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1.
BMC Health Serv Res ; 24(1): 1064, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39272121

RESUMO

BACKGROUND: Quebec's healthcare system faces significant challenges due to labour shortage, particularly in long-term care facilities (CHSLDs). The aging population and increasing demand for services compound this issue. Teleconsultation presents a promising solution to mitigate labour shortage, especially in small CHSLDs outside urban centers. This study aims to evaluate the cost and cost savings associated with teleconsultation in CHSLDs, utilizing the Time-Driven Activity-Based Costing (TDABC) model within the framework of Value-Based Healthcare (VBHC). METHODS: This study focuses on CHSLDs with fewer than 50 beds in remote regions of Quebec, where teleconsultation for nighttime nursing care was implemented. Time and cost data were collected from three CHSLDs over varying periods. The TDABC model, aligned with VBHC principles, was applied through five steps, including process mapping, estimating activity times, calculating resource costs, and determining total costs. RESULTS: Teleconsultation increased the cost per minute for nursing care compared to traditional care, attributed to additional tasks during remote consultations and potential technical challenges. However, cost savings were realized due to reduced need for onsite nursing staff during non-eventful nights. Overall, substantial savings were observed over the project duration, aligning with VBHC's focus on delivering high-value healthcare. CONCLUSIONS: This study contributes both theoretically and practically by demonstrating the application of TDABC within the VBHC framework in CHSLDs. The findings support the cost savings from the use of teleconsultation in small CHSLDs. Further research should explore the long-term sustainability and scalability of teleconsultation across different CHSLD sizes and settings within the VBHC context to ensure high-value healthcare delivery.


Assuntos
Redução de Custos , Assistência de Longa Duração , Consulta Remota , Humanos , Consulta Remota/economia , Redução de Custos/métodos , Assistência de Longa Duração/economia , Quebeque , Custos e Análise de Custo/métodos , Casas de Saúde/economia , Cuidados de Saúde Baseados em Valores
2.
Int J Health Policy Manag ; 13: 8006, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39099514

RESUMO

BACKGROUND: The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards universal health coverage (UHC) by 2030 by providing an Essential Package of Health Services (EPHS). Starting in 2019, the Disease Control Priorities 3rd edition (DCP3) evidence framework was used to guide the development of Pakistan's EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process. METHODS: A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, and bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out. RESULTS: Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing. CONCLUSION: We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.


Assuntos
Cobertura Universal do Seguro de Saúde , Paquistão , Humanos , Cobertura Universal do Seguro de Saúde/economia , Custos e Análise de Custo/métodos , Atenção à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde/economia
3.
Neurosurgery ; 95(3): 556-565, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38465927

RESUMO

BACKGROUND AND OBJECTIVE: Our primary objective was to compare the marginal intraoperative cost of 3 different methods for pedicle screw placement as part of transforaminal lumbar interbody fusions (TLIFs). Specifically, we used time-driven activity-based costing to compare costs between robot-assisted TLIF (RA-TLIF), TLIF with intraoperative navigation (ION-TLIF), and freehand (non-navigated, nonrobotic) TLIF. METHODS: Total cost was divided into direct and indirect costs. We identified all instances of RA-TLIF (n = 20), ION-TLIF (n = 59), and freehand TLIF (n = 233) from 2020 to 2022 at our institution. Software was developed to automate the extraction of all intraoperatively used personnel and material resources from the electronic medical record. Total costs were determined through a combination of direct observation, electronic medical record extraction, and interdepartmental collaboration (business operations, sterile processing, pharmacy, and plant operation departments). Multivariable linear regression analysis was performed to compare costs between TLIF modalities, accounting for patient-specific factors as well as number of levels fused, surgeon, and hospital site. RESULTS: The average total intraoperative cost per case for the RA-TLIF, ION-TLIF, and freehand TLIF cohorts was $24 838 ± $10 748, $15 991 ± $6254, and $14 498 ± $6580, respectively. Regression analysis revealed that RA-TLIF had significantly higher intraoperative cost compared with both ION-TLIF (ß-coefficient: $7383 ± $1575, P < .001) and freehand TLIF (ß-coefficient: $8182 ± $1523, P < .001). These cost differences were primarily driven by supply cost. However, there were no significant differences in intraoperative cost between ION-TLIF and freehand TLIF ( P = .32). CONCLUSION: We demonstrate a novel use of time-driven activity-based costing methodology to compare different modalities for executing the same type of lumbar fusion procedure. RA-TLIF entails significantly higher supply cost when compared with other modalities, which explains its association with higher total intraoperative cost. The use of ION, however, does not add extra expense compared with freehand TLIF when accounting for confounders. This might have implications as surgeons and hospitals move toward bundled payments.


