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1.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 619-626, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31721598

RESUMEN

Introduction: In recent decades, medical devices (MDs) have increasingly become an integral part of patient care. However, when it comes to designing and appraising economic models, researchers typically follow pharmaceutical templates (e.g. CHEERS) to assess their economic viability. This study evaluates the generalizability of four device-specific criteria, as recommended by the recent MedtechHTA project, of learning curve, incremental innovation, dynamic pricing, and organizational impact with a broader group of MDs including diagnostics and implantables. The purpose was to determine the applicability of these criteria to a broader range of MDs.Areas Covered: We determined the extent to which these criteria could be applied to each device type and attempted to identify common themes. We performed a literature search using PubMed and Google of a range of devices to understand the clinical significance, operation, and economic viability.Expert Opinion: Our findings suggest that the four characteristics are not applicable to all device types. Prior evaluation of a device's intrinsic properties (such as longevity and device location) and its FDA risk classification could help to indicate the applicability of the criteria. Documenting this process when assessing the additional four criteria on the CHEERS checklist would improve the transparency of future economic evaluations.


Asunto(s)
Equipos y Suministros/economía , Modelos Económicos , Evaluación de la Tecnología Biomédica/métodos , Lista de Verificación , Análisis Costo-Beneficio/métodos , Humanos , Evaluación de la Tecnología Biomédica/economía
2.
AIDS Care ; 24(1): 108-18, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-21780991

RESUMEN

The objective of this study was to determine and compare the cost to treat HIV(+) and HIV(-) pediatric patients both before and after HIV prophylaxis became the standard of care. Retrospective chart review of a pediatric HIV/AIDS specialty clinic's medical charts was conducted for clinical and healthcare utilization data on 125 children diagnosed from 1986 to 2007. Mean HIV-related costs were compared using bootstrapped t-tests for children born in the pre-prophylaxis (1979-1993) and prophylaxis eras (1994-2007). Patients were also stratified into two categories based on death during the follow-up period. Lastly, national cost-savings were estimated using mean costs, national number of at-risk births, and national perinatal HIV transmission rates in each era. For HIV(+) children, mean annual per patient treatment cost was $15,067 (95% CI: $10,169-$19,965) in the pre-prophylaxis era (n = 40) and $14,959 (95% CI: $9140-$20,779) in the prophylaxis era (n = 14); difference not statistically significant (p > 0.05). For HIV(-) children, mean annual per patient treatment cost was $204 (95% CI: $219-$627) for the pre-prophylaxis era (n = 2) and $427 (95% CI: $277-$579) for the prophylaxis era (n = 69); difference statistically significant (p < 0.05). A projected cost-savings of $16-23 million annually in the USA was observed due to the adoption of prophylaxis treatment guidelines in pediatric HIV care. The prophylaxis era of pediatric HIV treatment has been successful in decreasing perinatal HIV transmission and mortality, as reflected by clinical trials and national cost-savings data, and emphasizes the value of the rapid adoption of evidence-based practice guidelines.


Asunto(s)
Infecciones por VIH/economía , Transmisión Vertical de Enfermedad Infecciosa/economía , Pediatría/economía , Complicaciones Infecciosas del Embarazo/economía , Adolescente , Niño , Preescolar , Costos y Análisis de Costo , Femenino , Estudios de Seguimiento , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estudios Retrospectivos , Estados Unidos
3.
Dermatol Surg ; 38(4): 570-84, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22145798

RESUMEN

OBJECTIVE: To compare fees for biopsy, treatment procedure, repair, and 2-month follow-up for nonmelanoma skin cancer (NMSC) treatments: electrodesiccation and curettage (ED&C), excision, and Mohs micrographic surgery (MMS). METHODS: A cost comparison of 936 primary NMSCs diagnosed in 1999/2000 at a University affiliated dermatology practice. Clinical data was from medical record review. 2007 Medicare Fee Schedule costs determined fees for surgical care. Pearson chi-square tests, t-tests and analysis of variance compared fee differences. Linear regression determined independent effects of tumor and treatment characteristics on fees. RESULTS: Mean fees/lesion were $463 for ED&C, $1,222 for excision, and $2,085 for MMS (p < .001). For all treatments, primary procedure costs were highest (38%, 45%, and 41%). Total repair fees were higher with MMS ($735) vs excisions ($197). Fees were higher for head and neck tumors (p < .001), H-zone tumors (p < .001), and tumors smaller than 10 mm in diameter (p = .04). Regression models predicted that the treatment fees would be $2,109 for MMS and $1,252 for excision (p < .001). Tumor size greater than 10 mm in diameter (added $128), tumors on the head and neck (added $966), and MMS (added $857 vs excision) were independently related to higher fees (p < .001). CONCLUSION: Even after adjusting for risk factors, MMS has higher fees than excision for primary NMSC. Repairs accounted for the majority of this difference. These fee comparisons provide a basis for comparative effectiveness studies of treatments for this common cancer.


