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1.
Am J Med Qual ; 36(2): 73-83, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33830094

RESUMEN

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/organización & administración , Administración Hospitalaria/normas , Entrenamiento Simulado/organización & administración , Ahorro de Costo , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Humanos , Satisfacción en el Trabajo , Pandemias , Seguridad del Paciente/normas , Salud Poblacional , Indicadores de Calidad de la Atención de Salud , Entrenamiento Simulado/normas , Flujo de Trabajo
2.
JAMA Netw Open ; 4(3): e2037334, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33646311

RESUMEN

Importance: There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers. Objective: To evaluate the association of GED programs with Medicare costs per beneficiary. Design, Setting, and Participants: This cross-sectional study included data on Medicare fee-for-service beneficiaries at 2 hospitals implementing Geriatric Emergency Department Innovations in Care Through Workforce, Informatics, and Structural Enhancement (GEDI WISE) (Mount Sinai Medical Center [MSMC] and Northwestern Memorial Hospital [NMH]) from January 1, 2013, to November 30, 2016. Analyses were conducted and refined from August 28, 2018, to November 20, 2020, using entropy balance to account for observed differences between the treatment and comparison groups. Interventions: Treatment included consultation with a transitional care nurse (TCN) or a social worker (SW) trained for the GEDI WISE program at a beneficiary's first ED visit (index ED visit). The comparison group included beneficiaries who were never seen by either a TCN or an SW during the study period. Main Outcomes and Measures: The main outcome evaluated was prorated total Medicare payer expenditures per beneficiary over 30 and 60 days after the index ED visit encounter. Results: Of the total 24 839 unique Medicare beneficiaries, 4041 were seen across the 2 EDs; 1947 (17.4%) at MSMC and 2094 (15.4%) at the NMH received treatment from either a GED TCN and/or a GED SW. The mean (SD) age of beneficiaries at MSMC was 78.8 (8.5) years and at NMH was 76.4 (7.7) years. Most patients at both hospitals were female (6821 [60.8%] at MSMC and 8023 [58.9%] at NMH) and White (7729 [68.9%] at MSMC and 9984 [73.3%] at NMH). Treatment was associated with statistically significant mean savings per beneficiary of $2436 (95% CI, $1760-$3111; P < .001) at one ED and $2905 (95% CI, $2378-$3431; P < .001) at the other ED in the 30 days after the index ED visit. The association between treatment and mean cumulative savings at 60 days after the index ED visit per beneficiary was also significant: $1200 (95% CI, $231-$2169; P = .02) at one ED and $3202 (95% CI, $2452-$3951; P < .001) at the other ED. Conclusions and Relevance: Among Medicare fee-for-service beneficiaries, receipt of ED-based geriatric treatment by a TCN and/or an SW was associated with lower Medicare expenditures. These estimated cost savings may be used when calculating or considering the bundled value and potential reimbursement per patient for GED care programs.


Asunto(s)
Servicio de Urgencia en Hospital/economía , Planes de Aranceles por Servicios , Servicios de Salud para Ancianos/economía , Costos de Hospital , Hospitales , Medicare , Atención al Paciente/economía , Anciano , Anciano de 80 o más Años , Ahorro de Costo , Estudios Transversales , Servicios Médicos de Urgencia , Evaluación Geriátrica , Humanos , Derivación y Consulta/economía , Servicio Social/economía , Cuidado de Transición/economía , Estados Unidos
3.
Milbank Q ; 99(1): 240-272, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33751664

RESUMEN

Policy Points  Spending on prescription drugs is much higher per capita in the United States than in most other industrialized nations, including France.  Lower prescription drug spending in France is due to different approaches to managing drug prices, volume of prescribing, and global health budgets.  Linking a drug's price to value both at the launch of the drug and over its lifetime is key to controlling spending. Regulations on prescription volume and global spending complement the interventions on prices.  If the United States adopted the French approach to regulating drug pricing, Medicare could potentially save billions of dollars annually on prescription drug spending. CONTEXT: Prescription drug spending per capita in the United States is higher than in most other industrialized countries. Policymakers seeking to lower drug spending often suggest benchmarking prices against other countries, including France, which spends half as much as the United States per capita on prescription drugs. Because differences in drug prices may result from how markets are organized in each nation, we sought to directly compare drug prices and pricing regulations between the United States and France. METHODS: For the six brand-name drugs with the highest gross expenditures in Medicare Part D in 2017, we compared the price dynamics in France and the United States between 2010 and 2018 and analyzed associations between price changes in each country and key regulatory events. We also comprehensively reviewed US and French laws and regulations related to drug pricing. FINDINGS: Prices for the six drugs studied were higher in the United States than in France. In 2018, if Medicare had paid French prices for the brand-name drugs in our cohort, the agency would have saved $5.1 billion. We identified 12 factors that explain why the United States spends more than France on drugs, including variations in unit prices and the volume of prescriptions, driven by use of health technology assessment and value-based pricing in France. CONCLUSIONS: Key drivers of lower drug spending in France compared to the United States are that the French government regulates drug prices when products are launched and prohibits substantial price increases after launch. The regulation of prescription drugs in France is governed by rules that can inform discussions of US prescription drug policy and potential Medicare price negotiations.


