Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.838
Filtrar
1.
Lancet ; 395(10223): 524-533, 2020 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-32061298

RESUMEN

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Ahorro de Costo/métodos , Prestación de Atención de Salud/economía , Costos de los Medicamentos/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Medicare/economía , Patient Protection and Affordable Care Act , Pronóstico , Estados Unidos
2.
J Surg Res ; 246: 123-130, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31569034

RESUMEN

BACKGROUND: National changes in health care disparities within the setting of trauma care have not been examined within Accountable Care Organizations (ACOs) or non-ACOs. We sought to examine the impact of ACOs on post-treatment outcomes (in-hospital mortality, 90-day complications, and readmissions), as well as surgical intervention among whites and nonwhites treated for spinal fractures. MATERIALS AND METHODS: We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications, and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Nonwhites were compared with whites treated in non-ACOs between 2009 and 2011 as the referent. RESULTS: We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, whereas 7% were nonwhite. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.44, 1.28). A disparity in the development of complications existed for nonwhites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among nonwhites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for nonwhites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). CONCLUSIONS: Our work reinforces the idea that ACOs could improve health care disparities among nonwhites. There is also the potential that as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.


Asunto(s)
Organizaciones Responsables por la Atención/estadística & datos numéricos , Fijación de Fractura/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Fracturas de la Columna Vertebral/cirugía , Organizaciones Responsables por la Atención/economía , Anciano , Anciano de 80 o más Años , Grupos de Población Continentales/estadística & datos numéricos , Ahorro de Costo/economía , Ahorro de Costo/estadística & datos numéricos , Grupos Étnicos , Femenino , Fijación de Fractura/efectos adversos , Fijación de Fractura/economía , Gastos en Salud/estadística & datos numéricos , Disparidades en Atención de Salud/organización & administración , Mortalidad Hospitalaria , Humanos , Masculino , Medicare/economía , Medicare/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/estadística & datos numéricos , Factores Socioeconómicos , Fracturas de la Columna Vertebral/economía , Estados Unidos/epidemiología
3.
Vasc Endovascular Surg ; 54(2): 102-110, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31746273

RESUMEN

OBJECTIVE: Compare technical, clinical, and economic outcomes between endovascular and open approaches in patients with type D aortoiliac occlusive disease according to the TransAtlantic Inter-Society Consensus. METHODS: Patients undergoing revascularization for type D aortoiliac lesions, either endovascular or open surgery approach, from 2 Portuguese institutions between January 2011 and October 2017 were included. The surgical technique was left to the surgeon discretion. Patients with common femoral artery affection, both obstructive and aneurysmatic, were excluded. RESULTS: Twenty-seven patients underwent aortobifemoral bypass and 32 patients were submitted to endovascular repair. The patients undergoing endovascular procedure were more likely to present with chronic heart failure (P = .001) and chronic kidney disease (P = .022) and less likely to have a history of smoking (P = .05). The mean follow-up period was 67.84 (95% confidence interval = 61.85-73.83) months. The open surgery approach resulted in a higher technical success (P = .001); however, limb salvage and patency rates were not different between groups. Endovascular approach was associated with a shorter length-of-stay, both inpatient (6 vs 9 days; P = .041) and patients admitted in the intensive care unit (0 vs 3.81 days; P = .001) as well as lower hospital expenses (US$9281 vs US$23 038; P = .001) with a similar procedure cost (US$2316 vs US$1173; P = .6). No differences were found in the postsurgical quality of life. CONCLUSION: Endovascular approach is, at least, clinically equivalent to open surgery approach and is more cost-efficient. The "endovascular-first" approach should be considered for type D occlusive aortoiliac lesions.


