Cost-per-Response Analysis of Pure Hypochlorous Acid Among Patients with Chronic Venous Leg Ulcers: A Health Economic Analysis.

OBJECTIVE: To estimate the total cost-per-wound healing response (CPR) and the per-day CPR of patients with chronic leg ulcers treated with pure hypochlorous acid (pHA) as part of their overall would healing regimen. METHODS: The authors developed a deterministic decision-tree model to estimate the incremental CPR for pHA. The analysis was performed using clinical data from a published single-arm prospective study. The outcome of interest was re-epithelialization at 90 days. Economic data for pHA were based on public prices of pHA per dressing change from the wound care center perspective. The following time points were assessed: 90, 60, and 30 days. Dressing changes occurred every 2.5 days. Sensitivity analysis was performed to gauge the robustness of the results. RESULTS: A total of 31 patients (68% women) with 31 lesions (average age of wound, 29 months; range, 1-240 months) were included in the clinical study. Re-epithelialization occurred in 23 lesions (74%) at 90 days, 17 (55%) at 60 days, and 3 (10%) at 30 days. The total CPRs were $75.69, $68.27, and $193.44, and the per-day CPRs were $0.84, $1.13, and $6.45 at 90, 60, and 30 days, respectively. The sensitivity analysis revealed that CPRs ranged from $0.63 to $1.12 per day at 90 days. CONCLUSIONS: Incorporating pHA into standard wound healing protocols is a minimal added expense and may yield a substantial economic savings of $2,695 at 90 days.

Health Economic Analysis of Two-Layer Bandage System for Treatment of Chronic Venous Insufficiency.

Background: Compression therapy is the gold standard for the treatment of chronic venous insufficiency (CVI). Two-layer bandage (2LB) systems have been shown to be a safe and effective treatment option. Objective: To estimate the total cost per response (CPR) for the resolution of edema and wounds in patients with CVI treated with a 2LB system as part of their overall wound healing regimen. Methods: A probabilistic decision tree model was developed to estimate the incremental CPR for a 2LB system. The model simulated 10 000 patients to estimate the CPR for the resolution of edema and wound healing. The analysis was performed using clinical data from a published single-arm, multicenter prospective study of CVI indicated for compression therapy. The response outcomes of interest were resolution of edema and rate of wound healing. The follow-up time was a maximum of 6 weeks, and the perspective of the study was a US outpatient treatment center. Economic data for compression therapy were based on the public prices of a 2LB system. Dressing changes occurred per manufacturer instructions for use. Results: The study comprised 702 patients (56% female), with a total of 414 wounds. The median duration of the wounds was 42 days, and the median size at the initial visit was 3.5 cm2. The average pain reduction fell by 67% using a visual analog score. Bandages were typically changed once or twice a week (51.7%). Wound healing occurred in 128 of the 414 wounds (30.9%). The expected incremental CPR of a 2LB system for the resolution of edema was $65.67 (range, $16.67-$124.32). The expected incremental CPR of a 2LB system for the healing of a wound was $138.71 (range, $35.71-$273.53). Conclusion: This economic evaluation complements previous clinical effectiveness and safety studies of 2LB systems for the treatment of CVI. The results demonstrate that the costs of incorporating 2LB into standard wound-healing protocols are negligible compared with overall treatment costs. Two-layer bandages may be considered a cost-effective first-line system for the treatment of wounds caused by CVI.

Time and labor costs of compression therapy wrap system for lower extremity edema: results from a single center.

INTRODUCTION: Compression therapy is the standard of care for the treatment of lower extremity edema. However, compression therapy systems can be time-consuming to apply, which adds costs to the health care system and further strains human resources. OBJECTIVE: The purpose of this study was to assess time and labor costs associated with the application of a 2LB versus 4LB compression therapy system. MATERIALS AND METHODS: Time and labor cost data associated with the application of a 2LB system for the treatment of lower extremity edema of all etiologies were collected from a single high-volume wound care center located in Dayton, Ohio. The time and labor costs were compared to a 4LB system over the course of a single day (n = 38). RESULTS: The application time and associated costs were 50% lower for the 2LB system. The expected savings of a 2LB compression system over the course of a month was 16:27 hours and $427 compared to a 4LB compression system, and the revenue gain was estimated at $15 210 revenue per month over the course of the month for the practice. CONCLUSION: The use of a 2LB compression system may be associated with substantial time and cost savings compared to a 4LB system.