Asunto(s)
Carcinoma Basocelular/economía , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/economía , Carcinoma de Células Escamosas/cirugía , Honorarios y Precios , Práctica Privada , Neoplasias Cutáneas/economía , Neoplasias Cutáneas/cirugía , Femenino , Humanos , Masculino
4.
Womens Health Issues ; 21(3): 246-53, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21521625

RESUMEN

OBJECTIVE: Our objective was to estimate lifetime medical expenditures that can be attributed to hypertension, by gender, in the United States, given important gender differences in both survival and medical expenditures. METHODS: We estimated lifetime medical expenditures among hypertensive and nonhypertensive men and women aged 20 and older. Expenditures were estimated from the 2001 to 2004 Medical Expenditure Panel Survey and life expectancies were estimated from the 1986 to 2002 National Health Interview Survey Linked Mortality Files. Assuming that medical technology, the cost of health care services, the incidence of disease, and survival were fixed, the cross-sectional age-specific expenditures and the survival profiles were used to estimate the lifetime expenditures from ages 20 to older than 85. PRINCIPAL FINDINGS: The estimated lifetime expenditure for an average life table individual at age 20 was $188,300 for hypertensive men and $254,910 for hypertensive women; however, a greater share of lifetime expenditures can be attributed to hypertension among men ($88,033) than among women ($40,960). CONCLUSION: Although hypertensive women had greater lifetime expenditures than hypertensive men, hypertension was associated with a greater increase in lifetime expenditures for men than for women. Gender differences in both survival and health care utilization have important implications for gender differences in lifetime medical expenditures.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Servicios de Salud/economía , Hipertensión/economía , Adulto , Anciano , Anciano de 80 o más Años , Costos y Análisis de Costo , Estudios Transversales , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Esperanza de Vida , Masculino , Persona de Mediana Edad , Factores Sexuales , Estados Unidos , Adulto Joven
5.
Epilepsia ; 52(5): 957-64, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21320113

RESUMEN

PURPOSE: To determine the persistence of disparities in health care use and outcomes in socioeconomically diverse populations of epilepsy patients. METHODS: We followed patients for a year at one clinic in Houston and two in New York City that serve predominantly low-income, minority, Medicaid-insured, or uninsured patients, and a fourth clinic in Houston that serves a more balanced racial/ethnic and higher socioeconomic status (SES) population. We interviewed the patients several times regarding health care use, seizures, side effects, and outcomes, and examined differences between the patients at the three low-SES clinics and the patients at the high-SES clinic. KEY FINDINGS: After controlling for patients' age, gender, race/ethnicity, marital status, seizures, and side effects we found that low SES patients had consistently higher use of the hospital emergency room and more visits to a general practitioner. Hospitalizations were also consistently higher but the differences were not significant in most periods. Neurologist visits were relatively similar. Patients at the low SES sites also had a greater likelihood of having uncontrolled seizures, drug-related side effects, to be stigmatized, and have a lower overall quality of life throughout the study period. SIGNIFICANCE: These findings suggest the persistence of SES-related disparities in health care use and outcomes among patients with epilepsy who are receiving regular care.