Asunto(s)
Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Anciano , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/economía , Enfermedades de la Aorta/fisiopatología , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/economía , Arteriopatías Oclusivas/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/economía , Implantación de Prótesis Vascular/instrumentación , Ahorro de Costo , Análisis Costo-Beneficio , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/economía , Procedimientos Endovasculares/instrumentación , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Costos de la Atención en Salud , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Portugal , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Stents , Factores de Tiempo , Resultado del Tratamiento
4.
J Urol ; 203(3): 609-610, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31841069
6.
Int J Cancer ; 146(3): 781-790, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30977121

RESUMEN

Bronchoscopy is the safest procedure for lung cancer diagnosis when an invasive evaluation is required after imaging procedures. However, its sensitivity is relatively low, especially for small and peripheral lesions. We assessed benefits and costs of introducing a bronchial gene-expression classifier (BGC) to improve the performance of bronchoscopy and the overall diagnostic process for early detection of lung cancer. We used discrete-event simulation to compare clinical and economic outcomes of two different strategies with the standard practice in former and current smokers with indeterminate nodules: (i) location-based strategy-integrated the BGC to the bronchoscopy indication; (ii) simplified strategy-extended use of bronchoscopy plus BGC also on small and peripheral lesions. Outcomes modeled were rate of invasive procedures, quality-adjusted-life-years (QALYs), costs and incremental cost-effectiveness ratios. Compared to the standard practice, the location-based strategy (i) reduced absolute rate of invasive procedures by 3.3% without increasing costs at the current BGC market price. It resulted in savings when the BGC price was less than $3,000. The simplified strategy (ii) reduced absolute rate of invasive procedures by 10% and improved quality-adjusted life expectancy, producing an incremental cost-effectiveness ratio of $10,109 per QALY. In patients with indeterminate nodules, both BGC strategies reduced unnecessary invasive procedures at high risk of adverse events. Moreover, compared to the standard practice, the simplified use of BGC for central and peripheral lesions resulted in larger QALYs gains at acceptable cost. The location-based is cost-saving if the price of classifier declines.


Asunto(s)
Análisis Costo-Beneficio , Detección Precóz del Cáncer/normas , Neoplasias Pulmonares/diagnóstico , Anciano , Biomarcadores de Tumor/genética , Biopsia/efectos adversos , Biopsia/economía , Biopsia/normas , Bronquios/diagnóstico por imagen , Bronquios/patología , Broncoscopía/efectos adversos , Broncoscopía/economía , Broncoscopía/normas , Simulación por Computador , Ahorro de Costo , Detección Precóz del Cáncer/economía , Detección Precóz del Cáncer/métodos , Femenino , Estudios de Seguimiento , Perfilación de la Expresión Génica/economía , Perfilación de la Expresión Génica/normas , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Modelos Económicos , Años de Vida Ajustados por Calidad de Vida , Sensibilidad y Especificidad , Nivel de Atención/economía , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/economía , Tomografía Computarizada por Rayos X/normas
7.
PLoS Negl Trop Dis ; 13(11): e0007788, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31693661

RESUMEN

INTRODUCTION: Cutaneous leishmaniasis (CL), endemic in Bolivia, mostly affects poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages and a lack of safe conditions to deliver treatment are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in a Bolivian endemic area. METHODS: The cost-per-patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N = 12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization. Costs were reported in 2017 international dollars (1 INT$ = 3.10 BOB). RESULTS: Treating CL using ILPA was associated with a cost-saving of $248 per-patient-treated from the MoH perspective, and $688 per-patient-treated from the societal perspective. Switching first-line treatment to ILPA while maintaining the current budget would allow two-and-a-half times the current number of patients to be treated. ILPA remained cost-saving compared to SPA in the sensitivity analysis. CONCLUSIONS: The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries.