The High Cost of Death After Acute Myocardial Infarctions: Results from a National US Hospital Database.

Introduction: This study described the differences in costs and length of stay (LOS) among patients with AMI who died versus survived using a large, nationally representative cohort of AMI patients. Methods: The 2019 HCUP NIS was used to analyze costs, and LOS among all patients with a principal diagnosis of AMI. A propensity-score matched analysis and multivariable regression were used to adjust for patient and hospital characteristics. Results: There were 4559 visits in each of the cohorts (total 9118). The adjusted mean hospital cost was $18,970 (95% CI $16,453 - $21,871) for those that survived and $23,173 (95% CI $20,167 - $26,626; p <0.001) for those that died. The LOS was 3.95 (95% CI 3.41-4.57) in survivors and 4.24 (95% CI 3.67-4.89; p <0.001) in those who died. Conclusion: Survivors of AMI incurred lower costs and length of stay than those who died. Higher costs were attributed to greater LOS and higher-level care. The results suggest that economic evaluations of cardiovascular interventions that do not include the cost of dying may underestimate the benefits of the intervention.

A Retrospective Health Economic Analysis of a Stable Hypochlorous Acid Preserved Wound Cleanser Versus 0.9% Saline Solution as Instillation for Negative-Pressure Wound Therapy in Severe and Infected Wounds.

Introduction Negative-pressure wound therapy (NPWT) with instillation and dwell time is an accepted adjunct therapy for infected wounds. A study was conducted to assess whether the use of hypochlorous acid preserved wound cleanser (HAPWOC) (Vashe, Urgo Medical North America, Fort Worth, TX, USA) as the irrigant would reduce the cost of care in comparison to 0.9% saline (NaCl). Method A comparative, observational, retrospective analysis assessed 27 serious and infected wounds in 24 patients. The lesions were of different and complex etiologies, including necrotizing fasciitis and stage IV diabetic foot ulcers. NPWT was used as part of the overall multimodal treatment regimen. The only variance in the treatment protocol was the use of saline (N=8) or HAPWOC (N=19) as the irrigant. Results When compared to NaCl, wounds treated with HAPWOC trended toward fewer operating room (OR) visits versus NaCl (3.3 versus 4.1) and a shorter length of hospital stay (LOS) (24.3 days versus 37.9 days). The Orlando Health Transparency guide shows the cost of OR debridement as $2,525. Thus, debridement for HAPWOC-treated wounds ($8,332) costs $2,020 (24%) less than for NaCl-treated wounds ($10,352). Using the 2016 Kaiser Health data (average daily hospital cost, excludingall interventions: $2,052), the cost of HAPWOC and NaCl instill translates to $49,864 and $77,771, respectively, a difference of $27,906 (56%) more for NaCl treatment. The Agency for Healthcare Research and Quality (AHRQ) 2012 data indicate an average daily cost of hospital stay, including all interventions, of $10,400. Thus, HAPWOC treatment cost translates to $252,720 versus NaCl-related costs of $394,160; in these calculations, using NaCl costs $141.440 (+56%) more per patient than HAPWOC. Conclusion The use of NPWT with HAPWOC versus NaCl as instillation in NPWT reduces the number of visits to the operating room and LOS. This has a significant impact on lowering the cost of care when HAPWOC is used.

Cost-effectiveness of catheter ablation versus medical therapy for the treatment of atrial fibrillation in the United Kingdom.

