of palliative care units is to provide a dignified life for people with advanced progressive chronic disease through appropriate symptom management, communication between medical specialists and the patient and his family, as well as the coordination of care. Many palliative care units struggle with low incomes from the National Health Fund (NHF), which causes serious economic problems. The aim of the study was to estimate of direct and administrative costs of care and the actual cost per patient per day in selected palliative care units and comparison of the results to the valuation of the NHF. Material and methods The study of the costs of hospitalization of 175 patients was conducted prospectively in five palliative care units (PCUs). The costs directly associated with care were recorded on the specially prepared forms in each unit and also personnel and administrative costs provided by the accounting departments. Results The total costs of analyzed units amounted to 209 002 EUR (898 712 PLN), while the payment for palliative care services from the NHF amounted to 126 010 EUR (541 844 PLN), which accounted for only 60% of the costs incurred by the units. The average cost per person per day of hospitalization, calculated according to the actual duration of hospitalization in the unit, was 83 EUR (357 PLN), and the average payment from the NHF was 52.8 EUR (227 PLN). Underpayment per person per day was approximately 29.2 EUR (125 PLN). Conclusions The study showed a significant difference between the actual cost of palliative care units and the level of refund from the NHF. Based on the analysis of costs, the application has been submitted to the NHF to change the reimbursement amount of palliative care services in 2013. PMID:27186194

The Cost of Ménière's Disease: A Novel Multisource Approach.

PubMed

Tyrrell, Jessica; Whinney, David J; Taylor, Timothy

2016-01-01

To estimate the annual cost of Ménière's disease and the cost per person in the UK population and to investigate the direct and indirect costs of the condition. The authors utilized a multidata approach to provide the first estimate of the cost of Ménière's. Data from the UK Biobank (a study of 500,000 individuals collected between 2007 and 2012), the Hospital Episode Statistics (data on all hospital admissions in England from 2008 to 2012) and the UK Ménière's Society (2014) were used to estimate the cost of Ménière's. Cases were self-reported in the UK Biobank and UK Ménière's Society, within the Hospital Episode Statistics cases were clinician diagnosed. The authors estimated the direct and indirect costs of the condition, using count data to represent numbers of individuals reporting specific treatments, operations etc. and basic statistical analyses (χ tests, linear and logistic regression) to compare cases and controls in the UK Biobank. Ménière's was estimated to cost between £541.30 million and £608.70 million annually (equivalent to US $829.9 to $934.2 million), equating to £3,341 to £3,757 ($5112 to $5748) per person per annum. The indirect costs were substantial, with loss of earnings contributing to over £400 million per annum. For the first time, the authors were able to estimate the economic burden of Ménière's disease. In the UK, the annual cost of this condition is substantial. Further research is required to develop cost-effective treatments and management strategies for Ménière's to reduce the economic burden of the disease. These findings should be interpreted with caution due to the uncertainties inherent in the analysis.

Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

PubMed

Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

2016-03-01

The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable. This is the first detailed analysis of the hospital department's cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.

PubMed

Bergevin, Anna; Zick, Cathleen D; McVicar, Stephanie Browning; Park, Albert H

2015-12-01

In this study, we estimate an ex ante cost-benefit analysis of a Utah law directed at improving early cytomegalovirus (CMV) detection. We use a differential cost of treatment analysis for publicly insured CMV-infected infants detected by a statewide hearing-directed CMV screening program. Utah government administrative data and multi-hospital accounting data are used to estimate and compare costs and benefits for the Utah infant population. If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not successful, the program represents a net cost, but may still have non-monetary benefits such as accelerated achievement of diagnostic milestones. The CMV education and treatment program costs are modest and show potential for significant cost savings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Outcomes and costs of treating chronic obstructive pulmonary disease with inhaled fixed combinations: the Italian perspective of the PATHOS study.

PubMed

Roggeri, Alessandro; Micheletto, Claudio; Roggeri, Daniela Paola

2014-01-01

Fixed-dose combinations of inhaled corticosteroids and long-acting β2-agonists have proven to prevent and reduce chronic obstructive pulmonary disease (COPD) exacerbations. The aim of this analysis was to explore the clinical consequences and direct health care costs of applying the findings of the PATHOS (An Investigation of the Past 10 Years Health Care for Primary Care Patients with Chronic Obstructive Pulmonary Disease) study to the Italian context. Effectiveness data from the PATHOS study, a population-based, retrospective, observational registry study conducted in Sweden, in terms of reduction in COPD and pneumonia-related hospitalizations, were considered, in order to estimate the differences in resource consumption between patients treated with budesonide/formoterol and fluticasone/salmeterol. The base case considers the average dosages of the two drugs reported in the PATHOS study and the actual public price in charges to the Italian National Health Service, while the difference in hospitalization rates reported in the PATHOS study was costed based on Italian real-world data. The PATHOS study demonstrated a significant reduction in COPD hospitalizations and pneumonia-related hospitalizations in patients treated with budesonide/formoterol versus fluticasone/salmeterol (-29.1% and -42%, respectively). In the base case, the treatment of a patient for 1 year with budesonide/formoterol led to a saving of €499.90 (€195.10 for drugs, €193.10 for COPD hospitalizations, and €111.70 for pneumonia hospitalizations) corresponding to a -27.6% difference compared with fluticasone/salmeterol treatment. Treatment of COPD with budesonide/formoterol compared with fluticasone/salmeterol could lead to a reduction in direct health care costs, with relevant improvement in clinical outcomes.

Costs of Medically Attended Acute Gastrointestinal Infections: The Polish Prospective Healthcare Utilization Survey.

PubMed

Czech, Marcin; Rosinska, Magdalena; Rogalska, Justyna; Staszewska, Ewa; Stefanoff, Pawel

The burden of acute gastrointestinal infections (AGIs) on the society has not been well studied in Central European countries, which prevents the implementation of effective, targeted public health interventions. We investigated patients of 11 randomly selected general practices and 8 hospital units. Each patient meeting the international AGI case definition criteria was interviewed on costs incurred related to the use of health care resources. Follow-up interview with consenting patients was conducted 2 to 4 weeks after the general practitioner (GP) visit or discharge from hospital, collecting information on self-medication costs and indirect costs. Costs were recalculated to US dollars by using the purchasing power parity exchange rate for Poland. Weighting the inpatient costs by age-specific probability of hospital referral by GPs, the societal cost of a medically attended AGI case was estimated to be US $168. The main cost drivers of direct medical costs were cost of hospital bed days (US $28), cost of outpatient pharmacotherapy (US $20), and cost of GP consultation (US $10). Patients covered only the cost of outpatient pharmacotherapy. Considering the AGI population GP consultation rate, the age-adjusted societal cost of medically attended AGI episodes was estimated at US $2222 million, of which 53% was attributable to indirect costs. Even though AGIs generate a low cost for individuals, they place a high burden on the society, attributed mostly to indirect costs. Higher resources could be allocated to the prevention and control of AGIs. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Analysis of Direct Costs of Outpatient Arthroscopic Rotator Cuff Repair.

PubMed

Narvy, Steven J; Ahluwalia, Avtar; Vangsness, C Thomas

2016-01-01

Arthroscopic rotator cuff surgery is one of the most commonly performed orthopedic surgical procedures. We conducted a study to calculate the direct cost of arthroscopic repair of rotator cuff tears confirmed by magnetic resonance imaging. Twenty-eight shoulders in 26 patients (mean age, 54.5 years) underwent primary rotator cuff repair by a single fellowship-trained arthroscopic surgeon in the outpatient surgery center of a major academic medical center. All patients had interscalene blocks placed while in the preoperative holding area. Direct costs of this cycle of care were calculated using the time-driven activity-based costing algorithm. Mean time in operating room was 148 minutes; mean time in recovery was 105 minutes. Calculated surgical cost for this process cycle was $5904.21. Among material costs, suture anchor costs were the main cost driver. Preoperative bloodwork was obtained in 23 cases, adding a mean cost of $111.04. Our findings provide important preliminary information regarding the direct economic costs of rotator cuff surgery and may be useful to hospitals and surgery centers negotiating procedural reimbursement for the increased cost of repairing complex tears.

Adapting customer service to consumer-directed health care.

PubMed

Hammer, David C

2006-09-01

A growing number of hospitals are implementing new tools that provide convenient, more detailed patient access to billing information. These tools are paying off for hospitals through reduced calls to their billing offices, decreased mailing costs, and increased payments, as well as higher rates of customer satisfaction.

Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy.

PubMed

Atluri, Pavan; Stetson, Robert L; Hung, George; Gaffey, Ann C; Szeto, Wilson Y; Acker, Michael A; Hargrove, W Clark

2016-02-01

Mitral valve surgery is increasingly performed through minimally invasive approaches. There are limited data regarding the cost of minimally invasive mitral valve surgery. Moreover, there are no data on the specific costs associated with mitral valve surgery. We undertook this study to compare the costs (total and subcomponent) of minimally invasive mitral valve surgery relative to traditional sternotomy. All isolated mitral valve repairs performed in our health system from March 2012 through September 2013 were analyzed. To ensure like sets of patients, only those patients who underwent isolated mitral valve repairs with preoperative Society of Thoracic Surgeons scores of less than 4 were included in this study. A total of 159 patients were identified (sternotomy, 68; mini, 91). Total incurred direct cost was obtained from hospital financial records. Analysis demonstrated no difference in total cost (operative and postoperative) of mitral valve repair between mini and sternotomy ($25,515 ± $7598 vs $26,049 ± $11,737; P = .74). Operative costs were higher for the mini cohort, whereas postoperative costs were significantly lower. Postoperative intensive care unit and total hospital stays were both significantly shorter for the mini cohort. There were no differences in postoperative complications or survival between groups. Minimally invasive mitral valve surgery can be performed with overall equivalent cost and shorter hospital stay relative to traditional sternotomy. There is greater operative cost associated with minimally invasive mitral valve surgery that is offset by shorter intensive care unit and hospital stays. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Retrospective database study to assess the economic impact of hip fracture in the United Kingdom.

PubMed

Lambrelli, Dimitra; Burge, Russel; Raluy-Callado, Mireia; Chen, Shih-Yin; Wu, Ning; Schoenfeld, Michael J

2014-11-01

Publications containing recent, real-world data on the economic impact of hip fractures in the UK are lacking. This retrospective electronic medical records database analysis assessed medication and healthcare resource use, direct healthcare costs, and factors predicting increased resource use and costs in adult UK hip fracture patients. Data were obtained from the Clinical Practice Research Datalink linked to the Hospital Episode Statistics for adult patients hospitalized for their first hip fracture between January 1, 2006 and March 31, 2011 (index event); healthcare costs were calculated from the National Health Service perspective using 2011-2012 cost data. Data from 8028 patients were analyzed. Resource use and costs were statistically significantly higher in the year following fracture (mean total [standard deviation (SD)] cost £7359 [£14,937]) compared with the year before fracture (mean total [SD] cost £3122 [£9435]; p < 0.001), and were similar to the total amount of the index hospitalization (mean total [SD] cost £8330 [£2627]). Multivariate regression analysis (using an estimated generalized linear model) showed that older age, male gender, higher comorbidity, osteoporosis, discharge to another institution compared with home, and pre-index hospitalization and outpatient visits were associated with increased post-index hospitalization healthcare costs (all p < 0.05). Although we did not capture all pre- and post-index costs and healthcare utilization, this study provides important insights regarding the characteristics of patients with hip fracture, and information that will be useful in burden-of-illness and economic analyses.

Cost of management of severe pneumonia in young children: systematic analysis.

PubMed

Zhang, Shanshan; Sammon, Peter M; King, Isobel; Andrade, Ana Lucia; Toscano, Cristiana M; Araujo, Sheila N; Sinha, Anushua; Madhi, Shabir A; Khandaker, Gulam; Yin, Jiehui Kevin; Booy, Robert; Huda, Tanvir M; Rahman, Qazi S; El Arifeen, Shams; Gentile, Angela; Giglio, Norberto; Bhuiyan, Mejbah U; Sturm-Ramirez, Katharine; Gessner, Bradford D; Nadjib, Mardiati; Carosone-Link, Phyllis J; Simões, Eric Af; Child, Jason A; Ahmed, Imran; Bhutta, Zulfiqar A; Soofi, Sajid B; Khan, Rumana J; Campbell, Harry; Nair, Harish

2016-06-01

Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health. We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non-severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate. We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low- and-middle income countries (LMIC) and high-income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5-8.7), US$ 51.7 (95% CI 17.4-91.0) and US$ 242.7 (95% CI 153.6-341.4)-559.4 (95% CI 268.9-886.3) in community, out-patient facilities and different levels of hospital in-patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%-115.8% of patients' monthly household income in LMIC. The mean direct non-medical cost and indirect cost for severe pneumonia management accounted for 0.5-31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3-6.4) and 7.7 (IQR 5.5-9.9) days in LMIC and HIC respectively for these children. This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.

A standardized stepwise drug treatment algorithm for depression reduces direct treatment costs in depressed inpatients - Results from the German Algorithm Project (GAP3).

PubMed

Ricken, Roland; Wiethoff, Katja; Reinhold, Thomas; Stamm, Thomas J; Baghai, Thomas C; Fisher, Robert; Seemüller, Florian; Brieger, Peter; Cordes, Joachim; Laux, Gerd; Hauth, Iris; Möller, Hans-Jürgen; Heinz, Andreas; Bauer, Michael; Adli, Mazda

2018-03-01

In a previous single center study we found that a standardized drug treatment algorithm (ALGO) was more cost effective than treatment as usual (TAU) for inpatients with major depression. This report aimed to determine whether this promising initial finding could be replicated in a multicenter study. Treatment costs were calculated for two time periods: the study period (from enrolment to exit from study) and time in hospital (from enrolment to hospital discharge) based on daily hospital charges. Cost per remitted patient during the study period was considered as primary outcome. 266 patients received ALGO and 84 received TAU. For the study period, ALGO costs were significantly lower than TAU (ALGO: 7 848 ± 6 065 €; TAU: 10 033 ± 7 696 €; p = 0.04). For time in hospital, costs were not different (ALGO: 14 734 ± 8 329 €; TAU: 14 244 ± 8 419 €; p = 0.617). Remission rates did not differ for the study period (ALGO: 57.9%, TAU: 50.0%; p=0.201). Remission rates were greater in ALGO (83.3%) than TAU (66.2%) for time in hospital (p = 0.002). Cost per remission was lower in ALGO (13 554 ± 10 476 €) than TAU (20 066 ± 15 391 €) for the study period (p < 0.001) and for time in hospital (ALGO: 17 582 ± 9 939 €; TAU: 21 516 ± 12 718 €; p = 0.036). Indirect costs were not assessed. Different dropout rates in TAU and ALGO complicated interpretation. Treatment algorithms enhance the cost effectiveness of the care of depressed inpatients, which replicates our prior results in an independent sample. Copyright © 2017. Published by Elsevier B.V.

A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive?

PubMed

Rowe, Courtney K; Pierce, Michael W; Tecci, Katherine C; Houck, Constance S; Mandell, James; Retik, Alan B; Nguyen, Hiep T

2012-07-01

Cost in healthcare is an increasing and justifiable concern that impacts decisions about the introduction of new devices such as the da Vinci(®) surgical robot. Because equipment expenses represent only a portion of overall medical costs, we set out to make more specific cost comparisons between open and robot-assisted laparoscopic surgery. We performed a retrospective, observational, matched cohort study of 146 pediatric patients undergoing either open or robot-assisted laparoscopic urologic surgery from October 2004 to September 2009 at a single institution. Patients were matched based on surgery type, age, and fiscal year. Direct internal costs from the institution were used to compare the two surgery types across several procedures. Robot-assisted surgery direct costs were 11.9% (P=0.03) lower than open surgery. This cost difference was primarily because of the difference in hospital length of stay between patients undergoing open vs robot-assisted surgery (3.8 vs 1.6 days, P<0.001). Maintenance fees and equipment expenses were the primary contributors to robotic surgery costs, while open surgery costs were affected most by room and board expenses. When estimates of the indirect costs of robot purchase and maintenance were included, open surgery had a lower total cost. There were no differences in follow-up times or complication rates. Direct costs for robot-assisted surgery were significantly lower than equivalent open surgery. Factors reducing robot-assisted surgery costs included: A consistent and trained robotic surgery team, an extensive history of performing urologic robotic surgery, selection of patients for robotic surgery who otherwise would have had longer hospital stays after open surgery, and selection of procedures without a laparoscopic alternative. The high indirect costs of robot purchase and maintenance remain major factors, but could be overcome by high surgical volume and reduced prices as competitors enter the market.

Cost analysis of breast cancer diagnostic assessment programs.

PubMed

Honein-AbouHaidar, G N; Hoch, J S; Dobrow, M J; Stuart-McEwan, T; McCready, D R; Gagliardi, A R

2017-10-01

Diagnostic assessment programs (daps) appear to improve the diagnosis of cancer, but evidence of their cost-effectiveness is lacking. Given that no earlier study used secondary financial data to estimate the cost of diagnostic tests in the province of Ontario, we explored how to use secondary financial data to retrieve the cost of key diagnostic test services in daps, and we tested the reliability of that cost-retrieving method with hospital-reported costs in preparation for future cost-effectiveness studies. We powered our sample at an alpha of 0.05, a power of 80%, and a margin of error of ±5%, and randomly selected a sample of eligible patients referred to a dap for suspected breast cancer during 1 January-31 December 2012. Confirmatory diagnostic tests received by each patient were identified in medical records. Canadian Classification of Health Intervention procedure codes were used to search the secondary financial data Web portal at the Ontario Case Costing Initiative for an estimate of the direct, indirect, and total costs of each test. The hospital-reported cost of each test received was obtained from the host-hospital's finance department. Descriptive statistics were used to calculate the cost of individual or group confirmatory diagnostic tests, and the Wilcoxon signed-rank test or the paired t-test was used to compare the Ontario Case Costing Initiative and hospital-reported costs. For the 191 identified patients with suspected breast cancer, the estimated total cost of $72,195.50 was not significantly different from the hospital-reported total cost of $72,035.52 ( p = 0.24). Costs differed significantly when multiple tests to confirm the diagnosis were completed during one patient visit and when confirmatory tests reported in hospital data and in medical records were discrepant. The additional estimated cost for non-salaried physicians delivering diagnostic services was $28,387.50. It was feasible to use secondary financial data to retrieve the cost of key diagnostic tests in a breast cancer dap and to compare the reliability of the costs obtained by that estimation method with hospital-reported costs. We identified the strengths and challenges of each approach. Lessons learned from this study have to be taken into consideration in future cost-effectiveness studies.

Evaluating Direct Costs of Gastric Cancer Treatment in Iran - Case Study in Kerman City in 2015.

PubMed

Izadi, Azar; Sirizi, Mohammad Jaffari; Esmaeelpour, Safa; Barouni, Mohsen

2016-01-01

Gastrointestinal cancers are common malignancies associated with high mortality rates. Health- care systems are always faced with high costs of treatment of gastrointestinal cancers including stomach cancer. Identification and prioritization of these costs can help determine economic burden and then improve of health planning by policy-makers. This study was performed in 2015 in Kerman City aimed at estimating the direct hospital costs for patients with gastric cancer. In this cross-sectional study, the medical records of 160 patients with stomach cancer admitted from 2011 to 2014 to Shafa Hospital were examined, the current stage of the disease and the patients' health status were identified, and the direct costs related to the type of treatment in the public and private sectors were calculated. SPSS-19 was used for statistical analysis of the data. Of the patients studied, 103 (65%) were men and 57 (35%) were women. The mean age of patients was 65 years. Distribution into four stages of the disease was 5%, 20%, 30%, and 45%, respectively. Direct costs in four stages of the disease were calculated as 2191.07, 2642.93, 2877, and 2674.07 USD (63,045,879, 76,047,934, 82,783,019, and 76,943,800 IRR), respectively. The highest percentage of costs was related to surgery in Stage I and to medication in Stages II, III, and IV. According to the results of direct costs of treatment for stomach cancer in Kerman, the mean total cost of treating a patient in the public sector was estimated at 74,705,158 IRR, of which averages of 60,141,384 IRR and 14,563,774 IRR were the shares of insurance and patients, respectively. The high prevalence and diagnosis of disease in old age and at advanced stages of disease impose great costs on the patients and the health system. Early diagnosis through screening and selecting an appropriate treatment method might largely ameliorate the economic burden of the disease.

Methodology for cost analysis of film-based and filmless portable chest systems

NASA Astrophysics Data System (ADS)

Melson, David L.; Gauvain, Karen M.; Beardslee, Brian M.; Kraitsik, Michael J.; Burton, Larry; Blaine, G. James; Brink, Gary S.

1996-05-01

Many studies analyzing the costs of film-based and filmless radiology have focused on multi- modality, hospital-wide solutions. Yet due to the enormous cost of converting an entire large radiology department or hospital to a filmless environment all at once, institutions often choose to eliminate film one area at a time. Narrowing the focus of cost-analysis may be useful in making such decisions. This presentation will outline a methodology for analyzing the cost per exam of film-based and filmless solutions for providing portable chest exams to Intensive Care Units (ICUs). The methodology, unlike most in the literature, is based on parallel data collection from existing filmless and film-based ICUs, and is currently being utilized at our institution. Direct costs, taken from the perspective of the hospital, for portable computed radiography chest exams in one filmless and two film-based ICUs are identified. The major cost components are labor, equipment, materials, and storage. Methods for gathering and analyzing each of the cost components are discussed, including FTE-based and time-based labor analysis, incorporation of equipment depreciation, lease, and maintenance costs, and estimation of materials costs. Extrapolation of data from three ICUs to model hypothetical, hospital-wide film-based and filmless ICU imaging systems is described. Performance of sensitivity analysis on the filmless model to assess the impact of anticipated reductions in specific labor, equipment, and archiving costs is detailed. A number of indirect costs, which are not explicitly included in the analysis, are identified and discussed.

Economic Evaluation of Hospital and Community Pharmacy Services.

PubMed

Gammie, Todd; Vogler, Sabine; Babar, Zaheer-Ud-Din

2017-01-01

To review the international body of literature from 2010 to 2015 concerning methods of economic evaluations used in hospital- and community-based studies of pharmacy services in publicly funded health systems worldwide, their clinical outcomes, and economic effectiveness. The literature search was undertaken between May 2, 2015, and September 4, 2015. Keywords included "health economics" and "evaluation" "assessment" or "appraisal," "methods," "hospital" or "community" or "residential care," "pharmacy" or "pharmacy services" and "cost minimisation analysis" or "cost utility analysis" or "cost effectiveness analysis" or "cost benefit analysis." The databases searched included MEDLINE, PubMed, Google Scholar, Science Direct, Springer Links, and Scopus, and journals searched included PLoS One, PLoS Medicine, Nature, Health Policy, Pharmacoeconomics, The European Journal of Health Economics, Expert Review of Pharmacoeconomics and Outcomes Research, and Journal of Health Economics. Studies were selected on the basis of study inclusion criteria. These criteria included full-text original research articles undertaking an economic evaluation of hospital- or community-based pharmacy services in peer-reviewed scientific journals and in English, in countries with a publicly funded health system published between 2010 and 2015. 14 articles were included in this review. Cost-utility analysis (CUA) was the most utilized measure. Cost-minimization analysis (CMA) was not used by any studies. The limited use of cost-benefit analyses (CBAs) is likely a result of technical challenges in quantifying the cost of clinical benefits, risks, and outcomes. Hospital pharmacy services provided clinical benefits including improvements in patient health outcomes and reductions in adverse medication use, and all studies were considered cost-effective due to meeting a cost-utility (per quality-adjusted life year) threshold or were cost saving. Community pharmacy services were considered cost-effective in 8 of 10 studies. Economic evaluations of hospital and community pharmacy services are becoming increasingly commonplace to enable an understanding of which health care services provide value for money and to inform policy makers as to which services will be cost-effective in light of limited health care resources.

The Influence of a Postdischarge Intervention on Reducing Hospital Readmissions in a Medicare Population

PubMed Central

Frey, Beth; Hall, Benjamin; Painter, Philip

2013-01-01

Abstract Hospital readmissions in the Medicare population may be related to a number of factors, including reoccurrence of illness, failure to understand or follow physician direction, or lack of follow-up care, among others. These readmissions significantly increase cost and utilization in this population, and are expected to increase with the projected growth in Medicare enrollment. The authors examined whether a postdischarge telephonic intervention for patients reduced 30-day hospital readmissions as compared to a matched control population. Postdischarge telephone calls were placed to patients after discharge from a hospital. Readmissions were monitored through health care claims data analysis. Of 48,538 Medicare members who received the intervention, 4504 (9.3%) were readmitted to the hospital within 30 days, as compared to 5598 controls (11.5%, P<0.0001). A direct correlation was observed between the timing of the intervention and the rate of readmission; the closer the intervention to the date of discharge the greater the reduction in number of readmissions. Furthermore, although emergency room visits were reduced in the intervention group as compared to controls (8.1% vs. 9.4%, P<0.0001), physician office visits increased (76.5% vs. 72.3%, P<0.0001), suggesting the intervention may have encouraged members to seek assistance leading to avoidance of readmission. As a group, overall cost savings were $499,458 for members who received the intervention, with $13,964,773 in savings to the health care plan. Support for patients after hospital discharge clearly affected hospital readmission and associated costs and warrants further development. (Population Health Management 2013;16:310–316) PMID:23537154

Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

PubMed

Loganathan, Tharani; Lee, Way-Seah; Lee, Kok-Foo; Jit, Mark; Ng, Chiu-Wan

2015-01-01

While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking. We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia. A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur) and rural (Kuala Terengganu) setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained. Of the 658 stool samples collected at both centers, 248 (38%) were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001). The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33%) households in Kuala Lumpur to experience catastrophic expenditure and 11 (3%) households to incur poverty. However in Kuala Terengganu, only one household (0.5%) experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%). The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03) than at Kuala Terengganu (0.24). While urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health inequities in Malaysia.

Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.

PubMed

Malagoni, Anna Maria; Vagnoni, Emidia; Felisatti, Michele; Mandini, Simona; Heidari, Mahdi; Mascoli, Francesco; Basaglia, Nino; Manfredini, Roberto; Zamboni, Paolo; Manfredini, Fabio

2011-01-01

Patients with intermittent claudication (IC) could benefit from low-cost, effective rehabilitative programs. This retrospective study evaluates compliance, impact on Quality of Life (QoL) and cost-effectiveness of a hospital prescribed, at-home performed (Test-in/Train-out) rehabilitative program for patients with IC. Two-hundred and eighty-nine patients with IC (71 ± 10.1 years, M = 210) were enrolled for a 2-year period. Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed, with serial check-ups at the hospital. Compliance with the program was assessed by assigning a score of 1 (lowest compliance) to 4 (highest compliance). The SF-36 questionnaire and a constant-load treadmill test were used to evaluate QoL and Initial/Absolute Claudication Distance, respectively. Both direct and indirect costs of the program were considered for cost-effectiveness analysis. Two-hundred and fifty patients (70.5 ± 9.2 years, M = 191), at Fontaine's II-B stage (86%), were included in the study. No adverse events were reported. The average compliance score was 3.1. At discharge, both SF-36 domains and walking performance significantly increased (P < 0.0001). A total of 1,839 in-hospital check-ups (7.36 /patient) were performed. Direct and indirect costs represented 93% and 7% of the total costs, respectively. The average costs of a visit and of a therapy cycle were C68.93 and C507.20, respectively. The cost to walk an additional meter before stopping was C9.22. A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Cost effectiveness and cost utility model of public place defibrillators in improving survival after prehospital cardiopulmonary arrest.

PubMed

Walker, Andrew; Sirel, Jane M; Marsden, Andrew K; Cobbe, Stuart M; Pell, Jill P

2003-12-06

To determine the cost effectiveness and cost utility of locating defibrillators in all major airports, railway stations, and bus stations throughout Scotland. Economic modelling exercise with data from Heartstart (Scotland). Parameters used in economic model included direct costs derived for increased accident and emergency attendances, increased hospital bed days, purchase and maintenance of defibrillators, and training in their use; life years gained calculated from increased discharges from hospital and mean survival after discharge; utility (quality of life) obtained from published data. Sensitivity analyses tested the robustness of model. Future gains discounted at 1.5% a year and future costs at 6%. Whole of Scotland. Records of all prehospital cardiac arrests due to presumed heart disease that occurred in a major airport, railway, or bus station between May 1991 and March 1998 and were not witnessed by ambulance or medical staff. Observed survival to hospital admission and observed survival to discharge. Predicted survival calculated by applying observed survival in patients attended by ambulance staff within three minutes to those who waited longer. The total discounted direct costs were 18 325 pounds sterling a year. The cost per life year gained was 29 625 pounds sterling (49 625 dollars, 43 151 Euros) and the cost per quality adjusted life year (QALY) gained was pound 41 146 (68 924 dollars, 59 932 Euros). More widespread provision of public place defibrillators would increase these figures. The cost per QALY calculated for public place defibrillators represents poorer value for money than some alternative strategies for improving survival after prehospital cardiopulmonary arrest, such as the use of other trained first responders. The figure exceeds the commonly discussed cut off levels for funding in the United Kingdom and United States of pound 30 000 and 50 000 dollars per QALY, respectively.

Radiography on wheels arrives to nursing homes - an economic assessment of a new health care technology in southern Sweden.

PubMed

Dozet, Alexander; Ivarsson, Bodil; Eklund, Karin; Klefsgård, Rosemarie; Geijer, Mats

2016-12-01

The process of transferring older, vulnerable adults from an elder care facility to the hospital for medical care can be an emotionally and physically stressful experience. The recent development of modern mobile radiography may help to ease this anxiety by allowing for evaluation in the nursing home itself. Up until this point, no health economic evaluation of the technology has been attempted in a Swedish setting. The objective of this study was to determine whether examinations of patients in elder care facilities with mobile radiography were cost-effective from a societal perspective compared with hospital-based radiological examinations. This prospective study included two groups of nursing home residents in two different areas in southern Sweden. All residents in the nursing homes were targeted for the study. Seventy-one patients were examined with hospital-based radiography at two hospitals, and 312 patients were examined using mobile radiography in nursing homes. Given that the diagnostic effects are regarded as equivalent, a cost minimization method was applied. Direct costs were estimated using prices from the county council, Region Skåne, Sweden. From a societal perspective, mobile radiography was shown to have significantly lower costs per examination compared with hospital-based radiography. The difference in health care-related costs was also significant in favour of mobile radiography. Mobile radiography can be used to examine patients in nursing homes at a lower cost than hospital-based radiography. Patients benefit from not having to transfer to a hospital for radiography, resulting in reduced anxiety for patients. © 2016 John Wiley & Sons, Ltd.

Economic costs and health-related quality of life outcomes of hospitalised patients with high HIV prevalence: A prospective hospital cohort study in Malawi.

PubMed

Maheswaran, Hendramoorthy; Petrou, Stavros; Cohen, Danielle; MacPherson, Peter; Kumwenda, Felistas; Lalloo, David G; Corbett, Elizabeth L; Clarke, Aileen

2018-01-01

Although HIV infection and its associated co-morbidities remain the commonest reason for hospitalisation in Africa, their impact on economic costs and health-related quality of life (HRQoL) are not well understood. This information is essential for decision-makers to make informed choices about how to best scale-up anti-retroviral treatment (ART) programmes. This study aimed to quantify the impact of HIV infection and ART on economic outcomes in a prospective cohort of hospitalised patients with high HIV prevalence. Sequential medical admissions to Queen Elizabeth Central Hospital, Malawi, between June-December 2014 were followed until discharge, with standardised classification of medical diagnosis and estimation of healthcare resources used. Primary costing studies estimated total health provider cost by medical diagnosis. Participants were interviewed to establish direct non-medical and indirect costs. Costs were adjusted to 2014 US$ and INT$. HRQoL was measured using the EuroQol EQ-5D. Multivariable analyses estimated predictors of economic outcomes. Of 892 eligible participants, 80.4% (647/892) were recruited and medical notes found. In total, 447/647 (69.1%) participants were HIV-positive, 339/447 (75.8%) were on ART prior to admission, and 134/647 (20.7%) died in hospital. Mean duration of admission for HIV-positive participants not on ART and HIV-positive participants on ART was 15.0 days (95%CI: 12.0-18.0) and 12.2 days (95%CI: 10.8-13.7) respectively, compared to 10.8 days (95%CI: 8.8-12.8) for HIV-negative participants. Mean total provider cost per hospital admission was US$74.78 (bootstrap 95%CI: US$25.41-US$124.15) higher for HIV-positive than HIV-negative participants. Amongst HIV-positive participants, the mean total provider cost was US$106.87 (bootstrap 95%CI: US$25.09-US$106.87) lower for those on ART than for those not on ART. The mean total direct non-medical and indirect cost per hospital admission was US$87.84. EQ-5D utility scores were lower amongst HIV-positive participants, but not significantly different between those on and not on ART. HIV-related hospital care poses substantial financial burdens on health systems and patients; however, per-admission costs are substantially lower for those already initiated onto ART prior to admission. These potential cost savings could offset some of the additional resources needed to provide universal access to ART.