Asunto(s)
Antiprotozoarios/economía , Presupuestos , Ahorro de Costo , Leishmaniasis Cutánea/tratamiento farmacológico , Gluconato de Sodio Antimonio/economía , Gluconato de Sodio Antimonio/uso terapéutico , Antiprotozoarios/uso terapéutico , Bolivia , Análisis Costo-Beneficio , Costos de los Medicamentos , Costos de la Atención en Salud , Humanos , Antimoniato de Meglumina/economía , Antimoniato de Meglumina/uso terapéutico
8.
Br J Nurs ; 28(20): S21-S26, 2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31714827

RESUMEN

Regardless of the amount of literature and evidence on leg ulcer management, there are still significant variations in treatment. Implementing a standardised leg ulcer pathway to ensure patients are appropriately and timely assessed could help reduce nursing time and overall costs, while improving healing outcomes and patients' quality of life. Such a pathway was introduced in Lincolnshire and Leicestershire, UK, to treat venous leg ulcers (VLUs). The results showed improved healing times, reduced costs and fewer nurse visits, among other findings.


Asunto(s)
Vías Clínicas , Úlcera de la Pierna/economía , Úlcera de la Pierna/enfermería , Cicatrización de Heridas/fisiología , Adulto , Anciano , Ahorro de Costo , Humanos , Úlcera de la Pierna/epidemiología , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Reino Unido/epidemiología , Úlcera Varicosa/economía , Úlcera Varicosa/enfermería
9.
BMC Health Serv Res ; 19(1): 827, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718624

RESUMEN

BACKGROUND: In 2014 and 2015, biosimilars for the drugs filgrastim, infliximab, and insulin glargine were approved for use in Canada. The introduction of biosimilars in Canada could provide significant cost savings for the Canadian healthcare system over originator biologic drugs, however it is known that the use of biosimilars varies widely across the world. The aim of this study was to estimate the use of biosimilars in Canada and potential cost-savings from their use. METHODS: We performed a retrospective analysis of Canadian drug purchases for filgrastim, infliximab, and insulin glargine from July 2016 to June 2018. This was a cross-sectional study and the time horizon was limited to the study period. As a result, no discounting of effects over time was included. Canadian drugstore and hospital purchases data, obtained from IQVIA™, were used to estimate the costs per unit and unit volume for biosimilars and originator biologic drugs within each province. Potential cost-savings were calculated as a product of the units of reference originator product purchased and the cost difference between the originator biologic and its corresponding biosimilar. RESULTS: The purchase of biosimilars varied by each province in Canada, ranging from a low of 0.1% to a high of 81.6% of purchases. In total, $1,048,663,876 Canadian dollars in savings could have been realized with 100% use of biosimilars over the originator products during this 2 year time period. The potential savings are highest in the province of Ontario ($349 million); however, even in smaller markets (PEI and Newfoundland), $28 million could have potentially been saved. Infliximab accounted for the vast majority of the potential cost-savings, whereas the purchases of the biosimilar filgrastim outpaced that of the originator drug in some provinces. In sensitivity analyses assuming only 80% of originator units would be eligible for use as a biosimilar, $838 million dollars in cost savings over this two-year time period would still have been realized. CONCLUSIONS: The overall use of biosimilar drugs in Canada is low. Policy makers, healthcare providers, and patients need to be informed of potential savings by increased use of biosimilars, particularly in an increasingly costly healthcare system.


Asunto(s)
Biosimilares Farmacéuticos/economía , Ahorro de Costo , Filgrastim/economía , Infliximab/economía , Insulina Glargina/economía , Estudios Transversales , Bases de Datos Factuales , Humanos , Terranova y Labrador , Ontario , Estudios Retrospectivos
10.
Rev Esp Salud Publica ; 932019 Nov 15.
Artículo en Español | MEDLINE | ID: mdl-31719517