INTRODUCTION: Research evidence has shown that catheter ablation is a safe and superior treatment for atrial fibrillation (AF) compared to medical therapy, but real-world practice has been slow to adopt an early interventional approach. This study aims to determine the cost effectiveness of catheter ablation compared to medical therapy from the perspective of the United Kingdom. METHODS: A patient-level Markov health-state transition model was used to conduct a cost-utility analysis. The population included patients previously treated for AF with medical therapy, including those with heart failure (HF), simulated over a lifetime horizon. Data sources included published literature on utilization and cardiovascular event rates in real world patients, a systematic literature review and meta-analysis of randomized controlled trials for AF recurrence, and publicly available government data/reports on costs. RESULTS: Catheter ablation resulted in a favorable incremental cost-effectiveness ratio (ICER) of £8614 per additional quality adjusted life years (QALY) gained when compared to medical therapy. More patients in the medical therapy group failed rhythm control at any point compared to catheter ablation (72% vs. 24%) and at a faster rate (median time to treatment failure: 3.8 vs. 10 years). Additionally, catheter ablation was estimated to be more cost-effective in patients with AF and HF (ICER = £6438) and remained cost-effective over all tested time horizons (10, 15, and 20 years), with the ICER ranging from £9047-£15 737 per QALY gained. CONCLUSION: Catheter ablation is a cost-effective treatment for atrial fibrillation, compared to medical therapy, from the perspective of the UK National Health Service.

Cost-Effectiveness of Hypochlorous Acid Preserved Wound Cleanser versus Saline Irrigation in Conjunction with Ultrasonic Debridement for Complex Wounds.

Objective: Low-frequency ultrasound debridement with irrigation is an effective method of wound bed preparation. A recent clinical study compared hypochlorous acid preserved wound cleanser (HAPWOC) to saline and found HAPWOC to be a more effective adjunct to low frequency ultrasound debridement. However, HAPWOC has an added cost. The primary objective of this study was to assess the cost-effectiveness of HAPWOC as an irrigation modality with low-frequency ultrasound debridement for the treatment of severely complex wounds that were destined to be closed primarily via a flap. The secondary objective of this study was to estimate the number needed to treat (NNT) to avoid a wound-related complication and its expected cost per NNT. Methods: A patient-level Monte-Carlo simulation model was used to conduct a cost-effectiveness analysis from the US health system perspective. All clinical data were obtained from a prospective clinical trial. Cost data were obtained from the publicly available data sources in 2021 US dollars. The effect measure was the avoidance of wound-related complications at 14-days post-debridement. The primary outcome was the incremental cost-effectiveness ratio (ICER), a measure of the additional cost per benefit. The secondary outcomes were the NNT and expected cost per NNT to avoid one complication (complementary to the ICER in assessing cost-effectiveness). Deterministic and probabilistic sensitivity analyses (PSA) were performed to gauge the robustness and reliability of the results. Results: The ICER for HAPWOC versus saline irrigation was US$90.85 per wound complication avoided. The expected incremental cost per patient in the study and effect was US$49.97 with 55% relative reduction in wound-related complications at day 14 post debridement procedure. The NNT and cost per NNT were 2 and US$99.94, respectively. Sensitivity analyses demonstrated that these results were robust to variation in model parameters. Conclusion: HAPWOC was a cost-effective strategy for the treatment of complex wounds during ultrasonic debridement. For every two patients treated with HAPWOC, one complication was avoided.

Cost-utility analysis of single nucleotide polymorphism panel-based machine learning algorithm to predict risk of opioid use disorder.

Aim: To conduct a cost-utility analysis of a novel genetic diagnostic test (OUDTEST) for risk of developing opioid use disorder for elective orthopedic surgery patients. Materials & Methods: A simulation model assessed cost-effectiveness and quality-adjusted life-years (QALYs) for OUDTEST from private insurer and self-insured employer perspectives over a 5-year time horizon for a hypothetical patient population. Results: OUDTEST was found to cost less and increase QALYs, over a 5-year period for private insurance (savings US$2510; QALYs 0.02) and self-insured employers (-US$2682; QALYs 0.02). OUDTEST was a dominant strategy in 71.1% (private insurance) and 72.7% (self-insured employer) of model iterations. Sensitivity analyses revealed robust results except for physician compliance. Conclusion: OUDTEST was expected to be a cost-effective solution for personalizing postsurgical pain management in orthopedic patients.

Estimates of the value of life lost from COVID-19 in Ohio.

The economic burden of mortality due to the novel coronavirus (COVID-19) extends beyond the lives lost. Data from the Ohio Department of Public Health and Social Security Administration was used to estimate the years of potential life lost, 72,274 and economic value of those lost lives, US$17.39 billion. These estimates may be used to assess the risk-trade off of COVID-19 mitigation strategies in Ohio.