Assuntos
Custos e Análise de Custo , Vértebras Lombares , Procedimentos Cirúrgicos Robóticos , Fusão Vertebral , Humanos , Fusão Vertebral/economia , Fusão Vertebral/métodos , Fusão Vertebral/instrumentação , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Custos e Análise de Custo/métodos , Idoso , Parafusos Pediculares/economia , Adulto
4.
J Trauma Acute Care Surg ; 92(1): e1-e9, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34570063

RESUMO

BACKGROUND: With health care expenditures continuing to increase rapidly, the need to understand and provide value has become more important than ever. In order to determine the value of care, the ability to accurately measure cost is essential. The acute care surgeon leader is an integral part of driving improvement by engaging in value increasing discussions. Different approaches to quantifying cost exist depending on the purpose of the analysis and available resources. Cost analysis methods range from detailed microcosting and time-driven activity-based costing to less complex gross and expenditure-based approaches. An overview of these methods and a practical approach to costing based on the needs of the acute care surgeon leader is presented.


Assuntos
Custos e Análise de Custo/métodos , Cuidados Críticos , Custos de Cuidados de Saúde/classificação , Análise Custo-Benefício/métodos , Cuidados Críticos/economia , Cuidados Críticos/normas , Humanos , Melhoria de Qualidade/organização & administração , Escalas de Valor Relativo
5.
Braz. J. Pharm. Sci. (Online) ; 58: e19586, 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1384008

RESUMO

Abstract Design of experiment (DoE) is a useful time and cost-effective tool for analyzing the effect of independent variables on the formulation characteristics. The aim of this study is to evaluate the effect of the process variables on the characteristics involved in the preparation of Diclofenac Sodium (DC) loaded ethylcellulose (EC) nanoparticles (NP) using Central Composite Design (CCD). NP were prepared by W/O/W emulsion solvent evaporation method. Three factors were investigated (DC/EC mass ratio, PVA concentration, homogenization speed) in order to optimize the entrapment efficiency (EE) and the particle size of NP. The optimal formulation was characterized by Fourier Transform Infrared (FTIR), Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC), and in vitro release. Optimized formulation showed an EE of 49.09 % and an average particle size of 226.83 nm with a polydispersity index of 0.271. No drug-polymer interaction was observed in FTIR and DSC analysis. SEM images showed that the particles are spherical and uniform. The in vitro release study showed a sustained release nature, 53.98 % of the encapsulated drug has been released over 24hours period. This study demonstrated that statistical experimental design methodology can optimize the formulation and the process variables to achieve favorable responses.


Assuntos
Preparações Farmacêuticas , Diclofenaco/análise , Otimização de Processos , Nanopartículas/análise , Técnicas In Vitro/instrumentação , Varredura Diferencial de Calorimetria/instrumentação , Microscopia Eletrônica de Varredura/métodos , Espectroscopia de Infravermelho com Transformada de Fourier , Custos e Análise de Custo/métodos , Metodologia como Assunto , Análise de Fourier
6.
Sci Rep ; 11(1): 24082, 2021 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-34916570

RESUMO

To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. Prospective cohort study between 2011 and 2017. The unexposed group comprised patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. Variables analyzed were demographics, medical comorbidities, treatment, blood parameters, surgical delay, LOS, re-admissions, mortality, and a composite outcome considering in-hospital mortality and/or LOS > 10 days. We performed a Poisson regression and cost analysis. The cohort included 681 patients: 310 unexposed and 371, exposed. The exposed group showed a shorter surgical delay (3.0 vs. 3.6 days; p < 0.001), and a higher proportion received surgery within 48 h (46.1% vs. 34.2%, p = 0.002). They also showed lower rates of 30-day readmission (9.4% vs. 15.8%, p = 0.012), 30-day mortality (4.9% vs. 9.4%, p = 0.021), in-hospital mortality (3.5% vs. 7.7%; p = 0.015), and LOS (8.4 vs. 9.1 days, p < 0.001). Multivariable analysis showed a protective effect of the protocol on the composite outcome (risk ratio 0.62, 95% CI 0.48-0.80, p < 0.001). Hospital costs were reduced by EUR 112,153.3. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients.