Economic costs and health-related quality of life outcomes of hospitalised patients with high HIV prevalence: A prospective hospital cohort study in Malawi

PubMed Central

Petrou, Stavros; Cohen, Danielle; MacPherson, Peter; Kumwenda, Felistas; Lalloo, David G.; Corbett, Elizabeth L.; Clarke, Aileen

2018-01-01

Introduction Although HIV infection and its associated co-morbidities remain the commonest reason for hospitalisation in Africa, their impact on economic costs and health-related quality of life (HRQoL) are not well understood. This information is essential for decision-makers to make informed choices about how to best scale-up anti-retroviral treatment (ART) programmes. This study aimed to quantify the impact of HIV infection and ART on economic outcomes in a prospective cohort of hospitalised patients with high HIV prevalence. Methods Sequential medical admissions to Queen Elizabeth Central Hospital, Malawi, between June-December 2014 were followed until discharge, with standardised classification of medical diagnosis and estimation of healthcare resources used. Primary costing studies estimated total health provider cost by medical diagnosis. Participants were interviewed to establish direct non-medical and indirect costs. Costs were adjusted to 2014 US$ and INT$. HRQoL was measured using the EuroQol EQ-5D. Multivariable analyses estimated predictors of economic outcomes. Results Of 892 eligible participants, 80.4% (647/892) were recruited and medical notes found. In total, 447/647 (69.1%) participants were HIV-positive, 339/447 (75.8%) were on ART prior to admission, and 134/647 (20.7%) died in hospital. Mean duration of admission for HIV-positive participants not on ART and HIV-positive participants on ART was 15.0 days (95%CI: 12.0–18.0) and 12.2 days (95%CI: 10.8–13.7) respectively, compared to 10.8 days (95%CI: 8.8–12.8) for HIV-negative participants. Mean total provider cost per hospital admission was US$74.78 (bootstrap 95%CI: US$25.41-US$124.15) higher for HIV-positive than HIV-negative participants. Amongst HIV-positive participants, the mean total provider cost was US$106.87 (bootstrap 95%CI: US$25.09-US$106.87) lower for those on ART than for those not on ART. The mean total direct non-medical and indirect cost per hospital admission was US$87.84. EQ-5D utility scores were lower amongst HIV-positive participants, but not significantly different between those on and not on ART. Conclusions HIV-related hospital care poses substantial financial burdens on health systems and patients; however, per-admission costs are substantially lower for those already initiated onto ART prior to admission. These potential cost savings could offset some of the additional resources needed to provide universal access to ART. PMID:29543818

Assessment of medical resource utilization for Taiwanese children hospitalized for intracranial injuries.

PubMed

Lin, Chih-Ming; Li, Chung-Yi

2014-04-01

Compared to adults, children and adolescents are at greater risk for traumatic brain injury (TBI), with increased severity and prolonged recovery when compared to adults. It is a challenge to provide care for those children who are at risk for complications of TBI under health care resource constraints. To investigate hospitalization among children with intracranial injuries in terms of incidence and factors related to length of stay (LOS) and medical cost. Data from the National Health Insurance Research Database from 2007-2009 were used. In total 8632 children aged <=18 years with acute traumatic intracranial injuries caused by accidents were discharged from hospitals in Taiwan. The associations between patient and hospital covariates (e.g., age, gender, accreditation level of hospital, surgical intervention, and number of comorbid conditions) and log-transferred hospitalization cost and length of stay (LOS) were examined with multivariable regression analysis and mediation analyses. The incidence rate of hospitalization for acute intracranial injury was 63.3/100,000 per year. Motor vehicle crashes and falls accounted for 63.5% and 23.8% of intracranial injuries, respectively. The mean LOS for children was 5.0 days (median, 3 days), incurring a mean direct medical cost of $US 916.70 (median, $356.2). Boy sustained more injury (64.1%) and greater medicals cost ($965) occurred in boys. Patients with subarachnoid subdural and extradural haemorrhage tended to have a longer LOS and incur greater medical costs. Surgical intervention and type of healthcare institution were also significant predictors for medical costs. Additionally, LOS was the dominant mediator for the relationship between predictor and medical cost. Acute intracranial injuries among children incur a substantial health care burden. Therefore, health authorities need to optimally allocate medical resources in care. Copyright © 2013 Elsevier Ltd. All rights reserved.

The financial burden of malnutrition in hospitalized pediatric patients under five years of age.

PubMed

Kittisakmontri, Kulnipa; Sukhosa, Onwaree

2016-10-01

Under-five children are a medically fragile group which is compromised by hospitalization. Malnutrition in those patients not only increases complications and mortality but also affects hospital resource utilization. Therefore, this study was conducted to clarify the impact of malnutrition on hospital expenditures. This prospective cohort study was performed at a tertiary hospital in Thailand. Under-five children who were admitted to general pediatric wards were included. Demographic data, the length of stay (LOS), and anthropometric measurements at admission were recorded. The classification of wasting and stunting were defined according to the World Health Organization (WHO) classification. Moreover, all hospital expenses were calculated directly based on the actual billing including the total hospital cost, cost of bed, enteral formula, medications, medical apparatus and procedures, nursing care, investigations and surgery. One-hundred and five patients with a mean age of 26.8 ± 1.8 months were included. The majority of them were males (61%) with the leading cause of infectious disease. According to the prevalence of malnutrition, the percentage of patients who had only stunting or wasting were 24.8% and 10.5%, respectively while 15.2% of all patients had both stunting and wasting. Regardless of stunting, the wasting patients had a significantly higher cost of bed, enteral formula, nursing care, and medical apparatus. Particularly, the highest costs of all expenditures including the total hospital cost were found in patients who were both stunted and wasting. Apart from the financial burdens, the wasting patients stayed longer in the hospital and the LOS also significantly correlated with the total hospital cost (r = 0.84, p = 0.01). The present study underscores the high prevalence of malnutrition in under-five pediatric patients. The malnourished patients, in particular the wasting group, had longer LOS and consequently had increased hospital expenses. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Regionalization of laboratory care: a viable option for the 21st century.

PubMed

Steiner, J W; Root, J M

1990-06-01

The conversion of the hospital laboratory to a cost center under pressure of prospective payment and fixed reimbursement is increasingly forcing hospitals to consider alternative modes for delivery of laboratory care. Changes in the health care environment, amended statutes and regulations, and, particularly, dramatic developments in laboratory equipment, methodologies, and data processing technology make it advisable and feasible to contemplate the creation of regional laboratory consortia. A fundamental step in this direction is the "commercialization" of the hospital laboratory through a change in focus from being an in-house support program to becoming a regional resource. By the same token, the hospital laboratory can become an effective competitor of independent laboratories and be reconverted to a profit center. Creation of hospital laboratory consortia in a splintered, competitive environment requires a committed entrepreneurial effort and convincing evidence of potential benefits. The sequence of steps needed to achieve regional laboratory integration include concerting the goals and objectives of the interested parties, creating an appropriate committee structure, conducting a feasibility assessment, identifying alternative organizational and operational options, selecting a favorite option viewed by all parties as a win/win proposition, developing a business plan, and determining an implementation action plan. The major disadvantages of regionalization of laboratories are employee displacement, potential leveling of quality standards, and reduced hospital control. The major advantages include elimination of duplicate capital, personnel, and service costs, improved efficiency through test batching, reduced unit costs, increased technical capability through staff, instrument, and systems sharing, disengagement from hospital-imposed limitations, strengthened ability to penetrate the marketplace, freeing of hospital space for more direct patient care activities, and achieving a means for bonding physicians to the institutions.

Direct costs associated with the management of progressive early onset scoliosis: estimations based on gold standard technique or with magnetically controlled growing rods.

PubMed

Charroin, C; Abelin-Genevois, K; Cunin, V; Berthiller, J; Constant, H; Kohler, R; Aulagner, G; Serrier, H; Armoiry, X

2014-09-01

The main disadvantage of the surgical management of early onset scoliosis (EOS) using conventional growing rods is the need for iterative surgical procedures during childhood. The emergence of an innovative device using distraction-based magnetically controlled growing rods (MCGR) provides the opportunity to avoid such surgeries and therefore to improve the patient's quality of life. Despite the high cost of MCGR and considering its potential impact in reducing hospital stays, the use of MCGR could reduce medical resource consumption in a long-term view in comparison to traditional growing rod (TGR). A cost-simulation model was constructed to assess the incremental cost between the two strategies. The cost for each strategy was estimated based on probability of medical resource consumption determined from literature search as well as data from EOS patients treated in our centre. Some medical expenses were also estimated from expert interviews. The time horizon chosen was 4 years as from first surgical implantation. Costs were calculated in the perspective of the French sickness fund (using rates from year 2013) and were discounted by an annual rate of 4%. Sensitivity analyses were conducted to test model strength to various parameters. With a time horizon of 4 years, the estimated direct costs of TGR and MCGR strategies were 49,067 € and 42,752 €, respectively leading to an incremental costs of 6135 € in favour of MCGR strategy. In the first case, costs were mainly represented by hospital stays expenses (83.9%) whereas in the other the cost of MCGR contributed to 59.5% of the total amount. In the univariate sensitivity analysis, the tariffs of hospital stays, the tariffs of the MCG, and the frequency of distraction surgeries were the parameters with the most important impact on incremental cost. MCGR is a recent and promising innovation in the management of severe EOS. Besides improving the quality of life, its use in the treatment of severe EOS is likely to be offset by lower costs of hospital stays. Level IV, economic and decision analyses, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Economic Evaluation of the HF-ACTION Randomized Controlled Trial: An Exercise Training Study of Patients With Chronic Heart Failure

PubMed Central

Reed, Shelby D.; Whellan, David J.; Li, Yanhong; Friedman, Joëlle Y.; Ellis, Stephen J.; Piña, Ileana L.; Settles, Sharon J.; Davidson-Ray, Linda; Johnson, Johanna L.; Cooper, Lawton S.; O’Connor, Christopher M.; Schulman, Kevin A.

2011-01-01

Background HF-ACTION assigned 2331 outpatients with medically stable heart failure to exercise training or usual care. We compared medical resource use and costs incurred by these patients during follow-up. Methods and Results Extensive data on medical resource use and hospital bills were collected throughout the trial for estimates of direct medical costs. Intervention costs were estimated using patient-level trial data, administrative records, and published unit costs. Mean follow-up was 2.5 years. There were 2297 hospitalizations in the exercise group and 2332 in the usual care group (P = .92). The mean number of inpatient days was 13.6 (SD, 27.0) in the exercise group and 15.0 (SD, 31.4) in the usual care group (P = .23). Other measures of resource use were similar between groups, except for trends indicating that fewer patients in the exercise group underwent high-cost inpatient procedures. Total direct medical costs per participant were an estimated $50,857 (SD, $81,488) in the exercise group and $56,177 (SD, $92,749) in the usual care group (95% confidence interval for the difference, $–12,755 to $1547; P = .10). The direct cost of exercise training was an estimated $1006 (SD, $337). Patient time costs were an estimated $5018 (SD, $4600). Conclusions The cost of exercise training was relatively low for the health care system, but patients incurred significant time costs. In this economic evaluation, there was little systematic benefit in terms of overall medical resource use with this intervention. Trial Registration clinicaltrials.gov Identifier: NCT00047437 PMID:20551371

The Impact of Surgeon Volume on Perioperative Outcomes and Cost for Patients Receiving Robotic Partial Nephrectomy.

PubMed

Khandwala, Yash S; Jeong, In Gab; Kim, Jae Heon; Han, Deok Hyun; Li, Shufeng; Wang, Ye; Chang, Steven L; Chung, Benjamin I

2017-09-01

Little is known about the impact of surgeon volume on the success of the robot-assisted partial nephrectomy (RAPN). The objective of this study was to compare the perioperative outcomes and cost related to RAPN by annual surgeon volumes. Using the Premier Hospital Database, we retrospectively analyzed 39,773 patients who underwent RAPN between 2003 and 2015 in the United States. Surgeons for each index case were grouped into quintiles for each respective year. Outcomes were 90-day postoperative complications, operating room time (ORT), blood transfusion, length of stay, and direct hospital costs. Logistic regression and generalized linear models were used to identify factors predicting complications and cost. After accounting for patient and hospital demographics, high- and very high-volume surgeons had 40% and 42% decreased odds of having major complications (p = 0.045 and p = 0.027, respectively). Surgeons with higher volumes were associated with fewer odds of prolonged ORT (0.68 for low, 0.72 for intermediate, 0.56 for high, 0.44 for very high volume, all p < 0.05) and length of hospital stay (0.67 for intermediate, 0.51 for high, 0.45 for very high volume, all p < 0.01) compared with very low-volume surgeons. The 90-day hospital cost was also significantly lower for the surgeons with higher volume, but the statistical significance diminished after consideration of hospital clustering. Surgeons with very high RAPN volumes were found to have superior perioperative outcomes. Although cost of care appeared to correlate with surgeon volume, there may be other more influential factors predicting cost.

Impact of immigration on the cost of emergency visits in Barcelona (Spain)

PubMed Central

Cots, Francesc; Castells, Xavier; García, Oscar; Riu, Marta; Felipe, Aida; Vall, Oriol

2007-01-01

Background The impact of immigration on health services utilisation has been analysed by several studies performed in countries with lower levels of immigration than Spain. These studies indicate that health services utilisation is lower among the immigrant population than among the host population and that immigrants tend to use hospital emergency services at the expense of primary care. We aimed to quantify the relative over-utilisation of emergency services in the immigrant population. Methods Emergency visits to Hospital del Mar in Barcelona in 2002 and 2003 were analysed. The country of origin, gender, age, discharge-related circumstances (hospital admission, discharge to home, or death), medical specialty, and variable cost related to medical care were registered. Immigrants were grouped into those from high-income countries (IHIC) and those from low-income countries (ILIC) and the average direct cost was compared by country of origin. A multivariate linear mixed model of direct costs was adjusted by country of origin (classified in five groups) and by the individual variables of age, gender, hospital admission, and death as a cause of discharge. Medical specialty was considered as a random effect. Results With the exception of gynaecological emergency visits, costs resulting from emergency visits by both groups of immigrants were lower than those due to visits by the Spanish-born population. This effect was especially marked for emergency visits by adults. Conclusion Immigrants tend to use the emergency department in preference to other health services. No differences were found between IHIC and ILIC, suggesting that this result was due to the ease of access to emergency services and to lack of knowledge about the country's health system rather than to poor health status resulting from immigrants' socioeconomic position. The use of costs as a variable of complexity represents an opportunistic use of a highly exhaustive registry, which is becoming ever more frequent in hospitals and which overcomes the lack of clinical information related to outpatient activity. PMID:17239236

An analysis of clinical outcomes and costs of a long term acute care hospital.

PubMed

Votto, John J; Scalise, Paul J; Barton, Randall W; Vogel, Cristine A

2011-01-01

Compare clinical outcomes and costs in a study group of long-term acute care hospital (LTCH) patients with a control group of LTCH-eligible patients in an acute care hospital. LTCHs were created to provide post-acute care services not available at other post-acute settings. This is based on the premise that these patients would otherwise have stayed at acute care hospitals as high-cost outliers. The LTCH hospital is intended to deliver care to patients more efficiently, however, there are little documented clinical and financial data regarding the comparative clinical outcomes and costs for patients. Retrospective medical and billing record review of patients from the following groups: (1) LTCH study comprising patients admitted directly from an acute care hospital to the study LTCH and discharged from the LTCH from September 2004 through August 2006; (2) a control group of LTCH-eligible, medically complex patients treated and discharged from an acute care hospital in FY 2002. The control group was selected from approximately 500 patients who had at least one of the ten most common principle diagnosis DRGs of the study LTCH with >30-day length of stay at the referring hospital and met NALTH admitting guidelines. Discharge disposition is an important outcome measure of the quality of care of medically complex patients. The in-hospital mortality rate trended lower and home discharge was 3 times higher for the LTCH study group than for the control group. As a possible result, SNF discharge of LTCH patients was approximately half that of the control group. Both mean patient cost per day and mean total cost per patient were significantly higher in the control group than in the LTCH study group. The patients in the LTCH study group had both better clinical outcomes and lower cost of care than the control group.

Costs of venous thromboembolism associated with hospitalization for medical illness.

PubMed

Cohoon, Kevin P; Leibson, Cynthia L; Ransom, Jeanine E; Ashrani, Aneel A; Petterson, Tanya M; Long, Kirsten Hall; Bailey, Kent R; Heit, Johm A

2015-04-01

To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Population-based cohort study conducted in Olmsted County, Minnesota. Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County residents with objectively diagnosed incident VTE during or within 92 days of hospitalization for acute medical illness over the 18-year period of 1988 to 2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case for event date (±1 year), duration of prior medical history, and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or December 31, 2011 (study end date). We censored follow-up such that each case and matched control had similar periods of observation. We used generalized linear modeling (controlling for age, sex, preexisting conditions, and costs 1 year before index) to predict costs for cases and controls. Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P<.001) from index to up to 5 years post index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared with controls for up to 3 years. VTE during or after recent hospitalization for medical illness contributes a substantial economic burden.

The cost of implementing inpatient bar code medication administration.

PubMed

Sakowski, Julie Ann; Ketchel, Alan

2013-02-01

To calculate the costs associated with implementing and operating an inpatient bar-code medication administration (BCMA) system in the community hospital setting and to estimate the cost per harmful error prevented. This is a retrospective, observational study. Costs were calculated from the hospital perspective and a cost-consequence analysis was performed to estimate the cost per preventable adverse drug event averted. Costs were collected from financial records and key informant interviews at 4 not-for profit community hospitals. Costs included direct expenditures on capital, infrastructure, additional personnel, and the opportunity costs of time for existing personnel working on the project. The number of adverse drug events prevented using BCMA was estimated by multiplying the number of doses administered using BCMA by the rate of harmful errors prevented by interventions in response to system warnings. Our previous work found that BCMA identified and intercepted medication errors in 1.1% of doses administered, 9% of which potentially could have resulted in lasting harm. The cost of implementing and operating BCMA including electronic pharmacy management and drug repackaging over 5 years is $40,000 (range: $35,600 to $54,600) per BCMA-enabled bed and $2000 (range: $1800 to $2600) per harmful error prevented. BCMA can be an effective and potentially cost-saving tool for preventing the harm and costs associated with medication errors.

Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy: what about the costs?

PubMed

Dionigi, Gianlorenzo; Bacuzzi, Alessandro; Boni, Luigi; Rausei, Stefano; Rovera, Francesca; Dionigi, Renzo

2012-04-01

The objective of the present study was to evaluate costs for thyroidectomy performed with the aid of intraoperative neural monitoring (IONM), which has gained widespread acceptance during thyroid surgery as an adjunct to the gold standard of visual nerve identification. Through a micro-costing approach, the thyroidectomy patient-care process (with and without IONM) was analyzed by considering direct costs (staff time, consumables, equipment, drugs, operating room, and general expenses). Unit costs were collected from hospital accounting and standard tariff lists. To assess the impact of the IONM technology on hospital management, three macro-scenarios were considered: (1) traditional thyroidectomy; (2) thyroidectomy with IONM in a high-volume setting (5 procedures per week); and (3) thyroidectomy with IONM in a low-volume setting (1 procedure per week). Energy-based devices (EBD) for hemostasis and dissection in thyroidectomy were also evaluated, as well as the reimbursement made by the Italian Healthcare System on the basis of diagnosis related groups (DRGs), about €2,600. Comparison between costs and the DRG fee shows an underfunding of total hospitalization costs for all thyroidectomies, regardless of IONM use (scenario 1: €3,471). The main cost drivers are consumables and technologies (25%), operating room (16%), and staff (14%). Hospitalization costs for a thyroidectomy with IONM range from €3,713 to €3,770 (scenarios 2 and 3), 5–7% higher than those for traditional thyroidectomy. Major economic differences emerge when an EBD is used (€3,969). The regional DRG tariff for thyroid surgery is barely sufficient to cover conventional surgery costs. Intraoperative neural monitoring accounts for 5–7% of the hospitalization costs for a thyroidectomy.

Vitamin D and health care costs: Results from two independent population-based cohort studies.

PubMed

Hannemann, A; Wallaschofski, H; Nauck, M; Marschall, P; Flessa, S; Grabe, H J; Schmidt, C O; Baumeister, S E

2017-10-31

Vitamin D deficiency is associated with higher morbidity. However, there is few data regarding the effect of vitamin D deficiency on health care costs. This study examined the cross-sectional and longitudinal associations between the serum 25-hydroxy vitamin D concentration (25OHD) and direct health care costs and hospitalization in two independent samples of the general population in North-Eastern Germany. We studied 7217 healthy individuals from the 'Study of Health in Pomerania' (SHIP n = 3203) and the 'Study of Health in Pomerania-Trend' (SHIP-Trend n = 4014) who had valid 25OHD measurements and provided data on annual total costs, outpatient costs, hospital stays, and inpatient costs. The associations between 25OHD concentrations (modelled continuously using factional polynomials) and health care costs were examined using a generalized linear model with gamma distribution and a log link. Poisson regression models were used to estimate relative risks of hospitalization. In cross-sectional analysis of SHIP-Trend, non-linear associations between the 25OHD concentration and inpatient costs and hospitalization were detected: participants with 25OHD concentrations of 5, 10 and 15 ng/ml had 226.1%, 51.5% and 14.1%, respectively, higher inpatient costs than those with 25OHD concentrations of 20 ng/ml (overall p-value = 0.001) in multivariable models. We found a relation between lower 25OHD concentrations and increased inpatient health care costs and hospitalization. Our results thus indicate an influence of vitamin D deficiency on health care costs in the general population. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

The costs in provision of haemodialysis in a developing country: a multi-centered study.

PubMed

Ranasinghe, Priyanga; Perera, Yashasvi S; Makarim, Mohamed F M; Wijesinghe, Aruna; Wanigasuriya, Kamani

2011-09-06

Chronic Kidney Disease is a major public health problem worldwide with enormous cost burdens on health care systems in developing countries. We aimed to provide a detailed analysis of the processes and costs of haemodialysis in Sri Lanka and provide a framework for modeling similar financial audits. This prospective study was conducted at haemodialysis units of three public and two private hospitals in Sri Lanka for two months in June and July 2010. Cost of drugs and consumables for the three public hospitals were obtained from the price list issued by the Medical Supplies Division of the Department of Health Services, while for the two private hospitals they were obtained from financial departments of the respective hospitals. Staff wages were obtained from the hospital chief accountant/chief financial officers. The cost of electricity and water per month was calculated directly with the assistance of expert engineers. An apportion was done from the total hospital costs of administration, cleaning services, security, waste disposal and, laundry and sterilization for each unit. The total number of dialysis sessions (hours) at the five hospitals for June and July were 3341 (12959) and 3386 (13301) respectively. Drug and consumables costs accounted for 70.4-84.9% of the total costs, followed by the wages of the nursing staff at each unit (7.8-19.7%). The mean cost of a dialysis session in Sri Lanka was LKR 6,377 (US$ 56). The annual cost of haemodialysis for a patient with chronic renal failure undergoing 2-3 dialysis session of four hours duration per week was LKR 663,208-994,812 (US$ 5,869-8,804). At one hospital where facilities are available for the re-use of dialyzers (although not done during study period) the cost of consumables would have come down from LKR 5,940,705 to LKR 3,368,785 (43% reduction) if the method was adopted, reducing costs of haemodialysis per hour from LKR 1,327 at present to LKR 892 (33% reduction). This multi-centered study demonstrated that the costs of haemodialysis in a developing country remained significantly lower compared to developed countries. However, it still places a significant burden on the health care sector, whilst possibility of further cost reduction exists.

The costs in provision of haemodialysis in a developing country: A multi-centered study

PubMed Central

2011-01-01

Background Chronic Kidney Disease is a major public health problem worldwide with enormous cost burdens on health care systems in developing countries. We aimed to provide a detailed analysis of the processes and costs of haemodialysis in Sri Lanka and provide a framework for modeling similar financial audits. Methods This prospective study was conducted at haemodialysis units of three public and two private hospitals in Sri Lanka for two months in June and July 2010. Cost of drugs and consumables for the three public hospitals were obtained from the price list issued by the Medical Supplies Division of the Department of Health Services, while for the two private hospitals they were obtained from financial departments of the respective hospitals. Staff wages were obtained from the hospital chief accountant/chief financial officers. The cost of electricity and water per month was calculated directly with the assistance of expert engineers. An apportion was done from the total hospital costs of administration, cleaning services, security, waste disposal and, laundry and sterilization for each unit. Results The total number of dialysis sessions (hours) at the five hospitals for June and July were 3341 (12959) and 3386 (13301) respectively. Drug and consumables costs accounted for 70.4-84.9% of the total costs, followed by the wages of the nursing staff at each unit (7.8-19.7%). The mean cost of a dialysis session in Sri Lanka was LKR 6,377 (US$ 56). The annual cost of haemodialysis for a patient with chronic renal failure undergoing 2-3 dialysis session of four hours duration per week was LKR 663,208-994,812 (US$ 5,869-8,804). At one hospital where facilities are available for the re-use of dialyzers (although not done during study period) the cost of consumables would have come down from LKR 5,940,705 to LKR 3,368,785 (43% reduction) if the method was adopted, reducing costs of haemodialysis per hour from LKR 1,327 at present to LKR 892 (33% reduction). Conclusions This multi-centered study demonstrated that the costs of haemodialysis in a developing country remained significantly lower compared to developed countries. However, it still places a significant burden on the health care sector, whilst possibility of further cost reduction exists. PMID:21896190

Economic Evaluation of a Patient-Directed Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support.

PubMed

Chlan, Linda L; Heiderscheit, Annette; Skaar, Debra J; Neidecker, Marjorie V

2018-05-04

Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. Midwestern ICUs. Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support. Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist. The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of $2,322/patient compared with usual ICU care, resulting in patient-directed music dominance. The probabilistic cost-effectiveness analysis found that average patient-directed music intervention costs were $2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below $2,651, a value eight times the base case of $329. Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients.

Template Matching for Auditing Hospital Cost and Quality

PubMed Central

Silber, Jeffrey H; Rosenbaum, Paul R; Ross, Richard N; Ludwig, Justin M; Wang, Wei; Niknam, Bijan A; Mukherjee, Nabanita; Saynisch, Philip A; Even-Shoshan, Orit; Kelz, Rachel R; Fleisher, Lee A

2014-01-01

Objective Develop an improved method for auditing hospital cost and quality. Data Sources/Setting Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006. Study Design A template of 300 representative patients was constructed and then used to match 300 patients at hospitals that had a minimum of 500 patients over a 3-year study period. Data Collection/Extraction Methods From each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching. Principal Findings The matching algorithm found close matches on procedures and patient characteristics, far more balanced than measured covariates would be in a randomized clinical trial. These matched samples displayed little to no differences across hospitals in common patient characteristics yet found large and statistically significant hospital variation in mortality, complications, failure-to-rescue, readmissions, length of stay, ICU days, cost, and surgical procedure length. Similar patients at different hospitals had substantially different outcomes. Conclusion The template-matched sample can produce fair, directly standardized audits that evaluate hospitals on patients with similar characteristics, thereby making benchmarking more believable. Through examining matched samples of individual patients, administrators can better detect poor performance at their hospitals and better understand why these problems are occurring. PMID:24588413

Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis.

PubMed

Leow, Jeffrey J; Reese, Stephen; Trinh, Quoc-Dien; Bellmunt, Joaquim; Chung, Benjamin I; Kibel, Adam S; Chang, Steven L

2015-05-01

To evaluate the relationship between surgeon volume of radical cystectomy (RC) and postoperative morbidity, and to assess the economic burden of bladder cancer in the USA. We captured all patients who underwent RC (International Classification of Diseases, ninth revision, code 57.71) between 2003 and 2010, using a nationwide hospital discharge database. Patient, hospital and surgical characteristics were evaluated. The annual volume of RCs performed by the surgeons was divided into quintiles. Multivariable regression models were developed, adjusting for clustering and survey weighting, to evaluate the outcomes, including 90-day major complications (Clavien grade III-V) and direct patient costs. We adjusted for clustering and weighting to achieve a nationally representative analysis. The weighted cohort included 49,792 patients who underwent RC, with an overall 90-day major complication rate of 16.2%. Compared with surgeons performing one RC annually, surgeons performing ≥7 RCs each year had 45% lower odds of major complications (odds ratio [OR] 0.55; P < 0.001) and lower costs by $1690 (P = 0.02). Results were consistent when we analysed surgeon volume as a continuous variable and when we examined the surgeons with the highest volumes (≥28 cases annually), which showed markedly lower odds of major complications compared with the surgeons with the lowest volumes (OR 0.45, 95% CI 0.31-0.67; P < 0.001). Compared with patients who did not have any complications, those who had a major complication were associated with significantly higher 90-day median direct hospital costs ($43,965 vs $24,341; P < 0.001). We showed that there was an inverse relationship between surgeon volume and the development of postoperative 90-day major complication rates as well as direct hospital costs. Centralisation of RC to surgeons with higher volumes may reduce the development of postoperative major complications, thereby decreasing the burden of bladder cancer on the healthcare system. © 2014 The Authors. BJU International © 2014 BJU International.

The cost of antiretroviral therapy in Haiti

PubMed Central

Koenig, Serena P; Riviere, Cynthia; Leger, Paul; Severe, Patrice; Atwood, Sidney; Fitzgerald, Daniel W; Pape, Jean W; Schackman, Bruce R

2008-01-01

Background We determined direct medical costs, overhead costs, societal costs, and personnel requirements for the provision of antiretroviral therapy (ART) to patients with AIDS in Haiti. Methods We examined data from 218 treatment-naïve adults who were consecutively initiated on ART at the GHESKIO Center in Port-au-Prince, Haiti between December 23, 2003 and May 20, 2004 and calculated costs and personnel requirements for the first year of ART. Results The mean total cost of treatment per patient was $US 982 including $US 846 in direct costs, $US 114 for overhead, and $US 22 for societal costs. The direct cost per patient included generic ART medications $US 355, lab tests $US 130, nutrition $US 117, hospitalizations $US 62, pre-ART evaluation $US 58, labor $US 51, non-ART medications $US 39, outside referrals $US 31, and telephone cards for patient retention $US 3. Higher treatment costs were associated with hospitalization, change in ART regimen, TB treatment, and survival for one year. We estimate that 1.5 doctors and 2.5 nurses are required to treat 1000 patients in the first year after initiating ART. Conclusion Initial ART treatment in Haiti costs approximately $US 1,000 per patient per year. With generic first-line antiretroviral drugs, only 36% of the cost is for medications. Patients who change regimens are significantly more expensive to treat, highlighting the need for less-expensive second-line drugs. There may be sufficient health care personnel to treat all HIV-infected patients in urban areas of Haiti, but not in rural areas. New models of HIV care are needed for rural areas using assistant medical officers and community health workers. PMID:18275615

Differences in the use of health resources by Spanish and immigrant HIV-infected patients.

PubMed

Velasco, María; Castilla, Virgilio; Guijarro, Carlos; Moreno, Leonor; Barba, Raquel; Losa, Juan E

2012-10-01

HIV-immigrant use of health services and related cost has hardly been analysed. We compared resource utilisation patterns and direct health care costs between Spanish and immigrant HIV-infected patients. All HIV-infected adult patients treated during the years 2003-2005 (372 patients) in this hospital were included. We evaluated the number of out-patient, Emergency Room (ER) and Day-care Unit visits, and number and length of admissions. Direct costs were analysed. We compared all variables between immigrant and Spanish patients. Immigrants represented 12% (n=43) of the cohort. There were no differences in the number of out-patient, ER, and day-care hospital visits per patient between both groups. The number of hospital admissions per patient for any cause was higher in immigrant than in Spanish patients, 1.3 (4.4) versus 0.9 (2.7), P=.034. A high proportion of visits, both for the immigrant (45.1%) and Spanish patients (43.0%), took place in services other than Infectious Diseases. Mean unitary cost per patient per admission, out-patient visits and ER visits were similar between groups. Pharmacy costs per year was higher in Spanish patients than in immigrants (7351.8 versus 7153.9 euros [year 2005], P=.012). There were no differences in the total cost per patient per year between both groups. The global distribution of cost was very similar between both groups; almost 75% of the total cost was attributed to pharmacy in both groups. There are no significant differences in health resource utilisation and associated costs between immigrant and Spanish HIV patients. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Costs of examinations performed in a hospital laboratory in Chile.