Asunto(s)
Ahorro de Costo , Regulación Gubernamental , Medicare Part D/economía , Medicamentos bajo Prescripción/economía , Costos y Análisis de Costo , Costos de los Medicamentos/legislación & jurisprudencia , Francia , Cobertura del Seguro , Legislación de Medicamentos , Estados Unidos
4.
J Stroke Cerebrovasc Dis ; 30(5): 105705, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33711759

RESUMEN

OBJECTIVES: To investigate the effects of hydration with or without Hydroxyethyl Starch (HES) 130/0.4 on neurological outcomes and medical costs during hospitalisation in patients with a single infarction (SI) in the posterior lenticulostriate artery (LSA) territory. MATERIALS AND METHODS: In this retrospective, single-centre, non-blinded cohort study, SI in the posterior LSA was defined as an ischaemic lesion with a high-signal intensity area ≥20 mm. All patients received basic stroke care within 48 h of symptom onset between April 2015 and January 2019. Patients were divided into the following two groups by clinician's preference: 1) those administered HES 130/0.4 and 2) those receiving other infusion fluid. The relationships between hospital costs and hydration therapy type were examined. RESULTS: Eighteen (31%) of 58 patients received HES 130/0.4. The HES group had a significantly lower total cost than the control group (3.6 vs. 6.4 million yen, p=0.006). Moreover, the HES group had a significantly shorter hospital stay duration (79.5 vs. 141.0 days) and lower National Institutes of Health Stroke Scale score on day 7. Multivariate analysis found that HES 130/0.4 administration was an independent factor associated with high costs. CONCLUSIONS: Hydration therapy with HES 130/0.4 significantly decreased the total costs and hospitalisation duration of patients with SI in the posterior LSA territory.


Asunto(s)
Infarto Encefálico/economía , Infarto Encefálico/terapia , Fluidoterapia/economía , Costos de Hospital , Derivados de Hidroxietil Almidón/economía , Derivados de Hidroxietil Almidón/uso terapéutico , Evaluación de Procesos y Resultados en Atención de Salud/economía , Sustitutos del Plasma/economía , Sustitutos del Plasma/uso terapéutico , Anciano , Infarto Encefálico/diagnóstico , Ahorro de Costo , Análisis Costo-Beneficio , Femenino , Fluidoterapia/efectos adversos , Humanos , Derivados de Hidroxietil Almidón/efectos adversos , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Sustitutos del Plasma/efectos adversos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
5.
Eur J Vasc Endovasc Surg ; 61(3): 447-455, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33414066

RESUMEN

OBJECTIVE: The AMBUVASC trial evaluated the cost effectiveness of outpatient vs. inpatient hospitalisation for endovascular repair of lower extremity arterial disease (LEAD). METHODS: AMBUVASC was a national multicentre, prospective, randomised controlled trial conducted in nine public and two private French centres. The primary endpoint was the incremental cost effectiveness ratio (ICER), defined by cost per quality adjusted life year (QALY). Analysis was conducted from a societal perspective, excluding indirect costs, and considering a one month time horizon. RESULTS: From 16 February 2016 to 29 May 2017, 160 patients were randomised (80 per group). A modified intention to treat analysis was performed with 153 patients (outpatient hospitalisation: n = 76; inpatient hospitalisation: n = 77). The patients mainly presented intermittent claudication (outpatient arm: 97%; inpatient arm: 92%). Rates of peri-operative complications were 20% (15 events) and 18% (14 events) for the outpatient and inpatient arms respectively (p = .81). Overall costs (difference: €187.83; 95% confidence interval [CI] -275.68-651.34) and QALYs (difference: 0.00277; 95% CI -0.00237 - 0.00791) were higher for outpatients due to more re-admissions than the inpatient arm. The mean ICER was €67 741 per QALY gained for the base case analysis with missing data imputed using multiple imputation by predictive mean matching. The outpatient procedure was not cost effective for a willingness to pay of €50 000 per QALY and the probability of being cost effective was only 59% for a €100 000/QALY threshold. CONCLUSION: Outpatient hospitalisation is not cost effective compared with inpatient hospitalisation for endovascular repair of patients with claudication at a €50 000/QALY threshold.


Asunto(s)
Atención Ambulatoria/economía , Procedimientos Endovasculares/economía , Costos de Hospital , Hospitalización/economía , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/economía , Enfermedad Arterial Periférica/terapia , Anciano , Ahorro de Costo , Análisis Costo-Beneficio , Procedimientos Endovasculares/efectos adversos , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Estudios Prospectivos , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Factores de Tiempo , Resultado del Tratamiento
6.
JAMA Oncol ; 7(4): 597-602, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33410867

RESUMEN

Importance: The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality. Objective: To examine the outcomes of a cancer center-wide virtual care program in response to the COVID-19 pandemic. Design, Setting, and Participants: This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020. Main Outcomes and Measures: Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients. Results: The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD$ 202 537, and displacement-related cost savings to patients totaled CAD$ 3 155 946. Conclusions and Relevance: These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era.