Assuntos
Fraturas do Quadril/cirurgia , Equipe de Assistência ao Paciente/economia , Assistência Perioperatória/economia , Assistência Perioperatória/métodos , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo/métodos , Feminino , Fraturas do Quadril/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Tempo para o Tratamento , Resultado do Tratamento
7.
BMC Pregnancy Childbirth ; 21(1): 705, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670514

RESUMO

BACKGROUND: Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is the application of a time-driven activity-based method in order to estimate the cost of childbirth at a maternal department. Moreover, this study shows how this costing method can be used to outline how childbirth costs vary according to considered patient and disease characteristics. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost. METHODS: A prospective cohort study design is performed in a maternity department. Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly. RESULTS: Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+ 33,3 min) and monitoring (+ 775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >  25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks. CONCLUSIONS: TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.


Assuntos
Custos e Análise de Custo/métodos , Parto Obstétrico/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Parto , Adulto , Bélgica , Feminino , Humanos , Gravidez , Estudos Prospectivos
8.
J Manag Care Spec Pharm ; 27(9): 1309-1313, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464208

RESUMO

During the Trump administration, members of Congress and the administration proposed the introduction of international reference pricing (IRP) to Medicare in order to reduce US drug spending by benchmarking prices to those in other countries. Many other countries currently use IRP. We examined how US policy proposals compare with the implementation of IRP in the countries that would be referenced by the United States. Nearly two-thirds of comparator countries use IRP but also use other price negotiation strategies. The congressional proposal was most like the approach used by other countries, while the Trump administration's proposals took an uncommon approach to IRP by not adopting additional pricing strategies. DISCLOSURES: This work was supported by Arnold Ventures, which provided overall funding but was not involved in conception, design, or conduct of this work. Kesselheim provides guidance to the Massachusetts Health Policy Commission on its prescription drug price review process under a contract to Brigham and Women's Hospital but does not receive personal funding for this work. Rand has nothing to disclose.


Assuntos
Custos e Análise de Custo/métodos , Internacionalidade , Medicamentos sob Prescrição/economia , Custos de Medicamentos , Produto Interno Bruto , Estados Unidos
9.
Urology ; 157: 107-113, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34391774

RESUMO

OBJECTIVE: To characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. METHODS: We defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces. This facilitated calculation of cost per minute for all aspects of care delivery, which were multiplied by associated process times. These were added to consumable costs to determine cost for each specific step and later aggregated to determine total cost for each sub-process. We compared costs of eight common clinical pathways for acute stone management, defining total cycle of care cost as the sum of all sub-processes that comprised each pathway. RESULTS: Cost per sub-process included $920 for emergency department (ED) care, $1665 for operative stent placement, $2368 for percutaneous nephrostomy tube placement, $106 for urology clinic consultation, $238 for preoperative center visit, $4057 for ureteroscopy with laser lithotripsy (URS), $2923 for extracorporeal shock wave lithotripsy, $169 for clinic stent removal, $197 for abdominal x-ray, and $166 for ultrasound. The lowest cost pathway ($1388) was for medical expulsive therapy, whereas the most expensive pathway ($8002) entailed a repeat ED visit prompting temporizing stent placement and interval URS. CONCLUSION: We found a high degree of cost variation between care pathways common to management of acute ureteral stone episodes. Reliable cost accounting data and an understanding of variability in clinical pathway costs can inform value-based care redesign as payors move away from pure fee-for-service reimbursement.


Assuntos
Custos de Cuidados de Saúde , Cálculos Ureterais/economia , Cálculos Ureterais/terapia , Doença Aguda , Custos e Análise de Custo/métodos , Remoção de Dispositivo/economia , Serviço Hospitalar de Emergência/economia , Humanos , Litotripsia a Laser/economia , Nefrostomia Percutânea/economia , Cuidados Pré-Operatórios/economia , Implantação de Prótese/economia , Radiografia Abdominal/economia , Encaminhamento e Consulta/economia , Stents/economia , Ultrassonografia/economia , Cálculos Ureterais/diagnóstico por imagem , Ureteroscopia/economia
10.
Clin Radiol ; 76(11): 862.e19-862.e28, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34261595