PubMed

Andrade, Germán Lobos; Palma, Carolina Salas

2018-01-01

To determine the total average costs related to laboratory examinations performed in a hospital laboratory in Chile. Retrospective study with data from July 2014 to June 2015. 92 examinations classified in ten groups were selected according to the analysis methodology. The costs were estimated as the sum of direct and indirect laboratory costs and indirect institutional factors. The average values obtained for the costs according to examination group (in USD) were: 1.79 (clinical chemistry), 10.21 (immunoassay techniques), 13.27 (coagulation), 26.06 (high-performance liquid chromatography), 21.2 (immunological), 3.85 (gases and electrolytes), 156.48 (cytogenetic), 1.38 (urine), 4.02 (automated hematological), 4.93 (manual hematological). The value, or service fee, returned to public institutions who perform laboratory services does not adequately reflect the true total average production costs of examinations.

A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution.

PubMed

Hardy, Krista M; Kwong, Josephine; Pitzul, Kristen B; Vergis, Ashley S; Jackson, Timothy D; Urbach, David R; Okrainec, Allan

2014-04-01

The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution. Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann-Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost. There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost. Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.

Costs of Home Versus Inpatient Treatment for Fever and Neutropenia: Analysis of a Multicenter Randomized Trial

PubMed Central

Hendricks, Ann M.; Loggers, Elizabeth Trice; Talcott, James A.

2011-01-01

Purpose For patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation. Methods We collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008. Results Mean total charges for the hospital arm were 49% higher than for the home treatment arm ($16,341 v $10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher ($10,143 v $7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean, $201 v $74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work. Conclusion Home intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden. PMID:21931037

Financial return-on-investment of ophthalmic interventions: a new paradigm.

PubMed

Brown, Melissa M; Brown, Gary C; Lieske, Heidi B; Lieske, P Alexander

2014-05-01

Although the patient value gain (improvement in quality-of-life and/or length-of-life) has been highlighted in Value-based Medicine cost-utility analyses, the financial value gain associated with healthcare interventions has received less emphasis. It is important for professional healthcare providers to realize their interventions often confer a large financial return-on-investment (ROI) to society. The societal costs associated with vitreoretinal and other ophthalmic interventions include: direct ophthalmic medical costs expended (hospital, physician, drug, diagnostic testing and so forth), direct medical costs saved (decreased costs for depression, injury, skilled nursing facility, nursing home and others), direct nonmedical costs saved (decreased costs for caregivers, transportation, residence costs, moving costs, and others), and indirect medical costs saved (improving employment incidence and wages). The financial ROI for direct ophthalmic medical costs expended for ranibizumab therapy for neovascular age-related macular degeneration is 450%, whereas that for cataract surgery is 4500% and for medical open-angle glaucoma therapy is 4000%. Many costs gained add to the Gross Domestic Product and increase the wealth of the nation. Many vitreoretinal and other ophthalmologic interventions confer considerable patient value, but also result in a large financial ROI to society. This financial ROI increases the wealth of the nation.

Costs associated with febrile neutropenia in Japanese patients with primary breast cancer: post-hoc analysis of a randomized clinical trial.

PubMed

Miyake, Osamu; Murata, Kyoko; Tanaka, Shiro; Ishiguro, Hiroshi; Toi, Masakazu; Tamura, Kazuo; Kawakami, Koji

2018-05-01

Febrile neutropenia (FN), a decrease in blood neutrophils accompanied by fever, is a major adverse event (AE) associated with cancer chemotherapy. We aimed to estimate the direct medical costs associated with FN management in breast cancer patients within a clinical trial with pegfilgrastim, a pegylated form of recombinant granulocyte colony-stimulating factor (G-CSF). We obtained data from 346 Japanese breast cancer patients in a randomized, placebo-controlled clinical trial comparing FN incidence due to TC adjuvant chemotherapy (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2) between pegfilgrastim-treated and placebo groups. We estimated mean costs for chemotherapy drugs, drugs for all AEs and FN, and hospitalization for all AEs and FN. We also calculated mean costs associated with drugs and hospitalization for FN specifically for patients who developed FN in the placebo group. For the pegfilgrastim and placebo groups, the total cost during the first cycle of chemotherapy was ¥189 135 and ¥98 106. This difference is associated with prophylactic use of pegfilgrastim. Our analysis clarified in the placebo group that FN incidents of 119/173 (68.6%), the mean drug cost related to all AEs and hospitalization caused by the first cycle of chemotherapy were ¥14 411and ¥11 180, respectively. The cost of each for FN treatment was ¥16 429 for the placebo group. The mean treatment cost for patients who developed FN in placebo group, was ¥11 145 for drugs and ¥28 420 for drugs and hospitalization. Pegfilgrastim reduced the costs incurred for both drugs and hospitalization for AEs as well as FN, although the total medical cost during the chemotherapy increased. Our study constitutes baseline data for further health economic evaluations of pegfilgrastim.

Time to add a new priority target for child injury prevention? The case for an excess burden associated with sport and exercise injury: population-based study

PubMed Central

Finch, Caroline F; Wong Shee, Anna; Clapperton, Angela

2014-01-01

Objective To determine the population-level burden of sports injuries compared with that for road traffic injury for children aged <15 years in Victoria, Australia. Design Retrospective observational study. Setting Analysis of routinely collected data relating to non-fatal hospital-treated sports injury and road traffic injury cases for children aged <15 years in Victoria, Australia, over 2004–2010, inclusive. Participants 75 413 non-fatal hospital-treated sports injury and road traffic injury cases in children aged <15 years. Data included: all Victorian public and private hospital hospitalisations, using the International Statistical Classification of Diseases and Health Related Problems, 10th Revision, Australian Modification (ICD-10-AM) activity codes to identify sports-related cases and ICD-10-AM cause and location codes to identify road traffic injuries; and injury presentations to 38 Victorian public hospital emergency departments, using a combination of activity, cause and location codes. Main outcome measures Trends in injury frequency and rate were analysed by log-linear Poisson regression and the population-level injury burden was assessed in terms of years lived with disability (YLD), hospital bed-days and direct hospital costs. Results Over the 7-year period, the annual frequency of non-fatal hospital-treated sports injury increased significantly by 29% (from N=7405 to N=9923; p<0.001) but the frequency of non-fatal hospital-treated road traffic injury decreased by 26% (from N=1841 to N=1334; p<0.001). Sports injury accounted for a larger population health burden than did road traffic injury on all measures: 3-fold the number of YLDs (7324.8 vs 2453.9); 1.9-fold the number of bed-days (26 233 vs 13 886) and 2.6-fold the direct hospital costs ($A5.9 millions vs $A2.2 millions). Conclusions The significant 7-year increase in the frequency of hospital-treated sports injury and the substantially higher injury population-health burden (direct hospital costs, bed-day usage and YLD impacts) for sports injury compared with road traffic injury for children aged <15 years indicates an urgent need to prioritise sports injury prevention in this age group. PMID:24993758

Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization.

PubMed

Manjunath, Ranjani; Paradis, Pierre Emmanuel; Parisé, Hélène; Lafeuille, Marie-Hélène; Bowers, Brian; Duh, Mei Sheng; Lefebvre, Patrick; Faught, Edward

2012-10-30

To quantify the clinical and economic burden of uncontrolled epilepsy in patients requiring emergency department (ED) visit or hospitalization. Health insurance claims from a 5-state Medicaid database (1997Q1-2009Q2) and 55 self-insured US companies ("employer," 1999Q1 and 2008Q4) were analyzed. Adult patients with epilepsy receiving antiepileptic drugs (AED) were selected. Using a retrospective matched-cohort design, patients were categorized into cohorts of "uncontrolled" (≥ 2 changes in AED therapy, then ≥ 1 epilepsy-related ED visit/hospitalization within 1 year) and "well-controlled" (no AED change, no epilepsy-related ED visit/hospitalization) epilepsy. Matched cohorts were compared for health care resource utilization and costs using multivariate conditional regression models and nonparametric methods. From 110,312 (Medicaid) and 36,529 (employer) eligible patients, 3,454 and 602 with uncontrolled epilepsy were matched 1:1 to patients with well-controlled epilepsy, respectively. In both populations, uncontrolled epilepsy cohorts presented about 2 times more fractures and head injuries (all p values < 0.0001) and higher health care resource utilization (ranges of adjusted incidence rate ratios [IRRs] [all-cause utilization]: AEDs = 1.8-1.9, non-AEDs = 1.3-1.5, hospitalizations = 5.4-6.7, length of hospital stays = 7.3-7.7, ED visits = 3.7-5.0, outpatient visits = 1.4-1.7, neurologist visits = 2.3-3.1; all p values < 0.0001) than well-controlled groups. Total direct health care costs were higher in patients with uncontrolled epilepsy (adjusted cost difference [95% confidence interval (CI)] Medicaid = $12,258 [$10,482-$14,083]; employer = $14,582 [$12,019-$17,097]) vs well-controlled patients. Privately insured employees with uncontrolled epilepsy lost 2.5 times more work days, with associated indirect costs of $2,857 (95% CI $1,042-$4,581). Uncontrolled epilepsy in patients requiring ED visit or hospitalization was associated with significantly greater health care resource utilization and increased direct and indirect costs compared to well-controlled epilepsy in both publicly and privately insured settings.

Estimating the costs of psychiatric hospital services at a public health facility in Nigeria.

PubMed

Ezenduka, Charles; Ichoku, Hyacinth; Ochonma, Ogbonnia

2012-09-01

Information on the cost of mental health services in Africa is very limited even though mental health disorders represent a significant public health concern, in terms of health and economic impact. Cost analysis is important for planning and for efficiency in the provision of hospital services. The study estimated the total and unit costs of psychiatric hospital services to guide policy and psychiatric hospital management efficiency in Nigeria. The study was exploratory and analytical, examining 2008 data. A standard costing methodology based on ingredient approach was adopted combining top-down method with step-down approach to allocate resources (overhead and indirect costs) to the final cost centers. Total and unit cost items related to the treatment of psychiatric patients (including the costs of personnel, overhead and annualised costs of capital items) were identified and measured on the basis of outpatients' visits, inpatients' days and inpatients' admissions. The exercise reflected the input-output process of hospital services where inputs were measured in terms of resource utilisation and output measured by activities carried out at both the outpatient and inpatient departments. In the estimation process total costs were calculated at every cost center/department and divided by a measure of corresponding patient output to produce the average cost per output. This followed a stepwise process of first allocating the direct costs of overhead to the intermediate and final cost centers and from intermediate cost centers to final cost centers for the calculation of total and unit costs. Costs were calculated from the perspective of the healthcare facility, and converted to the US Dollars at the 2008 exchange rate. Personnel constituted the greatest resource input in all departments, averaging 80% of total hospital cost, reflecting the mix of capital and recurrent inputs. Cost per inpatient day, at $56 was equivalent to 1.4 times the cost per outpatient visit at $41, while cost per emergency visit was about two times the cost per outpatient visit. The cost of one psychiatric inpatient admission averaged $3,675, including the costs of drugs and laboratory services, which was equivalent to the cost of 90 outpatients' visits. Cost of drugs was about 4.4% of the total costs and each prescription averaged $7.48. The male ward was the most expensive cost center. Levels of subsidization for inpatient services were over 90% while ancillary services were not subsidized hence full cost recovery. The hospital costs were driven by personnel which reflected the mix of inputs that relied most on technical manpower. The unit cost estimates are significantly higher than the upper limit range for low income countries based on the WHO-CHOICE estimates. Findings suggest a scope for improving efficiency of resource use given the high proportion of fixed costs which indicates excess capacity. Adequate research is needed for effective comparisons and valid assessment of efficiency in psychiatric hospital services in Africa. The unit cost estimates will be useful in making projections for total psychiatric hospital package and a basis for determining the cost of specific neuropsychiatric cases.

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

PubMed

Kulkarni, Arvind Gopalrao; Patel, Ravish Shammi; Dutta, Shumayou

2016-12-01

Retrospective review of prospectively collected data. To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.

Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients.

PubMed

Santos, L A; Oliveira, M A; Faresin, S M; Santoro, I L; Fernandes, A L G

2007-07-01

Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2%) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.

Economic evaluation of the prophylaxis for thromboembolism in critical care trial (E-PROTECT): study protocol for a randomized controlled trial.

PubMed

Fowler, Robert A; Mittmann, Nicole; Geerts, William H; Heels-Ansdell, Diane; Gould, Michael K; Guyatt, Gordon; Krahn, Murray; Finfer, Simon; Pinto, Ruxandra; Chan, Brian; Ormanidhi, Orges; Arabi, Yaseen; Qushmaq, Ismael; Rocha, Marcelo G; Dodek, Peter; McIntyre, Lauralyn; Hall, Richard; Ferguson, Niall D; Mehta, Sangeeta; Marshall, John C; Doig, Christopher James; Muscedere, John; Jacka, Michael J; Klinger, James R; Vlahakis, Nicholas; Orford, Neil; Seppelt, Ian; Skrobik, Yoanna K; Sud, Sachin; Cade, John F; Cooper, Jamie; Cook, Deborah

2014-12-20

Venous thromboembolism (VTE) is a common complication of critical illness with important clinical consequences. The Prophylaxis for ThromboEmbolism in Critical Care Trial (PROTECT) is a multicenter, blinded, randomized controlled trial comparing the effectiveness of the two most common pharmocoprevention strategies, unfractionated heparin (UFH) and low molecular weight heparin (LMWH) dalteparin, in medical-surgical patients in the intensive care unit (ICU). E-PROTECT is a prospective and concurrent economic evaluation of the PROTECT trial. The primary objective of E-PROTECT is to identify and quantify the total (direct and indirect, variable and fixed) costs associated with the management of critically ill patients participating in the PROTECT trial, and, to combine costs and outcome results to determine the incremental cost-effectiveness of LMWH versus UFH, from the acute healthcare system perspective, over a data-rich time horizon of ICU admission and hospital admission. We derive baseline characteristics and probabilities of in-ICU and in-hospital events from all enrolled patients. Total costs are derived from centers, proportional to the numbers of patients enrolled in each country. Direct costs include medication, physician and other personnel costs, diagnostic radiology and laboratory testing, operative and non-operative procedures, costs associated with bleeding, transfusions and treatment-related complications. Indirect costs include ICU and hospital ward overhead costs. Outcomes are the ratio of incremental costs per incremental effects of LMWH versus UFH during hospitalization; incremental cost to prevent a thrombosis at any site (primary outcome); incremental cost to prevent a pulmonary embolism, deep vein thrombosis, major bleeding event or episode of heparin-induced thrombocytopenia (secondary outcomes) and incremental cost per life-year gained (tertiary outcome). Pre-specified subgroups and sensitivity analyses will be performed and confidence intervals for the estimates of incremental cost-effectiveness will be obtained using bootstrapping. This economic evaluation employs a prospective costing methodology concurrent with a randomized controlled blinded clinical trial, with a pre-specified analytic plan, outcome measures, subgroup and sensitivity analyses. This economic evaluation has received only peer-reviewed funding and funders will not play a role in the generation, analysis or decision to submit the manuscripts for publication. Clinicaltrials.gov Identifier: NCT00182143 . Date of registration: 10 September 2005.

What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

PubMed

Slover, James D; Mullaly, Kathleen A; Payne, Ashley; Iorio, Richard; Bosco, Joseph

2016-12-01

The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies. We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility. The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted. The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

Health services costs and their determinants in women with fibromyalgia.

PubMed

Penrod, John R; Bernatsky, Sasha; Adam, Viviane; Baron, Murray; Dayan, Natalie; Dobkin, Patricia L

2004-07-01

Patients with fibromyalgia (FM) use health services extensively. Knowledge about costs of FM is limited because of non-inclusiveness in assessing direct costs, because attempts to assess indirect costs are largely absent, and because determinants of costs have yet to be identified. We investigated the 6-month costs (direct and indirect) in women with primary FM, and we identified determinants of direct costs. Subjects (n = 180 women) completed a health resource questionnaire as well as measures of pain, psychological distress, comorbidity, and disability. Unit costs for resources were obtained from government, hospital, laboratory, and professional association sources. Regression modeling for 6-month direct cost included age, disability, comorbidity, pain intensity, psychological distress, education, and work status. The average 6-month direct cost was $CDN 2298 (SD 2303). The largest components were medications ($CDN 758; SD 654), complementary and alternative medicine (CAM; $CDN 398; SD 776), and diagnostic tests ($CDN 356; SD 580). Our most conservative estimate of average 6-month indirect cost was $CDN 5035 (SD 7439). Comorbidity and FM disability were statistically significant contributors to direct costs in the multivariate analysis. Costs increased by approximately 20% with each additional comorbid condition. Women with FM are high consumers of both conventional and CAM services. Our estimates of costs exceed those from most other studies; this may be due to our inclusion of a broader set of health services, medications, and indirect costs. Although in univariate analyses the number of comorbidities and indices of the effect of FM, psychological distress, and pain intensity were associated with higher direct cost, in a multiple regression analysis, only the measure of FM disability and the number of comorbidities were significant direct-cost determinants. FM also imposes important indirect costs, which were nearly 70% of the economic burden.

The costs of breast cancer in a Mexican public health institution

PubMed Central

Gómez-Rico, Jacobo Alejandro; Altagracia-Martínez, Marina; Kravzov-Jinich, Jaime; Cárdenas-Elizalde, Rosario; Rubio-Poo, Consuelo

2008-01-01

Breast cancer (BC) is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94) were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM) surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS) were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS. PMID:22312199

Direct medical costs of hospitalisations for mental disorders in Shanghai, China: a time series study

PubMed Central

Chen, Wenming; Wang, Shengnan; Wang, Qi; Wang, Weibing

2017-01-01

Objectives To provide cost burden estimates and long-term trend forecast of mental disorders that need hospitalisations in Shanghai, China. Design Daily hospital admissions and medical expenditures for mental disorder hospitalisations between 1 January 2011 and 31 December 2015 were used for analysis. Yearly total health expenditures and expenditures per hospital admission for different populations, as well as per-admission-per-year medical costs of each service for mental disorder hospitalisations, were estimated through data from 2015. We also established time series analyses to determine the long-time trend of total direct medical expenditures for mental disorders and forecasted expenditures until 31 December 2030. Setting Shanghai, China. Participants Daily hospital admissions for mental disorders of registered residents living in all 16 districts of Shanghai, who participated in workers’ basic medical insurance or the urban residents’ basic medical insurance (n=60 306). Results From 2011 to 2015, there were increased yearly trends for both hospitalisations (from 10 919 to 14 054) and total costs (from US$23.56 to 42.13 million per year in 2015 currency) in Shanghai. Cost per mental disorder hospitalisation in 2015 averaged US$2998.01. Most direct medical costs were spent on medical supplies. By the end of 2030, the average cost per admission per month for mental disorders was estimated to be US$7394.17 (95% CI US$6782.24 to 8006.10) for mental disorders, and the total health expenditure for mental disorders would reach over US$100.52 million (95% CI US$92.20 to 108.83 million) without additional government interventions. Conclusions These findings suggest total health expenditures for mental disorders in Shanghai will be higher in the future. Effective measures should be taken to reduce the rapid growth of the economic burden of mental disorders. PMID:29084785

Direct medical costs of hospitalisations for mental disorders in Shanghai, China: a time series study.

PubMed

Chen, Wenming; Wang, Shengnan; Wang, Qi; Wang, Weibing

2017-10-30

To provide cost burden estimates and long-term trend forecast of mental disorders that need hospitalisations in Shanghai, China. Daily hospital admissions and medical expenditures for mental disorder hospitalisations between 1 January 2011 and 31 December 2015 were used for analysis. Yearly total health expenditures and expenditures per hospital admission for different populations, as well as per-admission-per-year medical costs of each service for mental disorder hospitalisations, were estimated through data from 2015. We also established time series analyses to determine the long-time trend of total direct medical expenditures for mental disorders and forecasted expenditures until 31 December 2030. Shanghai, China. Daily hospital admissions for mental disorders of registered residents living in all 16 districts of Shanghai, who participated in workers' basic medical insurance or the urban residents' basic medical insurance (n=60 306). From 2011 to 2015, there were increased yearly trends for both hospitalisations (from 10 919 to 14 054) and total costs (from US$23.56 to 42.13 million per year in 2015 currency) in Shanghai. Cost per mental disorder hospitalisation in 2015 averaged US$2998.01. Most direct medical costs were spent on medical supplies. By the end of 2030, the average cost per admission per month for mental disorders was estimated to be US$7394.17 (95% CI US$6782.24 to 8006.10) for mental disorders, and the total health expenditure for mental disorders would reach over US$100.52 million (95% CI US$92.20 to 108.83 million) without additional government interventions. These findings suggest total health expenditures for mental disorders in Shanghai will be higher in the future. Effective measures should be taken to reduce the rapid growth of the economic burden of mental disorders. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[An assessment of the direct costs of healthcare for victims of sexual assaults in hospital emergency units].

PubMed

Hiquet, J; Christin, E; Tovagliaro, F; Fougas, J; Dubourg, O; Chevalier, C; Abel, F; Ebouat, M; Ploquin, M-E; Malo, M; Gromb-Monnoyeur, S

2018-03-01

The Forensic medicine reform in 2011 enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23 of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care. Furthermore, this first assessment may serve as a basis for further reflection on creating other medical judicial units but also for reviewing existing structures. The direct costs for medical care of a recent rape victim (<48hours) was quantified by including staff and consumables costs, treatments, biological tests and other expenses. The overall time for the entire medical care procedure was approximately three hours, for an overall cost of 673.92€, of which 41.5 % (279.90€) was paid by the Ministry of Justice. The medical, psychological and social aspects stood for the major expenditure items (394.02€), attributable mainly to the biological screening tests for sexually transmissible infections (STIs). These frequent situations require the convergence of human and material needs with a financial burden shared between the Ministry of Justice and health establishments. Authors suggest that in the annual hospital budgetary allocation allotted by the Ministry of Justice, the care of victims of sexual assault be based on the rate of day hospitalization "Medicine, medical specialties part time day or night common regime", allowing to provide optimal multidisciplinary care, which lessens the risks of complications and reduces the global cost created by these situations. Copyright © 2018. Published by Elsevier Masson SAS.

"A manager in the minds of doctors:" a comparison of new modes of control in European hospitals.

PubMed

Kuhlmann, Ellen; Burau, Viola; Correia, Tiago; Lewandowski, Roman; Lionis, Christos; Noordegraaf, Mirko; Repullo, Jose

2013-07-02

Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) 'integrated' control with high levels of coordination and coherent patterns for cost and quality controls; (2) 'partly integrated' control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) 'fragmented' control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Our comparison highlights how organisations matter and brings the crucial relevance of 'coordination' of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.

Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer.

PubMed

Limat, Samuel; Bracco-Nolin, Claire-Hélène; Legat-Fagnoni, Christine; Chaigneau, Loic; Stein, Ulrich; Huchet, Bernard; Pivot, Xavier; Woronoff-Lemsi, Marie-Christine

2006-06-01

The cost of chemotherapy has dramatically increased in advanced colorectal cancer patients, and the schedule of fluorouracil administration appears to be a determining factor. This retrospective study compared direct medical costs related to two different de Gramont schedules (standard vs. simplified) given in first-line chemotherapy with oxaliplatin or irinotecan. This cost-minimization analysis was performed from the French Health System perspective. Consecutive unselected patients treated in first-line therapy by LV5FU2 de Gramont with oxaliplatin (Folfox regimen) or with irinotecan (Folfiri regimen) were enrolled. Hospital and outpatient resources related to chemotherapy and adverse events were collected from 1999 to 2004 in 87 patients. Overall cost was reduced in the simplified regimen. The major factor which explained cost saving was the lower need for admissions for chemotherapy. Amount of cost saving depended on the method for assessing hospital stay. In patients treated by the Folfox regimen the per diem and DRG methods found cost savings of Euro 1,997 and Euro 5,982 according to studied schedules; in patients treated by Folfiri regimen cost savings of Euro 4,773 and Euro 7,274 were observed, respectively. In addition, travel costs were also reduced by simplified regimens. The robustness of our results was showed by one-way sensitivity analyses. These findings demonstrate that the simplified de Gramont schedule reduces costs of current first-line chemotherapy in advanced colorectal cancer. Interestingly, our study showed several differences in costs between two costing approaches of hospital stay: average per diem and DRG costs. These results suggested that standard regimen may be considered a profitable strategy from the hospital perspective. The opposition between health system perspective and hospital perspective is worth examining and may affect daily practices. In conclusion, our study shows that the simplified de Gramont schedule in combination with oxaliplatin or irinotecan is an attractive option from the French Health System perspective. This safe and less costly regimen must compared to alternative options such as oral fluoropyrimidines.

Utilization of Reflex Testing for Direct Bilirubin in the Early Recognition of Biliary Atresia.

PubMed

Lam, Leo; Musaad, Samarina; Kyle, Campbell; Mouat, Stephen

2017-05-01

Delayed diagnosis of biliary atresia is an important cause of pediatric end-stage liver failure and liver transplantation. We sought to determine whether direct bilirubin is underutilized by retrospectively reviewing patients with biliary atresia. Further, we aimed to determine the role of reflex testing for direct bilirubin in patients suspected for jaundice. The time intervals between total bilirubin and direct bilirubin measurements were retrospectively reviewed in patients with biliary atresia. We also audited the results of two major laboratories that had implemented reflex testing for direct bilirubin. We evaluated the clinical impact and cost of reflex testing in infants with increased direct bilirubin (>1.5 mg/dL; >25 μmol/L). In patients with known biliary atresia, an isolated total bilirubin measurement preceded direct bilirubin measurement in 46% (40/87) of patients; with a median delay of 19 days (interquartile range 3-44 days). In the community setting, direct bilirubin had a higher clinical specificity for biliary atresia than in the hospital setting. Reporting direct bilirubin results in 1591 infants younger than 2 weeks of age in the community was associated with three admissions to the hospital, one of whom was diagnosed with biliary atresia. The cost for the two laboratories for direct-bilirubin testing was estimated at US$3200 (NZ$4600) for each newly diagnosed case of biliary atresia. We identified underutilization of direct bilirubin as a cause of delay in the recognition of biliary atresia and show that reflex testing for direct bilirubin in jaundiced infants is a cost-effective solution. © 2017 American Association for Clinical Chemistry.

Cost avoidance associated with optimal stroke care in Canada.

PubMed

Krueger, Hans; Lindsay, Patrice; Cote, Robert; Kapral, Moira K; Kaczorowski, Janusz; Hill, Michael D

2012-08-01

Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion. Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008-2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided. Comprehensive and optimal stroke care in Canada would decrease the number of annual hospital episodes by 1062 (3.3%), the number of acute care days by 166 000 (25.9%), and the number of residential care days by 573 000 (12.8%). The number of deaths in the hospital would be reduced by 1061 (14.9%). Total avoidance of costs was estimated at $682 million annually ($307.4 million in direct costs, $374.3 million in indirect costs). The costs of stroke care in Canada can be substantially reduced, at the same time as improving patient outcomes, with the greater use of known effective treatment modalities.

Costs of inguinal hernia repair associated with using different medical devices in the Czech Republic.

PubMed

Marešová, Petra; Peteja, Matus; Lerch, Milan; Zonca, Pavel; Kuca, Kamil

2016-01-01

Inguinal hernia repair is one of the most frequently carried out operations worldwide. The purpose of this article is to analyze the costs of hernia repair and to specify the loss or profit made under the conditions in the Czech Republic with respect to the currently used medical devices and approaches. This article is based on the Drummond and O'Brien methodology, which specifically determines the content of direct and indirect costs in health services. The costs of operations during the period 2010-2014 were specified for a total of 746 patients. The cost details are described for four patients who represent the use of different types of medical devices. The procedure was a laparoscopic surgery in all cases. The total costs of inguinal hernia repairs (as per 2015 currency conversion rate) are €1,248,579; only part is covered from public funds, resulting in a loss of €218,359 for the hospital. The obtained data indicate that this operation is unprofitable for hospitals under the present conditions. The loss in the subject facility amounts to 17% of the total cost, which is the cost incurred by the hospital in the Czech Republic. The study conducted in the Czech Republic refers to different economic results when using various medical device types. So the medical device selection depends on advantages or disadvantages for the patients, as well as on the cost effectiveness for the hospital.

Epidemiology of Leishmaniasis in Spain Based on Hospitalization Records (1997–2008)

PubMed Central

Gil-Prieto, Ruth; Walter, Stefan; Alvar, Jorge; de Miguel, Angel Gil

2011-01-01

All the records from the Spanish information system for hospital data of patients diagnosed with leishmaniasis during a 12-year period (1997–2008) were studied. The 2,028 individuals were hospitalized because of leishmaniasis, as indicated by the principal diagnostic code. The average hospitalization rate was 0.41/100,000 inhabitants. One-third of them were co-infected with human immunodeficiency virus (HIV). The incidence of hospitalization in the adult population with leishmaniasis co-infected with HIV increased with age, peaked at 35–39 years of age and subsequently declined. In the pediatric population, all leishmaniasis cases occurred in HIV-negative children. Incidence of hospitalizations was highest in Madrid and in the Mediterranean coast. The cost per inpatient hospital care was $9,601 corresponding to an annual direct cost of more than $1.5 million for inpatient care alone. The economical burden of leishmaniasis is not neglectable and in the 12-year study period it represented more than $19 million. PMID:22049034

Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: a multi-institution study.

PubMed

Cunningham, Aaron J; Lofberg, Katrine M; Krishnaswami, Sanjay; Butler, Marilyn W; Azarow, Kenneth S; Hamilton, Nicholas A; Fialkowski, Elizabeth A; Bilyeu, Pamela; Ohm, Erika; Burns, Erin C; Hendrickson, Margo; Krishnan, Preetha; Gingalewski, Cynthia; Jafri, Mubeen A

2017-12-01

An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p=0.09). Complication rates (1.8% vs. 3.9%, p=0.86, no deaths) were similar. An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. Retrospective cohort study. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

A population-based estimate of the economic burden of influenza in Peru, 2009-2010.

PubMed

Tinoco, Yeny O; Azziz-Baumgartner, Eduardo; Rázuri, Hugo; Kasper, Matthew R; Romero, Candice; Ortiz, Ernesto; Gomez, Jorge; Widdowson, Marc-Alain; Uyeki, Timothy M; Gilman, Robert H; Bausch, Daniel G; Montgomery, Joel M

2016-07-01

Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru. We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identified through a household cohort in Peru. We determined the self-reported direct and indirect costs of self-treatment, outpatient care, emergency ward care, and hospitalizations through standardized questionnaires. We recorded costs accrued 15-day from illness onset. Direct costs represented medication, consultation, diagnostic fees, and health-related expenses such as transportation and phone calls. Indirect costs represented lost productivity during days of illness by both cases and caregivers. We estimated the annual economic cost and the impact of a case of influenza on a household. There were 1321 confirmed influenza cases, of which 47% sought health care. Participants with confirmed influenza illness paid a median of $13 [interquartile range (IQR) 5-26] for self-treatment, $19 (IQR 9-34) for ambulatory non-medical attended illness, $29 (IQR 14-51) for ambulatory medical attended illness, and $171 (IQR 113-258) for hospitalizations. Overall, the projected national cost of an influenza illness was $83-$85 millions. Costs per influenza illness represented 14% of the monthly household income of the lowest income quartile (compared to 3% of the highest quartile). Influenza virus infection causes an important economic burden, particularly among the poorest families and those hospitalized. Prevention strategies such as annual influenza vaccination program targeting SAGE population at risk could reduce the overall economic impact of seasonal influenza. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Cost-effectiveness of molecular point-of-care testing for influenza viruses in elderly patients at ambulatory care setting.

PubMed

You, Joyce H S; Tam, Lok-Pui; Lee, Nelson L S

2017-01-01

Early initiation of antiviral therapy in elderly patients with influenza is associated with reduced risk of extra clinic visit, hospitalization and death. This study examined the cost-effectiveness of molecular POCT for detection of influenza viruses in Hong Kong elderly patients with influenza-like illness (ILI) in the outpatient clinics. A decision analytic model was used to simulate outcomes of a hypothetical cohort of elderly patients presented with ILI at outpatient clinics during peak season of influenza with two diagnostic approaches: Rapid molecular assay (POCT-PCR group) and clinical judgement with no POCT. Outcome measures included influenza-associated direct medical cost, hospitalization and mortality rates, quality-adjusted life year loss (QALY loss), and incremental cost per QALY saved (ICER). In base-case analysis, POCT-PCR group was expected to reduce hospitalization (1.38% versus 2.85%) and mortality rate (0.08% versus 0.16%) and save 0.00112 QALYs at higher cost (by USD33.2 per ILI patient), comparing with clinical judgement group. The ICER of POCT-PCR was 29,582 USD/QALY saved. One-way sensitivity analyses found ICER sensitive to: Hospitalization rate without prompt antiviral therapy; odds ratio of hospitalization with prompt therapy; influenza prevalence; patient age and mortality rate of hospitalized patients. POCT-PCR was cost-effective in 60.6% and 99.4% of 10,000 Monte Carlo simulations at willingness-to-pay threshold of 1x and 3x gross domestic product per capita of Hong Kong, respectively. Molecular POCT for influenza detection in elderly patients with ILI at outpatient clinics during peak influenza season appeared to be cost-effective in Hong Kong.