Economic Analysis of the European Healthcare Burden of Sternal-Wound Infections Following Coronary Artery Bypass Graft.

Background: Sternal wound infections (SWIs) can be some of the most complex surgical-site infections (SSIs) and pose a considerable risk following coronary artery bypass graft surgery (CABG). Objective: To capture the cost burden of SWIs following CABG across European countries. Methods: We modeled a standardized care pathway for CABG, starting at the point of surgery and extending to 1-year post surgery. The Markov model captures the incidence and cost of an SWI (deep or superficial SWIs). The cost burden is calculated from a hospital perspective such that the main inputs relating to costs were intensive-care-unit (ICU) and general-ward (GW) days. Outpatient care, not in the hospital setting, has no cost in this analysis. Model input parameters were taken from Eurostat and a review of published, peer-reviewed literature. European countries were included in this analysis when values for 50% of the required input parameters per country were identified. Missing data points were interpolated from available data. The robustness of results was assessed via probabilistic sensitivity analysis. Results: Full required input data were available for 8 European countries; a further 18 countries had sufficient data for analysis. The median (interquartile range) for SWI incidence across the 26 countries was 3.9% (2.9-5.6%). The total burden for all 26 countries of SWIs after CABG was €170.8 million. These costs were made up of 25,751 additional ICU days, 137,588 additional GW days, and 7,704 readmissions. The mean cost of an SWI ranged from €8,924 in Poland to €21,321 in Denmark. Relative to the costs of post-CABG care without an SWI complication, the incremental cost of an SWI was highest in Greece (24.9% increase) and lowest in the UK (3.8% increase) with a median (interquartile range) of 12% (10-16%) across all 26 countries. Conclusions: SWIs following CABG present a considerable burden to healthcare budgets.

Cost-minimization analysis of negative pressure wound therapy technologies for the treatment of moderate-to-severe foot infections.

Aim: The objective was to estimate the cost of care associated with two negative pressure wound therapy (NPWT) technologies used to treat patients admitted to the hospital with moderate-to-severe foot infections. Materials & methods: A decision tree simulation model was developed to estimate the hospital costs associated with two different NPWT technologies: Cardinal Health™ PRO (NPWT-C) and V.A.C. ULTA™ (NPWT-K). Clinical data were obtained from a previously completed single-site prospective trial. One-way and probabilistic sensitivity analyses were performed to gauge the robustness of the results. Results: The total expected per-patient costs were US$41,206 (SD: US$8,194) for NPWT-C and US$44,439 (SD: US$8,963) for NPWT-K. Conclusion: This study found that NPWT-C was expected to minimize the total costs over the episode of treatment. Larger and more clinically diverse studies are recommended to confirm these findings.

Disparities in Opioid Use Disorder Treatment Admissions.

OBJECTIVES: The Cincinnati region has been at the epicenter of the nation's unfolding opioid epidemic. The objectives of this study were twofold: (1) to compare the Cincinnati region to the United States in length of time to obtain treatment and planned medication-assisted therapy for the treatment for opioid use disorder (OUD); and (2) to assess racial disparities within the Cincinnati region in wait time and type of treatment. METHODS: The 2017 Treatment Episode Data Set: Admissions (TEDS-A) from the Substance Abuse and Mental Health Services Administration (SAMHSA) was used to identify a cohort of eligible individuals with a primary substance use of opioids, including opioid derivatives. Logistic regression models were performed to assess the differences for treatment wait time and type of planned treatment. Model covariates included patient demographics and socioeconomic characteristics. Three different models were performed to assess the influence of covariates of the outcomes. RESULTS: There were 678 766 US and 3298 Cincinnati region individuals admitted for OUD treatment in 2017. The rate per 1000 for treatment admissions was 2.08 and 1.51 (P value < 0.0001) for the United States and Cincinnati, respectively. The fully saturated regression results found that the odds of Cincinnati individuals receiving planned medication-assisted therapy were 0.497 (95% CI, 0.451-0.546; P value < 0.001). The odds of waiting longer for treatment in Cincinnati were higher than in the United States as a whole: 2.33 (95% CI, 2.19-2.48; P value < 0.001). In Cincinnati, there were 3102 Caucasian, 123 African American, and 73 Other admissions. The fully saturated model results found that Caucasians and Other had an increased likelihood of receiving planned medicationassisted therapy (OR 1.89, P value 0.039; OR 7.07, P value 0.002, respectively) compared to African Americans. Within Cincinnati, there was not a statistically significant difference in the likelihood of waiting time to receive treatment by race. CONCLUSION: Individuals seeking treatment for OUD in Cincinnati were less likely to receive planned medication-assisted therapy and were more likely to wait longer than individuals in the United States as a whole. These results suggest that the demand for treatment is greater than the supply in Cincinnati. Within Cincinnati, there does not appear to be a racial disparity in treatment type or length of time to receive treatment for OUD.