RESUMO

AIM: To quantify the real-world clinical and cost impact of computed tomography (CT) coronary angiography (CTCA)-derived fractional flow reserve (FFRCT) in the National Health Service (NHS). MATERIALS AND METHODS: Consecutive clinical CTCA examinations from September to December 2018 with ≥1 stenosis of ≥25% underwent FFRCT analysis. The Heart Team reviewed clinical data and CTCA findings, blinded to FFRCT values, and documented hypothetical consensus management. FFRCT results were then unblinded and hypothetical consensus management re-recorded. Diagnostic waiting times for management pathways were estimated. A per-patient cost analysis for diagnostic certainty regarding coronary artery disease (CAD) management was performed using 2014-2020 NHS tariffs for pre- and post-FFRCT pathways. RESULTS: Two hundred and fifty-one CTCAs were performed during the study period. Fifty-seven percent (145/251) had no CAD or stenosis <25%. One study was non-diagnostic. Of the remaining 42% (105/251), two were ineligible for FFRCT and there was a 5% (5/103) failure rate. FFRCT led to a change in hypothetical management in 65% (64/98; p<0.001) patients with a functional imaging test cancelled in 17% (17/98) and a diagnostic angiogram cancelled in 47% (46/98). FFRCT-guided management had a reduced mean time to definitive investigation compared with CTCA alone (28 ± 4 versus 44 ± 4 days; p=0.004). Using the proposed 2020/21 tariff, CTCA + FFRCT for stenosis ≥50% resulted in a diagnostic pathway £44.97 more expensive per patient than usual care without FFRCT. CONCLUSIONS: In the real-world NHS setting, FFRCT-guided management has the potential to rationalise patient management, accelerate diagnostic pathways, and depending on the stenosis severity modelled, may be cost-effective.


Assuntos
Angiografia por Tomografia Computadorizada/economia , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/economia , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Custos e Análise de Custo/métodos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Estenose Coronária/economia , Estenose Coronária/fisiopatologia , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Medicina Estatal , Reino Unido
11.
J Plast Reconstr Aesthet Surg ; 74(10): 2458-2466, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34217645

RESUMO

BACKGROUND: Economic evaluations in healthcare are designed to inform decisions by the estimation of cost and effect trade-off of two or more interventions. This review identified and appraised the quality of reporting of economic evaluations in plastic surgery based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. METHODS: Electronic databases were searched: MEDLINE, EMBASE, The Cochrane Library, Ovid Health Star, and Business Source Complete from January 1, 2012 to November 30, 2019. Data extracted included: the type of economic evaluation (i.e., cost-utility analysis (CUA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), cost-minimization analysis (CMA)), domain of plastic surgery, journal, year, and country of publication. The CHEERS checklist (with 24 items) was used to appraise the quality of reporting. RESULTS: Ninety-two economic evaluations were identified; CUA (10%), CEA (31%), CBA (4%), and CMA (50%). Breast surgery was the top domain (48%). Most were conducted in the USA (61%) and published in Plastic and Reconstructive Surgery journal (28%). One-third were published in the last two years. The average CHEERS checklist compliance score was 15 (63%). The average CHEERS checklist compliance score per type of evaluation was 19 (77%) for CUA, 17 (70%) for CEA, 13 (52%) for CBA, and 14 (57%) for CMA. The least reported CHEERS checklist items included: time horizon (15%), discount rate (18%), and assessment of heterogeneity (15%). Thirty-two percent of studies were inappropriately titled (i.e., methodologically incorrect). CONCLUSION: Quality of reporting of economic evaluations is suboptimal. The CHEERS checklist should be consulted when performing and reporting economic evaluations in plastic surgery.