Determinants of psychogeriatric inpatient length of stay and direct medical costs: a 6-year longitudinal study using a national database in Taiwan.

PubMed

Liu, Chin-Ming; Li, Chu-Shiu; Liu, Chwen-Chi; Tu, Chu-Chin

2012-08-01

This research examined factors related to the average length of hospital stay (LOS) and average direct medical costs (DMC) for 2291 psychogeriatric inpatients (aged 65 and over) admitted for the first time to a psychiatric ward in 2002. Hospitalization claim data of these inpatients were traced for the subsequent 6 years (2002-2007) from the dataset of Taiwan's National Health Insurance program. Analysis was carried out using the t-test, χ(2) -test and zero truncated Tobit regression. Mean LOS and mean DMC were significantly different according to sex, psychiatric diagnosis, institution type, ownership type, and number of hospitalizations, but age was the exception. Both LOS and DMC exhibited downward U-shape for the number of hospitalizations. Factors significantly associated with longer LOS and higher DMC were: male sex; schizophrenic and delusional disorders (compared with dementia); and public institution (compared with private hospital). Compared with dementia, organic mental and anxiety disorders had significantly shorter LOS, and affective disorders had shorter LOS but higher DMC. Community and psychiatric hospitals (compared with general hospital) significantly influenced LOS but not DMC. Our results can be used as a reference for providers and policymakers to improve psychiatric care efficiency and carry out National Health Insurance financial reform for psychogeriatric inpatients. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

Indirect, out-of-pocket and medical costs from influenza-related illness in young children.

PubMed

Ortega-Sanchez, Ismael R; Molinari, Noelle-Angelique M; Fairbrother, Gerry; Szilagyi, Peter G; Edwards, Kathryn M; Griffin, Marie R; Cassedy, Amy; Poehling, Katherine A; Bridges, Carolyn; Staat, Mary Allen

2012-06-13

Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza. To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children. Using a population-based surveillance network, we evaluated a representative group of children aged <5 years with laboratory-confirmed, medically attended influenza during the 2003-2004 season. Children hospitalized or seen in emergency department (ED) or outpatient settings in surveillance counties with laboratory-confirmed influenza were identified and data were collected from medical records, accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications. Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients. Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination. Published by Elsevier Ltd.

Analysis of the costs and quality of cardiovascular care in oncological monitoring.

PubMed

Costa, Élide Sbardellotto Mariano da; Hyeda, Adriano

2016-11-01

To analyze the health care costs specifically related to cardiovascular diseases, which were spent by patients of a private healthcare provider in southern Brazil, after their diagnosis of cancer. We developed an observational, cross-sectional, retrospective study, with a qualitative-quantitative strategy, through the activity of analytical internal audit of medical accounts. 860 accounts from 2012 to 2015 were analyzed, 73% referred to female users, with average age of 62.38 years, and a total direct cost of BRL 241,103.72. There was prevalence of 37% of breast cancer, 15% of prostate cancer and 9% of colon cancer. In relation to the cardiovascular care, 44% were consultations, 44% were complementary exams, 10% were emergency care, and 3% were hospitalizations. Regarding the health care costs with cardiovascular services, higher costs were in hospitalizations (51%), followed by complementary exams (37%), consultations (8%) and emergency care (4%). The cancer survivors commonly use health care in other specialties such as cardiology, and the main cost refers to hospitalization. It is recommended to invest in prevention (consultation and complementary exam) as well as in programs of chronic disease management to reduce costs and improve the quality of health care.

[An analysis of cost and profit of a nursing unit using performance-based costing: case of a general surgical ward in a general hospital].

PubMed

Lim, Ji Young

2008-02-01

The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.

Cost Drivers of a Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia Phase 3 Clinical Trial

PubMed Central

Stergiopoulos, Stella; Calvert, Sara B; Brown, Carrie A; Awatin, Josephine; Tenaerts, Pamela; Holland, Thomas L; DiMasi, Joseph A; Getz, Kenneth A

2018-01-01

Abstract Background Studies indicate that the prevalence of multidrug-resistant infections, including hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP), has been rising. There are many challenges associated with these disease conditions and the ability to develop new treatments. Additionally, HABP/VABP clinical trials are very costly to conduct given their complex protocol designs and the difficulty in recruiting and retaining patients. Methods With input from clinicians, representatives from industry, and the US Food and Drug Administration, we conducted a study to (1) evaluate the drivers of HABP/VABP phase 3 direct and indirect clinical trial costs; (2) to identify opportunities to lower these costs; and (3) to compare (1) and (2) to endocrine and oncology clinical trials. Benchmark data were gathered from proprietary and commercial databases and used to create a model that calculates the fully loaded (direct and indirect) cost of typical phase 3 HABP/VABP endocrine and oncology clinical trials. Results Results indicate that the cost per patient for a 200-site, 1000-patient phase 3 HABP/VABP study is $89600 per patient. The cost of screen failures and screen failure rates are the main cost drivers. Conclusions Results indicate that biopharmaceutical companies and regulatory agencies should consider strategies to improve screening and recruitment to decrease HABP/VABP clinical trial costs. PMID:29020279

Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology.

PubMed

Tan, Siok Swan; Bakker, Jan; Hoogendoorn, Marga E; Kapila, Atul; Martin, Joerg; Pezzi, Angelo; Pittoni, Giovanni; Spronk, Peter E; Welte, Robert; Hakkaart-van Roijen, Leona

2012-01-01

The objective of the present study was to measure and compare the direct costs of intensive care unit (ICU) days at seven ICU departments in Germany, Italy, the Netherlands, and the United Kingdom by means of a standardized costing methodology. A retrospective cost analysis of ICU patients was performed from the hospital's perspective. The standardized costing methodology was developed on the basis of the availability of data at the seven ICU departments. It entailed the application of the bottom-up approach for "hotel and nutrition" and the top-down approach for "diagnostics," "consumables," and "labor." Direct costs per ICU day ranged from €1168 to €2025. Even though the distribution of costs varied by cost component, labor was the most important cost driver at all departments. The costs for "labor" amounted to €1629 at department G but were fairly similar at the other departments (€711 ± 115). Direct costs of ICU days vary widely between the seven departments. Our standardized costing methodology could serve as a valuable instrument to compare actual cost differences, such as those resulting from differences in patient case-mix. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The Influence of Procedure Delay on Resource Utilization: A National Study of Patients with Open Tibial Fracture

PubMed Central

Sears, Erika Davis; Burke, James F.; Davis, Matthew M.; Chung, Kevin C.

2016-01-01

Background The purpose of this study is to 1) understand national variation in delay of emergency procedures in patients with open tibial fracture at the hospital level and 2) compare length of stay (LOS) and cost in patients cared for at the best and worst performing hospitals for delay. Methods We retrospectively analyzed the 2003 – 2009 Nationwide Inpatient Sample. Adult patients with primary diagnosis of open tibial fracture were selected for inclusion. We calculated hospital probability of delay of emergency procedures beyond the day of admission (day 0). Multilevel linear regression random effects models were created to evaluate the relationship between the treating hospital’s tendency for delay (in quartiles) and the log-transformed outcomes of LOS and cost, while adjusting for patient and hospital variables. Results The final sample included 7,029 patients from 332 hospitals. Adjusted analyses demonstrate that patients treated at hospitals in the fourth (worst) quartile for delay were estimated to have 12% (95% CI 2–21%) higher cost compared to patients treated at hospitals in the first quartile. In addition, patients treated at hospitals in the fourth quartile had an estimated 11% (CI 4–17%) longer LOS compared to patients treated at hospitals in the first quartile. Conclusions Patients with open tibial fracture treated at hospitals with more timely initiation of surgical care had lower cost and shorter LOS than patients treated at hospitals with less timely initiation of care. Policies directed toward mitigating variation in care are not only beneficial for patient outcomes, but may also reduce unnecessary waste. Level II (Prognostic) PMID:23142940

A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion.

PubMed

Singh, Kern; Nandyala, Sreeharsha V; Marquez-Lara, Alejandro; Fineberg, Steven J; Oglesby, Mathew; Pelton, Miguel A; Andersson, Gunnar B; Isayeva, Darya; Jegier, Briana J; Phillips, Frank M

2014-08-01

Emerging literature suggests superior clinical short- and long-term outcomes of MIS (minimally invasive surgery) TLIFs (transforaminal lumbar interbody fusion) versus open fusions. Few studies to date have analyzed the cost differences between the two techniques and their relationship to acute clinical outcomes. The purpose of the study was to determine the differences in hospitalization costs and payments for patients treated with primary single-level MIS versus open TLIF. The impact of clinical outcomes and their contribution to financial differences was explored as well. This study was a nonrandomized, nonblinded prospective review. Sixty-six consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open, 33 MIS). Patients in either cohort (MIS/open) were matched based on race, sex, age, smoking status, medical comorbidities (Charlson Comorbidity index), payer, and diagnosis. Every patient in the study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Operative time (minutes), length of stay (LOS, days), estimated blood loss (EBL, mL), anesthesia time (minutes), Visual Analog Scale (VAS) scores, and hospital cost/payment amount were assessed. The MIS and open TLIF groups were compared based on clinical outcomes measures and hospital cost/payment data using SPSS version 20.0 for statistical analysis. The two groups were compared using bivariate chi-squared analysis. Mann-Whitney tests were used for non-normal distributed data. Effect size estimate was calculated with the Cohen d statistic and the r statistic with a 95% confidence interval. Average surgical time was shorter for the MIS than the open TLIF group (115.8 minutes vs. 186.0 minutes respectively; p=.001). Length of stay was also reduced for the MIS versus the open group (2.3 days vs. 2.9 days, respectively; p=.018). Average anesthesia time and EBL were also lower in the MIS group (p<.001). VAS scores decreased for both groups, although these scores were significantly lower for the MIS group (p<.001). Financial analysis demonstrated lower total hospital direct costs (blood, imaging, implant, laboratory, pharmacy, physical therapy/occupational therapy/speech, room and board) in the MIS versus the open group ($19,512 vs. $23,550, p<.001). Implant costs were similar (p=.686) in both groups, although these accounted for about two-thirds of the hospital direct costs in the MIS cohort ($13,764) and half of these costs ($13,778) in the open group. Hospital payments were $6,248 higher for open TLIF patients compared with the MIS group (p=.267). MIS TLIF technique demonstrated significant reductions of operative time, LOS, anesthesia time, VAS scores, and EBL compared with the open technique. This reduction in perioperative parameters translated into lower total hospital costs over a 60-day perioperative period. Although hospital reimbursements appear higher in the open group over the MIS group, shorter surgical times and LOS days in the MIS technique provide opportunities for hospitals to reduce utilization of resources and to increase surgical case volume. Copyright © 2014 Elsevier Inc. All rights reserved.

Economic measurement of medical errors using a hospital claims database.

PubMed

David, Guy; Gunnarsson, Candace L; Waters, Heidi C; Horblyuk, Ruslan; Kaplan, Harold S

2013-01-01

The primary objective of this study was to estimate the occurrence and costs of medical errors from the hospital perspective. Methods from a recent actuarial study of medical errors were used to identify medical injuries. A visit qualified as an injury visit if at least 1 of 97 injury groupings occurred at that visit, and the percentage of injuries caused by medical error was estimated. Visits with more than four injuries were removed from the population to avoid overestimation of cost. Population estimates were extrapolated from the Premier hospital database to all US acute care hospitals. There were an estimated 161,655 medical errors in 2008 and 170,201 medical errors in 2009. Extrapolated to the entire US population, there were more than 4 million unique injury visits containing more than 1 million unique medical errors each year. This analysis estimated that the total annual cost of measurable medical errors in the United States was $985 million in 2008 and just over $1 billion in 2009. The median cost per error to hospitals was $892 for 2008 and rose to $939 in 2009. Nearly one third of all medical injuries were due to error in each year. Medical errors directly impact patient outcomes and hospitals' profitability, especially since 2008 when Medicare stopped reimbursing hospitals for care related to certain preventable medical errors. Hospitals must rigorously analyze causes of medical errors and implement comprehensive preventative programs to reduce their occurrence as the financial burden of medical errors shifts to hospitals. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: recommendations for policy and prevention.

PubMed

Taylor, Benjamin; Rehm, Jürgen; Patra, Jayadeep; Popova, Svetlana; Baliunas, Dolly

2007-01-01

Alcohol is one of the most important risk factors for burden of disease, particularly in high-income countries such as Canada. The purpose of this article was to estimate the number of hospitalizations, hospital days, and the resulting costs attributable to alcohol for Canada in 2002. Exposure distribution was taken from the Canadian Addiction Survey and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and gender-specific alcohol-attributable fractions. For injury, alcohol-attributable fractions were taken directly from available statistics. Data on the most responsible diagnosis, length of stay for hospitalizations, and costs were obtained from the national Canadian databases. For Canada in 2002, there were 195,970 alcohol-related diagnoses among acute care hospitalizations, 2,058 alcohol-attributable psychiatric hospitalizations, and 183,589 alcohol-attributable admissions to specialized treatment centers. These accounted for 1,246,945 hospital days in acute care facilities, 54,114 hospital days in psychiatric hospitals, and 3,018,688 hospital days in specialized treatment centers (inpatient and outpatient). The main causes of alcohol-attributable morbidity were neuropsychiatric conditions, cardiovascular disease, and unintentional injuries. In total, Can. $2.29 billion were spent on alcohol-related health care. Alcohol poses a heavy burden of disease as well as a financial strain on Canadian society. However, there are evidence-based effective and cost-effective policy and legislative interventions as well as measures to better enforce these laws.

Applying activity-based costing to the nuclear medicine unit.

PubMed

Suthummanon, Sakesun; Omachonu, Vincent K; Akcin, Mehmet

2005-08-01

Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better.

[The cost of tobacco-related diseases for Brazil's Unified National Health System].

PubMed

Pinto, Márcia; Ugá, Maria Alicia Domínguez

2010-06-01

This study aimed to identify the direct costs of hospitalizations due to three smoking-related groups of diseases - cancer and circulatory and respiratory diseases - in Brazil's Unified National Health System (SUS) in 2005. For cancer, the cost of chemotherapy was also included. The study derived cost estimates using administrative databases, relative risks, smoking prevalence, and smoking-attributable fraction. According to the estimates, smoking- attributable medical expenditures for the three disease groups amounted to R$338,692,516.02 (approximately U$185 million), accounting for 27.6% of total medical expenditures. Considering all hospitalizations and chemotherapy provided by the National Health System, tobacco-related diseases accounted for 7.7% of total medical expenditures. These costs also represented 0.9% of expenditures by federally funded public health services. This study provides a conservative estimate of smoking-related costs and suggests the need for continued research on comprehensive approaches to measure the total burden of smoking for society.

Staff nurse turnover costs: Part II, Measurements and results.

PubMed

Jones, C B

1990-05-01

This study demonstrated that the costs of nursing turnover can be high (over +10,000 per RN turnover), and that the potential for adverse impact on the nursing department, the hospital environment, and the healthcare environment exists. The results of this study are important, particularly in the midst of a national nursing shortage, for several reasons. CNEs are responsible for obtaining, allocating, and managing nursing department resources; knowledge of nursing turnover costs will allow them to make more informed decisions about how best to allocate scarce resources. The findings of this study are also important to hospital administrators because they demonstrate the financial impact of high rates of nursing turnover on healthcare delivery. Finally, these findings provide nurse researchers direction for future research into the costs and benefits of nursing turnover and retention activities, so that cost-effective methods of minimizing organizational costs can be determined.

Cost of management of severe pneumonia in young children: systematic analysis

PubMed Central

Zhang, Shanshan; Sammon, Peter M.; King, Isobel; Andrade, Ana Lucia; Toscano, Cristiana M.; Araujo, Sheila N; Sinha, Anushua; Madhi, Shabir A.; Khandaker, Gulam; Yin, Jiehui Kevin; Booy, Robert; Huda, Tanvir M; Rahman, Qazi S; El Arifeen, Shams; Gentile, Angela; Giglio, Norberto; Bhuiyan, Mejbah U.; Sturm–Ramirez, Katharine; Gessner, Bradford D.; Nadjib, Mardiati; Carosone–Link, Phyllis J.; Simões, Eric AF; Child, Jason A; Ahmed, Imran; Bhutta, Zulfiqar A; Soofi, Sajid B; Khan, Rumana J; Campbell, Harry; Nair, Harish

2016-01-01

Background Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health. Methods We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate. Results We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low– and–middle income countries (LMIC) and high–income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5–8.7), US$ 51.7 (95% CI 17.4–91.0) and US$ 242.7 (95% CI 153.6–341.4)–559.4 (95% CI 268.9–886.3) in community, out–patient facilities and different levels of hospital in–patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%–115.8% of patients’ monthly household income in LMIC. The mean direct non–medical cost and indirect cost for severe pneumonia management accounted for 0.5–31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3–6.4) and 7.7 (IQR 5.5–9.9) days in LMIC and HIC respectively for these children. Conclusion This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies. PMID:27231544

The Economic Burden of Visceral Leishmaniasis in Sudan: An Assessment of Provider and Household Costs

PubMed Central

Meheus, Filip; Abuzaid, Abuzaid A.; Baltussen, Rob; Younis, Brima M.; Balasegaram, Manica; Khalil, Eltahir A. G.; Boelaert, Marleen; Musa, Ahmed M.

2013-01-01

Visceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated and is endemic in eastern Sudan. We estimated the direct and indirect costs of treatment of VL from the perspective of the provider and the household at three public hospitals in Gedaref State. The median total cost for one VL episode was estimated to be US$450. Despite the free provision of VL drugs at public hospitals, households bore 53% of the total cost of VL with one episode of VL representing 40% of the annual household income. More than 75% of households incurred catastrophic out-of-pocket expenditures. The length of treatment of 30 days led to important costs for both health providers and households. Alternative treatment regimens that reduce the duration of treatment are urgently needed. PMID:24189368

Health consequences of road accidents: insights from local health authority registries.

PubMed

Bertoncello, C; Furlan, P; Baldovin, T; Marcolongo, A; Casale, P; Cocchio, S; Buja, A; Baldo, V

2013-01-01

Road accidents are a major public health problem that affect all age groups but their impact is most striking among the young. The aim of this study is to quantify the burden of road traffic injuries, their mortality and direct in-patient economic costs and to identify the age classes at highest risk for severe road traffic injuries, through analysis of data collected by information systems of an Italian Local Health Authority. The study was conducted in a Local Health Authority of Veneto Region. Injured people were selected from Emergency Department (2006-2010). Data were linked to the Hospital Information System for hospital admissions and to the Mortality Registry to check 30-day mortality. The direct costs associated to hospitalizations were estimated through Diagnosis Related Group reimbursement rates. Multivariate analysis was performed using hospitalization and mortality as the dependent variables and gender, age, day of week when accident occurred as the independent variables. Traffic injury, hospitalization and mortality incidence rates were calculated by gender and age per 100,000 residents per year. The road traffic injuries were 9,192, decreasing from 2,112 in 2006 to 1,980 in 2010. Among injured persons 55.3% were male (68.1% among 15-19 age class); 41.7% young people aged 15-34 years (43.9% among male, 39.0% among female). Total hospitalisation rate was 5.9%. Overall mortality rate was 0.3% (0.9% among aged 65 or older). The cost of hospital admission was euro 2,742,505 (hospitalization mean cost euro 5,097). Risk of hospitalization and death was higher in male, in elderly and during week end. Young people aged 15-19 had the highest incidence of visits (2,258.4 per 100,000) and high hospitalisation weekend and mortality rates (respectively 101.5 and 8.5). Analysis at local level, using current data sources, permits to estimate the burden of injuries caused by road-traffic, to describe the characteristics of injured persons and finally to estimate costs of care. All this information could be used to make the population aware of its own risk for road accidents. Linkage of these data with police and transport data is required to focus prevention on higher risk groups and to adopt effective local road safety strategies.

Costs of Dengue to the Health System and Individuals in Colombia from 2010 to 2012

PubMed Central

Rodriguez, Raul Castro; Galera-Gelvez, Katia; Yescas, Juan Guillermo López; Rueda-Gallardo, Jorge A.

2015-01-01

Dengue fever (DF) is an important health issue in Colombia, but detailed information on economic costs to the healthcare system is lacking. Using information from official databases (2010–2012) and a face-to-face survey of 1,483 households with DF and dengue hemorrhagic fever (DHF) patients, we estimated the average cost per case. In 2010, the mean direct medical costs to the healthcare system per case of ambulatory DF, hospitalized DF, and DHF (in Colombian pesos converted to US dollars using the average exchange rate for 2012) were $52.8, $235.8, and $1,512.2, respectively. The mean direct non-medical costs to patients were greater ($29.7, $46.7, and $62.6, respectively) than the mean household direct medical costs ($13.3, $34.8, and $57.3, respectively). The average direct medical cost to the healthcare system of a case of ambulatory DF in 2010 was 57% of that in 2011. Our results highlight the high economic burden of the disease and could be useful for assigning limited health resources. PMID:25667054

The Use of Parenteral Nutrition Support in an Acute Care Hospital and the Cost Implications of Short-term Parenteral Nutrition.

PubMed

Wong, Alvin Tc; Ong, Jeannie Pl; Han, Hsien Hwei

2016-06-01

Parenteral nutrition (PN) is indicated for patients who are unable to progress to oral or enteral nutrition. There are no local studies done on estimating the cost of PN in acute settings. The aims of this study are to describe the demographics, costs of PN and manpower required; and to determine the avoidable PN costs for patients and hospital on short-term PN. Patient data between October 2011 and December 2013 were reviewed. Data collected include demographics, length of stay (LOS), and the indication/duration of PN. PN administration cost was based on the cost of the PN bags, blood tests and miscellaneous items, adjusted to subsidy levels. Manpower costs were based on the average hourly rate. Costs for PN and manpower were approximately S$1.2 million for 2791 PN days. Thirty-six cases (18.8%) of 140 PN days were short-term and considered to be avoidable where patients progressed to oral/enteral diet within 5 days. These short-term cases totalled $59,154.42, where $42,183.15 was payable by the patients. The daily costs for PN is also significantly higher for patients on short-term PN (P <0.001). In our acute hospital, 90% of patients referred for PN were surgical patients. Majority of the cost comes from the direct daily cost of the bag and blood tests, while extensive manpower cost was borne by the hospital; 18.8% of our cohort had short-term avoidable PN. Daily PN may cost up to 60% more in patients receiving short-term PN. Clinicians should assess patient's suitability for oral/enteral feeding to limit the use of short-term PN.

Stapled hemorrhoidopexy, an innovative surgical procedure for hemorrhoidal prolapse: cost-utility analysis.

PubMed

Ribarić, Goran; Kofler, Justus; Jayne, David G

2011-08-15

To undertake full economic evaluation of stapled hemorrhoidopexy (PPH) to establish its cost-effectiveness and investigate whether PPH can become cost-saving compared to conventional excisional hemorrhoidectomy (CH). A cost-utility analysis in hospital and health care system (UK) was undertaken using a probabilistic, cohort-based decision tree to compare the use of PPH with CH. Sensitivity analyses allowed showing outcomes in regard to the variations in clinical practice of PPH procedure. The participants were patients undergoing initial surgical treatment of third and fourth degree hemorrhoids within a 1-year time-horizon. Data on clinical effectiveness were obtained from a systematic review of the literature. Main outcome measures were the cost per procedure at the hospital level, total direct costs from the health care system perspective, quality adjusted life years (QALY) gained and incremental cost per QALY gained. A decrease in operating theater time and hospital stay associated with PPH led to a cost saving compared to CH of GBP 27 (US $43.11, €30.50) per procedure at the hospital level and to an incremental cost of GBP 33 (US $52.68, €37.29) after one year from the societal perspective. Calculation of QALYs induced an incremental QALY of 0.0076 and showed an incremental cost-effective ratio (ICER) of GBP 4316 (US $6890.47, €4878.37). Taking into consideration recent literature on clinical outcomes, PPH becomes cost saving compared to CH for the health care system. PPH is a cost-effective procedure with an ICER of GBP 4136 and it seems that an innovative surgical procedure could be cost saving in routine clinical practice.

[Costs of exacerbations of chronic obstructive pulmonary disease in primary and secondary care in 2007--results of multicenter Polish study].

PubMed

Jahnz-Rózyk, Karina; Targowski, Tomasz; From, Sławomir

2009-03-01

Exacerbations are the key drivers of the costs of chronic obstructive pulmonary disease (COPD). This was the multicenter study of patients with COPD aimed at evaluating direct and indirect cost of exacerbations under usual clinical practice in primary and secondary care form societal perspective. It was observational, multicenter study with participation of 196 subjects with moderate or severe COPD, defined according to the current GOLD criteria. Patients presenting at the selected health care centres were included into the study in the sequential manner if they fulfilled the inclusion criteria. Exacerbations were divided into three different severity types according to Anthonisen N.R. classification. The management of exacerbations followed the usual clinical practice. The number of exacerbations was 3.8 (3.2-4.4) in hospitalised patients and 1.7 (1.4-1.9) in ambulatory treated patients (1EURO was 3.85 PLN in 2007). The average direct health-care cost per exacerbation was PLN 5548 (95% CI = 4543; 6502) and PLN 524.1 (95% CI = 443; 614) in secondary and primary care respectively. In secondary care, the drug acquisition and oxygen therapy cost represented 18.3% of total direct costs, diagnostic tests costs accounted for 14.5%, the other hospital care and post-discharge followup visit costs 67%. Costs varied considerably with the severity of COPD before the exacerbation as well as the duration of COPD. In primary care the cost structure was as follows: diagnostic tests and medical devices 47.5%, drug acquisition costs 41% and doctors visits 11.4%. The average indirect costs per exacerbation were PLN 127.78 and PLN 100.56, in secondary and primary respectively (n.s) Exacerbations of COPD are costly. Cost of exacerbation managed in secondary care is almost 10-fold higher than in primary care. Prevention of moderate-to-severe exacerbations, requiring hospitalization could be very cost-effective strategy.

Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective

PubMed Central

2013-01-01

Background Cholera poses a substantial health burden to developing countries such as Bangladesh. In this study, the objective is to estimate the economic burden of cholera treatments incurred by households. The study was carried out in the context of a large vaccine trial in an urban area of Bangladesh. Methods The study used a combination of prospective and retrospective incidence-based cost analyses of cholera illness per episode per household. A total of 394 confirmed cholera hospitalized cases were identified and treated in the study area during June–October 2011. Households with cholera patients were interviewed within 15 days after discharge from hospitals or clinics. To estimate the total cost of cholera illness a structured questionnaire was used, which included questions on direct medical costs, non-medical costs, and the indirect costs of patients and caregivers. Results The average total household cost of treatment for an episode of cholera was US$30.40. Total direct and indirect costs constituted 24.6% (US$7.40) and 75.4% (US$23.00) of the average total cost, respectively. The cost for children under 5 years of age (US$21.50) was higher than that of children aged 5–14 years (US$17.50). The direct cost of treatment was similar for male and female patients, but the indirect cost was higher for males. Conclusion Our study suggests that by preventing one cholera episode (3 days on an average), we can avert a total cost of 2,278.50 BDT (US$30.40) per household. Among medical components, medicines are the largest cost driver. No clear socioeconomic gradient emerged from our study, but limited demographic patterns were observed in the cost of illness. By preventing cholera cases, large production losses can be reduced. PMID:24188717

Costs of illness analysis in Italian patients with chronic obstructive pulmonary disease (COPD): an update.

PubMed

Dal Negro, Roberto W; Bonadiman, Luca; Turco, Paola; Tognella, Silvia; Iannazzo, Sergio

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide, and its epidemiological, clinical, and socioeconomic impact is progressively increasing. A first estimate of the economic burden of COPD in Italy was conducted in 2008 (the SIRIO [Social Impact of Respiratory Integrated Outcomes] study). The aim of the present study is to provide an updated picture of the COPD economic burden in Italy. Sequential patients presenting at the specialist center for the first time during the period 2008-2012 and with record file complete (demographic, clinical, lung function, and therapeutic data; health care resources consumed in the 12 months before the enrollment and for the 3 subsequent years) were selected from the institutional database. Two hundred and seventy-five COPD patients fitting the inclusion criteria were selected (226 males; mean age: 70.9 years [standard deviation: ±8.4 years]; 45.8% were from the north, 25.1% from central Italy, and 29.1% from south Italy). COPD-related average costs per patient in the 12 months before enrollment were as follows: hospitalization: €1,970; outpatient care: €463; pharmaceutical: €499; and indirect costs: €358. Average direct costs and total societal costs were €2,932 and €3,291, respectively. Direct cost was €2,461 (hospitalization: €1,570; outpatient: €344; and pharmaceutical: €547) in the first year of follow-up, while total societal cost was €2,707. No significant difference was reported in any cost category between sexes. The therapeutic approach followed in a specialist center, based on the application of clinical guidelines, has been shown to be a highly effective investment for the long-term management of COPD. A small increase of pharmaceutical costs per year allowed a substantial saving in terms of hospitalizations, costs related to outpatient services, and indirect costs.

European Union-28: An annualised cost-of-illness model for venous thromboembolism.

PubMed

Barco, Stefano; Woersching, Alex L; Spyropoulos, Alex C; Piovella, Franco; Mahan, Charles E

2016-04-01

Annual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5-2.2 billion, €1.0-1.5 billion, €0.5-1.1 billion and €0.2-0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8-3.3 billion, €1.2-2.4 billion, €0.6-1.8 billion and €0.2-0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0-8.5 billion, €2.2-6.2 billion, €1.1-4.6 billion and €0.5-1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5-13.2 billion, €1.0-9.7 billion, €0.5-7.3 billion and €0.2-6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28's healthcare systems and that significant savings could be realised if better preventive measures are applied.

Impact of rheumatoid arthritis in the public health system in Santa Catarina, Brazil: a descriptive and temporal trend analysis from 1996 to 2009.

PubMed

Gomes, Rafael Kmiliauskis Santos; Pires, Fabio Antero; Nobre, Moacyr Roberto Cuce; Marchi, Mauricio Felippi de Sá; Rickli, Jennifer Cristina Kozechen

There are few studies that carried out a descriptive and trend analysis based on available data from the Unified Health System (SUS) between pre- and post-free dispensing of pharmacological treatment of rheumatoid arthritis (RA) from the perspective of the public health system, in terms of the direct cost of the disease among adults and elderly residents of the State of Santa Catarina, Brazil. This study aims to characterize the direct cost of medical and surgical procedures before and after the dispensing of drugs in this state. This is a time series-type study with a cross-sectional survey of data from the Hospital (SIH) and Outpatient (SIA) Information System of SUS during the period from 1996 to 2009. Between 1996 and 2009, the total expenditure for hospital- and outpatient pharmacological treatment of rheumatoid arthritis was R$ 26,659,127.20. After the dispensing of drug treatment by SUS a decrease of 36% in the number of hospital admissions was observed; however, an increase of 19% in clinical procedures was noted. During the observed period, a reduction in the number of hospital admissions for both clinical and orthopedic surgical procedures related to this disease was observed. Nevertheless, there was an increase in the cost of medical admissions. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

Consumer-directed health plans: what happened?

PubMed

Goldsmith, Jeff

2007-08-01

CDHPs can stabilize growth in health costs, but the health plan-subscriber relationship should be more transparent. CFOs should ensure that increased cost exposure in CDHPs is paired with broad, deep disease management and employee assistance support. Hospitals should plan for the likelihood that, one way or another, consumers will be paying more of their healthcare bill.

The challenge of corporatisation: the experience of Portuguese public hospitals.

PubMed

Rego, Guilhermina; Nunes, Rui; Costa, José

2010-08-01

The inability of traditional state organisations to respond to new economic, technological and social challenges and the associated emerging problems has made it necessary to adopt new methods of health management. As a result, new directions have emerged in the reform of Public Administration together with the introduction of innovative models. The aim is to achieve a type of management that focuses on results as well as on effort and efficiency. We intend to analyse to what extent the adoption of business management models by hospital healthcare units can improve their performance, mainly in terms of standards of efficiency. Data envelopment analysis (DEA) was used to investigate the efficiency of a set of public Portuguese hospitals. The aim was to evaluate the impact of business management in Portuguese public hospitals with regards to efficiency, specifically taking into account the fact that lack of resources and increased health care needs are a present and future reality. From a total of 83 public hospitals, a sample of 59 hospitals was chosen, of which 21 are state-owned hospital enterprises (SA) and 38 are traditional public administration sector hospitals (SPA). This study evaluates hospital performance by calculating two efficiency measures associated with two categories of inputs. The first efficiency measures the costs associated with hospital production lines and the number of beds (representing fixed capacity) as inputs. The annual costs generated by the hospitals in the consumption of capital and work (direct and indirect costs) are used. A second measure of efficiency is calculated separately. This measure includes in the inputs the number of beds as well as the human resources available (number of doctors, number of nurses and other personnel) in each hospital. With regard to output, the variables that best reflect the hospital services rendered were considered: number of inpatient days, patients discharged, outpatient visits, emergencies services, sessions in hospital day care services and the number of surgeries. The results seem to suggest that the introduction of market processes and changes in organisational structure--such as managerial autonomy and corporatisation of public hospitals--have had a positive impact on Portuguese public hospitals. This positive evolution was particularly evident in SA hospitals, but further studies are needed to confirm these preliminary results.