Asunto(s)
Atención Ambulatoria/organización & administración , Instituciones Oncológicas/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Oncología Médica/organización & administración , Telemedicina/organización & administración , Centros de Atención Terciaria/organización & administración , Atención Ambulatoria/economía , Citas y Horarios , Actitud del Personal de Salud , Instituciones Oncológicas/economía , Ahorro de Costo , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/economía , Estudios de Factibilidad , Costos de la Atención en Salud , Gastos en Salud , Humanos , Oncología Médica/economía , Ontario , Satisfacción del Paciente , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Indicadores de Calidad de la Atención de Salud/organización & administración , Telemedicina/economía , Centros de Atención Terciaria/economía , Factores de Tiempo , Carga de Trabajo
7.
Lancet Glob Health ; 9(2): e199-e208, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33482140

RESUMEN

BACKGROUND: The intermittent administration of seasonal malaria chemoprevention (SMC) is recommended to prevent malaria among children aged 3-59 months in areas of the Sahel subregion in Africa. However, the cost-effectiveness and cost savings of SMC have not previously been evaluated in large-scale studies. METHODS: We did a cost-effectiveness and cost-savings analysis of a large-scale, multi-country SMC campaign with sulfadoxine-pyrimethamine plus amodiaquine for children younger than 5 years in seven countries in the Sahel subregion (Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, and The Gambia) in 2016. The financial and economic costs were analysed from the programmatic perspective and are reported in 2016 US$ for each country. The estimated numbers of averted malaria cases, deaths, and disability-adjusted life-years (DALYs) were based on numbers of SMC treatments administered and modelled malaria transmission. Cost savings were calculated from a programmatic perspective corresponding to the diagnostic and treatment costs for malaria cases averted. FINDINGS: The total cost of SMC for all seven countries was $22·8 million, and the weighted average economic cost of administering four monthly SMC cycles was $3·63 per child (ranging from $2·71 in Niger to $8·20 in The Gambia). Based on 80% modelled effectiveness of SMC, the incremental economic cost per malaria case averted ranged from $2·91 in Niger to $30·73 in The Gambia; the cost per severe case averted ranged from $119·63 in Niger to $506·00 in The Gambia; the cost per death averted ranged from $533·56 in Niger to $2256·92 in The Gambia; and the cost per DALY averted (discounted by 3%) ranged from $18·66 in Niger to $78·91 in The Gambia. The estimated total economic cost savings to the health systems in all seven countries were US$66·0 million and the total net economic cost savings were US$43·2 million. INTERPRETATION: SMC is a low-cost and highly cost-effective intervention that contributes to substantial cost savings by reducing malaria diagnostic and treatment costs among children. FUNDING: Unitaid.


Asunto(s)
Antimaláricos/uso terapéutico , Quimioprevención , Ahorro de Costo , Análisis Costo-Beneficio , Malaria/prevención & control , Años de Vida Ajustados por Calidad de Vida , Estaciones del Año , África , Quimioprevención/economía , Niño , Preescolar , Humanos , Lactante
8.
Ann Emerg Med ; 77(2): 163-173, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33500115

RESUMEN

STUDY OBJECTIVE: In patients with a distal radius buckle fracture, we determine whether home removal of a splint and physician follow-up as needed (home management) is noninferior to primary care physician follow-up in 1 to 2 weeks with respect to functional recovery. We also compare groups with respect to health care and patient-level costs. METHODS: This was a noninferiority randomized controlled trial conducted at a tertiary care children's hospital. Eligible patients were randomized to home management versus primary care physician follow-up and received telephone contact at 3 and 6 weeks after the index ED visit. Functional recovery was measured with the Activities Scale for Kids-performance, and participants reported wrist-injury-related health care interventions and expenses. The primary outcome was a comparison of the performance score between groups at 3 weeks. RESULTS: We enrolled 149 patients with mean age 9.5 years (SD 2.7 years), and 81 (54.4%) were male patients. Of the 133 patients (89.3%) with completed 3-week follow-up, the mean Activities Scale for Kids-performance score was 95.4% in the home management group (n=66) and 95.9% in the primary care physician follow-up group (n=67) (mean difference -0.4%; lower bound of the 95% confidence interval -2.4%). There was a mean costs savings of -$100.10 (95% confidence interval -$130.0 to -$70.20) in health care and -$28.2 (95% confidence interval -$49.6 to -$7.0) in patient costs in the home management versus primary care physician follow-up group. CONCLUSION: In patients with distal radius buckle fractures, home management is at least as good as primary care physician follow-up with respect to functional recovery. Implementation of the home management strategy also demonstrated significant cost savings.