Assuntos
Análise Custo-Benefício/normas , Setor de Assistência à Saúde/economia , Cirurgia Plástica/economia , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Humanos
12.
Health Serv Res ; 56(4): 635-642, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34080188

RESUMO

OBJECTIVE: To compare the predictive accuracy of two approaches to target price calculations under Bundled Payments for Care Improvement-Advanced (BPCI-A): the traditional Centers for Medicare and Medicaid Services (CMS) methodology and an empirical Bayes approach designed to mitigate the effects of regression to the mean. DATA SOURCES: Medicare fee-for-service claims for beneficiaries discharged from acute care hospitals between 2010 and 2016. STUDY DESIGN: We used data from a baseline period (discharges between January 1, 2010 and September 30, 2013) to predict spending in a performance period (discharges between October 1, 2015 and June 30, 2016). For 23 clinical episode types in BPCI-A, we compared the average prediction error across hospitals associated with each statistical approach. We also calculated an average across all clinical episode types and explored differences by hospital size. DATA COLLECTION/EXTRACTION METHODS: We used a 20% sample of Medicare claims, excluding hospitals and episode types with small numbers of observations. PRINCIPAL FINDINGS: The empirical Bayes approach resulted in significantly more accurate episode spending predictions for 19 of 23 clinical episode types. Across all episode types, prediction error averaged $8456 for the CMS approach versus $7521 for the empirical Bayes approach. Greater improvements in accuracy were observed with increasing hospital size. CONCLUSIONS: CMS should consider using empirical Bayes methods to calculate target prices for BPCI-A.


Assuntos
Custos e Análise de Custo/métodos , Medicare/organização & administração , Pacotes de Assistência ao Paciente/economia , Mecanismo de Reembolso/organização & administração , Teorema de Bayes , Centers for Medicare and Medicaid Services, U.S./organização & administração , Planos de Pagamento por Serviço Prestado/economia , Humanos , Revisão da Utilização de Seguros , Medicare/economia , Mecanismo de Reembolso/economia , Estados Unidos
13.
PLoS One ; 16(6): e0252138, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34081711

RESUMO

Facing the pressure of environment, sustainable development is the demand of the current construction industry development. Prefabricated construction technologies has been actively promoted in China. Cost has always been one of the important factors in the development of prefabricated buildings. The hidden cost of prefabricated buildings has a great impact on the total cost of the project, and it exists in the whole process of building construction. In this paper innovatively studies the cost of prefabricated buildings from the perspective of hidden cost. In order to analysis the hidden cost of prefabricated buildings, the influencing factor index system in terms of design, management, technology, policy and environment has been established, which includes 13 factors in total. And the hidden cost analysis model has been proposed based on FISM-BN, this model combines fuzzy interpretive structure model(FISM) with Bayesian network(BN). This model can comprehensively analyze the hidden cost through the combination of qualitative and quantitative methods. And the analysis process is dynamic, not fixed at a certain point in time to analyze the cost. We can get the internal logical relationship among the influencing factors of the hidden cost, and present it in the form of intuitive chart by FISM-BN. Furthermore the model could not only predict the probability of the hidden cost of prefabricated buildings and realize in-time control through causal reasoning, but also predict the posterior probability of other influencing factors through diagnostic reasoning when the hidden cost occurs and find out the key factors that lead to the hidden cost. Then the final influencing factors are determined after one by one check. Finally, the model is demonstrated on the hidden cost analysis of prefabricated buildings the probability of recessive cost is 26%. In the analysis and control of the hidden cost of prefabricated buildings, scientific and effective decision-making and reference opinions are provided for managers.


Assuntos
Indústria da Construção/economia , Controle de Custos/economia , Custos e Análise de Custo/métodos , China , Tomada de Decisões , Financiamento de Construções , Humanos , Modelos Teóricos , Inquéritos e Questionários , Urbanização
14.
PLoS One ; 16(5): e0251406, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33974661

RESUMO

BACKGROUND: Back pain is a common and costly health problem worldwide. There is yet a lack of consistent methodologies to estimate the economic burden of back pain to society. OBJECTIVE: To systematically evaluate the methodologies used in the published cost of illness (COI) literature for estimating the direct and indirect costs attributed to back pain, and to present a summary of the estimated cost burden. METHODS: Six electronic databases were searched to identify COI studies of back pain published in English up to February 2021. A total of 1,588 abstracts were screened, and 55 full-text studies were subsequently reviewed. After applying the inclusion criteria, 45 studies pertaining to the direct and indirect costs of back pain were analysed. RESULTS: The studies reported data on 15 industrialised countries. The national cost estimates of back pain in 2015 USD ranged from $259 million ($29.1 per capita) in Sweden to $71.6 billion ($868.4 per capita) in Germany. There was high heterogeneity among the studies in terms of the methodologies used for analysis and the resulting costs reported. Most of the studies assessed costs from a societal perspective (n = 29). The magnitude and accuracy of the reported costs were influenced by the case definition of back pain, the source of data used, the cost components included and the analysis method. Among the studies that provided both direct and indirect cost estimates (n = 15), indirect costs resulting from lost or reduced work productivity far outweighed the direct costs. CONCLUSION: Back pain imposes substantial economic burden on society. This review demonstrated that existing published COI studies of back pain used heterogeneous approaches reflecting a lack of consensus on methodology. A standardised methodological approach is required to increase credibility of the findings of COI studies and improve comparison of estimates across studies.