Postintroduction Study of Cost Effectiveness of Pneumococcal Vaccine PCV10 from Public Sector Payer's Perspective in the State of Santa Catarina, Brazil.

PubMed

Kupek, Emil; Viertel, Ilse

2018-05-14

To evaluate cost effectiveness of 10-valent pneumococcal conjugate vaccine in the routine immunization program for children younger than 5 years in Brazil by a postintroduction study. Ecological study of prevaccine (2006-2009) versus postvaccine (2011-2014) period related the changes in mortality rate and hospitalization rate to direct cost of pneumonia treatment from the payer's perspective to estimate the cost effectiveness regarding lives saved, life-years gained, and disability-adjusted life-year for children younger than 5 years in the southern Brazilian state of Santa Catarina. All-cause pneumonia (ICD-10 J12-J18) deaths, hospital admissions, and associated costs were retrieved from the Brazilian Ministry of Health official Web site. Life expectancy at birth, population, ambulatory costs, cost savings, and plausible range of these parameters were used from published sources. Computer simulations with sensitivity analysis were performed to obtain the cost-effectiveness estimates. About 27 lives were saved and 2573 hospitalizations averted by the 10-valent pneumococcal conjugate vaccine vaccination in the 2011 to 2014 period at the cost of US $24,348 per life-year gained and US $27,748 per disability-adjusted life-year. The latter cost is 81% of Brazilian gross domestic product per capita over the same period. The vaccine was very cost-effective according to the World Health Organization criterion. Copyright © 2018. Published by Elsevier Inc.

The costs and financing of perinatal care in the United States.

PubMed Central

Long, S H; Marquis, M S; Harrison, E R

1994-01-01

OBJECTIVES. The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. METHODS. Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. RESULTS. The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. CONCLUSIONS. National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid. PMID:8092374

Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

PubMed

Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

2017-11-01

Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

Robotic Single-Site and Conventional Laparoscopic Surgery in Gynecology: Clinical Outcomes and Cost Analysis of a Matched Case-Control Study.

PubMed

El Hachem, Lena; Andikyan, Vaagn; Mathews, Shyama; Friedman, Kathryn; Poeran, Jashvant; Shieh, Kenneth; Geoghegan, Michael; Gretz, Herbert F

2016-01-01

To assess the clinical outcomes and costs associated with robotic single-site (RSS) surgery compared with those of conventional laparoscopy (CL) in gynecology. Retrospective case-control study (Canadian Task Force classification II-2). University-affiliated community hospital. Female patients undergoing RSS or CL gynecologic procedures. Comparison of consecutive RSS gynecologic procedures (cases) undertaken between October 2013 and March 2014 with matched CL procedures (controls) completed during the same time period by the same surgeon. Patient demographic data, operative data, and hospital financial data were abstracted from the electronic charts and financial systems. An incremental cost analysis based on the use of disposable equipment was performed. Total hospital charges were determined for matched RSS cases vs CL cases. RSS surgery was completed in 25 out of 33 attempts; 3 cases were aborted before docking, and 5 were converted to a multisite surgery. There were no intraoperative complications or conversions to laparotomy. The completed cases included 11 adnexal cases and 14 hysterectomies, 3 of which included pelvic lymph node dissection. Compared with the CL group, total operative times were higher in the RSS group; however, there were no significant between-group differences in estimated blood loss, length of hospital stay, or complication rates. Disposable equipment cost per case, direct costs, and total hospital charges were evaluated. RSS was associated with an increased disposable cost per case of $248 to $378, depending on the method used for vaginal cuff closure. The average total hospital charges for matched outpatient adnexal surgery were $15,450 for the CL controls and $18,585 for the RSS cases (p < .001), and the average total hospital charges for matched outpatient benign hysterectomy were $14,623 for the CL controls and $21,412 for the RSS cases (p < .001). Although RSS surgery and CL have comparable clinical outcomes in selected patients, RSS surgery remains associated with increased incremental disposable cost per case and total hospital charges. Careful case selection and judicious use of equipment are necessary to maximize cost-effectiveness in RSS gynecologic surgery. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Advantages and Disadvantages of Different Methods of Hospitals' Downsizing: A Narrative Systematic Review

PubMed Central

Mousazadeh, Yalda; Jannati, Ali; Jabbari Beiramy, Hossein; AsghariJafarabadi, Mohammad; Ebadi, Ali

2013-01-01

Background: Hospitals as key actors in health systems face growing pres­sures especially cost cutting and search for costeffective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital' downsizing. Methods:The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis. Results: Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees’ workload and dissatisfaction. Conclusion: Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion. PMID:24688978

Referral by outreach specialist reduces hospitalisation costs of rural patients with digestive tract cancer: a report from medical consortium in China.

PubMed

Shi, Ge; Zhou, Bin; Cai, Zhi-Chang; Wu, Tao; Li, Xian-Feng; Xu, Weiguo

2014-01-01

The authors examined the effect of referrals from outreach specialists on total hospitalisation costs of rural Chinese patients receiving surgical treatment for digestive tract cancer at a tertiary hospital within a vertically integrated medical consortium. A retrospective cohort study was conducted within the Taiyuan Central Hospital medical consortium between January 2008 and December 2010. This consortium consists of Taiyuan Central Hospital (a tertiary hospital) and three county hospitals in Taiyuan city, the capital of Shanxi province in China. Patients admitted for surgery to treat digestive tract cancer (N=359) were assigned to control (direct admission without referral), referral by local doctor (RL), or referral by outreach specialist (RO) groups according to referral type. Length of stay (LOS) and hospitalisation costs were examined. Regression-adjusted costs were estimated by a multivariate model that controlled for gender, age, type of cancer, Charlson Comorbidity Index (CCI) score, and referral type. Significant differences were found between the three groups (p<0.001) for LOS and total hospitalisation costs. Both were highest for the control group, followed by RL and then the RO groups (LOS: 28.3 ± 4.9, 24.2 ± 5.9, and 19.2 ± 3.7 days; hospitalisation cost: Chinese yuan (CNY)35,087.87 ± 6208.30, 32,853.38 ± 5195.40, and 29,794.56 ± 5250.20). A strong association was found between RO and substantially reduced hospitalisation costs in patients receiving digestive tract cancer surgery within the medical consortium as compared to RL. This finding suggests that the strengthened collaboration between outreach specialists and local doctors, herein referred to as the green referral channel, is the key factor leading to reduced hospitalisation costs.

Transforming Patient Value: Comparison of Hospital, Surgical, and General Surgery Patients.

PubMed

Pitt, Henry A; Tsypenyuk, Ella; Freeman, Susan L; Carson, Steven R; Shinefeld, Jonathan A; Hinkle, Sally M; Powers, Benjamin D; Goldberg, Amy J; DiSesa, Verdi J; Kaiser, Larry R

2016-04-01

Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs. Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation. For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients. Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis.

PubMed

Eichler, Klaus; Urner, Martin; Twerenbold, Claudia; Kern, Sabine; Brügger, Urs; Spahn, Donat R; Beck-Schimmer, Beatrice; Ganter, Michael T

2017-03-01

Pharmacologic pre- and postconditioning with sevoflurane compared with total IV anesthesia in patients undergoing liver surgery reduced complication rates as shown in 2 recent randomized controlled trials. However, the potential health economic consequences of these different anesthesia regimens have not yet been assessed. An expostcost analysis of these 2 trials in 129 patients treated between 2006 and 2010 was performed. We analyzed direct medical costs for in-hospital stay and compared pharmacologic pre- and postconditioning with sevoflurane (intervention) with total IV anesthesia (control) from the perspective of a Swiss university hospital. Year 2015 costs, converted to US dollars, were derived from hospital cost accounting data and compared with a multivariable regression analysis adjusting for relevant covariables. Costs with negative prefix indicate savings and costs with positive prefix represent higher spending in our analysis. Treatment-related costs per patient showed a nonsignificant change by -12,697 US dollars (95% confidence interval [CI], 10,956 to -36,352; P = .29) with preconditioning and by -6139 US dollars (95% CI, 6723 to -19,000; P = .35) with postconditioning compared with the control group. Results were robust in our sensitivity analysis. For both procedures (control and intervention) together, major complications led to a significant increase in costs by 86,018 US dollars (95% CI, 13,839-158,198; P = .02) per patient compared with patients with no major complications. In this cost analysis, reduced in-hospital costs by pharmacologic conditioning with sevoflurane in patients undergoing liver surgery are suggested. This possible difference in costs compared with total IV anesthesia is the result of reduced complication rates with pharmacologic conditioning, because major complications have significant cost implications.

Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis

PubMed Central

Urner, Martin; Twerenbold, Claudia; Kern, Sabine; Brügger, Urs; Spahn, Donat R.; Beck-Schimmer, Beatrice; Ganter, Michael T.

2017-01-01

BACKGROUND: Pharmacologic pre- and postconditioning with sevoflurane compared with total IV anesthesia in patients undergoing liver surgery reduced complication rates as shown in 2 recent randomized controlled trials. However, the potential health economic consequences of these different anesthesia regimens have not yet been assessed. METHODS: An expostcost analysis of these 2 trials in 129 patients treated between 2006 and 2010 was performed. We analyzed direct medical costs for in-hospital stay and compared pharmacologic pre- and postconditioning with sevoflurane (intervention) with total IV anesthesia (control) from the perspective of a Swiss university hospital. Year 2015 costs, converted to US dollars, were derived from hospital cost accounting data and compared with a multivariable regression analysis adjusting for relevant covariables. Costs with negative prefix indicate savings and costs with positive prefix represent higher spending in our analysis. RESULTS: Treatment-related costs per patient showed a nonsignificant change by −12,697 US dollars (95% confidence interval [CI], 10,956 to −36,352; P = .29) with preconditioning and by −6139 US dollars (95% CI, 6723 to −19,000; P = .35) with postconditioning compared with the control group. Results were robust in our sensitivity analysis. For both procedures (control and intervention) together, major complications led to a significant increase in costs by 86,018 US dollars (95% CI, 13,839-158,198; P = .02) per patient compared with patients with no major complications. CONCLUSIONS: In this cost analysis, reduced in-hospital costs by pharmacologic conditioning with sevoflurane in patients undergoing liver surgery are suggested. This possible difference in costs compared with total IV anesthesia is the result of reduced complication rates with pharmacologic conditioning, because major complications have significant cost implications. PMID:28067701

Direct medical costs attributable to type 2 diabetes mellitus: a population-based study in Catalonia, Spain.

PubMed

Mata-Cases, Manel; Casajuana, Marc; Franch-Nadal, Josep; Casellas, Aina; Castell, Conxa; Vinagre, Irene; Mauricio, Dídac; Bolíbar, Bonaventura

2016-11-01

We estimated healthcare costs associated with patients with type 2 diabetes compared with non-diabetic subjects in a population-based primary care database through a retrospective analysis of economic impact during 2011, including 126,811 patients with type 2 diabetes in Catalonia, Spain. Total annual costs included primary care visits, hospitalizations, referrals, diagnostic tests, self-monitoring test strips, medication, and dialysis. For each patient, one control matched for age, gender and managing physician was randomly selected from a population database. The annual average cost per patient was €3110.1 and €1803.6 for diabetic and non-diabetic subjects, respectively (difference €1306.6; i.e., 72.4 % increased cost). The costs of hospitalizations were €1303.1 and €801.6 (62.0 % increase), and medication costs were €925.0 and €489.2 (89.1 % increase) in diabetic and non-diabetic subjects, respectively. In type 2 diabetic patients, hospitalizations and medications had the greatest impact on the overall cost (41.9 and 29.7 %, respectively), generating approximately 70 % of the difference between diabetic and non-diabetic subjects. Patients with poor glycaemic control (glycated haemoglobin >7 %; >53 mmol/mol) had average costs of €3296.5 versus €2848.5 for patients with good control. In the absence of macrovascular complications, average costs were €3008.1 for diabetic and €1612.4 for non-diabetic subjects, while its presence increased costs to €4814.6 and €3306.8, respectively. In conclusion, the estimated higher costs for type 2 diabetes patients compared with non-diabetic subjects are due mainly to hospitalizations and medications, and are higher among diabetic patients with poor glycaemic control and macrovascular complications.

Effect of a medical toxicology admitting service on length of stay, cost, and mortality among inpatients discharged with poisoning-related diagnoses.

PubMed

Curry, Steven C; Brooks, Daniel E; Skolnik, Aaron B; Gerkin, Richard D; Glenn, Stuart

2015-03-01

There are no published studies that have compared quality outcomes of hospitalized poisoned patients primarily under the care of physician medical toxicologists to patients treated by non-toxicologists. We hypothesized that inpatients primarily cared for by medical toxicologists would exhibit shorter lengths of stay (LOS), lower costs, and decreased mortality. Patients discharged in 2010 and 2011 from seven hospitals within the same health care system and greater metropolitan area with Medicare severity diagnosis-related groups for "poisoning and toxic effects of drugs" with and without major comorbidities or complications (917 & 918, respectively) were identified from a Premier® database. The database contained severity-weighted comparisons between expected and observed outcomes for each patient. Outcome parameters were differences between expected and observed LOS, cost, and percent mortality. These were then compared among groups of patients primarily admitted and cared for by (1) medical toxicologists at one hospital (Banner Good Samaritan Medical Center, BGS), (2) non-toxicologists at BGS, and (3) non-toxicologists at six other hospitals. Records of 3,581 patients contained complete data for assessment of at least one outcome measure. Patients cared for by medical toxicologists experienced favorable differences in LOS, costs, and mortality compared with other patient groups (p < 0.001). If patients cared for by non-toxicologists had experienced similar differences in observed over expected values for LOS, cost, and mortality as those cared for by medical toxicologists, there would have been a median savings of 1,483 hospital days, $4.269 million, and a significant decrease in mortality during the 2-year study period. Differences between observed and expected LOS, cost, and mortality in patients primarily cared for by medical toxicologists were significantly better than in patients cared for by non-toxicologists, regardless of facility. These data suggest that significant reductions in patient hospital days, costs, and mortality are possible when medical toxicologists directly care for hospitalized patients.

Contrary To Popular Belief, Medicaid Hospital Admissions Are Often Profitable Because Of Additional Medicare Payments.

PubMed

Stensland, Jeffrey; Gaumer, Zachary R; Miller, Mark E

2016-12-01

It is generally believed that most hospitals lose money on Medicaid admissions. The data suggest otherwise. Medicaid admissions are often profitable for hospitals because of payments from both the Medicaid program and the Medicare program, including payments for uncompensated care and from the Medicare disproportionate-share hospital program. On average, adding a single Medicaid patient day in fiscal year 2017 will increase most hospitals' Medicare payments by more than $300. When added to Medicaid payments, these payments often cause Medicaid patients to be profitable for hospitals. In contrast, adding a single charity care day in the same year will decrease overall Medicare payments by about $20 on average. The Centers for Medicare and Medicaid Services recently announced a proposal to shift some Medicare payments from supporting hospitals' costs for Medicaid patients to directly supporting their costs for uncompensated care. If that proposal is adopted, hospitals' profits on Medicaid patients would decrease, but their losses on care for the uninsured would be reduced. Project HOPE—The People-to-People Health Foundation, Inc.

Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

PubMed

Perkins, Barbara Bridgman

2010-02-01

Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution.

PubMed

Daskalaki, Despoina; Gonzalez-Heredia, Raquel; Brown, Marc; Bianco, Francesco M; Tzvetanov, Ivo; Davis, Myriam; Kim, Jihun; Benedetti, Enrico; Giulianotti, Pier C

2017-04-01

One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique. Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.

Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution

PubMed Central

Daskalaki, Despoina; Brown, Marc; Bianco, Francesco M.; Tzvetanov, Ivo; Davis, Myriam; Kim, Jihun; Benedetti, Enrico; Giulianotti, Pier C.

2017-01-01

Abstract Background: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. Methods: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. Results: Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique. Conclusions: Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital. PMID:28186429

The Economic Burden of Musculoskeletal Disease in Children and Adolescents in the United States.

PubMed

Rosenfeld, Scott B; Schroeder, Katherine; Watkins-Castillo, Sylvia I

2018-04-01

Musculoskeletal conditions are among the most common and costly conditions suffered by Americans. In 2011, there was an estimated $213 billion in annual cost of direct treatment for and lost wages due to musculoskeletal disease in the United States. Data on economic burden, however, comes mostly from the adult population, with significantly less information regarding the burden of these conditions in young patients available. The purpose of this report is to provide data on the economic burden of musculoskeletal diseases in children and adolescents in the United States. Eleven diagnosis categories were identified, with health care visits and hospitalization data derived from ICD-9-CM codes for each of the conditions searched. The largest database utilized was the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID). Total visits came from the KID, HCUP NEDS (emergency department), NCHS NHAMCS OP (outpatient), and NCHS NAMCS (physician office) databases. The National Health Interview Survey (NHIS) child sample was additionally searched to obtain patient/parent-reported data. In 2012, more than 19 million children and adolescents received treatment in medical centers, physicians' offices, and hospitals for a musculoskeletal-related condition. The most common reason for treatment (68%) was traumatic injury, followed by a pain syndrome (13%) and deformity (9%). Total hospital charges in 2012 for children and adolescents with a primary musculoskeletal-related diagnosis totaled $7.6 billion. Trauma (43%) and deformity (38%) were the major contributors to total hospital charges. Although we found that hospital-related charges for musculoskeletal diseases for children and adolescents in 2012 totaled $7.6 billion, this number underestimates the total cost for all pediatric musculoskeletal conditions. Musculoskeletal conditions accounted for 5.4% of hospital charges in the pediatric population. However, only 1.4% of pediatric research funding is designated to musculoskeletal research. Going forward, the data in this report may be used to further research and to stimulate development of better methods with which to measure the direct and indirect costs of musculoskeletal conditions in children. Level IV-economic and decision analysis.

Hospital closure: a review of current and proposed research.

PubMed Central

Hernandez, S R; Kaluzny, A D

1983-01-01

This paper reviews available data describing issues and research findings with implications for hospital closings. Factors contributing to fiscal problems of hospitals (e.g., inadequate reimbursement, inflation, management problems, organizational structure, societal factors) are discussed. Selected studies offering examples of hospital and community characteristics associated with closure are presented. This review suggests that future directions for research should focus not only on hospital cost control but also on insuring equity in the distribution of hospital services. Specifically, research is needed that further describes the hospital closure phenomenon, the effects of closure, and the policy choices that might be pursued to insure equity in the continuation of hospital services to disadvantaged populations. PMID:6360954

Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs

PubMed Central

Lemos, Laurinda; Alegria, Carlos; Oliveira, Joana; Machado, Ana; Oliveira, Pedro; Almeida, Armando

2011-01-01

In idiopathic trigeminal neuralgia (TN) the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1) a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol]), (2) the association of gabapentin (GBP) and analgesic block of trigger-points with ropivacaine (ROP) (GBP+ROP protocol), and (3) a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol). Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols) from cases of idiopathic TN, or selected for MVD surgery (n = 22) due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS) and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug therapies, while after MDV surgery several patients showed important side effects. Data reinforce that, (1) TN patients should be carefully evaluated before choosing therapy for pain control, (2) different pharmacological approaches are available to initiate pain control at low costs, and (3) criteria for surgical interventions should be clearly defined due to important side effects, with the initial higher costs being strongly reduced with time. PMID:21941455

The use of AlloDerm in postmastectomy alloplastic breast reconstruction: part II. A cost analysis.

PubMed

Jansen, Leigh A; Macadam, Sheina A

2011-06-01

Increasingly, AlloDerm is being used in alloplastic breast reconstruction, and has been the subject of a recent systematic review. The authors' objective was to perform a cost analysis comparing direct-to-implant with AlloDerm reconstruction to two-stage non-AlloDerm reconstruction. Seven clinically important health outcomes and their probabilities for both types of reconstruction were derived from the recent review. A decision analytic model from the Canadian provincial payer's perspective was constructed based on these health states. Direct medical costs were estimated from a university-based hospital, yielding expected costs for direct-to-implant reconstruction with AlloDerm and two-stage non-AlloDerm reconstruction. Sensitivity analyses were conducted. Baseline and expected costs were calculated for direct-to-implant AlloDerm and two-stage non-AlloDerm reconstruction. Direct-to-implant reconstruction with AlloDerm was found to be less expensive in the baseline ($10,240 versus $10,584) and expected cost ($10,734 versus $11,251) using a 6 × 16-cm AlloDerm sheet. With a 6 × 12-cm sheet, expected cost falls to $9673. By increasing direct-to-implant operative time from 2 hours to 2.5 hours, expected cost rises to $11,784. If capsular contracture rate requiring revision is set at 15 percent for both procedures, expected costs are $10,926 and $11,251 for direct-to-implant and two-stage procedures, respectively. If the capsular contracture rate is lowered for either procedure, this has minimal impact on expected cost. Although AlloDerm is expensive, it appears to be cost-effective if used for direct-to-implant breast reconstruction. The methods used here may be extrapolated to different centers incorporating local costs and complication rates. A formal randomized controlled trial, including costs, is recommended.

Cost identification of abdominal aortic aneurysm imaging by using time and motion analyses.

PubMed

Rubin, G D; Armerding, M D; Dake, M D; Napel, S

2000-04-01

To compare the costs of performing helical computed tomographic (CT) angiography with three-dimensional rendering versus intraarterial digital subtraction angiography (DSA) for preoperative imaging of abdominal aortic aneurysms (AAAs). A single observer determined the variable direct costs of performing nine intraarterial DSA and 10 CT angiographic examinations in age- and general health-matched patients with AAA by using time and motion analyses. All personnel directly involved in the cases were tracked, and the involvement times were recorded to the nearest minute. All material items used during the procedures were recorded. The cost of labor was determined from personnel reimbursement data, and the cost of materials, from vendor pricing. The variable direct costs of laboratory tests and using the ambulatory treatment unit for postprocedural monitoring, as well as all fixed direct costs, were assessed from hospital accounting records. The total costs were determined for each procedure and compared by using the Student t test and calculating the CIs. The mean total direct cost of intraarterial DSA (+/- SD) was $1,052 +/- 71, and that of CT angiography was $300 +/- 30, which are significantly different (P < 4.1 x 10(-11)). With 95% confidence, intraarterial DSA cost 3.2-3.7 times more than CT angiography for the assessment of AAA. Assuming equal diagnostic utility and procedure-related morbidity, institutions may have substantial cost savings whenever CT angiography can replace intraarterial DSA for imaging AAAs.

Costs of adverse drug events in German hospitals--a microcosting study.

PubMed

Rottenkolber, Dominik; Hasford, Joerg; Stausberg, Jürgen

2012-01-01

In Germany, only limited data are available to quantify the attributable resource utilization associated with adverse drug events (ADEs). The aim of this study was twofold: first, to calculate the direct treatment costs associated with ADEs leading to hospitalization and, second, to derive the excess costs and extra hospital days attributable to ADEs of inpatient treatments in selected German hospitals. This was a retrospective and medical record-based study performed from the hospitals' perspective based on administrative accounting data from three hospitals (49,462 patients) in Germany. Total treatment costs ("analysis 1") and excess costs (i.e., incremental resource utilization) between patients suffering from an ADE and those without ADEs were calculated by means of a propensity score-based matching algorithm ("analysis 2"). Mean treatment costs ("analysis 1") of ADEs leading to hospitalization (n = 564) were €1,978 ± 2,036 (range €191-18,147; median €1,446; €843-2,480 [Q1-Q3]). In analysis 2, the mean costs of inpatients suffering from an ADE (n = 1,891) as a concomitant disease or complication (€5,113 ± 10,059; range €179-246,288; median €2,701; €1,636-5,111 [Q1-Q3]) were significantly higher (€970; P < 0.0001) than those of non-ADE inpatients (€4,143 ± 6,968; range €154-148,479; median €2,387; €1,432-4,701 [Q1-Q3]). Mean inpatient length of stay of ADE patients (12.7 ± 17.2 days) and non-ADE patients (9.8 ± 11.6 days) differed by 2.9 days (P < 0.0001). A nationwide extrapolation resulted in annual total treatment costs of €1.058 billion. This is one of the first administrative data-based analyses calculating the economic consequences of ADEs in Germany. Further efforts are necessary to improve pharmacotherapy and relieve health care payers of preventable treatment costs. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Financial impact of nosocomial infections in the intensive care units of a charitable hospital in Minas Gerais, Brazil

PubMed Central

Nangino, Glaucio de Oliveira; de Oliveira, Cláudio Dornas; Correia, Paulo César; Machado, Noelle de Melo; Dias, Ana Thereza Barbosa

2012-01-01

Objective Infections in intensive care units are often associated with a high morbidity and mortality in addition to high costs. An analysis of these aspects can assist in optimizing the allocation of relevant financial resources. Methods This retrospective study analyzed the hospital administration and quality in intensive care medical databases [Sistema de Gestão Hospitalar (SGH)] and RM Janus®. A cost analysis was performed by evaluating the medical products and materials used in direct medical care. The costs are reported in the Brazilian national currency (Real). The cost and length of stay analyses were performed for all the costs studied. The median was used to determine the costs involved. Costs were also adjusted by the patients' length of stay in the intensive care unit. Results In total, 974 individuals were analyzed, of which 51% were male, and the mean age was 57±18.24 years. There were 87 patients (8.9%) identified who had nosocomial infections associated with the intensive care unit. The median cost per admission and the length of stay for all the patients sampled were R$1.257,53 and 3 days, respectively. Compared to the patients without an infection, the patients with an infection had longer hospital stays (15 [11-25] versus 3 [2-6] days, p<0.01), increased costs per patient in the intensive care unit (median R$9.763,78 [5445.64 - 18,007.90] versus R$1.093,94 [416.14 - 2755.90], p<0.01) and increased costs per day of hospitalization in the intensive care unit (R$618,00 [407.81 - 838.69] versus R$359,00 [174.59 - 719.12], p<0.01). Conclusion Nosocomial infections associated with the intensive care unit were determinants of increased costs and longer hospital stays. However, the study design did not allow us to evaluate specific aspects of cause and effect. PMID:23917933

Reasons for and costs of hospitalization for pediatric asthma: a prospective 1-year follow-up in a population-based setting.

PubMed

Korhonen, K; Reijonen, T M; Remes, K; Malmström, K; Klaukka, T; Korppi, M

2001-12-01

The aims of this study were to examine the frequency of, and the reasons for, emergency hospitalization for asthma among children. In addition, the costs of hospital treatment, preventive medication, and productivity losses of the caregivers were evaluated in a population-based setting during 1 year. Data on purchases of regular asthma medication were obtained from the Social Insurance Institution. In total, 106 (2.3/1000) children aged up to 15 years were admitted 136 times for asthma exacerbation to the Kuopio University Hospital in 1998. This represented approximately 5% of all children with asthma in the area. The trigger for the exacerbation was respiratory infection in 63% of the episodes, allergen exposure in 24%, and unknown in 13%. The age-adjusted risk for admittance was 5.3% in children on inhaled steroids, 5.8% in those on cromones, and 7.9% in those with no regular medication for asthma. The mean direct cost for an admission was $1,209 (median $908; range $454-6,812) and the indirect cost was $358 ($316; $253-1,139). The cost of regular medication for asthma was, on average, $272 per admitted child on maintenance. The annual total cost as a result of asthma rose eight-fold if a child on regular medication was admitted for asthma.

Measuring the direct costs of graduate medical education training in Minnesota.

PubMed

Blewett, L A; Smith, M A; Caldis, T G

2001-05-01

To demonstrate the usefulness of self-reported cost-accounting data from the sponsors of training programs for estimating the direct costs of graduate medical education (GME). The study also assesses the relative contributions of resident, faculty, and administrative costs to primary care, surgery, and the combined programs of radiology, emergency medicine, anesthesiology, and pathology (REAP). The data were the FY97 direct costs of clinical education reported to Minnesota's Department of Health by eight sponsors of 117 accredited medical education programs, representing 394 sites of training (both hospital- and community-based) and 2,084 full-time-equivalent trainees (both residents and fellows). Average costs of clinical training were calculated as residency, faculty, and administrative costs. Preliminary analysis showed average costs by type of training programs, comparing the cost components for surgery, primary care, and REAP. The average direct cost of clinical training in FY97 was $130,843. Faculty costs were 52%, resident costs were 26%, and administrative costs were 20% of the total. Primary care programs' average costs were lower than were those of either surgery or REAP programs, but proportionally they included more administrative costs. As policymakers assess government subsidies for GME, more detailed cost information will be required. Self-reported data are more cost-effective and efficient than are the more detailed and costly time-and-motion studies. This data-collection study also revealed that faculty costs, driven by faculty hours and base salaries, represent a higher proportion of direct costs of GME than studies have shown in the past.

Reassessment of osteoporosis-related femoral fractures and economic burden in Saudi Arabia.

PubMed

Sadat-Ali, Mir; Al-Dakheel, Dakheel A; Azam, Md Q; Al-Bluwi, Mohammed T; Al-Farhan, Mohammed F; AlAmer, Hussein A; Al-Meer, Zakaria; Al-Mohimeed, Abdallah; Tabash, Ibrahim K; Karry, Maher O; Rassasy, Yaseen M; Baragaba, Mohammed A; Amer, Ahmed S; AlJawder, Abdallah; Al-Bouri, Kamil M; ElTinay, Mohammed; Badawi, Hamed A; Al-Othman, Abdallah A; Tayara, Badar K; Al-Faraidy, Moaad H; Amin, Ahmed H

2015-01-01

The current study reassesses the prevalence of fragility fractures and lifetime costs in the Eastern Province of Saudi Arabia. Forty-two percent (391) of the fractures were at the neck of the femur, and 38.6 % (354) were inter-trochanteric fractures. The overall incidence was assessed to be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). A National Fracture Registry and osteoporosis awareness programs are recommended. Proximal femur fragility fractures are reported to be increasing worldwide due to increased life expectancy. The current study is carried out to assess the incidence of such fractures in the Eastern Province of Saudi Arabia and to assess the costs incurred in managing them annually. Finally, by extrapolating the data, the study can calculate the overall economic burden in Saudi Arabia. The data of fragility proximal femur fractures was collected from 24 of 28 hospitals in the Eastern Province. The data included age, sex, mode of injury, type of fracture, prescribed drug (and its cost), and length of hospital stay. Population statistics were obtained from the Department of Statistics of the Saudi Arabian government Web site. Twenty-four hospitals (85 %) participated in the study. A total of 780 fractures were sustained by 681 patients. Length of stay in the hospital averaged 23.28 ± 13.08 days. The projected fracture rate from all the hospitals would be 917 (an incidence of 5.81/1000), with a total cost of SR68.77 million. Further extrapolation showed that the overall incidence could be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). Osteoporosis-related femoral fractures in Saudi Arabia are significant causes of morbidity besides incurring economic burden. We believe that a National Fracture Registry needs to be established, and osteoporosis awareness programs should be instituted in every part of Saudi Arabia so that these patients can be diagnosed early and treated appropriately to reduce both the number of fractures and the economic burden of the fractures.

A comparative study of the quality of care and glycemic control among ambulatory type 2 diabetes mellitus clients, at a Tertiary Referral Hospital and a Regional Hospital in Central Kenya.

PubMed

Mwavua, Shillah Mwaniga; Ndungu, Edward Kiogora; Mutai, Kenneth K; Joshi, Mark David

2016-01-05

Peripheral public health facilities remain the most frequented by the majority of the population in Kenya; yet remain sub-optimally equipped and not optimized for non-communicable diseases care. We undertook a descriptive, cross sectional study among ambulatory type 2 diabetes mellitus clients, attending Kenyatta National Referral Hospital (KNH), and Thika District Hospital (TDH) in Central Kenya. Systematic random sampling was used. HbA1c was assessed for glycemic control and the following, as markers of quality of care: direct client costs, clinic appointment interval and frequency of self monitoring test, affordability and satisfaction with care. We enrolled 200 clients, (Kenyatta National Hospital 120; Thika District Hospital 80); Majority of the patients 66.5% were females, the mean age was 57.8 years; and 58% of the patients had basic primary education. 67.5% had diabetes for less than 10 years and 40% were on insulin therapy. The proportion (95% CI) with good glycemic was 17% (12.0-22.5 respectively) in the two facilities [Kenyatta National Hospital 18.3% (11.5-25.6); Thika District Hospital 15% (CI 7.4-23.7); P = 0.539]. However, in Thika District Hospital clients were more likely to have a clinic driven routine urinalysis and weight, they were also accorded shorter clinic appointment intervals; incurred half to three quarter lower direct costs, and reported greater affordability and satisfactions with care. In conclusion, we demonstrate that in Thika district hospital, glycemic control and diabetic care is suboptimal; but comparable to that of Kenyatta National Referral hospital. Opportunities for improvement of care abound at peripheral health facilities.