Asunto(s)
Epilepsia/terapia , Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud , Clase Social , Adolescente , Adulto , Anciano , Niño , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Medicina General/estadística & datos numéricos , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Pacientes no Asegurados , Persona de Mediana Edad , Grupos Minoritarios , Visita a Consultorio Médico/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Resultado del Tratamiento
6.
Pediatrics ; 126(3): e541-9, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20696721

RESUMEN

OBJECTIVE: Life has changed dramatically for infants exposed perinatally to HIV to HIV primarily because of a successful translational research program that has also affected treatment costs. We compared treatment costs among HIV+ patients in an HIV/AIDS specialty clinic across 3 treatment eras: monotherapy (pre-1990), combination therapy (1990-1996), and highly active antiretroviral therapy (HAART) (1997-2007). We also estimated cumulative health care costs among pediatric HIV/AIDS patients born in each era. PATIENTS AND METHODS: Data on health care use were collected from medical records of 126 infants born to HIV+ mothers during a 21-year period (1986-2007) (728 person-years). The Drug Topics Red Book 1999 was used for drug costs, the Current Procedural Terminology Medicare Fee Schedule codes for outpatient costs, and the Healthcare Cost and Utilization Project Kids' Inpatient Database for inpatient costs. Generalized estimating equations and bootstrapped ordinary least-squares models were used to determine 2007 costs, cumulative costs, and cost savings. RESULTS: Lifetime cost savings with HAART were $6.7 to $23.3 million, depending on incidence. Average total costs per HIV+ person per month were $1306 ($318 for drugs, $896 for total medical) in the monotherapy era, $2289 ($891 for drugs, $1180 for total medical) in the combination-therapy era, and $1814 ($1241 for drugs, $320 for total medical) in the HAART era. Total costs during the HAART era were 25.2% lower than costs during the combination-therapy era, because the 34% higher HAART drug costs were compensated for by total medical costs (inpatient+outpatient) that were 57% lower, which was a significant change (P<.001). The cumulative costs for treatment of an HIV+ patient were highest during the monotherapy era ($196,860) and lowest during the HAART era ($181,436). CONCLUSIONS: Our results show that the cost burden for the treatment of HIV+ pediatric patients has decreased over time. This historical examination of treatment-era costs demonstrates the value of technologic advances in treatment.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/economía , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Adolescente , Niño , Preescolar , Costo de Enfermedad , Femenino , Humanos , Lactante , Masculino , Análisis de Regresión , Factores de Tiempo
7.
Womens Health Issues ; 20(2): 114-25, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20211429

RESUMEN

OBJECTIVE: We sought to examine and attempt to explain gender disparities in hypertension-attributable expenditure among noninstitutionalized individuals in the United States. METHODS: Using the 2001-2004 Medical Expenditure Panel Survey and the Aday and Andersen health care use model, we estimated hypertension-attributable health care expenditures for inpatient stay, outpatient visits, prescription drugs, office visits, and emergency room (ER) visits among men and women by applying the method of recycled prediction. Hypertensive individuals were identified using International Classification of Diseases, 9th edition, codes or self-report of a diagnosis of hypertension. RESULTS: The adjusted mean hypertension-attributable expenditure per individual was significantly higher for women than for men for prescription drugs, inpatient stays, office visits, outpatient visits and ER visits expenditures. However, as age increased, the gender difference in adjusted mean expenditures became smaller and eventually reversed. This reversal occurred at different ages for different expenditures. For prescription drugs, office visits and outpatient expenditures, the reversal in expenditures occurred around age 50 to 59. The maximum difference was observed in outpatient expenditures, where women's average expenditure was $102 more than men's below age 45 but $103 less than men's above age 75. These differences remained significant even after controlling for predisposing, enabling, and need predictors of health care use. CONCLUSION: Our findings imply that there are gender disparities in hypertension-related expenditures, but that this disparity depends on age. These findings support recent findings on gender disparities in heart diseases and raise the question of physicians' bias in their diagnostic or prognostic approaches to hypertension in men and women.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Hipertensión/economía , Hipertensión/terapia , Salud de la Mujer/economía , Adulto , Distribución por Edad , Anciano , Atención Ambulatoria/economía , Estudios Transversales , Servicio de Urgencia en Hospital/economía , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/economía , Medicamentos bajo Prescripción/economía , Estudios Retrospectivos , Distribución por Sexo , Estados Unidos/epidemiología
8.
Epilepsy Res ; 87(1): 59-69, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19709857