Asunto(s)
Cuidados Posteriores/economía , Atención Domiciliaria de Salud , Médicos de Atención Primaria , Fracturas del Radio/terapia , Férulas (Fijadores) , Niño , Ahorro de Costo , Femenino , Atención Domiciliaria de Salud/economía , Hospitales Pediátricos , Humanos , Masculino , Recuperación de la Función
9.
Dis Colon Rectum ; 64(1): 112-118, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33306537

RESUMEN

BACKGROUND: The Bundled Payments for Care Improvement initiative links payments for service beneficiaries during an episode of care (limited to 90 days from index surgery discharge). OBJECTIVE: The purpose of this study was to identify drivers of costs/payments for the major bowel Bundled Payments for Care Improvement initiative. DESIGN: Discharges from the Medicare Standard Analytic Files of hospitals participating in the major bowel bundle of the Bundled Payments for Care Improvement initiative were analyzed. SETTINGS: The study was conducted at 4 tertiary care centers. PATIENTS: All patients in diagnostic related groups of 329, 330, or 331 treated at eligible facilities between September 1, 2012, and September 30, 2014, were included. MAIN OUTCOME MEASURES: We calculated all costs/payments for the bundled period, that is, 3 days before surgery, the index hospitalization including surgery, and the 90-day postoperative period. We then determined costs for laparoscopic versus open procedures using International Classification of Diseases, Ninth Revision, procedure codes for each of the diagnostic related groups, as well as in aggregate. Last, we calculated differential impact of cost drivers on overall total episode costs. RESULTS: In the cohort of hospitals participating in the major bowel Bundled Payments for Care Improvement initiative, open procedures ($45,073) cost 1.6 times more than laparoscopic. For the lowest complexity diagnostic related group (331), performance of the procedure with open techniques was the largest total episode cost driver, because use of postdischarge services remained low. In the highest complexity diagnostic related group (329), readmission costs, skilled nursing facilities costs, and home health services costs were the greatest cost drivers after hospital services. LIMITATIONS: The analyses are limited by the retrospective nature of the study. CONCLUSIONS: These results indicate that efforts to safely perform open procedures with laparoscopic techniques would be most effective in reducing costs for lower complexity diagnostic related groups, whereas efforts to impact readmission and postdischarge service use would be most impactful for the higher complexity diagnostic related groups. See Video Abstract at http://links.lww.com/DCR/B420. ¿CUÁLES SON LOS FACTORES DETERMINANTES DE LOS COSTOS DE LA INICIATIVA DE MEJORA DE LA ATENCIÓN DE PAGOS COMBINADOS PARA EL INTESTINO MAYOR?: La iniciativa de pagos combinados para la mejora de la atención (BPCI) vincula los pagos para los beneficiarios del servicio durante un episodio de atención (limitado a 90 días desde el alta hospitalaria de la cirugía índice).Identificar los factores determinantes de los costos / pagos de la iniciativa BPCI intestinal mayor.Análisis de altas de los Archivos Analíticos Estándar de Medicare de los hospitales que participan en el paquete intestinal principal de la iniciativa BPCI.Todos los pacientes en Grupos Relacionados con el Diagnóstico (GRD) de 329, 330 o 331 tratados en instalaciones elegibles desde el 1 de Septiembre de 2012 hasta el 30 de Septiembre de 2014.Calculamos todos los costos / pagos para el período combinado, es decir, tres días antes de la cirugía, el índice de hospitalización incluida la cirugía y el período posoperatorio de 90 días. Luego, determinamos los costos de los procedimientos laparoscópicos versus abiertos utilizando códigos de procedimiento ICD-9 para cada uno de los GRD, así como en conjunto. Por último, calculamos el impacto diferencial de los generadores de costos sobre los costos totales del episodio.En la cohorte de hospitales que participan en la iniciativa BPCI del intestino principal, los procedimientos abiertos ($ 45.073) cuestan 1,6 veces más que los laparoscópicos. Para el GRD de menor complejidad (331), la realización del procedimiento con técnicas abiertas fue el mayor factor de costo total del episodio, ya que la utilización de los servicios posteriores al alta se mantuvo baja. En el GRD de mayor complejidad (329), los costos de readmisión, los costos de las instalaciones de enfermería especializada y los costos de los servicios de salud en el hogar fueron los mayores factores de costo después de los servicios hospitalarios.Los análisis están limitados por la naturaleza retrospectiva del estudio.Estos resultados indican que los esfuerzos para realizar procedimientos abiertos de manera segura con técnicas laparoscópicas serían más efectivos para reducir los costos de los GRD de menor complejidad, mientras que los esfuerzos para impactar la readmisión y la utilización del servicio posterior al alta serían más impactantes para los GRD de mayor complejidad. See Video Abstract at http://links.lww.com/DCR/B420.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/economía , Costos de la Atención en Salud/estadística & datos numéricos , Intestinos/cirugía , Medicare/economía , Mejoramiento de la Calidad/economía , Ahorro de Costo , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/normas , Humanos , Laparoscopía/economía , Laparoscopía/normas , Alta del Paciente/economía , Estudios Retrospectivos , Estados Unidos
10.
Am J Otolaryngol ; 42(1): 102764, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33096338