[Cost analysis of treatment for severe rheumatoid arthritis in a city in southern Brazil].

PubMed

Buendgens, Fabíola Bagatini; Blatt, Carine Raquel; Marasciulo, Antônio Carlos Estima; Leite, Silvana Nair; Farias, Mareni Rocha

2013-11-01

Treatment of rheumatoid arthritis involves the use of medicines, non-pharmaceutical therapies, medical appointments, and complimentary tests, among other procedures. Based on sources of payment, this article presents the direct medical costs related to treatment of rheumatoid arthritis. The cost analysis included 103 patients with severe rheumatoid arthritis treated at the Specialized Division of Pharmaceutical Care in Florianopolis, Santa Catarina State, Brazil. Total annual direct cost was R$ 2,045,596.55 (approximately one million US dollars), or R$ 19,860.16 per patient/year (slightly less than ten thousand US dollars). Total cost breakdown was as follows: 90.8% for medicines, 2.5% for hospitalizations, 2.2% for complimentary tests, 2.1% for medical appointments, and 2.4% for all other costs. The public sector accounted for 73.6% of the total direct medical costs and 79.3% of the cost of medicines. The cost analysis provided a profile of how a group of individuals with a chronic non-communicable disease that requires resources circulates in the public-private mix that characterizes the Brazilian health system.

Household Catastrophic Healthcare Expenditure and Impoverishment Due to Rotavirus Gastroenteritis Requiring Hospitalization in Malaysia

PubMed Central

2015-01-01

Background While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking. Objectives We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia. Methods A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur) and rural (Kuala Terengganu) setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained. Results Of the 658 stool samples collected at both centers, 248 (38%) were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001). The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33%) households in Kuala Lumpur to experience catastrophic expenditure and 11 (3%) households to incur poverty. However in Kuala Terengganu, only one household (0.5%) experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%). The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03) than at Kuala Terengganu (0.24). Conclusions While urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health inequities in Malaysia. PMID:25941805

Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

PubMed

Buerhaus, Peter I

2009-01-01

The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

The costs of HIV antiretroviral therapy adherence programs and impact on health care utilization.

PubMed

Sansom, Stephanie L; Anthony, Monique N; Garland, Wendy H; Squires, Kathleen E; Witt, Mallory D; Kovacs Andrea, A; Larsen, Robert A; Valencia, Rosa; Pals, Sherri L; Hader, Shannon; Weidle, Paul J; Wohl, Amy R

2008-02-01

From a trial comparing interventions to improve adherence to antiretroviral therapy-directly administered antiretroviral therapy (DAART) or an intensive adherence case management (IACM)-to standard of care (SOC), for HIV-infected participants at public HIV clinics in Los Angeles County, California, we examined the cost of adherence programs and associated health care utilization. We assessed differences between DAART, IACM, and SOC in the rate of hospitalizations, hospital days, and outpatient and emergency department visits during an average of 1.7 years from study enrollment, beginning November 2001. We assigned costs to health care utilization and program delivery. We calculated incremental costs of DAART or IACM v SOC, and compared those costs with savings in health care utilization among participants in the adherence programs. IACM participants experienced fewer hospital days compared with SOC (2.3 versus 6.7 days/1000 person-days, incidence rate ratio [IRR]: 0.34, 97.5% confidence interval [CI]: 0.13-0.87). DAART participants had more outpatient visits than SOC (44.2 versus 31.5/1000 person-days, IRR: 1.4; 97.5% CI: 1.01-1.95). Average per-participant health care utilization costs were $13,127, $8,988, and $14,416 for DAART, IACM, and SOC, respectively. Incremental 6-month program costs were $2,120 and $1,653 for DAART and IACM participants, respectively. Subtracting savings in health care utilization from program costs resulted in an average net program cost of $831 per DAART participant; and savings of $3,775 per IACM participant. IACM was associated with a significant decrease in hospital days compared to SOC and was cost saving when program costs were compared to savings in health care utilization.

High-dose inactivated influenza vaccine is associated with cost savings and better outcomes compared to standard-dose inactivated influenza vaccine in Canadian seniors.

PubMed

Becker, Debbie L; Chit, Ayman; DiazGranados, Carlos A; Maschio, Michael; Yau, Eddy; Drummond, Michael

2016-12-01

Seasonal influenza infects approximately 10-20% of Canadians each year, causing an estimated 12,200 hospitalizations and 3,500 deaths annually, mostly occurring in adults ≥65 years old (seniors). A 32,000-participant, randomized controlled clinical trial (FIM12; Clinicaltrials.gov NCT01427309) showed that high-dose inactivated influenza vaccine (IIV-HD) is superior to standard-dose vaccine (SD) in preventing laboratory-confirmed influenza illness in seniors. In this study, we performed a cost-utility analysis (CUA) of IIV-HD versus SD in FIM12 participants from a Canadian perspective. Healthcare resource utilization data collected in FIM12 included: medications, non-routine/urgent care and emergency room visits, and hospitalizations. Unit costs were applied using standard Canadian cost sources to estimate the mean direct medical and societal costs associated with each vaccine (2014 CAD). Clinical illness data from the trial were mapped to quality-of-life data from the literature to estimate differences in effectiveness between vaccines. Time horizon was one influenza season, however, quality-adjusted life-years (QALYs) lost due to death during the study were captured over a lifetime. A probabilistic sensitivity analysis (PSA) was also performed. Average per-participant medical costs were $47 lower and societal costs $60 lower in the IIV-HD arm. Hospitalizations contributed 91% of the total cost and were less frequent in the IIV-HD arm. IIV-HD provided a gain in QALYs and, due to cost savings, dominated SD in the CUA. The PSA indicated that IIV-HD is 89% likely to be cost saving. In Canada, IIV-HD is expected to be a less costly and more effective alternative to SD, driven by a reduction in hospitalizations.

Clinical Laboratory Automation: A Case Study.

PubMed

Archetti, Claudia; Montanelli, Alessandro; Finazzi, Dario; Caimi, Luigi; Garrafa, Emirena

2017-04-13

This paper presents a case study of an automated clinical laboratory in a large urban academic teaching hospital in the North of Italy, the Spedali Civili in Brescia, where four laboratories were merged in a unique laboratory through the introduction of laboratory automation. The analysis compares the preautomation situation and the new setting from a cost perspective, by considering direct and indirect costs. It also presents an analysis of the turnaround time (TAT). The study considers equipment, staff and indirect costs. The introduction of automation led to a slight increase in equipment costs which is highly compensated by a remarkable decrease in staff costs. Consequently, total costs decreased by 12.55%. The analysis of the TAT shows an improvement of nonemergency exams while emergency exams are still validated within the maximum time imposed by the hospital. The strategy adopted by the management, which was based on re-using the available equipment and staff when merging the pre-existing laboratories, has reached its goal: introducing automation while minimizing the costs.

Economic Cost of Dengue in Puerto Rico

PubMed Central

Halasa, Yara A.; Shepard, Donald S.; Zeng, Wu

2012-01-01

Dengue, endemic in Puerto Rico, reached a record high in 2010. To inform policy makers, we derived annual economic cost. We assessed direct and indirect costs of hospitalized and ambulatory dengue illness in 2010 dollars through surveillance data and interviews with 100 laboratory-confirmed dengue patients treated in 2008–2010. We corrected for underreporting by using setting-specific expansion factors. Work absenteeism because of a dengue episode exceeded the absenteeism for an episode of influenza or acute otitis media. From 2002 to 2010, the aggregate annual cost of dengue illness averaged $38.7 million, of which 70% was for adults (age 15+ years). Hospitalized patients accounted for 63% of the cost of dengue illness, and fatal cases represented an additional 17%. Households funded 48% of dengue illness cost, the government funded 24%, insurance funded 22%, and employers funded 7%. Including dengue surveillance and vector control activities, the overall annual cost of dengue was $46.45 million ($12.47 per capita). PMID:22556069

Relative costs of specialist services in a family practice population

PubMed Central

Norton, Peter G.; Nelson, Wendy; Rudner, Howard L.; Dunn, Earl V.

1985-01-01

The frequency and cost of referrals to specialists in March 1984 for 8980 rostered patients attending a family practice clinic located in a teaching hospital were analysed. The patients made 1891 visits to specialists. In all age groups and for all specialties female patients were more likely to be seen. The total direct provider costs were higher for female patients than for male patients. However, costs per patient seen were higher for male patients, except for psychiatry and medicine. Visits to surgeons had the highest total cost, while visits to psychiatrists had the highest cost per patient seen. Of the direct provider costs 61% was for specialist services. The family physician, in the “gatekeeper” role, has an opportunity to control some of the costs of the health care system by ensuring that the best and most efficient use is made of the referral network. PMID:4042059

Cost of illness in rheumatoid arthritis in Germany in 1997-98 and 2002: cost drivers and cost savings.

PubMed

Kirchhoff, Timm; Ruof, Jörg; Mittendorf, Thomas; Rihl, Markus; Bernateck, Michael; Mau, Wilfried; Zeidler, Henning; Schmidt, Reinhold E; Merkesdal, Sonja

2011-04-01

Comparison of overall RA-related costs and of relative contribution of single-cost domains before and after the introduction of TNF-blocking agents in Germany. Two cohorts of RA outpatients (ACR '87 criteria) with long-standing disease are assessed in terms of disease-related costs and cost composition (n = 106 patients in 1997-98 and n = 180 patients in 2002 with similar patient characteristics). Full-cost analyses are performed including direct disease-related costs (medical and non-medical) and productivity costs as collected by patient questionnaires. Absolute costs (€/patient/year) are compared and the impact of single-cost domains on overall costing in RA is estimated (relative proportions of cost components within samples). Overall costs are comparable (1997-98: €4280; 2002: €3830; not significant). Differences can be observed in medication (1997-98: €550; 2002: €1580; P < 0.001) and hospitalization costs (1997-98: €1240; 2002: €500; P < 0.001). Productivity costs are significantly lower (€1480 vs €850; P < 0.05) in 2002. The impact of medication costs is outstanding in the 2002 sample (42 vs 12%), the proportion of hospitalization costs is substantially lower (29 vs 13%). Costs for DMARDs in 2002 are mostly driven by TNF blockers (37%). The number of DMARDs per patient is higher in 2002 as are costs for osteoporosis medication and gastroprotective treatment. Although overall costs before and after the introduction of TNF blockers are comparable, the decrease in hospitalization and productivity costs is promising in terms of future long-term cost savings. The development of these aspects and of the increasing medication costs will have to be evaluated with longer time frames.

Cost-Effectiveness of Monovalent Rotavirus Vaccination of Infants in Malawi: A Postintroduction Analysis Using Individual Patient–Level Costing Data

PubMed Central

Bar-Zeev, Naor; Tate, Jacqueline E.; Pecenka, Clint; Chikafa, Jean; Mvula, Hazzie; Wachepa, Richard; Mwansambo, Charles; Mhango, Themba; Chirwa, Geoffrey; Crampin, Amelia C.; Parashar, Umesh D.; Costello, Anthony; Heyderman, Robert S.; French, Neil; Atherly, Deborah; Cunliffe, Nigel A.

2016-01-01

Background. Rotavirus vaccination reduces childhood hospitalization in Africa, but cost-effectiveness has not been determined using real-world effectiveness and costing data. We sought to determine monovalent rotavirus vaccine cost-effectiveness in Malawi, one of Africa's poorest countries and the first Gavi-eligible country to report disease reduction following introduction in 2012. Methods. This was a prospective cohort study of children with acute gastroenteritis at a rural primary health center, a rural first referral–level hospital and an urban regional referral hospital in Malawi. For each participant we itemized household costs of illness and direct medical expenditures incurred. We also collected Ministry of Health vaccine implementation costs. Using a standard tool (TRIVAC), we derived cost-effectiveness. Results. Between 1 January 2013 and 21 November 2014, we recruited 530 children aged <5 years with gastroenteritis. Costs did not differ by rotavirus test result, but were significantly higher for admitted children and those with increased severity on Vesikari scale. Adding rotavirus vaccine to the national schedule costs Malawi $0.42 per dose in system costs. Vaccine copayment is an additional $0.20. Over 20 years, the vaccine program will avert 1 026 000 cases of rotavirus gastroenteritis, 78 000 inpatient admissions, 4300 deaths, and 136 000 disability-adjusted-life-years (DALYs). For this year's birth cohort, it will avert 54 000 cases of rotavirus and 281 deaths in children aged <5 years. The program will cost $10.5 million and save $8.0 million in averted healthcare costs. Societal cost per DALY averted was $10, and the cost per rotavirus case averted was $1. Conclusions. Gastroenteritis causes substantial economic burden to Malawi. The rotavirus vaccine program is highly cost-effective. Together with the demonstrated impact of rotavirus vaccine in reducing population hospitalization burden, its cost-effectiveness makes a strong argument for widespread utilization in other low-income, high-burden settings. PMID:27059360

Cost-Effectiveness of Monovalent Rotavirus Vaccination of Infants in Malawi: A Postintroduction Analysis Using Individual Patient-Level Costing Data.

PubMed

Bar-Zeev, Naor; Tate, Jacqueline E; Pecenka, Clint; Chikafa, Jean; Mvula, Hazzie; Wachepa, Richard; Mwansambo, Charles; Mhango, Themba; Chirwa, Geoffrey; Crampin, Amelia C; Parashar, Umesh D; Costello, Anthony; Heyderman, Robert S; French, Neil; Atherly, Deborah; Cunliffe, Nigel A

2016-05-01

Rotavirus vaccination reduces childhood hospitalization in Africa, but cost-effectiveness has not been determined using real-world effectiveness and costing data. We sought to determine monovalent rotavirus vaccine cost-effectiveness in Malawi, one of Africa's poorest countries and the first Gavi-eligible country to report disease reduction following introduction in 2012. This was a prospective cohort study of children with acute gastroenteritis at a rural primary health center, a rural first referral-level hospital and an urban regional referral hospital in Malawi. For each participant we itemized household costs of illness and direct medical expenditures incurred. We also collected Ministry of Health vaccine implementation costs. Using a standard tool (TRIVAC), we derived cost-effectiveness. Between 1 January 2013 and 21 November 2014, we recruited 530 children aged <5 years with gastroenteritis. Costs did not differ by rotavirus test result, but were significantly higher for admitted children and those with increased severity on Vesikari scale. Adding rotavirus vaccine to the national schedule costs Malawi $0.42 per dose in system costs. Vaccine copayment is an additional $0.20. Over 20 years, the vaccine program will avert 1 026 000 cases of rotavirus gastroenteritis, 78 000 inpatient admissions, 4300 deaths, and 136 000 disability-adjusted-life-years (DALYs). For this year's birth cohort, it will avert 54 000 cases of rotavirus and 281 deaths in children aged <5 years. The program will cost $10.5 million and save $8.0 million in averted healthcare costs. Societal cost per DALY averted was $10, and the cost per rotavirus case averted was $1. Gastroenteritis causes substantial economic burden to Malawi. The rotavirus vaccine program is highly cost-effective. Together with the demonstrated impact of rotavirus vaccine in reducing population hospitalization burden, its cost-effectiveness makes a strong argument for widespread utilization in other low-income, high-burden settings. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator.

PubMed

Khandelwal, Nita; Benkeser, David; Coe, Norma B; Engelberg, Ruth A; Curtis, J Randall

2016-12-01

In the intensive care unit (ICU), complex decision making by clinicians and families requires good communication to ensure that care is consistent with the patients' values and goals. To assess the economic feasibility of staffing ICUs with a communication facilitator. Data were from a randomized trial of an "ICU communication facilitator" linked to hospital financial records; eligible patients (n = 135) were admitted to the ICU at a single hospital with predicted mortality ≥30% and a surrogate decision maker. Adjusted regression analyses assessed differences in ICU total and direct variable costs between intervention and control patients. A bootstrap-based simulation assessed the cost efficiency of a facilitator while varying the full-time equivalent of the facilitator and the ICU mortality risk. Total ICU costs (mean 22.8k; 95% CI, -42.0k to -3.6k; P = 0.02) and average daily ICU costs (mean, -0.38k; 95% CI, -0.65k to -0.11k; P = 0.006)] were reduced significantly with the intervention. Despite more contacts, families of survivors spent less time per encounter with facilitators than did families of decedents (mean, 25 [SD, 11] min vs. 36 [SD, 14] min). Simulation demonstrated maximal weekly savings with a 1.0 full-time equivalent facilitator and a predicted ICU mortality of 15% (total weekly ICU cost savings, $58.4k [95% CI, $57.7k-59.2k]; weekly direct variable savings, $5.7k [95% CI, $5.5k-5.8k]) after incorporating facilitator costs. Adding a full-time trained communication facilitator in the ICU may improve the quality of care while simultaneously reducing short-term (direct variable) and long-term (total) health care costs. This intervention is likely to be more cost effective in a lower-mortality population.

Rural Hospital Ownership: Medical Service Provision, Market Mix, and Spillover Effects

PubMed Central

Horwitz, Jill R; Nichols, Austin

2011-01-01

Objective To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data Sources/Study Setting Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. Study Design We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Principal Findings Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Conclusions Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. PMID:21639860

Rural hospital ownership: medical service provision, market mix, and spillover effects.

PubMed

Horwitz, Jill R; Nichols, Austin

2011-10-01

To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

[Direct and indirect costs of fractures due to osteoporosis in Austria].

PubMed

Dimai, H-P; Redlich, K; Schneider, H; Siebert, U; Viernstein, H; Mahlich, J

2012-10-01

We examined the financial burden of osteoporosis in Austria. We took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. While there exist similar studies for other countries, this is the first comprehensive study for Austria. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria. Our estimation of the total annual costs in the year 2008 imposed by osteoporosis in Austria is 707.4 million €. The largest fraction of this amount is incurred by acute hospital treatment. Another significant figure, accounting for 29% of total costs, is the opportunity cost of informal care. The financial burden of osteoporosis in Austria is substantial. Economic evaluations of preventive and therapeutic interventions for the specific context of Austria are needed to inform health policy decision makers. © Georg Thieme Verlag KG Stuttgart · New York.

The effect of severity of depressive disorder on economic burden in a university hospital in Singapore.

PubMed

Ho, Roger C M; Mak, Kwok-Kei; Chua, Anna N C; Ho, Cyrus S H; Mak, Anselm

2013-08-01

Depressive disorder is treatable but costly, thus influencing quality of life of people. Determine direct and indirect costs incurred by depressive disorder in Singapore. A 1-year prospective naturalistic study was conducted in a university mood disorder center between 2007 and 2008. Patients with primary International Classification of Disease-10 diagnosis of depressive disorder were recruited. Disease costs between mild, moderate and severe depression, and cost predictors were analyzed and determined. Forty nine patients completed the study. Mean annual total costs per patient were US$7638. Indirect costs (81%) dominated the total costs. Approximately 50% of indirect costs were associated with loss of productivity and unemployment. Higher education level, higher mean Hamilton Rating Scale for Depression score and number of suicide attempts were independent variables associated with increased direct costs while mean Hamilton Rating Scale for Depression scale score was an independent variable for indirect costs. Medical cost saving strategies should focus on indirect costs.

Economic Cost and Burden of Dengue in the Philippines

PubMed Central

Edillo, Frances E.; Halasa, Yara A.; Largo, Francisco M.; Erasmo, Jonathan Neil V.; Amoin, Naomi B.; Alera, Maria Theresa P.; Yoon, In-Kyu; Alcantara, Arturo C.; Shepard, Donald S.

2015-01-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008–2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. PMID:25510723

Economic cost and burden of dengue in the Philippines.

PubMed

Edillo, Frances E; Halasa, Yara A; Largo, Francisco M; Erasmo, Jonathan Neil V; Amoin, Naomi B; Alera, Maria Theresa P; Yoon, In-Kyu; Alcantara, Arturo C; Shepard, Donald S

2015-02-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008-2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. © The American Society of Tropical Medicine and Hygiene.

Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey

PubMed Central

Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan

2016-01-01

Objective In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%. Methods A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza. Results Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective. Conclusions Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective. PMID:27322384

Cost of stroke from a tertiary center in northwest India.

PubMed

Kwatra, Gagandeep; Kaur, Paramdeep; Toor, Gagan; Badyal, Dinesh K; Kaur, Raminder; Singh, Yashpal; Pandian, Jeyaraj D

2013-01-01

We aimed to study the cost of stroke, its predictors, and the impact on social determinants of the family. This prospective study was done in the Stroke unit and Neurology clinic between April 2009 and October 2011. All first ever stroke patients during the study period were enrolled. Direct and indirect costs at admission, at 1 and 6 months follow-up were obtained. The follow-up included information about the patient's poststroke outcome using modified Rankin Scale (mRS), work status, modifications made at home, loan requirement, etc., Two hundred patients were enrolled in this study and final analysis was performed on 189 patients. The mean age was 58 ± 13 years and 128 (67.7%) were men. Majority (54%) were living in a joint family. The mean overall cost of stroke per patient was rupees (INR) 80612 at 6 months. Higher income (P = 0.008), poor outcome (mRS >2) (P = 0.001), and length of hospital stay (P = 0.001) were the cost driving factors of total cost of stroke at 6 months. There was a decline in the requirement of help (P < 0.0001) and need for loan (P = 0.003) at 6 months follow-up. Direct medical cost or acute care of stroke accounted for a major component of cost of stroke. Poor outcome, length of hospital stay, and higher income were the cost driving factors. The socioeconomic impact on the family decreased at follow up probably due to joint family system.

Economic evaluation of knee arthroscopy treatment in a general hospital.

PubMed

Blatnik, Patricia; Tušak, Matej; Bojnec, Štefan; Brezigar Masten, Arjana

2017-02-01

Aim The economic evaluation of medical programs applies procedures that search for and ensure the cheapest methods of medical treatment with the best feasible health results. The aim of this study was to thoroughly examine both the costs and results of medical outcomes, which were based upon two alternative methods of treatment. The purpose was to offer obtained information to the medical profession and hospital management, since they must decide on how to use the funds designed for knee arthroscopy surgery. Methods A cost-utility analysis of two competitive treatments for knee arthroscopy was evaluated: the first one was executed by a standard department of surgery and the second one for the implementation within the framework of ambulatory treatment. Results The direct costs of the existing knee arthroscopy surgery amount to 930.39 euro, while the alternative treatment amount to 419.80 euro. The second alternative treatment would significantly reduce labor costs, depreciation costs and material costs. The implementation of the second alternative would reduce the total cost by 54.88%. Outpatient surgical procedures can bring numerous potential advantages such as lower costs and unchanged or improved medical outcomes, when compared to the classical method of outpatient treatment. The results show that the outpatient treatment does not sacrifice quality in order to reduce hospital costs. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

Reducing financial barriers to emergency obstetric care: experience of cost-sharing mechanism in a district hospital in Burkina Faso.

PubMed

Richard, F; Ouédraogo, C; Compaoré, J; Dubourg, D; De Brouwere, V

2007-08-01

To describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. The direct cost of a MOI was on average 136US$, including referral cost. Through the cost-sharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization).

Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study.

PubMed

Zhang, Shanshan; Palazuelos-Munoz, Sarah; Balsells, Evelyn M; Nair, Harish; Chit, Ayman; Kyaw, Moe H

2016-08-25

Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain. We conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005-2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation. The average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90 % CI: $39,886, $44,765) and $21,448 (90 % CI: $21,152, $21,744) in 2015 US dollars. Hospital-onset CDI-attributable cost per case was $34,157 (90 % CI: $33,134, $35,180), which was 1.5 times the cost of community-onset CDI ($20,095 [90 % CI: $4991, $35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7-13.6) and 9.7 (90 % CI: 9.6-9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range: $1.9-$7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay. This review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.

Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches.

PubMed

Deen, Shaun A; Wilson, Jennifer L; Wilshire, Candice L; Vallières, Eric; Farivar, Alexander S; Aye, Ralph W; Ely, Robson E; Louie, Brian E

2014-03-01

Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures. A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis. In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p < 0.001) owing to the cost of robotic-specific supplies and depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases. VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Costs of treating patients with schizophrenia who have illness-related crisis events.

PubMed

Zhu, Baojin; Ascher-Svanum, Haya; Faries, Douglas E; Peng, Xiaomei; Salkever, David; Slade, Eric P

2008-08-26

Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA) hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management) were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18), psychiatric hospitalization in the past 6 months (n = 240), arrest in the past 6 months (n = 56), violent behaviors in the past 4 weeks (n = 62), and diagnosis of a co-occurring substance use disorder (n = 413). Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024), followed by persons with psychiatric hospitalization in the past 6 months ($37,329), persons with prior arrests ($31,081), and persons with violent behaviors ($18,778). Total cost was not significantly higher for those with co-occurring substance use disorder ($19,034). Recent crises, particularly suicide attempts, psychiatric hospitalizations, and criminal arrests, are predictive of higher mental health treatment costs in schizophrenia patients.

Costs of treating patients with schizophrenia who have illness-related crisis events

PubMed Central

Zhu, Baojin; Ascher-Svanum, Haya; Faries, Douglas E; Peng, Xiaomei; Salkever, David; Slade, Eric P

2008-01-01

Background Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Methods Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA) hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management) were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18), psychiatric hospitalization in the past 6 months (n = 240), arrest in the past 6 months (n = 56), violent behaviors in the past 4 weeks (n = 62), and diagnosis of a co-occurring substance use disorder (n = 413). Results Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024), followed by persons with psychiatric hospitalization in the past 6 months ($37,329), persons with prior arrests ($31,081), and persons with violent behaviors ($18,778). Total cost was not significantly higher for those with co-occurring substance use disorder ($19,034). Conclusion Recent crises, particularly suicide attempts, psychiatric hospitalizations, and criminal arrests, are predictive of higher mental health treatment costs in schizophrenia patients. PMID:18727831

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

Cost of dengue cases in eight countries in the Americas and Asia: a prospective study.

PubMed

Suaya, Jose A; Shepard, Donald S; Siqueira, João B; Martelli, Celina T; Lum, Lucy C S; Tan, Lian Huat; Kongsin, Sukhontha; Jiamton, Sukhum; Garrido, Fàtima; Montoya, Romeo; Armien, Blas; Huy, Rekol; Castillo, Leticia; Caram, Mariana; Sah, Binod K; Sughayyar, Rana; Tyo, Karen R; Halstead, Scott B

2009-05-01

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

Short-term therapy with enoxaparin or unfractionated heparin for venous thromboembolism in hospitalized patients: utilization study and cost-minimization analysis.

PubMed

Argenta, Catia; Ferreira, Maria Angélica Pires; Sander, Guilherme Becker; Moreira, Leila Beltrami

2011-01-01

To evaluate the direct costs of venous thromboembolism (VTE) treatment with unfractionated heparin (UFH) and low-molecular weight heparin, from the institutional perspective. This is a real-world cohort study that included inpatients treated with UFH or enoxaparin for deep venous thromboembolism or pulmonary embolism in a tertiary public hospital. To estimate medical costs we computed the acquisition costs of drugs, supplies for administration, laboratory tests, and hospitalization cost according to the patient ward. One hundred sixty-seven patients aged 18 to 92 years were studied (50 treated with UFH and 117 with enoxaparin). The median of days in use of heparin was the same in both groups. Activated partial thromboplastin time was monitored in 98% of patients using UFH and 56.4% using enoxaparin. Nonstatistically significant differences were observed between groups in the number of bleeding events (10.0% and 9.4%; P = 1.00); blood transfusion (2.0% and 2.6%; P = 1.00); death (8.0% and 3.4%; P = 0.24); and recurrent VTE, bleeding, or death (20.0% and 14.5%; P = 0.38). Daily mean cost per patient was US$12.63 ± $4.01 for UFH and US$9.87 ± $2.44 for enoxaparin (P < 0.001). The total costs considering the mean time of use were US$88.39 and US$69.11. The treatment of VTE with enoxaparin provided cost savings in a large teaching hospital located in southern Brazil. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The Estimated Annual Cost of Uterine Leiomyomata in the United States

PubMed Central

CARDOZO, Eden R.; CLARK, Andrew D.; BANKS, Nicole K.; HENNE, Melinda B.; STEGMANN, Barbara J.; SEGARS, James H.

2011-01-01

Objective To estimate the total annual societal cost of uterine fibroids in the United States, based on direct and indirect costs, including associated obstetric complications. Study Design A systematic review of the literature was conducted to estimate the number of women seeking treatment for symptomatic fibroids annually, the costs of medical and surgical treatment, work lost and obstetric complications attributable to fibroids. Total annual costs were converted to 2010 U.S. dollars. A sensitivity analysis was performed. Results The estimated annual direct costs (surgery, hospital admissions, outpatient visits, medications) were $4.1 to $9.4 billion. Estimated lost work costs ranged from $1.55 to $17.2 billion annually. Obstetric outcomes attributed to fibroids resulted in a cost of $238 million to $7.76 billion annually. Uterine fibroids were estimated to cost the US $5.9 to $34.4 billion annually. Conclusions Obstetric complications associated with fibroids contributed significantly to their economic burden. Lost work costs may account for the largest proportion of societal costs due to fibroids. PMID:22244472

Autos, tires, aluminum, oil--and cost containment.

PubMed

Friedman, E

1978-09-01

Faced with massive increases in the costs of the health care benefits they provide for their employees, many large U.S. corporations are becoming increasingly involved in efforts to contain health care costs. Often seeing their efforts as posing an alternative to direct federal government intervention, business leaders are implementing a wide range of programs, including specific arrangements with providers, education of hospital trustees who are also employees, and fitness and preventive medicine programs.

Burden of epilepsy: a prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy.

PubMed

Gao, Lan; Xia, Li; Pan, Song-Qing; Xiong, Tao; Li, Shu-Chuen

2015-02-01

We aimed to gauge the burden of epilepsy in China from a societal perspective by estimating the direct, indirect and intangible costs. Patients with epilepsy and controls were enrolled from two tertiary hospitals in China. Patients were asked to complete a Cost-of-Illness (COI), Willingness-to-Pay (WTP) questionnaires, two utility elicitation instruments and Mini Mental State Examination (MMSE). Healthy controls only completed WTP questionnaire, and utility instruments. Univariate analyses were performed to investigate the differences in cost on the basis of different variables, while multivariate analysis was undertaken to explore the predictors of cost/cost component. In total, 141 epilepsy patients and 323 healthy controls were recruited. The median total cost, direct cost and indirect cost due to epilepsy were US$949.29, 501.34 and 276.72, respectively. Particularly, cost of anti-epileptic drugs (AEDs) (US$394.53) followed by cost of investigations (US$59.34), cost of inpatient and outpatient care (US$9.62) accounted for the majority of the direct medical costs. While patients' (US$103.77) and caregivers' productivity costs (US$103.77) constituted the major component of indirect cost. The intangible costs in terms of WTP value (US$266.07 vs. 88.22) and utility (EQ-5D, 0.828 vs. 0.923; QWB-SA, 0.657 vs. 0.802) were both substantially higher compared to the healthy subjects. Epilepsy is a cost intensive disease in China. According to the prognostic groups, drug-resistant epilepsy generated the highest total cost whereas patients in seizure remission had the lowest cost. AED is the most costly component of direct medical cost probably due to 83% of patients being treated by new generation of AEDs. Copyright © 2014 Elsevier B.V. All rights reserved.

The economic burden of influenza-associated outpatient visits and hospitalizations in China: a retrospective survey.

PubMed

Yang, Juan; Jit, Mark; Leung, Kathy S; Zheng, Ya-Ming; Feng, Lu-Zhao; Wang, Li-Ping; Lau, Eric H Y; Wu, Joseph T; Yu, Hong-Jie

2015-10-06

The seasonal influenza vaccine coverage rate in China is only 1.9 %. There is no information available on the economic burden of influenza-associated outpatient visits and hospitalizations at the national level, even though this kind of information is important for informing national-level immunization policy decision-making. A retrospective telephone survey was conducted in 2013/14 to estimate the direct and indirect costs of seasonal influenza-associated outpatient visits and hospitalizations from a societal perspective. Study participants were laboratory-confirmed cases registered in the National Influenza-like Illness Surveillance Network and Severe Acute Respiratory Infections Sentinel Surveillance Network in China in 2013. Patient-reported costs from the survey were validated by a review of hospital accounts for a small sample of the inpatients. The study enrolled 529 outpatients (median age: eight years; interquartile range [IQR]: five to 20 years) and 254 inpatients (median age: four years; IQR: two to seven years). Among the outpatients, 22.1 % (117/529) had underlying diseases and among the inpatients, 52.8 % (134/254) had underlying diseases. The average total costs related to influenza-associated outpatient visits and inpatient visits were US$ 155 (standard deviation, SD US$ 122) and US$ 1,511 (SD US$ 1,465), respectively. Direct medical costs accounted for 45 and 69 % of the total costs related to influenza-associated outpatient and inpatient visits, respectively. For influenza outpatients, the mean cost per episode in children aged below five years (US$ 196) was higher than that in other age groups (US$ 129-153). For influenza inpatients, the mean cost per episode in adults aged over 60 years (US$ 2,735) was much higher than that in those aged below 60 years (US$ 1,417-1,621). Patients with underlying medical conditions had higher costs per episode than patients without underlying medical conditions (outpatients: US$ 186 vs. US$ 146; inpatients: US$ 1,800 vs. US$ 1,189). In the baseline analysis, inpatients reported costs were 18 % higher than those found in the accounts review (n = 38). The economic burden of influenza-associated outpatient and inpatient visits in China is substantial, particularly for young children, the elderly, and patients with underlying medical conditions. More widespread influenza vaccination would likely alleviate the economic burden of patients. The actual impact and cost-effectiveness analysis of the influenza immunization program in China merits further investigation.