Identifying diabetes management opportunity areas in the USA.

Using adherence to diabetes management guidelines as a case study, this paper applied a novel geospatial hot-spot and cold-spot methodology to identify priority counties to target interventions. Data for this study were obtained from the Dartmouth Atlas of Healthcare, the United States Census Bureau's American Community Survey and the University of Wisconsin County Health Rankings. A geospatial approach was used to identify four tiers of priority counties for diabetes preventive and management services: diabetes management cold-spots, clusters of counties with low rates of adherence to diabetes preventive and management services (Tier D); Medicare spending hot-spots, clusters of counties with high rates of spending and were diabetes management cold-spots (Tier C); preventable hospitalisation hot-spots, clusters of counties with high rates of spending and are diabetes management cold-spots (Tier B); and counties that were located in a diabetes management cold-spot cluster, preventable hospitalisation hot-spot cluster and Medicare spending hot-spot cluster (Tier A). The four tiers of priority counties were geographically concentrated in Texas and Oklahoma, the Southeast and central Appalachia. Of these tiers, there were 62 Tier A counties. Rates of preventable hospitalisations and Medicare spending were higher in Tier A counties compared with national averages. These same counties had much lower rates of adherence to diabetes preventive and management services. The novel geospatial mapping approach used in this study may allow practitioners and policy makers to target interventions in areas that have the highest need. Further refinement of this approach is necessary before making policy recommendations.

Trends in United States emergency department visits and associated charges from 2010 to 2016.

BACKGROUND: Demographic shifts and care delivery system evolution affect the number of Emergency Department (ED) visits and associated costs. Recent aggregate trends in ED visit rates and charges between 2010 and 2016 have not been evaluated. METHODS: Data from the National Emergency Department Sample, comprising approximately 30 million annual patient visits, were used to estimate the ED visit rate and charges per visit from 2010 to 2016. ED visits were grouped into 144 mutually exclusive clinical categories. Visit rates, compound annual growth rates (CAGRs), and per visit charges were estimated. RESULTS: From 2010 to 2016, the number of ED visits increased from 128.97 million to 144.82 million; the cumulative growth was 12.29% and the CAGR was 1.95%, while the population grew at a CAGR of 0.73%. Expressed as a population rate, ED visits per 1000 persons increased from 416.92 in 2010 to 448.19 in 2016 (p value <0.001). The mean charges per visit increased from $2061 (standard deviation $2962) in 2010 to $3516 (standard deviation $2962) in 2016; the CAGR was 9.31% (p value <0.001). Of 144 clinical categories, 140 categories had a CAGR for mean charges per visit of at least 5%. CONCLUSION: The rate of ED visits per 1000 persons and the mean charge per ED visit increased significantly between 2010 and 2016. Mean charges increased for both high- and low-acuity clinical categories. Visits for the 5 most common clinical categories comprise about 30% of ED visits, and may represent focus areas for increasing the value of ED care.

Incremental direct healthcare expenditures of valvular heart disease in the USA.

Aim: To quantify the healthcare expenditures for valvular heart disease (VHD) in the USA. Patients & methods: Direct annual incremental healthcare expenditures were estimated using multiple logistic and linear regression models. Results were stratified by age cohorts (18-64 years, ≥65 and ≥75 years) and disease status: symptomatic aortic valve disease (AVD), asymptomatic AVD, symptomatic mitral valve disease (MVD) and asymptomatic MVD. Results: A total of 1463 VHD patients were identified. The overall aggregated incremental direct expenditures were $56.62 billion ($26.48 billion for patients ≥75 years). Individuals ≥75 years with symptomatic AVD had the largest incremental effect on annual, per-patient healthcare expenditure of $30,949. The annualized incremental costs of VHD were greatest for individuals ≥75 years with AVD. Conclusion: Identification of VHD at an earlier stage may reduce the economic burden.