RESUMEN

OBJECTIVE: The increase in traffic accidents depends on multiple factors; it generates an economic and public health problem that must be analyzed jointly by agents involved in road safety. The aim of the work was to quantify the effect of various factors in the cost savings due to traffic accidents on interurban roads in Spain. METHODS: It was analyzed, through a lineal regression with panel data model and in the period 2000-2017, how different factors affected cost savings due to the risk of mortality or injury avoided on Spanish interurban roads. RESULTS: A 1% increase in traffic volume led to a reduction in costs per MVKT (million vehiclekilometres travelled) of €162.46 referring to the risk of mortality, €115.32 for serious injuries and €10.10 for mild injuries. This increase in unemployment caused a cost reduction of €31.43, €10.76 and €0.98, respectively. The same increase in the investment in replacement implied a reduction of these costs of €11 for any risk. A 1% increase in the ageing index led to an increase in costs of €276.83 in terms of mortality risk and €257.49 in terms of injury. Foreign tourism generated a cost of more than €40 for any risk. A 1% increase in GDP per capita led to an increase in costs of €155.50, €138.09 and €8.21 for defined risks. The points driving license led to an increase in costs of €785.50 per MVKR when referring to mortality risks. CONCLUSIONS: Determining factors for cost savings: motorization rate, unemployment rate and investment in replacement interurban roads. Determining factors that increased costs: expiry of the effect of the penalty - points driving licence, ageing index of the population, increase in GDP or proportion of foreign travelers.


Asunto(s)
Accidentes de Tránsito/economía , Ahorro de Costo/estadística & datos numéricos , Salud Urbana/economía , Heridas y Traumatismos/economía , Prevención de Accidentes/economía , Prevención de Accidentes/métodos , Accidentes de Tránsito/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Conducción de Automóvil/estadística & datos numéricos , Humanos , Modelos Lineales , Persona de Mediana Edad , Factores de Riesgo , España/epidemiología , Salud Urbana/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/etiología , Adulto Joven
11.
BMC Public Health ; 19(1): 1398, 2019 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-31660915

RESUMEN

BACKGROUND: Achieving the Sustainable Development Goal of a 90% reduction in neglected tropical diseases (NTDs) by 2030 requires innovative control strategies. This proof-of-concept study examined the effectiveness of integrating control programs for two NTDs: mass drug administration (MDA) for soil-transmitted helminths in humans and mass dog rabies vaccination (MDRV). METHODS: The study was carried out in 24 Tanzanian villages. The primary goal was to demonstrate the feasibility of integrating community-wide MDA for STH and MDRV for rabies. The objectives were to investigate the popularity, participation and cost and time savings of integrated delivery, and to investigate the reach of the MDA with respect to primary school-aged children and other community members. To implement, we randomly allocated villages for delivery of MDA and MDRV (Arm A), MDA only (Arm B) or MDRV only (Arm C). RESULTS: Community support for the integrated delivery was strong (e.g. 85% of focus group discussions concluded that it would result in people getting "two for one" health treatments). A high proportion of households participated in the integrated Arm A events (81.7% MDA, 80.4% MDRV), and these proportions were similar to those in Arms B and C. These findings suggest that coverage might not be reduced when interventions are integrated. Moreover, in addition to time savings, integrated delivery resulted in a 33% lower cost per deworming dose and a 16% lower cost per rabies vaccination. The median percentage of enrolled primary school children treated by this study was 76%. However, because 37% of the primary school aged children that received deworming treatment were not enrolled in school, we hypothesize that the employed strategy could reach more school-aged children than would be reached through a solely school-based delivery strategy. CONCLUSIONS: Integrated delivery platforms for health interventions can be feasible, popular, cost and time saving. The insights gained could be applicable in areas of sub-Saharan Africa that are remote or underserved by health services. These results indicate the utility of integrated One Health delivery platforms and suggest an important role in the global campaign to reduce the burden of NTDs, especially in hard-to-reach communities. TRIAL REGISTRATION: clinicaltrials.gov NCT03667079 , retrospectively registered 11th September 2018.


Asunto(s)
Prestación Integrada de Atención de Salud , Enfermedades de los Perros/prevención & control , Helmintiasis/prevención & control , Rabia/prevención & control , Suelo/parasitología , Animales , Niño , Ahorro de Costo/estadística & datos numéricos , Prestación Integrada de Atención de Salud/economía , Perros , Helmintiasis/transmisión , Humanos , Administración Masiva de Medicamentos/economía , Vacunación Masiva/economía , Vacunación Masiva/veterinaria , Evaluación de Programas y Proyectos de Salud , Rabia/transmisión , Rabia/veterinaria , Vacunas Antirrábicas/administración & dosificación , Vacunas Antirrábicas/economía , Población Rural , Tanzanía/epidemiología
12.
Am Surg ; 85(10): 1113-1117, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657305

RESUMEN

Although recommendations help guide surgeons' mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.