Cost-effectiveness of home-based care versus hospital care for chronically ill tuberculosis patients, Francistown, Botswana.

PubMed

Moalosi, G; Floyd, K; Phatshwane, J; Moeti, T; Binkin, N; Kenyon, T

2003-09-01

Francistown, Botswana, 1999. To determine the affordability and cost-effectiveness of home-based directly observed therapy (DOT) compared to hospital-based DOT for chronically ill tuberculosis (TB) patients, and to describe the characteristics of patients and their caregivers. Costs for each alternative strategy were analysed from the perspective of the health system and caregivers, in 1998 US dollars. Caregiver costs were assessed using a structured questionnaire administered to a sample of 50 caregivers. Health system costs were assessed using interviews with relevant staff and documentary data such as medical records and expenditure files. These data were used to calculate the average cost of individual components of care, and, for each alternative strategy, the average cost per patient treated. Cost-effectiveness was calculated as the cost per patient compliant with treatment. The characteristics of caregivers and patients were assessed using demographic and socio-economic data collected during interviews, and medical records. Overall, home-based care reduced the cost per patient treated by 44% compared with hospital-based treatment (dollars 1657 vs. dollars 2970). The cost to the caregiver was reduced by 23% (dollars 551 vs. dollars 720), while the cost to the health system was reduced by 50% (dollars 1106 vs. dollars 2206). The cost per patient complying with treatment was dollars 1726 for home-based care and dollars 2970 for hospitalisation. Caregivers were predominantly female relatives (88%), unemployed (48%), with primary school education or less (82%), and with an income of less than dollars 1000 per annum (71%). Of those patients with an HIV test result, 98% were HIV-positive. Home-based care is more affordable and cost-effective than hospital-based care for chronically ill TB patients, although costs to caregivers remain high in relation to their incomes. Structured home-based DOT should be included as a component of the National Tuberculosis Control Programme in Botswana.

“A manager in the minds of doctors:” a comparison of new modes of control in European hospitals

PubMed Central

2013-01-01

Background Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective. PMID:23819578

Incidence, recurrence and cost of hyperglycaemic crises requiring emergency treatment in Andalusia, Spain.

PubMed

Barranco, R J; Gomez-Peralta, F; Abreu, C; Delgado-Rodriguez, M; Moreno-Carazo, A; Romero, F; de la Cal, M A; Barranco, J M; Pasquel, F J; Umpierrez, G E

2017-07-01

Hyperglycaemic crises (diabetic ketoacidosis and hyperosmolar hyperglycaemic state) are medical emergencies in people with diabetes. We aimed to determine their incidence, recurrence and economic impact. An observational study of hyperglycaemic crises cases using the database maintained by the out-of-hospital emergency service, the Healthcare Emergency Public Service (EPES) during 2012. The EPES provides emergency medical services to the total population of Andalusia, Spain (8.5 million inhabitants) and records data on the incidence, resource utilization and cost of out-of-hospital medical care. Direct costs were estimated using public prices for health services updated to 2012. Among 1 137 738 emergency calls requesting medical assistance, 3157 were diagnosed with hyperglycaemic crises by an emergency coordinator, representing 2.9 cases per 1000 persons with diabetes [95% confidence intervals (CI) 2.8 to 3.0]. The incidence of diabetic ketoacidosis was 2.5 cases per 1000 persons with diabetes (95% CI 2.4 to 2.6) and the incidence of hyperosmolar hyperglycaemic state was 0.4 cases per 1000 persons with diabetes (95% CI 0.4 to 0.5). In total, 17.7% (n = 440) of people had one or more hyperglycaemic crisis. The estimated total direct cost was €4 662 151, with a mean direct cost per episode of €1476.8 ± 217.8. Hyperglycaemic crises require high resource utilization of emergency medical services and have a significant economic impact on the health system. © 2017 Diabetes UK.

Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues

PubMed Central

Kozhimannil, Katy Backes; Law, Michael R.; Virnig, Beth A.

2013-01-01

Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting. PMID:23459732

Value management: optimizing quality, service, and cost.

PubMed

Makadon, Harvey J; Bharucha, Farzan; Gavin, Michael; Oliveira, Jason; Wietecha, Mark

2010-01-01

Hospitals have wrestled with balancing quality, service, and cost for years--and the visibility and urgency around measuring and communicating real metrics has grown exponentially in the last decade. However, even today, most hospital leaders cannot articulate or demonstrate the "value" they provide to patients and payers. Instead of developing a strategic direction that is based around a core value proposition, they focus their strategic efforts on tactical decisions like physician recruitment, facility expansion, and physician alignment. In the healthcare paradigm of the next decade, alignment of various tactical initiatives will require a more coherent understanding of the hospital's core value positioning. The authors draw on their experience in a variety of healthcare settings to suggest that for most hospitals, quality (i.e., clinical outcomes and patient safety) will become the most visible indicator of value, and introduce a framework to help healthcare providers influence their value positioning based on this variable.

A short-stay unit for thyroidectomy patients increases discharge efficiency.

PubMed

Vrabec, Sara; Oltmann, Sarah C; Clark, Nicholas; Chen, Herbert; Sippel, Rebecca S

2013-09-01

Patients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge, which is the goal of a short-stay (SS) unit. Using an SS unit for thyroidectomy patients, who are often discharged in <24 h, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. A retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. We analyzed postoperative discharge information and hospital cost data. Adult patients who stayed a single night in the hospital were included. We compared patients staying on a designated SS unit versus a general surgery (GS) ward. A total of 223 patients were admitted to SS, and 177 to GS. Trends of admission location were blocked based on time period, with most patients per time period going to the same location. Discharge times were significantly quicker for patients admitted to SS (P < 0.001). A total of 70% of SS patients were discharged before noon, versus 40% of GS patients (P < 0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, owing to savings in pharmacy, recovery room, and nursing expenses (all P < 0.01). A designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared with those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow. Copyright © 2013 Elsevier Inc. All rights reserved.

Evaluating the total costs of chemotherapy-induced toxicity: results from a pilot study with ovarian cancer patients.

PubMed

Calhoun, E A; Chang, C H; Welshman, E E; Fishman, D A; Lurain, J R; Bennett, C L

2001-01-01

While chemotherapy-related toxicities affect cancer patients' activities of daily living and result in large expenditures of medical care for treatment, few studies have assessed the out-of-pocket and indirect costs incurred by patients who experience toxicity. The objective of this study was to evaluate the feasibility of obtaining detailed and comprehensive cost information from patients who experienced neutropenia, thrombocytopenia, or neurotoxicity during treatment. Ovarian cancer patients who experienced chemotherapy-associated hematologic or neurologic toxicities were asked to record detailed information about hospitalization, laboratories, physician visits, phone calls, home visits, medication, medical devices, lost productivity, and caregivers. Resource estimates were converted into cost units, with direct medical cost estimates based on hospital cost-accounting data and indirect costs (i.e., productivity loss) on modified labor force, employment, and earnings data. Direct medical costs were highest for neutropenia (mean of $7,546/episode), intermediate for thrombocytopenia (mean of $3,268/episode), and lowest for neurotoxicity (mean of $688/episode). Indirect costs relating to patient and caregiver work loss and payments for caregiver support were substantial, accounting for $4,220, $3,834, and $4,282 for patients who developed neurotoxicity, neutropenia, and thrombocytopenia, respectively. The total costs of chemotherapy-related neurotoxicity, neutropenia, and thrombocytopenia were $4,908, $11,830, and $7,550. Our study has shown that, with the assistance of patients who are experiencing toxicity, estimation of the total costs of cancer-related toxicities is feasible. Indirect costs, while not included in prior estimates of the costs of toxicity studies, accounted for 34% to 86% of the total costs of cancer supportive care.

Cost Accounting as a Tool for Increasing Cost Transparency in Selective Hepatic Transarterial Chemoembolization.

PubMed

Ahmed, Osman; Patel, Mikin; Ward, Thomas; Sze, Daniel Y; Telischak, Kristen; Kothary, Nishita; Hofmann, Lawrence V

2015-12-01

To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center. The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated. A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs. Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of laparoscopic versus open appendectomy in developing nations: a Colombian analysis.

PubMed

Ruiz-Patiño, Alejandro; Rey, Samuel; Molina, German; Dominguez, Luis Carlos; Rugeles, Saul

2018-04-01

Colombia is a developing nation in need for efficient resource administration in fields such as health care, where innovation is constant. Since the introduction of laparoscopic appendectomy (LA), direct costs have been increasing without definitive results in terms of clinical outcomes. The objective of this study is to determine the cost-effectiveness of open appendectomy (OA) versus LA and thereby help surgeons in clinical decision-making in a limited resource setting. A retrospective cost-effectiveness analysis comparing OA versus multiport LA during 2013 in a third-level university hospital (Hospital Universitario San Ignacio) in Bogota, Colombia was performed. Effectiveness was determined as the number of days in additional length of stay (LOS) due to the complications saved. A total of 377 clinical histories were collected by the authors and analyzed for the following variables: surgery type, conversion to open laparotomy, complications (surgical site infection, reintervention, and readmission), hospital LOS, and total cost of hospitalization for initial surgery and subsequent complications-related hospitalizations. The total accumulative costs and LOS for OA and LA plus complications were estimated. The cost-effectiveness threshold was set at US $46 (139,000 Colombian Peso [COP]), the cost of an additional day in LOS. An incremental cost-effectiveness ratio was calculated for OA as the comparator and LA as the intervention. The number of LA was 130 and of OA was 247. The two groups were balanced in terms of population characteristics. Complication rate was 13.7 % for OA and 10.4% for LA (P < 0.05), and LOS was 2 days for LA and OA (P = 0.9). No conversions from LA to OA were recorded. The total costs for complications for OA were US $8523 (25,569,220 COP) and US 3385 (10,157,758 COP) for LA. Cumulative costs including cost of surgery and complications and LOS for OA were US $65,753 (197,259,310 COP) and 297, respectively. Similarly, for LA were US $66,425 (199,276,948 COP) and 271, respectively. The incremental cost-effectiveness ratio was US $25.86 (77,601 COP) making LA a cost-effective alternative with a difference of US $20.76 (62,299 COP) under the cost-effectiveness threshold. LA is a cost-effective alternative over OA with an increasing cost of $25.85 per day of additional hospitalization due to complications saved. This is accounting the low cost of surgical interventions and complications in developing nations such as Colombia. Copyright © 2017 Elsevier Inc. All rights reserved.

Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital.

PubMed

Lampert, Markus L; Kraehenbuehl, Stephan; Hug, Balthasar L

2008-12-01

To evaluate the Pharmaceutical Care Network Europe (PCNE) classification system as a tool for documenting the impact of a hospital clinical pharmacology service. Two medical wards comprising totally 85 beds in a university hospital. Number of events classified with the PCNE-system, their acceptance by the medical staff and cost implications. Clinical pharmacy review of pharmacotherapy on ward rounds and from case notes were documented, and identified drug-related problems (DRPs) were classified using the PCNE system version 5.00. During 70 observation days 216 interventions were registered of which 213 (98.6%) could be classified: 128 (60.1%) were detected by reviewing the case notes, 33 (15.5%) on ward rounds, 32 (15.0%) by direct reporting to the clinical pharmacist (CP), and 20 (9.4%) on non-formulary prescriptions. Of 148 suggested interventions by the CP 123 (83.0%) were approved by the responsible physician, 12 ADR reports (8.1%) were submitted to the local pharmacovigilance centre and 31 (20.9%) specific information given without further need for action. An evaluation of the DRPs showed that direct drug costs of 2,058 within the study period or 10,731 per year could be avoided. We consider the PCNE system to be a practical tool in the hospital setting, which demonstrates the values of a clinical pharmacy service in terms of identifying and reducing DRPs and also has the potential to reduce prescribing costs.

Impact of Palliative Care Screening and Consultation in the ICU: A Multihospital Quality Improvement Project.

PubMed

Zalenski, Robert J; Jones, Spencer S; Courage, Cheryl; Waselewsky, Denise R; Kostaroff, Anna S; Kaufman, David; Beemath, Afzal; Brofman, John; Castillo, James W; Krayem, Hicham; Marinelli, Anthony; Milner, Bradley; Palleschi, Maria Teresa; Tareen, Mona; Testani, Sheri; Soubani, Ayman; Walch, Julie; Wheeler, Judy; Wilborn, Sonali; Granovsky, Hanna; Welch, Robert D

2017-01-01

There are few multicenter studies that examine the impact of systematic screening for palliative care and specialty consultation in the intensive care unit (ICU). To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was used to estimate the conditional probability of receiving a PCC and to balance important covariates. For patients with and without PCCs, outcomes studied were as follows: 1) change to "do not resuscitate" (DNR), 2) discharge to hospice, 3) 30-day readmission, 4) hospital length of stay (LOS), 5) total direct hospital costs. In 405 patients with positive screens, 161 (40%) who received a PCC were compared to 244 who did not. Patients receiving PCCs had higher rates of DNR-adjusted odds ratio (AOR) = 7.5; 95% CI 5.6-9.9) and hospice referrals-(AOR = 7.6; 95% CI 5.0-11.7). They had slightly lower 30-day readmissions-(AOR = 0.7; 95% CI 0.5-1.0); no overall difference in direct costs or LOS was found between the two groups. When patients receiving PCCs were stratified by time to PCC initiation, early consultation-by Day 4 of admission-was associated with reductions in LOS (1.7 days [95% CI -3.1, -1.2]) and average direct variable costs (-$1815 [95% CI -$3322, -$803]) compared to those who received no PCC. Receiving a PCC in the ICUs was significantly associated with more frequent DNR code status and hospice referrals, but not 30-day readmissions or hospital utilization. Early PCC was associated with significant LOS and direct cost reductions. Providing PCC early in the ICU should be considered. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Unit Cost of Medical Services at Different Hospitals in India

PubMed Central

Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

2013-01-01

Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes. PMID:23936088

Evaluating the Impact of Hospital Based Drug and Alcohol Consultation Liaison Services.

PubMed

Reeve, Rebecca; Arora, Sheena; Butler, Kerryn; Viney, Rosalie; Burns, Lucinda; Goodall, Stephen; van Gool, Kees

2016-09-01

Consultation liaison (CL) services provide direct access to specialist services for support, treatment advice and assistance with the management of a given condition. Alcohol and other drugs (AOD) CL services aim to improve identification and treatment of patients with AOD morbidity. Our objective was to evaluate the costs and consequences of AOD CL services in hospitals in New South Wales, Australia. Patients were surveyed at eight hospitals and problematic AOD use was identified using the Alcohol, Smoking and Substance Involvement Screening Test (n=1615). For consenting participants, medical record data were obtained from 18 months pre- to 12 months post-survey. We used interrupted time series analyses to compare utilization and costs for patients with and without AOD problems and changes over time between those who received AOD CL and similar patients. Approximately 35% of patients surveyed had AOD problems (excluding tobacco) with 7% requiring intensive treatment. Only 24% of patients requiring intensive treatment were treated by AOD CL. Those treated had relative improvements over time in the cost of presentations to emergency departments, emergency admission performance and increased uptake of appropriate pharmaceuticals. The estimated net benefit of AOD CL services was at least AUD$100,000 savings per hospital per year. Expanding AOD CL services to address current unmet need may lead to even greater cost savings for hospitals. Copyright © 2016 Elsevier Inc. All rights reserved.

Economic impact of hospital inpatient palliative care consultation: review of current evidence and directions for future research.

PubMed

May, Peter; Normand, Charles; Morrison, R Sean

2014-09-01

Maintaining the recent expansion of palliative care access in the United States is a recognized public health concern. Economic evaluation is essential to validate current provision and assess the case for new programs. Previous economic reviews in palliative care reported on programs across settings and systems; none has examined specifically the hospital consultative model, the dominant model of provision in the United States. To review systematically the economic evidence on specialist palliative care consultation teams in the hospital setting, to appraise this evidence critically, and to identify areas for future research in this field. A meta-review ("a review of existing reviews") was conducted of eight published systematic reviews and one relevant nonsystematic review. To identify articles published outside of the timeframe of these reviews, systematic searches were performed on the PubMed, CINAHL, and EconLit databases. Articles were included if they compared the costs and/or cost effectiveness of a specialist hospital inpatient palliative care consultation for adult patients with those of a comparator. Ten studies were included and these demonstrate a clear pattern of cost-saving impact from inpatient consultation programs. Nevertheless, knowledge gaps still exist regarding the economic effects of these programs. Current evidence has been generated from the hospital perspective; health system costs, patient and caregiver costs, and health outcomes are typically not included. Inpatient palliative care consultation programs have been shown to save hospitals money and to provide improved care to patients with serious illness. With a clear pattern of cost-saving using current methodology, it is timely to begin expanding the scope of economic evaluation in this field. Future research must address the measurement of both costs and outcomes to understand more fully the role that palliative care plays in enhancing value in health care. Relevant domains for such research are identified.

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

PubMed Central

Normand, Charles; Morrison, R. Sean

2014-01-01

Abstract Background: Maintaining the recent expansion of palliative care access in the United States is a recognized public health concern. Economic evaluation is essential to validate current provision and assess the case for new programs. Previous economic reviews in palliative care reported on programs across settings and systems; none has examined specifically the hospital consultative model, the dominant model of provision in the United States. Objectives: To review systematically the economic evidence on specialist palliative care consultation teams in the hospital setting, to appraise this evidence critically, and to identify areas for future research in this field. Data Sources: A meta-review (“a review of existing reviews”) was conducted of eight published systematic reviews and one relevant nonsystematic review. To identify articles published outside of the timeframe of these reviews, systematic searches were performed on the PubMed, CINAHL, and EconLit databases. Study Selection: Articles were included if they compared the costs and/or cost effectiveness of a specialist hospital inpatient palliative care consultation for adult patients with those of a comparator. Results: Ten studies were included and these demonstrate a clear pattern of cost-saving impact from inpatient consultation programs. Nevertheless, knowledge gaps still exist regarding the economic effects of these programs. Current evidence has been generated from the hospital perspective; health system costs, patient and caregiver costs, and health outcomes are typically not included. Conclusions: Inpatient palliative care consultation programs have been shown to save hospitals money and to provide improved care to patients with serious illness. With a clear pattern of cost-saving using current methodology, it is timely to begin expanding the scope of economic evaluation in this field. Future research must address the measurement of both costs and outcomes to understand more fully the role that palliative care plays in enhancing value in health care. Relevant domains for such research are identified. PMID:24984168

[Cost-Fffectiveness of Two Antiviral Therapies for Chronic Hepatitis B in Peru: Entecavir and Tenofovir].

PubMed

Bolaños-Díaz, Rafael; Tejada, Romina A; Sanabria, César; Escobedo-Palza, Seimer

2017-01-01

To compare in terms of cost-effectiveness to entecavir (ETV) and tenofovir (TDF) in the treatment of hepatitis B virus (HBV) in public hospitals in Peru. We structured a Markov model. We define effectiveness adjusted life years for quality (QALY). We include the direct costs of treatment in soles from the perspective of the Ministry of Health of Peru. We estimate the relationship between cost and effectiveness ratios (ICER). We performed sensitivity analyzes considering a range of willingness to pay (WTP) from one to three times the Gross Domestic Product (GDP) per capita, and a tornado analysis regarding Monetary Net Profit (BMN) or ICER. Treatment with TDF is more effective and less expensive than ETV. The ETV had a cost per QALY of PEN 4482, and PEN 1526 TDF. The PTO maintains a progressively larger with increasing WTP BMN. The discount rate was the only variable with a significant effect on model uncertainty. Treatment with TDF is more cost-effective than ETV in public hospitals in Peru.

[Descriptive study of the costs of diagnosis and treatment of cutaneous melanoma].

PubMed

Almazán-Fernández, F M; Serrano-Ortega, S; Moreno-Villalonga, J J

2009-11-01

Every year, health expenditure in Spain increases and, with it, the resources dedicated to cancer treatment. Cutaneous melanoma is the skin cancer with the highest morbidity and mortality. We performed a descriptive study of the costs, based on a theoretical model, to determine the healthcare expenditure for patients with cutaneous melanoma; the objective was to define the overall costs (direct and indirect) of the diagnostic and treatment process of cutaneous melanoma, divided into different stages or diagnostic-therapeutic steps, and the possible variations in these costs. For this purpose, we used the Andalusian analytical accountancy program of hospitals and districts (COAN-hyd) and the total costs module of the COAN for 2007, applied to the protocol we use in the melanoma unit of our hospital. The most important conclusions were that the greatest health care expenditure was observed inpatients with more advanced melanomas, with a poor prognosis. Management of the diagnostic-therapeutic process by dermatologists, the appropriate use of complementary tests, and operations performed by dermatologists reduce costs.

Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin.

PubMed

Boissonnault, William G; Lovely, Karen

2016-11-01

Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization. The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services. A descriptive survey was conducted. Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization. Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities. Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions. Respondents representing direct access organizations reported more timely access to physical therapist services, enhanced patient satisfaction, decreased organizational health care costs, and improved efficiency of resource utilization as benefits of model implementation. For organizations without direct access, not being an organizational priority, concerns from referral sources, and concerns that the physician-patient relationship would be negatively affected were noted as obstacles to model adoption. © 2016 American Physical Therapy Association.

EARNINGS MANAGEMENT IN U.S. HOSPITALS.

PubMed

Dong, Gang Nathan

2016-01-01

This paper examines the hospital management practices of manipulating financial earnings within the bounds of generally accepted accounting principles (GAAP). We conduct regression analyses that relate earnings management to hospital characteristics to assess the economic determinants of hospital earnings management behavior. From the CMS Cost Reports we collected hospital financial data of all U.S. hospitals that request reimbursement from the federal government for treating Medicare patients, and regress discretionary accruals on hospital size, profitability, asset liquidity, operating efficiency, labor cost, and ownership. Hospitals with higher profit margin, current ratio, working capital, days of patient receivables outstanding and total wage are associated with more earnings management, whereas those with larger size and higher debt level, asset turnover, days cash on hand, fixed asset age are associated with lower level of earnings manipulation. Additionally, managers of non-profit hospitals are more likely to undertake some form of window-dressing by manipulating accounting accruals without changing business models or pricing strategies than their public hospital counterparts. We provide direct evidence of the use of discretionary accruals to manage financial earnings among U.S. hospitals and the finding has profound policy implications in terms of assessing the pervasiveness of accounting manipulation and the overall integrity of financial reporting in this very special public and quasi-public service sector.

Analysis of hospitalization expenditures and influencing factors for inpatients with coronary heart disease in a tier-3 hospital in Xi'an, China: A retrospective study.

PubMed

Ding, Jing-Mei; Zhang, Xian-Zhi; Hu, Xue-Jun; Chen, Huo-Liang; Yu, Min

2017-12-01

The medical costs for inpatients with coronary heart disease (CHD) have risen to unprecedented levels, putting tremendous financial pressure on their families and the entire society. The objective of this study was to examine the actual direct medical costs of inpatients with CHD and to analyze the influencing factors of those costs, to provide advice on the prevention and control of high medical costs of patients with CHD. A retrospective descriptive analysis of hospitalization expenditures data examined 10,301 inpatients with coronary heart disease of a tier-3 hospital in Xi'an from January 1, 2015 to December 31, 2015. The data included demographic information, the average length of stay, and different types of expenses incurred during the hospitalization period. The difference between different groups was analyzed using a univariate analysis, and the influencing factors of hospitalization expenditures were explored by the multiple linear stepwise regression analysis. The average age of these patients was 60.0 years old, the average length of stay was 4.0 days, and the majority were males (7172, 69.6%). The average hospitalization expenses were $6791.38 (3294.16-9, 732.59), and the top 3 expenses were medical consumables, operation fees, and drugs. The influencing factors of hospitalization expenditures included the length of stay, the number of times of admission, the type of medical insurance schemes, whether have a surgery or not, the gender, the age, and the marriage status. The inpatients with CHD in this tier-3 hospital were mostly over 45 years old. The average medical cost of males was much higher than that of females. Our findings suggest that the solution for tremendous hospitalization expenditures should be that more attention is paid to controlling the high expense of medical consumables and that the traditional method of reducing medical expenses by shortening the length of stay is still important in nowadays. Furthermore, the type of medical insurance schemes has different impacts on medical expenses. Reducing or controlling high hospitalization expenditures is a complicated process that needs multifaceted cooperation. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study.

PubMed

Giorda, C B; Rossi, M C; Ozzello, O; Gentile, S; Aglialoro, A; Chiambretti, A; Baccetti, F; Gentile, F M; Romeo, F; Lucisano, G; Nicolucci, A

2017-03-01

To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year. Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Global Economic Burden of Norovirus Gastroenteritis

PubMed Central

Bartsch, Sarah M.; Lopman, Benjamin A.; Ozawa, Sachiko; Hall, Aron J.; Lee, Bruce Y.

2016-01-01

Background Despite accounting for approximately one fifth of all acute gastroenteritis illnesses, norovirus has received comparatively less attention than other infectious pathogens. With several candidate vaccines under development, characterizing the global economic burden of norovirus could help funders, policy makers, public health officials, and product developers determine how much attention and resources to allocate to advancing these technologies to prevent and control norovirus. Methods We developed a computational simulation model to estimate the economic burden of norovirus in every country/area (233 total) stratified by WHO region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses. Results Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2–5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4–83.4 billion) in societal costs per year. Disease amongst children <5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults ≥55 years. Productivity losses represented 84–99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs. In sensitivity analysis, the probability of hospitalization had the largest impact on health system cost estimates ($2.8 billion globally, assuming no hospitalization costs), while the probability of missing productive days had the largest impact on societal cost estimates ($35.9 billion globally, with a 25% probability of missing productive days). Conclusions The total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. Low, middle, and high income countries all have a considerable economic burden, suggesting that norovirus gastroenteritis is a truly global economic problem. Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions. PMID:27115736

Global Economic Burden of Norovirus Gastroenteritis.

PubMed

Bartsch, Sarah M; Lopman, Benjamin A; Ozawa, Sachiko; Hall, Aron J; Lee, Bruce Y

2016-01-01

Despite accounting for approximately one fifth of all acute gastroenteritis illnesses, norovirus has received comparatively less attention than other infectious pathogens. With several candidate vaccines under development, characterizing the global economic burden of norovirus could help funders, policy makers, public health officials, and product developers determine how much attention and resources to allocate to advancing these technologies to prevent and control norovirus. We developed a computational simulation model to estimate the economic burden of norovirus in every country/area (233 total) stratified by WHO region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses. Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2-5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4-83.4 billion) in societal costs per year. Disease amongst children <5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults ≥55 years. Productivity losses represented 84-99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs. In sensitivity analysis, the probability of hospitalization had the largest impact on health system cost estimates ($2.8 billion globally, assuming no hospitalization costs), while the probability of missing productive days had the largest impact on societal cost estimates ($35.9 billion globally, with a 25% probability of missing productive days). The total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. Low, middle, and high income countries all have a considerable economic burden, suggesting that norovirus gastroenteritis is a truly global economic problem. Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions.

A Generic Simulation Model of the Relative Cost-Effectiveness of ICU Versus Step-Down (IMCU) Expansion.

PubMed

Mahmoudian-Dehkordi, Amin; Sadat, Somayeh

2017-01-01

Many jurisdictions are facing increased demand for intensive care. There are two long-term investment options: intensive care unit (ICU) versus step-down or intermediate care unit (IMCU) capacity expansion. Relative cost-effectiveness of the two investment strategies with regard to patient lives saved has not been studied to date. We expand a generic system dynamics simulation model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to estimate the long-term effects of expanding ICU versus IMCU beds on patient lives saved under a common assumption of 2.1% annual increase in hospital arrivals. Two alternative policies of expanding ICU by two beds versus introducing a two-bed IMCU are compared over a ten-year simulation period. Russel equation is used to calculate total cost of patients' hospitalization. Using two possible values for the ratio of ICU to IMCU cost per inpatient day and four possible values for the percentage of patients transferred from ICU to IMCU found in the literature, nine scenarios are compared against the baseline scenario of no capacity expansion. Expanding ICU capacity by two beds is demonstrated as the most cost-effective scenario with an incremental cost-effectiveness ratio of 3684 (US $) per life saved against the baseline scenario. Sensitivity analyses on the mortality rate of patients in IMCU, direct transfer of IMCU-destined patients to the ward upon completing required IMCU length of stay in the ICU, admission of IMCU patient to ICU, adding two ward beds, and changes in hospital size do not change the superiority of ICU expansion over other scenarios. In terms of operational costs, ICU beds are more cost effective for saving patients than IMCU beds. However, capital costs of setting up ICU versus IMCU beds should be considered for a complete economic analysis.

Surgeon-Directed Cost Variation in Isolated Rotator Cuff Repair.

PubMed

Terhune, E Bailey; Cannamela, Peter C; Johnson, Jared S; Saad, Charles D; Barnes, John; Silbernagel, Janette; Faciszewski, Thomas; Shea, Kevin G

2016-12-01

As value becomes a larger component of heath care decision making, cost data can be evaluated for regional and physician variation. Value is determined by outcome divided by cost, and reducing cost increases value for patients. "Third-party spend" items are individual selections by surgeons used to perform procedures. Cost data for third-party spend items provide surgeons and hospitals with important information regarding care value, potential cost-saving opportunities, and the total cost of ownership of specific clinical decisions. To perform a cost review of isolated rotator cuff repair within a regional 7-hospital system and to document procedure cost variation among operating surgeons. Economic and decision analysis; Level of evidence, 4. Current Procedural Terminology (CPT) codes were used to retrospectively identify subjects who received an isolated rotator cuff repair within a 7-hospital system. Cost data were collected for clinically sensitive third-party spend items and divided into 4 cost groups: (1) suture anchors, (2) suture-passing devices and needles, (3) sutures used for cuff repair, and (4) disposable tools or instruments. A total of 62 isolated rotator cuff repairs were performed by 17 surgeons over a 13-month period. The total cost per case for clinically sensitive third-party spend items (in 2015 US dollars) ranged from $293 to $3752 (mean, $1826). Four surgeons had a mean procedure cost that was higher than the data set mean procedure cost. The cost of an individual suture anchor ranged from $75 to $1775 (mean, $403). One disposable suture passer was used, which cost $140. The cost of passing needles ranged from $140 to $995 (mean, $468). The cost per repair suture (used to repair cuff tears) varied from $18 to $298 (mean, $61). The mean suture (used to close wounds) cost per case was $81 (range, $0-$454). A total of 316 tools or disposable instruments were used, costing $1 to $1573 per case (mean, $624). This study demonstrates significant cost variation with respect to cost per case and cost of individual items used during isolated rotator cuff repair. Suture anchors represent the most expensive and variable surgeon-directed cost. The wide cost variation seen in all cost categories illustrates both the effect of surgeon choice in procedure cost and the opportunity for significant cost savings in cases of isolated rotator cuff repair. Engaging surgeons in discussion on cost can positively influence the value of care provided to patients if costs can be reduced without affecting the quality of patient outcomes.

Direct medical costs associated with atopic diseases among young children in Thailand.

PubMed

Ngamphaiboon, Jarungchit; Kongnakorn, Thitima; Detzel, Patrick; Sirisomboonwong, Krittawan; Wasiak, Radek

2012-01-01

Allergic diseases are the most common childhood illness in Thailand. Their prevalence has been rising over time, with several studies having revealed substantial economic burden. However, no such study had yet been conducted for Thailand. The aim of this study was to estimate direct medical costs associated with atopic diseases among children aged 0-5 years in Thailand. A cost-of-illness model was constructed to estimate the total direct medical costs of atopic diseases comprising atopic dermatitis, chronic rhinitis, asthma (i.e., recurrent wheeze), and cow's milk allergy. The model employed a prevalence-based approach, considering a total number of atopic cases in 2010. Direct medical costs were estimated using a bottom-up analysis with the estimation of the quantity of healthcare resource use and the unit costs. Epidemiological data were obtained from literature and Thai surveys, whereas treatment unit costs were from either a hospital database or Thai standard cost list. Expert opinion informed type, frequency, and quantity of medical resources utilized. Key limitations included lack of data-driven evidences on severity distribution for this particular age group, indirect costs, and medical resource use associated with each condition. Total direct cost was estimated to be THB 27.8 billion (US$899 million). Treatments contributed largest to the total costs (46%), followed by inpatient care (37%), outpatient care (12%), and monitoring and labs (5%). Costs per treated patient were highest in cow's milk allergy (THB 64,383; US$2077), followed by rhinitis (THB 12,669; US$409), asthma (THB 9633; US$312), and atopic dermatitis (THB 5432; US$175). Atopic diseases in young children are associated with substantial burden in direct medical costs to Thailand. These costs can be diminished through nutritional intervention recognized to effectively decrease the incidence of atopic diseases.