Characteristics and Trends of Emergency Department Visits in the United States (2010-2014).

BACKGROUND: It is important that policy makers, health administrators, and emergency physicians have up-to-date statistics on the most common diagnoses of patients seen in the emergency department (ED). OBJECTIVES: We sought to describe the changes that occurred in ED visits from 2010 through 2014 and to describe the frequency of different ED diagnoses. METHODS: This is a retrospective analysis of ED visit data from the National Emergency Department Sample from 2010 through 2014. Visits were stratified by age, sex, insurance status, disposition, diagnosis, and diagnostic category. We calculated the total annual ED visits and the ED visit rates by diagnoses and diagnostic categories. RESULTS: Between 2010 and 2014, the number of U.S. ED visits increased from 128.9 million to 137.8 million. The rate of ED Visits per 1000 persons increased from 416.92 (95% confidence interval [CI] 399.47-434.37) in 2010 to 432.51 (95% CI 411.51-453.61) in 2014 (p = 0.0136). ED visits grew twice as quickly (1.7%) as the overall population (0.7%). The most common reason for an ED visit was abdominal pain (11.75% [95% CI 11.61-11.89]). This was followed by mental health problems (4.45% [95% CI 4.19-4.72]). CONCLUSION: The number of ED visits in the United States continues to increase faster than the rate of population growth. Abdominal problems and mental health issues, including substance abuse, were the most common reasons for an ED visit in 2014.

Cost minimization analysis of catheter ablation for paroxysmal atrial fibrillation by catheter technology.

AIM: Compare the 1-year costs of three catheter ablation technologies for the treatment of paroxysmal atrial fibrillation (PAF). MATERIALS & METHODS: A decision tree model was developed to estimate 1-year hospital costs associated with an index and potential repeat PAF ablation procedure using the Thermocool® Smarttouch® Catheter (ST), Thermocool SF Catheter (SF) or Arctic Front Advance Cryoballoon (CB). Model parameters were estimated using the results of two recently published studies. RESULTS: The ST resulted in average per-patient savings for combined inpatient and outpatient populations of US$1488 and US$4494 compared with SF and  CB, respectively. These cost savings were greater in the inpatient setting. CONCLUSION: The 1-year expected hospital visit costs for PAF ablation were lower with ST than with SF or CB.

Geographic variation in hospital costs, payments, and length of stay for opioid-related hospital visits in the USA.

PURPOSE: Despite the rise in opioid-related hospitalizations, there has been little research regarding opioid-related healthcare utilization. The objective of this study was to estimate the mean adjusted hospital costs, payments, and length of stay (LOS) for opioid-related visits for the nation and each of the nine US census regions. METHODS: An observational study of retrospective claims data from the Vizient health system database was conducted. Eligible visits had a principal diagnosis of opioid use or dependence defined by ICD, ninth and tenth revision (ICD-9/10), and occurred between January 2014 and June 2017. Separate regression models for inpatient and outpatient visits were generated to estimate the adjusted costs, payments, and LOS for opioid-related visits. RESULTS: A total of 193,614 (32,713 inpatient and 160,901 outpatient) visits met the inclusion criteria. The overall adjusted mean cost, payment, and LOS for an inpatient opioid-related visit were $4,383 (range between regions: $2,894-$5,835), $6,689 (range between regions: $4,038-$9,001), and 4.35 days (range between regions: 3.8-5.7 days), respectively. The overall adjusted mean cost and payment for an outpatient opioid-related visit were $533 (range between regions: $395-$802) and $374 (range between regions: $187-$574), respectively. Opioid-related hospital costs, payments, and LOS varied across the US. Data on the regional variation and national averages are necessary for hospitals to benchmark their services and more effectively manage this population. CONCLUSION: Future research should examine intraregion utilization to understand the effect of prices and level of services.