RESUMO
BACKGROUND: Image guidance for shunt surgery results in more accurate proximal catheter placement. However, reduction in shunt failure remains unclear in the literature. There have been no prior studies evaluating the cost effectiveness of neuronavigation for shunt surgery. OBJECTIVE: To perform a cost analysis using available hospital charges of hypothetical shunt surgery performed with/without electromagnetic neuronavigation (EMN). METHODS: Hospital charges were collected for physician fees, radiology, operating room (OR) time and supplies, postanesthesia care unit, hospitalization days, laboratory, and medications. Index shunt surgery charges (de novo or revision) were totaled and the difference calculated. This difference was compared with hospital charges for shunt revision surgery performed under 2 clinical scenarios: (1) same hospital stay as the index surgery; and (2) readmission through the emergency department. RESULTS: Costs for freehand de novo and revision shunt surgery were $23 946.22 and $23 359.22, respectively. For stealth-guided de novo and revision surgery, the costs were $33 646.94 and $33 059.94, a difference of $9700.72. The largest charge increase was due to additional OR time (34 min; $4794), followed by disposable EMN equipment ($2672). Total effective charges to revise the shunt for scenarios 1 and 2 were $34 622.94 and $35 934.94, respectively. The cost ratios between the total revision charges for both scenarios and the difference in freehand vs EMN-assisted shunt surgery ($9700.72) were 3.57 and 3.70, respectively. CONCLUSION: From an economic standpoint and within the limitations of our models, the number needed to prevent must be 4 or less for the use of neuronavigation to be considered cost effective.
Assuntos
Preços Hospitalares , Hidrocefalia/economia , Hidrocefalia/cirurgia , Tomografia Computadorizada por Raios X/economia , Derivação Ventriculoperitoneal/economia , Feminino , Preços Hospitalares/tendências , Humanos , Hidrocefalia/diagnóstico por imagem , Imagens, Psicoterapia/economia , Imagens, Psicoterapia/tendências , Tempo de Internação/economia , Tempo de Internação/tendências , Masculino , Neuronavegação/economia , Neuronavegação/tendências , Salas Cirúrgicas/economia , Salas Cirúrgicas/tendências , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/tendências , Derivação Ventriculoperitoneal/tendênciasRESUMO
Objective The study looked at the impact that the switch from a reimbursement system with hospital per diem charges to a regional budget had on treatment. Methods Routine data from two clinics over a period of ten years were evaluated. Results Treatment took place in day clinics and on an outpatient basis to an increased extent after the change. Conclusion The change in reimbursement system was the cause of the change in treatment. Since similar effects can also be expected when switching from the new reimbursement system for psychiatry and psychosomatic medicine to a regional budget system, regional budgets are a reasonable alternative.
Assuntos
Assistência Ambulatorial/economia , Orçamentos/tendências , Hospital Dia/economia , Preços Hospitalares/tendências , Transtornos Mentais/economia , Unidade Hospitalar de Psiquiatria/economia , Mecanismo de Reembolso/economia , Adulto , Assistência Ambulatorial/tendências , Redução de Custos/tendências , Hospital Dia/tendências , Feminino , Previsões , Alemanha , Humanos , Tempo de Internação/economia , Tempo de Internação/tendências , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria/tendências , Regionalização da Saúde/tendências , Mecanismo de Reembolso/tendênciasAssuntos
Competição Econômica , Economia Hospitalar , Custos de Cuidados de Saúde/tendências , Preços Hospitalares/tendências , Seguro Saúde/economia , Prestação Integrada de Cuidados de Saúde , Reforma dos Serviços de Saúde , Gastos em Saúde , Fechamento de Instituições de Saúde , Custos Hospitalares , Marketing de Serviços de Saúde , Modelos Econômicos , Estados UnidosRESUMO
Hospital mergers, like Godzilla's comeback movie, promise that bulk means marketplace brawn. Yet as the dust settles, the payoff isn't always so clear. Promised efficiencies from merging duplicated programs--even shutting down entire hospitals--often fail to materialize. In fact, cutting the deal may turn out to be the easy part.