Glucose-6-phosphate dehydrogenase deficiency and the use of primaquine: top-down and bottom-up estimation of professional costs.

PubMed

Peixoto, Henry Maia; Brito, Marcelo Augusto Mota; Romero, Gustavo Adolfo Sierra; Monteiro, Wuelton Marcelo; Lacerda, Marcus Vinícius Guimarães de; Oliveira, Maria Regina Fernandes de

2017-10-05

The aim of this study has been to study whether the top-down method, based on the average value identified in the Brazilian Hospitalization System (SIH/SUS), is a good estimator of the cost of health professionals per patient, using the bottom-up method for comparison. The study has been developed from the context of hospital care offered to the patient carrier of glucose-6-phosphate dehydrogenase (G6PD) deficiency with severe adverse effect because of the use of primaquine, in the Brazilian Amazon. The top-down method based on the spending with SIH/SUS professional services, as a proxy for this cost, corresponded to R$60.71, and the bottom-up, based on the salaries of the physician (R$30.43), nurse (R$16.33), and nursing technician (R$5.93), estimated a total cost of R$52.68. The difference was only R$8.03, which shows that the amounts paid by the Hospital Inpatient Authorization (AIH) are estimates close to those obtained by the bottom-up technique for the professionals directly involved in the care.

Hospital downsizing and workforce reduction strategies: some inner workings.

PubMed

Weil, Thomas P

2003-02-01

Downsizing, manpower reductions, re-engineering, and resizing are used extensively in the United States to reduce cost and to evaluate the effectiveness and efficiency of various functions and processes. Published studies report that these managerial strategies result in a minimal impact on access to services, quality of care, and the ability to reduce costs. But, these approaches certainly alienate employees. These findings are usually explained by the significant difficulties experienced in eliminating nursing and other similar direct patient care-oriented positions and in terminating white-collar employees. Possibly an equally plausible reason why hospitals and physician practices react so poorly to these management strategies is their cost structure-high fixed (85%) and low variable (15%)-and that simply generating greater volume does not necessarily achieve economies of scale. More workable alternatives for health executives to effectuate cost reductions consist of simplifying prepayment, decreasing the overall availability and centralizing tertiary services at academic health centres, and closing superfluous hospitals and other health facilities. America's pluralistic values and these proposals having serious political repercussions for health executives and elected officials often present serious barriers in their implementation.

The cost of diabetes in Latin America and the Caribbean.

PubMed Central

Barceló, Alberto; Aedo, Cristian; Rajpathak, Swapnil; Robles, Sylvia

2003-01-01

OBJECTIVE: To measure the economic burden associated with diabetes mellitus in Latin America and the Caribbean. METHODS: Prevalence estimates of diabetes for the year 2000 were used to calculated direct and indirect costs of diabetes mellitus. Direct costs included costs due to drugs, hospitalizations, consultations and management of complications. The human capital approach was used to calculate indirect costs and included calculations of forgone earnings due to premature mortality and disability attributed to diabetes mellitus. Mortality and disability attributed to causes other than diabetes were subtracted from estimates to consider only the excess burden due to diabetes. A 3% discount rate was used to convert future earnings to current value. FINDINGS: The annual number of deaths in 2000 caused by diabetes mellitus was estimated at 339,035. This represented a loss of 757,096 discounted years of productive life among persons younger than 65 years (> billion US dollars). Permanent disability caused a loss of 12,699,087 years and over 50 billion US dollars, and temporary disability caused a loss of 136,701 years in the working population and over 763 million US dollars. Costs associated with insulin and oral medications were 4720 million US dollars, hospitalizations 1012 million US dollars, consultations 2508 million US dollars and care for complications 2,480 million US dollars. The total annual cost associated with diabetes was estimated as 65,216 million US dollars (direct 10,721 US dollars; indirect 54,496 US dollars). CONCLUSION: Despite limitations of the data, diabetes imposes a high economic burden to individuals and society in all countries and to Latin American and the Caribbean as whole. PMID:12640472

Operational and Clinical Strategies to Address Drug Cost Containment in the Acute Care Setting.

PubMed

McConnell, Karen J; Guzman, Oscar E; Pherwani, Nisha; Spencer, Dustin D; Van Cura, Jennifer D; Shea, Katherine M

2017-01-01

To provide clinical and operational strategies to generate drug cost savings in the hospital setting. A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. Investigators reviewed 937 abstracts. The review of the literature showed that acute care hospitals are under increasing financial pressures, and the pharmacy is often responsible for opportunities to manage drug costs. The literature also indicated that cost-containment strategies in the acute care setting range from pharmacy-directed activities to initiatives requiring interdisciplinary collaboration and strategic planning. Hospital pharmacies should consider establishing an interdisciplinary team that is responsible for systematically reviewing drug cost implications and leading any initiatives that are deemed necessary. Acute care settings can use various operational and clinical strategies to lower their expenditures on high-cost drugs. Operational strategies include various activities that pharmacy staff implement related to contracting, purchasing, and inventory management. Clinical strategies utilize clinical pharmacists working with interdisciplinary teams to develop and maintain a formulary, implement established-use criteria for select drugs, use dose optimization, and implement other clinical tactics aimed at cost containment. After initiatives are implemented, assessing the outcomes of the initiatives is important to determine how successful they were at lowering costs safely and effectively. Acute care hospitals can use various operational and clinical strategies to lower overall drug costs. A systematic stepwise approach is recommended to ensure relevant drugs are regularly reviewed and addressed as needed. © 2016 Pharmacotherapy Publications, Inc.

Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia.

PubMed

Ismail, Aniza; Suddin, Leny Suzana; Sulong, Saperi; Ahmed, Zafar; Kamaruddin, Nor Azmi; Sukor, Norlela

2017-01-01

Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective. A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach. Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$ 286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$ 62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting. Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease.

Determining the impacts of hospital cost-sharing on the uninsured near-poor households in Vietnam

PubMed Central

2014-01-01

Objectives The study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured. Methods A panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics. Results Average user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE. Conclusions Around 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households. PMID:24885268

Health care costs and work absenteeism in smokers: study in an urban community.

PubMed

Suárez-Bonel, María Pilar; Villaverde-Royo, María Victoria; Nerín, Isabel; Sanz-Andrés, Concepción; Mezquida-Arno, Julia; Córdoba-García, Rodrigo

2015-12-01

Higher morbidity caused by smoking-related diseases could increase health costs. We analyzed differences in the use of healthcare resources, healthcare costs and days of work absenteeism among smokers and non-smokers. Cross-sectional study in smokers and non-smokers, aged between 45 and 74 years, from one urban health area. The variables studied were: age, sex, alcohol intake, physical activity, obesity, diseases, attendance at primary care clinics and hospital emergency rooms, days of hospitalization, prescription drug consumption and work absenteeism (in days). Annual cost according to the unit cost of each service (direct costs), and indirect costs according to the number of days missed from work was calculated. Crude and adjusted risks were calculated using logistic regression. Five hundred patients were included: 50% were smokers, 74% (372) men and 26% (128) women. Smokers used more healthcare resources, consumed more prescription drugs and had more days off work than non-smokers. Respective direct and indirect costs in smokers were 848.64 euros (IQ 25-75: 332.65-1517.10) and 2253.90 euros (IQ 25-75: 1024.50-13113.60), and in non-smokers were 474.71 euros (IQ 25-75: 172.88-979.59) and 1434.30 euros (IQ 25-75: 614.70-4712.70). The likelihood of generating high healthcare costs was more than double for smokers (OR=2.14; 95% CI: 1.44-3.19). More investment in programs for the prevention and treatment of smoking, as a health policy priority, could help to reduce the health and social costs of smoking. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

Health Care Costs for Patients With Chronic Spinal Cord Injury in the Veterans Health Administration

PubMed Central

French, Dustin D; Campbell, Robert R; Sabharwal, Sunil; Nelson, Audrey L; Palacios, Polly A; Gavin-Dreschnack, Deborah

2007-01-01

Background/Objective: Recurring annual costs of caring for patients with chronic spinal cord injury (SCI) is a large economic burden on health care systems, but information on costs of SCI care beyond the acute and initial postacute phase is sparse. The objective of this study was to establish a frame of reference and estimate of the annual direct medical costs associated with health care for a sample of patients with chronic SCI (ie, >2 years after injury). Methods: Patients were recruited from 3 Veterans Health Administration (VHA) SCI facilities; baseline patient information was cross-referenced to the Decision Support System (DSS) National Data Extracts (NDE) to obtain patient-specific health care costs in VHA. Descriptive statistical analysis of annual DSS-NDE cost of patients with SCI (N = 675) for fiscal year (FY) 2005 by level and completeness of injury was conducted. Results: Total (inpatient and outpatient) annual (FY 2005) direct medical costs for 675 patients with SCI exceeded $14.47 million or $21,450 per patient. Average annual total costs varied from $28,334 for cervical complete SCI to $16,792 for thoracic incomplete SCI. Two hundred thirty-three of the 675 patients with SCI who were hospitalized over the study period accounted for a total of 378 hospital discharges, costing in excess of $7.19 million. This approximated a cost of outpatient care received of $7.28 million for our entire sample. Conclusions: The comprehensive nature of health care delivery and related cost capture for people with chronic SCI in the VHA provided us the opportunity to accurately determine health care costs for this population. Future SCI postacute care cost analyses should consider case-mix adjusting patients at high risk for rehospitalization. PMID:18092564

Direct health costs and clinical outcomes of open surgery in patients with abdominal aortic aneurysm in Spain. The RECAPTA study.

PubMed

Egea, Marta; Fernández-Samos, Rafael; Lechón, José Antonio; Reparaz, Luis; Álvarez, María; Cairols, Marc

2018-06-18

Abdominal aortic aneurysm (AAA) is a chronic, progressive disease that often requires surgical repair. This study aimed to assess the healthcare costs and clinical outcomes of open AAA repair in Spain. Observational, retrospective, multicenter study with a one-year follow-up. Healthcare resource use and costs related to the surgical procedure, hospital stay, and follow-up period were assessed. Ninety patients with asymptomatic AAA who underwent open repair were recruited between 2003 and 2009 at three Spanish hospitals. Four patients (4.44%) died in the first 30 postoperative days. Mean [standard deviation] procedure time was 292.83 [72.10] minutes and mean hospital length of stay was 11.44 days [5.42]. Thirty two patients (35.56%) presented in-hospital complications and three patients (3.45%) underwent re-intervention during follow-up. The mean overall cost per patient during the study period was €21,622.59, of which 42.40% (€9,168.19), 52.08% (€11,261.74), and 5.52% (€1,192.66) corresponded to the surgical procedure, the inpatient stay, and the study follow-up period, respectively. Given the economic burden imposed by the treatment of patients admitted with AAA on the Spanish health system, additional efforts comparing the cost of open repair with endovascular treatments are needed to ensure greater efficiency.

eHCM: Resources Reduction & Demand Increase, cover the gap by a managerial approach powered by an IT solutions.

PubMed

Buccioli, Matteo; Agnoletti, Vanni; Padovani, Emanuele; Perger, Peter

2014-01-01

The economic and financial crisis has also had an important impact on the healthcare sector. Available resources have decreased, while at the same time costs as well as demand for healthcare services are on the rise. This coalescing negative impact on availability of healthcare resources is exacerbated even further by a widespread ignorance of management accounting matters. Little knowledge about costs is a strong source of costs augmentation. Although it is broadly recognized that cost accounting has a positive impact on healthcare organizations, it is not widespread adopted. Hospitals are essential components in providing overall healthcare. Operating rooms are critical hospital units not only in patient safety terms but also in expenditure terms. Understanding OR procedures in the hospital provides important information about how health care resources are used. There have been several scientific studies on management accounting in healthcare environments and more than ever there is a need for innovation, particularly by connecting business administration research findings to modern IT tools. IT adoption constitutes one of the most important innovation fields within the healthcare sector, with beneficial effects on the decision making processes. The e-HCM (e-Healthcare Cost Management) project consists of a cost calculation model which is applicable to Business Intelligence. The cost calculation approach comprises elements from both traditional cost accounting and activity-based costing. Direct costs for all surgical procedures can be calculated through a seven step implementation process.

Impact of PACS in hospital management

NASA Astrophysics Data System (ADS)

Hur, Gham; Cha, Soon-Joo; Kim, Yong H.; Hwang, Yoon J.; Kim, Soo Y.

2002-05-01

Since the low-cost, NT-based, full PACS was successfully implemented in a large-scale hospital at the end of 1999, many hospital administrators have rushed to purchase the system competitively. It is now a worldwide trend to implement the technology, but Korea has several unique environments for the fast spread of the full PACS. Since hospitals in Korea operate inpatient and outpatient clinics in the same building and use identical OCS, full integration of PACS with the OCS was relatively easy and highly efficient. The simple governing structures of the hospitals also made the decision-making process short and effective. In addition, the national health insurance reimbursement policy that started pay in the beginning of 2000 has also played a catalytic role for the swift propagation of PACS. The recent appearance of the affordable PACS gave hospital administrators the opportunity to learn and understand the role of digital imaging in the areas that are directly related to the efficiency and quality of medical services, as well as cost containment. Furthermore, PACS provided them with windows to the 'all-digital hospital,' which will lead them to realign policies in the management of the hospitals in order to compete successfully in the fast-changing world of health care.

[A survey about client orientation and wayfinding in Chilean hospitals].

PubMed

Mora, Rodrigo; Oats, Amalia; Marziano, Pía

2014-10-01

Sense of orientation in hospitals can be tricky considering the large extension of buildings and the inadequate signage. To report some of the findings of a larger research project on wayfinding and patient navigation in Chilean hospitals. Five hundred nine hospital users waiting for attention in three hospitals were contacted and asked to answer a survey that lasted 10 minutes, about wayfinding and sense of orientation within the hospital. Users declared to have a good opinion of existing signage in the three hospitals analyzed as well as their architectural organization in terms of their capacity to orient people. However, the vast majority of users asked for directions to navigate within the hospital to staff and medical personnel. Patient navigation problems are imposing a great "hidden" cost to hospitals management due to missed appointments.

Health care utilization and outpatient, out-of-pocket costs for active convulsive epilepsy in rural northeastern South Africa: a cross-sectional Survey.

PubMed

Wagner, Ryan G; Bertram, Melanie Y; Gómez-Olivé, F Xavier; Tollman, Stephen M; Lindholm, Lars; Newton, Charles R; Hofman, Karen J

2016-06-28

Epilepsy is a common neurological disorder, with over 80 % of cases found in low- and middle-income countries (LMICs). Studies from high-income countries find a significant economic burden associated with epilepsy, yet few studies from LMICs, where out-of-pocket costs for general healthcare can be substantial, have assessed out-of-pocket costs and health care utilization for outpatient epilepsy care. Within an established health and socio-demographic surveillance system in rural South Africa, a questionnaire to assess self-reported health care utilization and time spent traveling to and waiting to be seen at health facilities was administered to 250 individuals, previously diagnosed with active convulsive epilepsy. Epilepsy patients' out-of-pocket, medical and non-medical costs and frequency of outpatient care visits during the previous 12-months were determined. Within the last year, 132 (53 %) individuals reported consulting at a clinic, 162 (65 %) at a hospital and 34 (14 %) with traditional healers for epilepsy care. Sixty-seven percent of individuals reported previously consulting with both biomedical caregivers and traditional healers. Direct outpatient, median costs per visit varied significantly (p < 0.001) between hospital (2010 International dollar ($) 9.08; IQR: $6.41-$12.83) and clinic consultations ($1.74; IQR: $0-$5.58). Traditional healer fees per visit were found to cost $52.36 (IQR: $34.90-$87.26) per visit. Average annual outpatient, clinic and hospital out-of-pocket costs totaled $58.41. Traveling to and from and waiting to be seen by the caregiver at the hospital took significantly longer than at the clinic. Rural South Africans with epilepsy consult with both biomedical caregivers and traditional healers for both epilepsy and non-epilepsy care. Traditional healers were the most expensive mode of care, though utilized less often. While higher out-of-pocket costs were incurred at hospital visits, more people with ACE visited hospitals than clinics for epilepsy care. Promoting increased use and effective care at clinics and reducing travel and waiting times could substantially reduce the out-of-pocket costs of outpatient epilepsy care.

The 3C study: coverage cost and care of type 1 diabetes in China--study design and implementation.

PubMed

McGuire, Helen; Kissimova-Skarbek, Katarzyna; Whiting, David; Ji, Linong

2011-11-01

To describe coverage, cost and care of type 1 diabetes (T1D) in 2 regions of China--Beijing and Shantou--including: This is a mixed-methods descriptive study with three arms--coverage, cost and care. It is taking place in 4 tertiary hospitals, 3 secondary hospitals and 4 primary health facilities in Beijing, and 2 tertiary hospitals, 2 secondary hospitals and 2 primary health centres in Shantou, China. Two additional hospitals are involved in the coverage arm of the study. T1D participants are recruited from a 3-year list generated by each hospital and from those attending the outpatient clinic or admitted to the inpatient ward. Participants also include health care professionals and government officials. To determine coverage of care, a list of people with T1D is being developed including information on diagnosis, age, sex and vital status. The age and sex distribution will be compared with the expected distribution. To estimate the economic burden of T1D three groups of costs will be calculated - direct medical costs, direct non-medical costs and indirect costs from different perspectives of analysis (patients and their families, health system, insurer and societal perspective). The data are being collected from people with T1D (patient-parents face-to-face interviews), hospital billing departments, medical records and government officials using a combined "top-down, bottom-up" approach developed to validate the data. Quality of life is assessed using the EQ-5D tool and burden of disease is measured based on clinical outcomes and complications. Standard care will be defined, costed and compared to the cost of current care identified within the study to determine the investment required to improve outcomes. The third arm includes three components - health policy, clinical care and education, and information management. Face-to-face, semi-structured interviews are conducted with people with T1D (for those <15 years of age parents are interviewed), health care professionals, senior hospital management and government officials. The core Summary of Diabetes Self-Care Activities Measure plus an additional 6 questions from the revised SDSCA scale are used to assess patient self-care. A medical records audit tool is used to assess care [7]. Clinical outcomes and self-care activities will be analysed for associations with care and education. Information management and care processes will be described using the Standard for Integration Definition for Function Modelling (IDEF0) [8]. At the time of writing (early October) the 3-year case list includes 1269 people with type 1 diabetes from Beijing and 481 people for Shantou, a total of 1750. In addition, two hundred and twenty people with T1D or their parents participated in face-to-face interviews in Beijing and 183 in Shantou, a total of 403. Key implementation considerations were identified early in the project. Project success is dependent on strong local partnerships with local opinion leaders and key officials. It is important that a physician is the first point of contact to build the case list and recruit participants. July, August and January are peak months for recruiting school-age children in the Children's Hospital as this is school vacation period when they are more likely to attend clinics. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

PubMed

Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

2010-04-01

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

[Hospital infections. Extended hospital queues and unnecessary costs of the health services].

PubMed

Andersen, B M

1992-01-30

In Norway the prevalence of nosocomial infections is 5-20%; more than 50,000 patients per year. The consequences may be serious for the individual patient and his family, a serious problem for the hospital department concerned and a burden on the Norwegian health services. Nosocomial infections can be treated by antimicrobial drugs which generate selective pressure towards more resistant organisms. Infections caused by resistant strains may result in longer hospitalization, more difficult treatment, and more severe illness. In future, efforts must be directed at preventing nosocomial infections by means of education, surveillance and control.

Modeling an integrated hospital management planning problem using integer optimization approach

NASA Astrophysics Data System (ADS)

Sitepu, Suryati; Mawengkang, Herman; Irvan

2017-09-01

Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.

Optimization Model for Capacity Management and Bed Scheduling for Hospital

NASA Astrophysics Data System (ADS)

Sitepu, Suryati; Mawengkang, Herman; Husein, Ismail

2018-01-01

Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing.. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.

Economic burden of inflammatory bowel disease: a UK perspective.

PubMed

Luces, Carlvin; Bodger, Keith

2006-08-01

Inflammatory bowel diseases (IBDs) are chronic, relapsing conditions that have no permanent drug cure, may occur for the first time in early life and have the potential to produce long-term morbidity. In the era of emerging biological drug therapies, the costs associated with IBD have attracted increased attention. This review considers the available information on the macroeconomics of ulcerative colitis and Crohn's disease. In relation to direct medical costs, the consistent findings are: hospital (in-patient) costs are incurred by a minority of sufferers but account for approximately half the total cost; and drug costs contribute less than a quarter of the total healthcare costs. Data for levels of costs associated with lost productivity are more variable, but some studies have estimated that 'indirect' costs falling on society exceed medical expenditures. Lifetime costs for IBD are comparable to a number of major diseases, including heart disease and cancer. Over the next 5-10 years, the contribution of drug costs to the overall profile of cost-of-illness will change significantly as biological therapies play an increasing role. A key economic question is whether the health gains realized from exciting new drugs will also lead to reduced expenditures on hospitalization and surgery.

Economic Analysis of Kiva VCF Treatment System Compared to Balloon Kyphoplasty Using Randomized Kiva Safety and Effectiveness Trial (KAST) Data.

PubMed

Beall, Douglas P; Olan, Wayne J; Kakad, Priyanka; Li, Qianyi; Hornberger, John

2015-01-01

Vertebral compression fractures (VCFs) are the most common osteoporotic fractures and cause persistent pain, kyphotic deformity, weight loss, depression, reduced quality of life, and even death. Current surgical approaches for the treatment of VCF include vertebroplasty (VP) and balloon kyphoplasty (BK). The Kiva® VCF Treatment System (Kiva System) is a next-generation alternative surgical intervention in which a percutaneously introduced nitinol Osteo Coil guidewire is advanced through a deployment cannula and subsequently a PEEK Implant is implanted incrementally and fully coiled in the vertebral body. The Kiva System's effectiveness for the treatment of VCF has been evaluated in a large randomized controlled trial, the Kiva Safety and Effectiveness Trial (KAST). The Kiva System was non-inferior to BK with respect to pain reduction (70.8% vs. 71.8% in Visual Analogue Scale) and physical function restoration (38.1 % vs. 42.2% reduction in Oswestry Disability Index) while using less bone cement. The economic impact of the Kiva system has yet to be analyzed. To analyze hospital resource use and costs of the Kiva System over 2 years for the treatment of VCF compared to BK. A representative US hospital. Economic analysis of the KAST randomized trial, focusing on hospital resource use and costs. The analysis was conducted from a hospital perspective and utilized clinical data from KAST as well as unit-cost data from the published literature. The cost of initial VCF surgery, reoperation cost, device market cost, and other medical costs were compared between the Kiva System and BK. The relative risk reduction rate in adjacent-level fracture with Kiva [31.6% (95% CI: -22.5%, 61.9%)] demonstrated in KAST was used in this analysis. With 304 vertebral augmentation procedures performed in a representative U.S. hospital over 2 years, the Kiva System will produce a direct medical cost savings of $1,118 per patient and $280,876 per hospital. This cost saving with the Kiva System was attributable to 19 reduced adjacent-level fractures with the Kiva System. This study does not compare the Kiva System with VP or any other non-surgical procedures for the treatment of VCF. This first-ever economic analysis of the KAST data showed that the Kiva System for vertebral augmentation is hospital resource and cost saving over BK in a hospital setting over 2 years. These savings are attributable to reduced risk of developing adjacent-level fractures with the Kiva System compared to BK.

Costs of treating bleeding and perforated peptic ulcers in The Netherlands.

PubMed

de Leest, Helena; van Dieten, Hiske; van Tulder, Maurits; Lems, Willem F; Dijkmans, Ben A C; Boers, Maarten

2004-04-01

Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs includes perforations and bleeds. Several preventive strategies are being tested for cost-effectiveness, but little is known about the costs of the complications they are trying to prevent. We estimated the direct costs of hospital treatment of bleeding and perforated ulcers in a university hospital, from data in discharge letters and the hospital management information system. Eligible patients had been treated in the VU University Medical Center between January 1997 and August 2000 for an ulcer bleed or perforation (International Classification of Diseases code 531-4). Resource use comprised hospitalization days and diagnostic and therapeutic interventions. Insurance claim prices determined the costs from the payers' perspective. In a secondary analysis we excluded resource use that was clearly related to the treatment of comorbid illness. Fifty-three patients with a bleeding (n = 35) or perforated ulcer (n = 15) or both (n = 3) were studied, including 14 with comorbidity; 22 complications occurred in the stomach, 29 in the duodenum, one in both stomach and duodenum, and one after partial gastrectomy. A simultaneous bleed and perforation was most expensive (26,000 euro), followed by perforation (19,000 euro) and bleeding (12,000 euro). A bleed in the duodenum was more expensive than in the stomach (13,000 euro vs 10,000 euro), while the opposite was seen for perforations (13,000 euro vs 21,000 euro). Comorbidity increased costs substantially: even after correction for procedures unrelated to the ulcer complication, comorbidity more than doubled the costs of treatment. Treatment of complicated ulcers is expensive, especially in patients with comorbid conditions.

Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

NASA Astrophysics Data System (ADS)

Eristina; Andayani, T. M.; Oetari, R. A.

2017-11-01

Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

[Meeting the needs of the European working time directive in german medical profession].

PubMed

Friedrich, M; Popov, A F; Schmitto, J D; Bireta, C; Emmert, A; Tirilomis, T

2011-06-01

The legal obligation of the European Working Time Directive with its implementation into a German Working Hours Act requires German hospitals to give up old structures and requires the implementation of new working time models. The failure of the revision of the European Working Time Directive in April 2009 prevented that any changes of status quo might happen in the near future. Fundamental terms of the working law for the medical area have been elucidated and have been implemented into concrete calculation formulas. The planned working time has been clearly determined. Particularly, on-call duties and a signed "OptOut-declaration" have huge effects on the upper limit of the working time that is to be determined. Shift duty leads to the greatest limitations of the upper limit of the working time. The Working Hours Act defines the maximal, available, individual working time budget and thus the working time budget of a hospital and it limits the maximal availability of the service providers of a hospital as well as defining the maximal personnel costs. Transparency in this area lays the foundation for an effective time management and the creation of new working time models in accordance with the European Working Time Directive as well as the Working Hours Act and the "TVÄ" (labour contract for doctors at municipal hospitals). It is possible, with the knowledge of the maximal working time budget and the thereof resulting personnel costs, to calculate the economical revenues better. The reallocation of the working time of doctors enables efficiency enhancement. It is necessary to demand a clear definition of the tasks of doctors with the consequential discharge of tasks that should not/do not belong to the responsibilities of a doctor. This would lead to a more attractive working environment for doctors at hospitals and thus to an improvement of the care of the patients. The implementation of the European Time Directive is not to be seen as unrealizable, as has been generally heard; instead, it enables the urgently necessary structural reform at German hospitals. © Georg Thieme Verlag KG Stuttgart · New York.

Robotic versus open pediatric ureteral reimplantation: Costs and complications from a nationwide sample.

PubMed

Kurtz, Michael P; Leow, Jeffrey J; Varda, Briony K; Logvinenko, Tanya; Yu, Richard N; Nelson, Caleb P; Chung, Benjamin I; Chang, Steven L

2016-12-01

We sought to compare complications and direct costs for open ureteral reimplantation (OUR) versus robot-assisted laparoscopic ureteral reimplantation (RALUR) in a sample of hospitals performing both procedures. Anecdotal reports suggest that use of RALUR is increasing, but little is known of the outcomes and costs nationwide. The aim was to determine the costs and 90-day complications (of any Clavien grade) in a nationwide cohort of pediatric patients undergoing OUR or RALUR. Using the Premier Hospital Database we identified pediatric patients (age < 21 years) who underwent ureteral reimplantation from 2003 to 2013. We compared 90-day complication rates and cost data for RALUR versus OUR using descriptive statistics and hierarchical models. We identified 17 hospitals in which both RALUR and OURs were performed, resulting in a cohort of 1494 OUR and 108 RALUR cases. The median operative time was 232 min for RALUR vs. 180 min for OUR (p = 0.0041). Incidence of any 90-day complications was higher in the RALUR group: 13.0% of RALUR vs. 4.5% of OUR (OR = 3.17, 95% CI: 1.46-6.91, p = 0.0037). The difference remained significant in a multivariate model accounting for clustering among hospitals and surgeons (OR, 3.14; 95% CI, 1.46-6.75; p = 0.0033) (Figure). The median hospital cost for OUR was $7273 versus $9128 for RALUR (p = 0.0499), and the difference persisted in multivariate analysis (p = 0.0043). Fifty-one percent (55/108) of the RALUR cases occurred in 2012-2013. We present the first nationwide sample comparing RALUR and OUR in the pediatric population. There is currently wide variation in the probability of complication reported in the literature. Some variability may be due to differential uptake and experience among centers as they integrate a new procedure into their practice, while some may be due to reporting bias. A strength of the current study is that cost and 90-day postoperative complication data are collected at participating hospitals irrespective of outcomes, providing some immunity from the reporting bias to which individual center surgical series' may be susceptible. Compared with OUR, RALUR was associated with a significantly higher rate of complications as well as higher direct costs even when adjusted for demographic and regional factors. These findings suggest that RALUR should be implemented with caution, particularly at sites with limited robotic experience, and that outcomes for these procedures should be carefully and systematically tracked. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Economic Burden of Osteoporosis in South Korea: Claim Data of the National Health Insurance Service from 2008 to 2011.

PubMed

Ha, Yong-Chan; Kim, Ha-Young; Jang, Sunmee; Lee, Young-Kyun; Kim, Tae-Young

2017-12-01

The purpose of this study was to estimate the current economic burden of osteoporosis in South Korea using national claim data of the Korean National Health Insurance Service (KNHIS) from 2008 to 2011. Patients aged 50 years or older were identified from KNHIS nationwide database for all records of outpatient visits or hospital admissions. Healthcare costs for osteoporotic patients included direct medical costs for hospitalization, outpatient care, and prescription drugs for the year after discharge. Healthcare costs were estimated based on the perspective of KNHIS, and calculated using a bottom-up approach. Between 2008 and 2011, total healthcare costs for osteoporotic patients increased from 3976 million USD to 5126 million USD, with an annual increase of 9.2% which accounted for one-sixth (16.7%) of national healthcare expenditure. Healthcare cost for hospitalization was the highest ($1903 million, 40.0% of total healthcare cost), followed by cost for outpatient care ($1474 million, 31.0%) and cost for prescription drugs ($1379 million, 29.0%). Although total healthcare cost for osteoporotic men was 6 times lower than that for osteoporotic women, the cost per person was 1.5 times higher than that for women. Total healthcare cost for osteoporotic patients without fractures was higher than that for osteoporotic patients with fractures. However, cost per person was the opposite. Osteoporosis entails substantial epidemiologic and economic burden in South Korea. This study provides information about the total healthcare burden, which could be important when determining what attention and awareness osteoporosis should be given in the public health system.

Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings

PubMed Central

Keus, Frederik; de Jonge, Trudy; Gooszen, Hein G; Buskens, Erik; van Laarhoven, Cornelis JHM

2009-01-01

Background After its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. However, analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome measure. This study focuses on a difference in costs between laparoscopic and small-incision cholecystectomy from a societal perspective with emphasis on internal validity and generalisability Methods A blinded randomized single-centre trial was conducted in a general teaching hospital in The Netherlands. Patients with reasonable to good health diagnosed with symptomatic cholecystolithiasis scheduled for cholecystectomy were included. Patients were randomized between laparoscopic and small-incision cholecystectomy. Total costs were analyzed from a societal perspective. Results Operative costs were higher in the laparoscopic group using reusable laparoscopic instruments (difference 203 euro; 95% confidence interval 147 to 259 euro). There were no significant differences in the other direct cost categories (outpatient clinic and admittance related costs), indirect costs, and total costs. More than 60% of costs in employed patients were caused by sick leave. Conclusion Based on differences in costs, small-incision cholecystectomy seems to be the preferred operative technique over the laparoscopic technique both from a hospital and societal cost perspective. Sick leave associated with convalescence after cholecystectomy in employed patients results in considerable costs to society. Trial registration ISRCTN Register, number ISRCTN67485658. PMID:19732431