RESUMEN

We assessed the concordance between healthcare utilization and cost measured with patient survey and billing data among 226 epilepsy patients in a large multi-specialty group practice. Does survey information on utilization combined with prices, provide a cost of care that is approximately equal to the cost of care derived from billing data, utilizing the same price structure? Do measures of cost from survey and billing data yield the same correlates of cost among epilepsy patients? If so, survey data may be utilized to estimate correlates and cost of epilepsy care in cases where complete billing information is not available. For five of eight outpatient services, the concordance coefficients exceeded the practical cut-off value for clinical studies, suggesting substantial agreement between the billing and survey data. Cost was higher when computed from billing data, but the overall concordance (.75) between the cost estimates is relatively high, and comparable to findings in studies on other types of patients. The average 6-month outpatient cost difference was $11 between the two sources of cost estimates. Correlates of cost were similar, whether cost was measured with survey or billing data. The results suggest that correlates of cost and cost estimates derived from survey data may yield similar findings to cost estimates from billing data for policy related studies of epilepsy patients.


Asunto(s)
Epilepsia/economía , Honorarios y Precios , Servicios de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Cobertura del Seguro/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Análisis de Regresión , Factores Socioeconómicos , Encuestas y Cuestionarios
9.
Epilepsia ; 50(5): 1040-50, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19054413

RESUMEN

PURPOSE: The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care. METHODS: Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients. The other half were at the remaining site in Houston that serves a more balanced racial/ethnic and higher sociodemographic population. Differences in general and specialist visits, hospital emergency room (ER) care, and hospitalizations were associated with race/ethnicity, income, and coverage. Logistic regression was used to assess the extent to which the differences persisted when adjusting for individual patient characteristics and site of care. RESULTS: Compared to whites, blacks and Hispanics had higher rates of generalist visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found related to patient income and coverage. The magnitude and significance of the disparities persisted when adjusting for individual characteristics but decreased substantially or were eliminated when site of care was added to the model. DISCUSSION: There are sociodemographic disparities in health care for people with epilepsy that are largely explained by differences in where patients receive care.


Asunto(s)
Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Epilepsia , Encuestas de Atención de la Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Intervalos de Confianza , Epilepsia/epidemiología , Epilepsia/terapia , Grupos Étnicos/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , New York/epidemiología , Oportunidad Relativa , Estudios Retrospectivos , Factores Socioeconómicos , Texas/epidemiología
10.
HIV Clin Trials ; 7(6): 309-18, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17197378

RESUMEN

PURPOSE: The April 2005 Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents recommended 9 regimens to be combined with 2 nucleoside reverse transcriptase inhibitors (NRTIs). These regimens are effective in lowering viral load but are expensive. This study aimed to determine the cost for each regimen to achieve an undetectable viral load. METHOD: 52 clinical trials were reviewed. The outcome measure was cost per undetectable patient, C/PU, where C = cost of a drug, and PU = percent of patients with undetectable viral loads. RESULTS: For 30 weeks, cost per undetectable (<400 copies/mL) ranged from 4,416 dollars (efavirenz) to 23,110 dollars (nelfinavir); for 42 weeks, the range was 5,729 dollars (efavirenz) to 24,071 dollars (indinavir/ritonavir); for 60 weeks, it ranged from 9,535 dollars (efavirenz) to 26,829 dollars (fosamprenavir); and for 84 weeks, it ranged from 12,203 dollars (efavirenz) to 22,960 dollars (nelfinavir). For <50 copies/mL, at 30 weeks the range was from 7,140 dollars (efavirenz) to 17,548 dollars (atazanavir); for 42 weeks, it ranged from 9,849 dollars (lopinavir/ritonavir) to 13,181 dollars (nelfinavir); for 60 weeks, it ranged from 8,702 dollars (nevirapine) to 36,034 dollars (atazanavir); and for 84 weeks, it ranged from 15,660 dollars (efavirenz) to 29,177 dollars (indinavir/ritonavir). CONCLUSION: Efavirenz's low price and high effectiveness make it the least expensive means of achieving an undetectable viral load.


Asunto(s)
Antirretrovirales/economía , Infecciones por VIH/economía , Inhibidores de la Transcriptasa Inversa/economía , Carga Viral/economía , Fármacos Anti-VIH/economía , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Quimioterapia Combinada , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Humanos , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Carga Viral/estadística & datos numéricos
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