RESUMEN

OBJECTIVES: Recognize the avoidable costs incurred due to overpacking of rhinoplasty instrument trays. Reduce rhinoplasty instrument trays by including only instruments used frequently. Establish methods to reduce trays prepared for other otolaryngologic procedures. METHODS: This is a prospective study. The study evaluates the specific use of instruments opened for rhinoplasty procedures at the New York Eye & Ear Infirmary of Mount Sinai. Instruments were counted in 10 rhinoplasty cases. Usage rate was calculated for each instrument. Additionally, all instruments used in at least 20% of cases were noted. This "20%" threshold was used to create new rhinoplasty tray inventories more reflective of actual instrument usage. Some instruments above the 20% threshold were included in multiples (i.e. two Adson Brown forceps vs. one curved iris scissor). RESULTS: 189 instruments were opened, and 32 instruments were used on average in each rhinoplasty. 55 instruments were used in at least 20% of cases. The 55 "high usage" instruments were used to create new, reduced rhinoplasty tray inventory lists. Based on our analysis, a new rhinoplasty tray inventory was created comprised of 68 instruments, a 64% reduction from 189. CONCLUSION: Instruments are sterilized and packed in gross excess for rhinoplasty procedures. Previously published figures estimate re-sterilization costs of $0.51 to $0.77 per instrument. Reduction in instruments opened from 189 to 68 is expected to lead to cost savings ranging from $62 to $93 per case, yielding a savings between $6200 and $9300 per 100 cases performed. LEVEL OF EVIDENCE: II-3.


Asunto(s)
Rinoplastia/instrumentación , Instrumentos Quirúrgicos/economía , Instrumentos Quirúrgicos/estadística & datos numéricos , Revisión de Utilización de Recursos , Ahorro de Costo/economía , Estudios Prospectivos , Rinoplastia/economía , Esterilización/economía
11.
Ann Pharmacother ; 55(1): 44-51, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32578446

RESUMEN

BACKGROUND: Inappropriate albumin use in clinical practice remains problematic. Health-systems face continued challenges in promoting cost-appropriate use. OBJECTIVE: To evaluate the clinical and economic impact of a clinical pharmacist-led intervention strategy targeting inappropriate albumin use in general ward patients. METHODS: A retrospective cohort study evaluated all adult (≥18 years) general ward patients administered ≥1 dose of albumin at a university medical center over a 2-year period. The intervention consisted of a clinical pharmacist-led strategy intervening on all albumin orders not in accordance with institutional guidelines. The primary end point was to compare inappropriate albumin utilization before and after implementation. Secondary end points compared the rates of inappropriate albumin use adjusted for hospital admission and patient-days as well as associated costs by appropriateness between study periods. RESULTS: A total of 4420 patients were screened, with 1971 (44.6%) patients meeting inclusion criteria. The clinical pharmacist strategy significantly reduced inappropriate albumin (grams) utilization by 86.0% (P < 0.001). A 7-fold reduction of inappropriate albumin administered adjusted for the number of patient admissions was found from the preimplementation period following clinical pharmacist intervention strategy implementation (415.3 ± 83.2 vs 57.5 ± 34.2 g per 100 general ward hospital admissions, respectively; P < 0.001). Also, the adjusted inappropriate albumin rate was reduced from 62.2 ± 12.3 to 8.6 ± 5.2 g per 100 patient-days in the preimplementation and postimplementation periods, respectively (P < 0.001). Annual cost savings were $421 455 overall, with $341 930 resulting from mitigation of inappropriate use. CONCLUSION AND RELEVANCE: Clinical pharmacist-led interventions significantly reduced inappropriate albumin use and costs in hospitalized patients.


Asunto(s)
Albúminas/economía , Utilización de Medicamentos/economía , Prescripción Inadecuada/economía , Servicio de Farmacia en Hospital/normas , Adulto , Albúminas/uso terapéutico , Ahorro de Costo , Costos de los Medicamentos , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Hospitalización/economía , Hospitales de Enseñanza/economía , Hospitales de Enseñanza/organización & administración , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Farmacéuticos/normas , Servicio de Farmacia en Hospital/estadística & datos numéricos , Estudios Retrospectivos
12.
Nihon Koshu Eisei Zasshi ; 67(10): 752-762, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-33361670

RESUMEN

Objectives To examine the effects of a multifactorial intervention for improving frailty-comprising resistance exercise and nutritional and psychosocial programs-on the risk of long-term care insurance (LTCI) certification, death, and long-term care (LTC) cost among community-dwelling older adults.Methods Seventy-seven individuals (47 in 2011 and 30 in 2013) from the Hatoyama Cohort Study (742 individuals) participated in a multifactorial intervention. Non-participants were from the same cohort (including people who were invited to participate in the multifactorial intervention but declined). We performed propensity score matching with a ratio of 1 : 2 (intervention group vs. non-participant group). Afterward, 70 individuals undergoing the multifactorial intervention and 140 non-participants were selected. The risk of LTCI certification and/or death and the mean LTC cost during the follow-up period (32 months) were compared using the Cox proportional hazards model and generalized linear model (gamma regression model).Results The incidence of new LTCI certification (per 1,000 person-years) tended to be lower in the intervention group than in the non-participant group (1.8 vs. 3.6), but this was not statistically significant as per the Cox proportional hazards model (hazard ratio=0.51, 95% confidence interval [CI]=0.17-1.54). Although the incidence of LTC cost was not significant, the mean cumulative LTC cost during the 32 months and the mean LTC cost per unit during the follow-up period (1 month) were 375,308 JPY and 11,906 JPY/month, respectively, in the intervention group and 1,040,727 JPY and 33,460 JPY/month, respectively, in the non-participant group. Cost tended to be lower in the intervention group than in the non-participant group as per the gamma regression model (cumulative LTC cost: cost ratio=0.36, 95%CI=0.11-1.21, P=0.099; LTC cost per unit follow-up period: cost ratio=0.36, 95%CI=0.11-1.12, P=0.076).Conclusions These results suggest that a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs is effective in lowering the incidence of LTCI certification, consequently saving LTC cost, although the results were not statistically significant. Further research with a stricter study design is needed.


Asunto(s)
Certificación/estadística & datos numéricos , Ahorro de Costo/economía , Ejercicio Físico/fisiología , Anciano Frágil , Fragilidad/prevención & control , Vida Independiente , Seguro de Cuidados a Largo Plazo , Cuidados a Largo Plazo/economía , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/métodos , Puntaje de Propensión , Entrenamiento de Resistencia , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Incidencia , Seguro de Cuidados a Largo Plazo/normas , Seguro de Cuidados a Largo Plazo/estadística & datos numéricos , Japón , Masculino , Riesgo
13.
Gac. sanit. (Barc., Ed. impr.) ; 34(6): 553-560, nov.-dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-200246

RESUMEN

OBJETIVO: El objetivo de este estudio fue cuantificar los beneficios económicos conseguidos antes y después de la implantación del permiso de conducción por puntos en las vías interurbanas en España. MÉTODO: Estudio descriptivo a través de la construcción de tres indicadores que expresaron el ahorro de costes por el número de víctimas evitadas. Se definieron dos periodos respecto al objetivo y se recopilaron datos de muertos, heridos graves y heridos leves en vías interurbanas entre 1999 y 2014 para cada provincia española. Se utilizaron para cada provincia datos de su población, producto interior bruto o número de vehículos-kilómetros recorridos en sus vías (MVKR). La cuantificación del ahorro se obtuvo utilizando las cifras oficiales de los costes para cada tipo de víctima en precios de 2014. RESULTADOS: El ahorro por habitante en muertos en el periodo de vigencia del permiso de conducción por puntos se situó entre 3,89 euros y 19,65 euros anuales. El ahorro en heridos graves por MVKR se redujo un 15%-66% entre 2006 y 2014, lo que supone anualmente desde 449,15 euros a 1707,88 euros. CONCLUSIONES: Durante el periodo de vigencia del permiso de conducción por puntos las provincias españolas han conseguido importantes ahorros de costes


OBJECTIVE: To quantify cost savings obtained before and after the implementation of the penalty-points driving licence on the interurban roads in Spain. METHOD: Descriptive study through the construction of three indicators that expressed the cost savings by the number of victims avoided. We defined two periods according to the objective and collected data on fatalities, serious injuries and slight injuries on interurban roads in 1999-2014 for each Spanish province. Thus, data for its population, GDP or number of vehicles-kilometres travelled on its roads (MVKT) were used for each province. The quantification of savings was obtained using official figures of costs for each type of victim in 2014 prices. RESULTS: The cost savings per inhabitant on fatalities in the period of validity of the penalty-points driving licence was between € 3.89 and € 19.65 per year. Savings on serious injuries by MVKT were reduced by 15%-66% between 2006 and 2014, being from € 449.15 to 1707.88 € annually. CONCLUSIONS: During the period of validity of the penalty-points driving licence, the Spanish provinces have achieved significant cost savings


Asunto(s)
Humanos , Accidentes de Tránsito/prevención & control , Conducción de Automóvil/normas , Traumatismo Múltiple/prevención & control , Ahorro de Costo/estadística & datos numéricos , Evaluación de Eficacia-Efectividad de Intervenciones , Estudios Controlados Antes y Después , Epidemiología Descriptiva , Medidas de Seguridad/tendencias , España/epidemiología
14.
Yakugaku Zasshi ; 140(11): 1365-1372, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-33132272