Asunto(s)
Pared Abdominal/cirugía , Materiales Biocompatibles/economía , Ahorro de Costo , Uso Excesivo de los Servicios de Salud/economía , Mallas Quirúrgicas/economía , Algoritmos , Materiales Biocompatibles/efectos adversos , Estudios de Cohortes , Humanos , Huésped Inmunocomprometido , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias , Recurrencia , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Mallas Quirúrgicas/efectos adversos , Mallas Quirúrgicas/estadística & datos numéricos
13.
Vasc Health Risk Manag ; 15: 385-393, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31564888

RESUMEN

Background: Perioperative health care utilization and costs in patients undergoing elective fast-track vs standard endovascular aneurysm repair (EVAR) remain unclear. Methods: The fast-track EVAR group included patients treated with a 14 Fr stent graft, bilateral percutaneous access, no general anesthesia or intensive care monitoring, and next-day hospital discharge. The standard EVAR group was identified from Medicare administrative claims using a matching algorithm to adjust for imbalances in patient characteristics. Hospital outcomes included operating room time, intensive care monitoring, hospital stay, secondary interventions, and major adverse events (MAEs). Perioperative outcomes occurring from hospital discharge to 30 days postdischarge included MAE, secondary interventions, and unrelated readmissions. Results: Among 1000 matched patients (250 fast-track; 750 standard), hospital outcomes favored the fast-track EVAR group, including shorter operating room time (2.30 vs 2.83 hrs, P<0.001), shorter hospital stay (1.16 vs 1.69 d, P<0.001), less need for intensive care monitoring (4.4% vs 48.0%, P<0.001), and lower secondary intervention rate (0% vs 2.4%, P=0.01). Postdischarge outcomes also favored fast-track EVAR with a lower rate of MAE (0% vs 7.2%, P<0.001) and all-cause readmission (1.6% vs 6.8%, P=0.001). The total cost to the health care system during the perioperative period was $26,730 with fast-track EVAR vs $30,730 with standard EVAR. Total perioperative health care costs were $4000 (95% CI: $3130-$4830) lower with fast-track EVAR vs standard EVAR, with $2980 in savings to hospitals and $1030 savings to health care payers. Conclusion: A fast-track EVAR protocol using a 14 Fr stent graft resulted in shorter procedure time, lower intensive care utilization, faster discharge, lower incidence of MAE, lower readmission rates, and lower perioperative costs compared to standard EVAR.


Asunto(s)
Aneurisma de la Aorta Abdominal/economía , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/economía , Procedimientos Endovasculares/economía , Costos de Hospital , Alta del Paciente/economía , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Prótesis Vascular/economía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Ahorro de Costo , Análisis Costo-Beneficio , Cuidados Críticos/economía , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Tempo Operativo , Readmisión del Paciente/economía , Diseño de Prótesis , Sistema de Registros , Retratamiento/economía , Stents/economía , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
14.
Med Care ; 57(11): 882-889, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31567863