Assuntos
Dor nas Costas/economia , Efeitos Psicossociais da Doença , Custos e Análise de Custo/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Europa (Continente) , Humanos , Japão , América do Norte
15.
J Investig Med ; 69(7): 1372-1376, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33712521

RESUMO

We performed a retrospective study of cardiology telemedicine visits at a large academic pediatric center between 2016 and 2019 (pre COVID-19). Telemedicine patient visits were matched to data from their previous in-person visits, to evaluate any significant differences in total charge, insurance compensation, patient payment, percent reimbursement and zero reimbursement. Miles were measured between patient's home and the address of previous visit. We found statistically significant differences in mean charges of telemedicine versus in-person visits (2019US$) (172.95 vs 218.27, p=0.0046), patient payment for telemedicine visits versus in-person visits (2019US$) (11.13 vs 62.83, p≤0.001), insurance reimbursement (2019US$) (65.18 vs 110.85, p≤0.001) and insurance reimbursement rate (43% vs 61%, p=0.0029). Rate of zero reimbursement was not different. Mean distance from cardiology clinic was 35 miles. No adverse outcomes were detected. This small retrospective study showed cost reduction and a decrease in travel time for families participating in telemedicine visits. Future work is needed to enhance compensation for telemedicine visits.


Assuntos
Assistência Ambulatorial , Serviço Hospitalar de Cardiologia , Doenças Cardiovasculares , Custos e Análise de Custo , Telemedicina , Assistência Ambulatorial/economia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , COVID-19/epidemiologia , Serviço Hospitalar de Cardiologia/economia , Serviço Hospitalar de Cardiologia/tendências , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Criança , Redução de Custos/métodos , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Saúde da Família , Feminino , Acessibilidade aos Serviços de Saúde/economia , Cardiopatias Congênitas/economia , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Humanos , Masculino , Estudos Retrospectivos , SARS-CoV-2 , Telemedicina/economia , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia
16.
Goiania; SES-GO; 21 jan. 2021. 1-3 p. mapas.
Não convencional em Português | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1148393

RESUMO

O Sistema único de Saúde (SUS) tem o desafio de equilibrar uma crescente demanda de serviços de saúde de um país de proporções continentais como o Brasil, frente à necessidade de administrar recursos escassos, considerando a complexidade das instituições de saúde (DELA PASE, 2015), e enfrentando ainda limitações na qualidade da atenção, na incorporação de novas tecnologias, na gestão de seus recursos e na distribuição equitativa dos serviços (LAFORGIA, 2009, apud MPMA, 2017). Diante deste cenário, o Ministério da Saúde (MS) instituiu o Programa Nacional de Gestão de Custos (PNGC), tendo por objetivo promover a cultura de gestão de custos no âmbito do SUS, com foco na qualidade do gasto, oferecendo ferramentas e capacitação para auxiliar os gestores na melhoria dos processos, para produzir informação gerencial e apoiar a tomada de decisões (BRASIL, 2018).


The Unified Health System (SUS) has the challenge of balancing a growing demand for health services in a country of continental proportions such as Brazil, given the need to manage scarce resources, considering the complexity of health institutions (DELA PASE, 2015), and also facing limitations in the quality of care, in the incorporation of new technologies, in the management of its resources and in the equitable distribution of services (LAFORGIA , 2009, apud MPMA, 2017). Given this scenario, the Ministry of Health (MS) instituted the National Cost Management Program (PNGC), aiming to promote the culture of cost management within the SUS, focusing on the quality of spending, offering tools and training to assist managers in improving processes, to produce management information and support decision-making (BRASIL, 2018).


Assuntos
Orçamentos/métodos , Gastos em Saúde/normas , Custos e Análise de Custo/métodos
17.
Clin Radiol ; 76(3): 202-212, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33109348

RESUMO

AIM: To map current contrast-enhanced computed tomography (CT) pathways, develop a risk-stratified pathway, and model associated costs and resource use. MATERIALS AND METHODS: Phase 1 comprised multicentre mapping of current practice and development of an alternative pathway, replacing pre-assessment of estimated glomerular filtration rate (eGFR) with a scan-day screening questionnaire for risk stratification and point of care (PoC) creatinine. Phase 2 measured resource use and analysis of routinely collected data, used to populate a model comparing the costs of current and risk-stratified pathways in Phase 3. RESULTS: Site variation across a range of processes within the clinical care pathway was identified. Data from a single centre suggested that 78% (n=347/447) could have avoided their pre-scan laboratory test as they did not have post-contrast acute kidney injury (AKI) risk factors. Only 24% of outpatients who underwent computed tomography (CT) would have identified risk factors, which would have prompted a scan-day PoC test. There was a 94% probability that the risk-stratified pathway was cost-saving, with an estimated 5-year potential cost saving of £69,620 (95% CI: -£13,295-£154,603). Although the cost of a laboratory serum creatinine test is cheaper than the PoC equivalent (£5.29 versus £5.96), the screening questionnaire ruled out the need for a large majority of the eGFR measurements specifically for the CT examination. CONCLUSION: The present study proposes an alternative pathway, which has the potential to improve the efficiency of the current CT pathway. A multicentre appraisal is required to demonstrate the impact of embedding this new pathway on a wider NHS level, particularly in light of new diagnostic guidance (DG37) published by NICE.


Assuntos
Meios de Contraste/efeitos adversos , Meios de Contraste/economia , Custos e Análise de Custo/métodos , Testes de Função Renal/métodos , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste/administração & dosagem , Custos e Análise de Custo/estatística & dados numéricos , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Medicina de Precisão/métodos , Intensificação de Imagem Radiográfica/economia , Medição de Risco , Fatores de Risco
18.
J Plast Reconstr Aesthet Surg ; 74(6): 1279-1285, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33279430

RESUMO

The aim of the study is to evaluate costs of free flap surgery for head and neck (H & N) reconstructions using the time-driven activity-based costing (ABC) method and to compare them with the refund provided by the Italian National Health System (NHS) amounting to 11,891€. We retrospectively selected 29 consecutive patients underwent free flap reconstruction in 2013 at IRCCS Casa Sollievo della Sofferenza. Patients were divided into three groups: Group 1 (n = 10) included patients receiving radial forearm free flap (RFFF), Group 2 (n = 10) receiving anterolateral thigh (ALT) free flap, and Group 3 (n = 9) composed of patients having fibular free flap. For each patient, costs were calculated using the ABC and divided into instay, surgical, and services costs. We observed an overall mean total cost of 27,802.40€. The mean costs related to hospital stay were 9,800.70€. The mean costs for surgery were 13,097.60€ and amounted to 4,904.10€ for services. RFFF appears to be less costing (25,175.40€) compared with ALT (29,191.60€) and fibula free flap (29,040.20€). ABC is an appropriate method to determine actual costs of free flap surgery by correctly allocating the resources used. The Italian NHS tariff seems to be inadequate to cover the real cost of this type of surgery.


Assuntos
Custos e Análise de Custo , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Procedimentos de Cirurgia Plástica , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Atenção à Saúde/economia , Feminino , Retalhos de Tecido Biológico/classificação , Retalhos de Tecido Biológico/economia , Neoplasias de Cabeça e Pescoço/economia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/economia , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos
19.
J Am Geriatr Soc ; 69(4): 916-923, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33368171

RESUMO

BACKGROUND/OBJECTIVES: To evaluate differences in end-of-life cost trajectories for cancer patients treated through Medicare versus by the Veterans Health Administration (VA). DESIGN: A retrospective analysis of VA and Medicare administrative data from FY 2010 to 2014. We employed three-level generalized estimating equations to evaluate monthly cost trajectories experienced by patients in their last year of life, with patients nested within hospital referral region. SETTING: Care received at VA facilities or by Medicare-reimbursed providers nationwide. PARTICIPANTS: A total of 36,401 patients dying from cancer and dually enrolled in VA and Medicare. MEASUREMENTS: We evaluated trajectories for total, inpatient, outpatient, and drug costs, using the last 12 months of life. Cost trajectories were prioritized as costs are not directly comparable across Medicare and VA. Patients were assigned to be VA-reliant, Medicare-reliant or Mixed-reliant based on their healthcare utilization in the last year of life. RESULTS: All three groups experienced significantly different cost trajectories for total costs in the last year of life. Inpatient cost trajectories were significantly different between Medicare-reliant and VA-reliant patients, but did not differ between VA-reliant and Mixed-reliant patients. Outpatient and drug cost trajectories exhibited the inverse pattern: they were significantly different between VA-reliant and Mixed-reliant patients, but not between VA-reliant and Medicare-reliant patients. However, visual examination of cost trajectories revealed similar cost patterns in the last year of life among all three groups; there was a sharp rise in costs as patients approach death, largely due to inpatient care. CONCLUSION: Despite substantially different financial incentives and organization, VA- and Medicare-treated patients exhibit similar patterns of increasing end-of-life costs, largely driven by inpatient costs. Both systems require improvement to ensure quality of end-of-life care is aligned with recommended practice.


Assuntos
Assistência Ambulatorial/economia , Custos e Análise de Custo , Hospitalização/economia , Medicare/economia , Neoplasias , Assistência Terminal , Idoso , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Hospitais de Veteranos/economia , Humanos , Masculino , Avaliação das Necessidades , Neoplasias/economia , Neoplasias/epidemiologia , Neoplasias/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Assistência Terminal/economia , Assistência Terminal/métodos , Assistência Terminal/normas , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/estatística & dados numéricos
20.
JAMA Netw Open ; 3(12): e2028510, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33295971

RESUMO

Importance: High out-of-pocket drug costs can cause patients to skip treatment and worsen outcomes, and high insurer drug payments could increase premiums. Drug wholesale list prices have doubled in recent years. However, because of manufacturer discounts and rebates, the extent to which increases in wholesale list prices are associated with amounts paid by patients and insurers is poorly characterized. Objective: To determine whether increases in wholesale list prices are associated with increases in amounts paid by patients and insurers for branded medications. Design, Setting, and Participants: Cross-sectional retrospective study analyzing pharmacy claims for patients younger than 65 years in the IBM MarketScan Commercial Database and pricing data from SSR Health, LLC, between January 1, 2010, and December 31, 2016. Pharmacy claims analyzed represent claims of employees and dependents participating in employer health benefit programs belonging to large employers. Rebate data were estimated from sales data from publicly traded companies. Analysis focused on the top 5 patent-protected specialty and 9 traditional brand-name medications with the highest total drug expenditures by commercial insurers nationwide in 2014. Data were analyzed from July 2017 to July 2020. Exposures: Calendar year. Main Outcomes and Measures: Changes in inflation-adjusted amounts paid by patients and insurers for branded medications. Results: In this analysis of 14.4 million pharmacy claims made by 1.8 million patients from 2010-2016, median drug wholesale list price increased by 129% (interquartile range [IQR], 78%-133%), while median insurance payments increased by 64% (IQR, 28%-120%) and out-of-pocket costs increased by 53% (IQR, 42%-82%). The mean percentage of wholesale list price accounted for by discounts increased from 17% in 2010 to 21% in 2016, and the mean percentage of wholesale list price accounted for by rebates increased from 22% in 2010 to 24% in 2016. For specialty medications, median patient out-of-pocket costs increased by 85% (IQR, 73%-88%) from 2010 to 2016 after adjustment for inflation and 42% (IQR, 25%-53%) for nonspecialty medications. During that same period, insurer payments increased by 116% for specialty medications (IQR, 100%-127%) and 28% for nonspecialty medications (IQR, 5%-34%). Conclusions and Relevance: This study's findings suggest that drug list prices more than doubled over a 7-year study period. Despite rising manufacturer discounts and rebates, these price increases were associated with large increases in patient out-of-pocket costs and insurer payments.


Assuntos
Custos e Análise de Custo , Custos de Medicamentos/tendências , Gastos em Saúde , Seguradoras , Medicamentos sob Prescrição , Custos e Análise de Custo/métodos , Custos e Análise de Custo/tendências , Medicamentos Essenciais/economia , Medicamentos Genéricos/economia , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Humanos , Seguradoras/economia , Seguradoras/estatística & dados numéricos , Revisão da Utilização de Seguros , Medicamentos sob Prescrição/classificação , Medicamentos sob Prescrição/economia , Estados Unidos
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