RESUMEN

Japan's health care system can be regarded as one of the best worldwide, provided it remains sustainable. It has relatively low costs, short wait times, low disease incidence, and high life expectancy. However, universal coverage in Japan faces financial challenges due to the country's rapidly aging population. Canada is another of the few developed countries that have universal health coverage. In contrast to Japan, Canada's health care spending is still sustainable according to recent studies. Effective cost control by payers has played a major role, with providers being steered toward evidence-based and cost-effective drug therapies. Furthermore, expanded pharmacy services have been important in suppressing spending on prescription drugs and minor health care services such as vaccination, government-funded smoking cessation, and medication review programs. This article outlines the services provided by Canadian pharmacists with expanded scope of practice. The pharmaceutical profession and its advocacy body in Canada have not only played a role in regulatory changes, but also put in place technological infrastructure called PharmaNet and contributed to appropriate prescribing. Given the current economic situation and demographic trends in Japan, more options should be explored in order to maintain universal health coverage by meeting the funding gap. Utilizing community pharmacies and pharmacists is proposed as one option.


Asunto(s)
Ahorro de Costo , Análisis Costo-Beneficio , Prestación de Atención de Salud , Práctica Clínica Basada en la Evidencia , Costos de la Atención en Salud , Servicios Farmacéuticos/economía , Cobertura Universal del Seguro de Salud/economía , Canadá , Servicios Comunitarios de Farmacia , Humanos , Japón , Formulación de Políticas , Medicamentos bajo Prescripción/economía , Cese del Hábito de Fumar
15.
IEEE Pulse ; 11(5): 24-27, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33064641

RESUMEN

Citizens' dissatisfaction with the scope of the United States health care system has been a hot topic for many years. In a country where patient to nurse ratios remain 6:1, even universal health care coverage cannot guarantee adequate patient care. These issues were further highlighted by the COVID-19 pandemic, where inadequate hospital funding and lack of attention to patients led to challenging situations in hotspot areas. Although this pandemic will shape us for many years to come with far reaching impacts, social distancing norms have accelerated technologies that enable services to be delivered remotely, a capability even more necessary in our health care system. By providing care that can be delivered remotely, we can focus in-person care in our hospitals to only the ones who really need it. This allows us to scale our systems, protect lives, and safeguard economic activity.


Asunto(s)
Prestación de Atención de Salud , Internet de las Cosas , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Ahorro de Costo , Prestación de Atención de Salud/economía , Equipos y Suministros , Humanos , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Tecnología de Sensores Remotos , Transportes , Estados Unidos/epidemiología , Administración de Residuos
17.
J Stroke Cerebrovasc Dis ; 29(11): 105213, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066879

RESUMEN

BACKGROUND: In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes. AIMS: This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data. METHODS: A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs. RESULTS: Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 - 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit. CONCLUSIONS: Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors.


Asunto(s)
Estimulantes del Sistema Nervioso Central/economía , Estimulantes del Sistema Nervioso Central/uso terapéutico , Costos de los Medicamentos , Fatiga/tratamiento farmacológico , Fatiga/economía , Modafinilo/economía , Modafinilo/uso terapéutico , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/terapia , Anciano , Australia , Estimulantes del Sistema Nervioso Central/efectos adversos , Ensayos Clínicos Fase II como Asunto , Ahorro de Costo , Análisis Costo-Beneficio , Fatiga/diagnóstico , Fatiga/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modafinilo/efectos adversos , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento
18.
Ann Thorac Cardiovasc Surg ; 26(5): 229-239, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-32921659

RESUMEN

Bilateral internal mammary artery (BIMA) in coronary artery bypass grafting (CABG) has traditionally been limited. This review looks at the recent outcome data on BIMA in CABG focusing on the management of risk factors for mediastinitis, one of the potential barriers for more extensive BIMA utilization. A combination of pre-, intra- and postoperative strategies are essential to reduce mediastinitis. Limited data indicate that the incidence of mediastinitis can be reduced using closed incision negative-pressure wound therapy as a part of these strategies with the possibility of offering patients best treatment options by extending BIMA to those with a higher risk of mediastinitis. Recent economic data imply that the technology may challenge the current low uptake of BIMA by reducing the short-term cost differentials between single internal mammary artery and BIMA. Given that most published randomized controlled trials and meta-analyses of observational long-term outcome data favor BIMA, if short-term complications of BIMA including mediastinitis can be controlled adequately, there may be opportunities for more extensive use of BIMA leading to improved long-term outcomes. An ongoing study looking at BIMA in high-risk patients may provide evidence to support the hypothesis that mediastinitis should not be a factor in limiting the use of BIMA in CABG.


Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Arterias Mamarias/cirugía , Mediastinitis/prevención & control , Puente de Arteria Coronaria/economía , Enfermedad de la Arteria Coronaria/economía , Ahorro de Costo , Análisis Costo-Beneficio , Costos de la Atención en Salud , Humanos , Mediastinitis/economía , Mediastinitis/etiología , Factores de Riesgo , Resultado del Tratamiento
19.
PLoS One ; 15(9): e0239704, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32976493

RESUMEN

In developed countries, most people living with HIV/AIDS are treated with costly brand single-tablet regimens. Given the economic impact, French guidelines recommend using generic antiretroviral therapy when possible to decrease antiretroviral therapy costs. We aimed to study HIV-infected patients' acceptability to switch from a brand single-tablet regimens [abacavir/lamivudine/dolutegravir (Triumeq®) or emtricitabine/tenofovir disoproxil fumarate/rilpivirine (Eviplera®)] to a treatment comprising of two pills: one is a fixed-dose generic combination of 2 Nucleoside Analogs and the second tablet is the third antiretroviral. This study was a prospective observational study in a French hospital. During their follow-up, patients on stable single-tablet regimens were made aware of the possible cost-saving. They were questioned about their willingness and barriers accepting the substitution. Participants chose between the two regimens, either to remain on single-tablet regimens or switch to the de-simplified regimen. Six months later, a second survey was given to the patient who chose to de-simplify and HIV viral load was controlled. The study included 98 patients: 60 receiving emtricitabine/tenofovir disoproxil fumarate/rilpivirine (Eviplera®) and 38 on abacavir/lamivudine/dolutegravir (Triumeq®). Forty-five patients accepted the de-simplified treatment, 37 refused and 16 were undecided and followed the decision offered by their physician. The main reason for unwillingness to switch is the number of pills (77.3%). In multivariate model analysis, male patients (p = 0.001) who have taken antiretroviral therapy for over 20 years (p = 0.04) and who retrieve their treatment in their community hospital (p = 0.03) are more likely to accept the switch. Fifty-one patients accepted to replace their single-tablet regimens and six months later, the majority was satisfied; only four returned to single-tablet regimens because of suspected side effects. Half of the people living with HIV/AIDS in our cohort accepted to switch from brand single-tablet regimens to a two-tablet regimen containing generic drugs within a process that emphasizes health expenditure savings.


Asunto(s)
Fármacos Anti-VIH/economía , Ahorro de Costo , Medicamentos Genéricos/economía , Satisfacción del Paciente , Comprimidos/economía , Adulto , Anciano , Fármacos Anti-VIH/administración & dosificación , Utilización de Medicamentos/economía , Medicamentos Genéricos/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Comprimidos/administración & dosificación
20.
J Vasc Interv Radiol ; 31(10): 1552-1559.e1, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32917502

RESUMEN

PURPOSE: To conduct a population-level analysis of surgical and endovascular interventions for symptomatic uterine leiomyomata by using administrative data from outpatient medical encounters. MATERIALS AND METHODS: By using administrative data from all outpatient hospital encounters in California (2005-2011) and Florida (2005-2014), all patients in the outpatient setting with symptomatic uterine leiomyomata were identified. Patients were categorized as undergoing hysterectomy, myomectomy, uterine artery embolization (UAE), or no intervention. Hospital stay durations and costs were recorded for each encounter. RESULTS: A total of 227,489 patients with uterine leiomyomata were included, among whom 39.9% (n = 90,800) underwent an intervention, including hysterectomy (73%), myomectomy (19%), or UAE (8%). The proportion of patients undergoing hysterectomy increased over time (2005, hysterectomy, 53.2%; myomectomy, 26.9%; UAE, 18.0%; vs 2013, hysterectomy, 80.1%; myomectomy, 14.4%; UAE, 4.0%). Hysterectomy was eventually performed in 3.5% of patients who underwent UAE and 4.1% who underwent myomectomy. Mean length of stay following hysterectomy was significantly longer (0.5 d) vs myomectomy (0.2 d) and UAE (0.3 d; P < .001 for both). The mean encounter cost for UAE ($3,772) was significantly less than those for hysterectomy ($5,409; P < .001) and myomectomy ($6,318; P < .001). Of the 7,189 patients who underwent UAE during the study period, 3.5% underwent subsequent hysterectomy. CONCLUSIONS: The proportion of women treated with hysterectomy in the outpatient setting has increased since 2005. As a lower-cost alternative with a low rate of conversion to hysterectomy, UAE may be an underutilized treatment option for patients with uterine leiomyomata.


Asunto(s)
Procedimientos Endovasculares/tendencias , Histerectomía/tendencias , Leiomioma/terapia , Pautas de la Práctica en Medicina/tendencias , Embolización de la Arteria Uterina/tendencias , Miomectomía Uterina/tendencias , Neoplasias Uterinas/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California , Ahorro de Costo , Análisis Costo-Beneficio , Bases de Datos Factuales , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/economía , Femenino , Florida , Costos de Hospital/tendencias , Humanos , Histerectomía/efectos adversos , Histerectomía/economía , Leiomioma/economía , Tiempo de Internación , Persona de Mediana Edad , Salud Poblacional , Complicaciones Posoperatorias/etiología , Pautas de la Práctica en Medicina/economía , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Embolización de la Arteria Uterina/efectos adversos , Embolización de la Arteria Uterina/economía , Miomectomía Uterina/efectos adversos , Miomectomía Uterina/economía , Neoplasias Uterinas/economía , Adulto Joven
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