RESUMEN

OBJECTIVE: The objective of this study was to assess the potential health and budgetary impacts of implementing a pharmacist-involved team-based hypertension management model in the United States. RESEARCH DESIGN: In 2017, we evaluated a pharmacist-involved team-based care intervention among 3 targeted groups using a microsimulation model designed to estimate cardiovascular event incidence and associated health care spending in a cross-section of individuals representative of the US population: implementing it among patients with: (1) newly diagnosed hypertension; (2) persistently (≥1 year) uncontrolled blood pressure (BP); or (3) treated, yet persistently uncontrolled BP-and report outcomes over 5 and 20 years. We describe the spending thresholds for each intervention strategy to achieve budget neutrality in 5 years from a payer's perspective. RESULTS: Offering this intervention could prevent 22.9-36.8 million person-years of uncontrolled BP and 77,200-230,900 heart attacks and strokes in 5 years (83.8-174.8 million and 393,200-922,900 in 20 years, respectively). Health and economic benefits strongly favored groups 2 and 3. Assuming an intervention cost of $525 per enrollee, the intervention generates 5-year budgetary cost-savings only for Medicare among groups 2 and 3. To achieve budget neutrality in 5 years across all groups, intervention costs per person need to be around $35 for Medicaid, $180 for private insurance, and $335 for Medicare enrollees. CONCLUSIONS: Adopting a pharmacist-involved team-based hypertension model could substantially improve BP control and cardiovascular outcomes in the United States. Net cost-savings among groups 2 and 3 make a compelling case for Medicare, but favorable economics may also be possible for private insurers, particularly if innovations could moderately lower the cost of delivering an effective intervention.


Asunto(s)
Presupuestos , Prestación Integrada de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hipertensión/economía , Grupo de Atención al Paciente/economía , Simulación por Computador , Ahorro de Costo , Análisis Costo-Beneficio , Estudios Transversales , Prestación Integrada de Atención de Salud/métodos , Humanos , Farmacéuticos/economía , Estados Unidos
15.
Int J Equity Health ; 18(1): 154, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615526

RESUMEN

INTRODUCTION: In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. The Missed opportunities for maternal and infant health (MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC. AIM: Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso). METHODS: PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6-10 that was most successful. RESULTS: The average unit cost of health services for days 6-10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6-10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization. CONCLUSION: In the context of growing reproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6-10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC.


Asunto(s)
Servicios de Salud Comunitaria/economía , Ahorro de Costo/economía , Accesibilidad a los Servicios de Salud/economía , Servicios de Salud Materna/economía , Adulto , Burkina Faso , Prestación de Atención de Salud/economía , Eficiencia Organizacional , Femenino , Humanos , Inmunización/economía , Lactante , Atención Posnatal/economía , Periodo Posparto , Embarazo
16.
Tech Vasc Interv Radiol ; 22(3): 125-126, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31623751

RESUMEN

While the tools and techniques employed by interventional radiologists on a day-to-day basis translate well to learning the skills required to perform basic endoscopic interventions, collaboration with other specialties is crucial to the success of an interventional radiology endoscopy program. As in any field in medicine, the paramount goal is to improve patient care. Adding the ability to directly visualize structures through an endoscope to certain interventional radiologic procedures may greatly augment the efficacy, safety, and success of interventional radiology procedures. Colleagues in urology, gastroenterology, and surgery should be involved in decision-making and treatment planning to ensure that a shared vision for optimal patient care is achieved.


Asunto(s)
Endoscopía , Comunicación Interdisciplinaria , Grupo de Atención al Paciente/organización & administración , Administración de la Práctica Médica/organización & administración , Radiografía Intervencional , Conducta Cooperativa , Ahorro de Costo , Endoscopía/economía , Gastroenterólogos/organización & administración , Costos de la Atención en Salud , Humanos , Grupo de Atención al Paciente/economía , Administración de la Práctica Médica/economía , Radiografía Intervencional/economía , Radiólogos/organización & administración , Urólogos/organización & administración
17.
Orthopade ; 48(11): 963-968, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31506824

RESUMEN

Total knee arthroplasty (TKA) is a frequent operation in Germany and in 2017 a total of 191,272 interventions were carried out. These interventions are associated with high costs and involve complex clinical workflow organization and time-consuming instrument logistics. With this in mind, the aim of this study was to identify the economic potential of the instrument configuration in order to optimize the entire process in TKA. Changing the composition of the set of instruments used in the operating theater for TKA resulted in time and cost saving for the complete TKA procedure, including all personnel and off-shoot procedures. In addition, the operating time saved by the introduction of a patient-specific instrumentation set meant that the operating theater could be used for more or other surgical procedures, also generating additional revenue.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Quirófanos/organización & administración , Osteoartritis de la Rodilla/cirugía , Instrumentos Quirúrgicos/economía , Artroplastia de Reemplazo de Rodilla/economía , Artroplastia de Reemplazo de Rodilla/métodos , Ahorro de Costo , Costos y Análisis de Costo , Eficiencia , Alemania , Costos de Hospital , Humanos , Quirófanos/economía
18.
Int J Public Health ; 64(9): 1273-1281, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31482196

RESUMEN

OBJECTIVES: Reducing nursing home hospitalizations for ambulatory care sensitive conditions (ACSC) has been identified as an opportunity to improve patient well-being and reduce costs. The aim of this study was to identify number of hospitalizations for ACSCs for nursing home residents in a Swiss national sample, examine demographic characteristics of nursing home hospitalizations due to ACSCs, and calculate hospital expenses from these hospitalizations. METHODS: Using merged hospital administrative data with payment data based on diagnosis-related groups (DRGs) for the year 2013, we descriptively examined nursing home residents who were 65 years of age or older and were admitted to an acute care hospital. RESULTS: Approximately 42% of all nursing home admissions were due to ACSCs. Payments to Swiss hospitals for ACSCs can be estimated at between 89 and 105 million Swiss francs in 2013. CONCLUSIONS: A sizable share of hospitalizations for nursing home residents is for ACSCs, and the associated costs are substantial. Programs and policies designed to reduce these potentially avoidable hospitalizations from the nursing home setting could lead to an increased patient well-being and lower costs.


Asunto(s)
Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Ahorro de Costo/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Casas de Salud/economía , Casas de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Costos y Análisis de Costo , Femenino , Humanos , Masculino , Suiza
19.
BMC Public Health ; 19(1): 1234, 2019 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-31492118

RESUMEN

BACKGROUND: The cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) risk-reduction interventions is not well established. Colorado Heart Healthy Solutions is a CHW-based intervention designed to reduce modifiable CVD risk factors. This program has previously demonstrated success, but the cost-effectiveness is unknown. CHW-based interventions are potentially attractive complements to healthcare delivery because laypersons implement the intervention at a lower cost relative to medical care and may be attractive in rural settings with limited clinical resources. METHODS: CHWs performed screenings and provided ongoing participant support within predominantly rural communities. A point-of-service software tool was used to generate 10-year Framingham CVD risk scores and assist CHWs to make medical referrals and provide ongoing individualized support for lifestyle changes. A sample of program participants returned for reassessment of risk factors. We calculated quality-adjusted life years (QALYs) gained and program costs using a Markov model. Transition probabilities were calculated using Framingham risk equations or derived from the literature using the observed mean reduction in 10-year CVD risk score over of 37- months follow-up. Program cost-effectiveness was calculated for both at-risk (abnormal baseline CVD risk factors) and overall program populations. RESULTS: The base-case scenario evaluating a 52-year-old male participant revealed an incremental cost savings of $3576 and a gain of 0.16 QALYs associated with the intervention. Cost savings were greater in at-risk populations. The economic dominance of the model was robust in multiple sensitivity analyses. CONCLUSIONS: A community-based CVD intervention demonstrated to reduce CVD risk is cost-effective. This suggests that population-based public health programs may have the potential to complement primary care preventative services to improve health and reduce the burden of traditional medical care.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Promoción de la Salud/economía , Salud Pública , Colorado , Agentes Comunitarios de Salud , Ahorro de Costo , Análisis Costo-Beneficio , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo , Población Rural
20.
N C Med J ; 80(5): 292-295, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31471512

RESUMEN

The success of Medicaid transformation in North Carolina depends on participating health plans' ability to bring about better value to deliver on the Triple Aim of health care. Blue Cross and Blue Shield of North Carolina, working in collaboration with Amerigroup Partnership Plan, LLC, is making value-based care a cornerstone of its approach to serving the state's Medicaid population.


Asunto(s)
Medicaid/economía , Medicaid/organización & administración , Planes de Seguros y Protección Cruz Azul , Ahorro de Costo , Humanos , North Carolina , Estados Unidos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA