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1.
Isr Med Assoc J ; 22(5): 303-309, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32378823

RESUMEN

BACKGROUND: Survivors of acute myocardial infarction (AMI) are at increased risk for recurrent cardiac events and tend to use excessive healthcare services, thus resulting in increased costs. OBJECTIVES: To evaluate the disparities in healthcare resource utilization and costs throughout a decade following a non-fatal AMI according to sex and ethnicity groups in Israel. METHODS: A retrospective study included AMI patients hospitalized at Soroka University Medical Center during 2002-2012. Data were obtained from electronic medical records. Post-AMI annual length of hospital stay (LOS); number of visits to the emergency department (ED), primary care facilities, and outpatient consulting clinics; and costs were evaluated and compared according sex and ethnicity groups. RESULTS: A total of 7685 patients (mean age 65.3 ± 13.6 years) were analyzed: 56.8% Jewish males (JM), 26.6% Jewish females (JF), 12.4% Bedouin males (BM), and 4.2% Bedouin females (BF). During the up-to 10-years follow-up (median 5.8 years), adjusted odds ratios [AdjOR] for utilizations of hospital-associated services were highest among BF (1.628 for LOS; 1.629 for ED visits), whereas AdjOR for utilization of community services was lowest in BF (0.722 for primary clinic, 0.782 for ambulatory, and 0.827 for consultant visits), compared with JM. The total cost of BF was highest among the study groups (AdjOR = 1.589, P < 0.01). CONCLUSIONS: Long-term use of hospital-associated healthcare services and total costs were higher among Bedouins (especially BF), whereas utilization of ambulatory services was lower in these groups. Culturally and economically sensitive programs optimizing healthcare resources utilization and costs is warranted.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Infarto del Miocardio/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Enfermedad Aguda , Adulto , Anciano , Árabes/estadística & datos numéricos , Femenino , Costos de la Atención en Salud , Disparidades en Atención de Salud/economía , Humanos , Israel , Judíos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/economía , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Factores Sexuales
2.
Medicine (Baltimore) ; 99(19): e20089, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384480

RESUMEN

To investigate the costs associated with postoperative complications following rectal resection.Rectal resection is a major surgical procedure that carries a significant risk of complications. The occurrence of complications following surgery has both health and financial consequences. There are very few studies that examine the incidence and severity of complications and their financial implications following rectal resection.We identified 381 consecutive patients who underwent a rectal resection within a major university hospital. Patients were included using the International Classification of Diseases (ICD) codes. Complications in the postoperative period were reported using the validated Clavien-Dindo classification system. Both the number and severity of complications were recorded. Activity-based costing methodology was used to report financial outcomes. Preoperative results were also recorded and assessed.A 76.9% [95% CI: 68.3:86.2] of patients experienced one or more complications. Patients who had a complication had a median total cost of $22,567 [IQR 16,607:33,641]. Patients who did not have a complication had a median total cost of $15,882 [IQR 12,971:19,861]. The adjusted additional median cost for patients who had a complication was $5308 [95% CI: 2938:7678] (P < .001). Patients who experienced a complication tended to undergo an open procedure (P = .001), were emergent patients (P = .003), preoperatively had lower albumin levels (36 vs 38, P = .0003) and were anemic (P = .001).Complications following rectal resection are common and are associated with increased costs. Our study highlights the importance of evaluating and preventing complications in the postoperative period.


Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/terapia , Proctectomía , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
4.
Medicine (Baltimore) ; 99(16): e19692, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32311946

RESUMEN

To evaluate the effect of the open abdomen (OA) and closed abdomen (CA) approaches for treating intestinal fistula with complicated intra-abdominal infection (IFWCIAI), and analyze the risk factors in OA treatment.IFWCIAI is associated with high mortality rates and healthcare costs, as well as longer postoperative hospital stay. However, OA treatment has also been linked with increased mortality and development of secondary intestinal fistula.A total of 195 IFWCIAI patients who were operated over a period of 7 years at our hospital were retrospectively analyzed. These patients were divided into the OA group (n = 112) and CA group (n = 83) accordingly, and the mortality rates, hospital costs, and hospital stay duration of both groups were compared. In addition, the risk factors in OA treatment were also analyzed.OA resulted in significantly lower mortality rates (9.8% vs 30.1%, P < .001) and hospital costs ($11721.40 ±â€Š$9368.86 vs $20365.36 ±â€Š$21789.06, P < .001) compared with the CA group. No incidences of secondary intestinal fistula was recorded and the duration of hospital stay was similar for both groups (P = .151). Delayed OA was an independent risk factor of death following OA treatment (hazard ratio [HR] = 1.316; 95% confidence interval [CI] = 1.068-1.623, P = .010), whereas early enteral nutrition (EN) exceeding 666.67 mL was a protective factor (HR = 0.996; 95% CI = 0.993-0.999, P = .018). In addition, Acinetobacter baumannii, Pseudomonas aeruginosa, and Candida albicans were the main pathogens responsible for the death of patients after OA treatment.OA decreased mortality rates and hospital costs of IFWCIAI patients, and did not lead to any secondary fistulas. Early OA and EN also reduced mortality rates.


Asunto(s)
Fístula del Sistema Digestivo/mortalidad , Fístula del Sistema Digestivo/cirugía , Infecciones Intraabdominales/mortalidad , Infecciones Intraabdominales/cirugía , Técnicas de Abdomen Abierto , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fístula del Sistema Digestivo/complicaciones , Fístula del Sistema Digestivo/economía , Femenino , Costos de la Atención en Salud , Humanos , Infecciones Intraabdominales/complicaciones , Infecciones Intraabdominales/economía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Técnicas de Abdomen Abierto/economía , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
5.
Arq Gastroenterol ; 57(1): 31-38, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32294733

RESUMEN

BACKGROUND: Over the next 20 years, the number of patients on the waiting list for liver transplantation (LTx) is expected to increase by 23%, while pre-LTx costs should raise by 83%. OBJECTIVE: To evaluate direct medical costs of the pre-LTx period from the perspective of a tertiary care center. METHODS: The study included 104 adult patients wait-listed for deceased donor LTx between October 2012 and May 2016 whose treatment was fully provided at the study transplant center. Clinical and economic data were obtained from electronic medical records and from a hospital management software. Outcomes of interest and costs of patients on the waiting list were compared through the Kruskal-Wallis test. A generalized linear model with logit link function was used for multivariate analysis. P-values <0.05 were considered statistically significant. RESULTS: The costs of patients who underwent LTx ($8,879.83; 95% CI 6,735.24-11,707.27; P<0.001) or who died while waiting ($6,464.73; 95% CI 3,845.75-10,867.28; P=0.04) were higher than those of patients who were excluded from the list for any reason except death ($4,647.78; 95% CI 2,469.35-8,748.04; P=0.254) or those who remained on the waiting list at the end of follow-up. CONCLUSION: Although protocols of inclusion on the waiting list vary among transplant centers, similar approaches exist and common problems should be addressed. The results of this study may help centers with similar socioeconomic realities adjust their transplant policies.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Fallo Hepático/cirugía , Trasplante de Hígado/economía , Anciano , Femenino , Humanos , Trasplante de Hígado/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Listas de Espera
6.
Bone Joint J ; 102-B(4): 449-457, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228074

RESUMEN

AIMS: The aim is to assess the cost-effectiveness of patellofemoral arthroplasty (PFA) in comparison with total knee arthroplasty (TKA) for the treatment of isolated patellofemoral osteoarthritis (OA) based on prospectively collected data on health outcomes and resource use from a blinded, randomized, clinical trial. METHODS: A total of 100 patients with isolated patellofemoral osteoarthritis were randomized to receive either PFA or TKA by experienced knee surgeons trained in using both implants. Patients completed patient-reported outcomes including EuroQol five-dimension questionnaire (EQ-5D) and 6-Item Short-Form Health Survey questionnaire (SF-6D) before the procedure. The scores were completed again after six weeks, three, six, and nine months, and again after one- and two-year post-surgery and yearly henceforth. Time-weighted outcome measures were constructed. Cost data were obtained from clinical registrations and patient-reported questionnaires. Incremental gain in health outcomes (quality-adjusted life-years (QALYs)) and incremental costs were compared for the two groups of patients. Net monetary benefit was calculated assuming a threshold value of €10,000, €35,000, and €50,000 per QALY and used to test the statistical uncertainty and central assumptions about outcomes and costs. RESULTS: The PFA group had an incremental 12 month EQ-5D gain of 0.056 (95% confidence interval (CI) 0.01 to 0.10) and an incremental 12 month cost of minus €328 (95% CI 836 to 180). PFA therefore dominates TKA by providing better and cheaper outcomes than TKA. The net monetary benefit of PFA was €887 (95% CI 324 to 1450) with the €10,000 threshold, and it was consistently positive when different measures of outcomes and different cost assumptions were used. CONCLUSION: This study provides robust evidence that PFA from a one-year hospital management perspective is cheaper and provides better outcomes than TKA when applied to patients with isolated patellofemoral osteoarthritis and performed by experienced knee surgeons. Cite this article: Bone Joint J 2020;102-B(4):449-457.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Articulación Patelofemoral/cirugía , Anciano , Artroplastia de Reemplazo de Rodilla/economía , Análisis Costo-Beneficio , Método Doble Ciego , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/economía , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento
7.
Crit Care ; 24(1): 131, 2020 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-32252807

RESUMEN

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. METHODS: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. RESULTS: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 56.4%. Survival at 1 year, 2 years, and 5 years was 51.5%, 50.0%, and 42.1%, respectively. Among survivors, 99.5% were discharged home. Median total costs among all patients in the year following hospital admission were $147,957 (IQR $70,571-$300,295). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (median $119,197, IQR $57,839-$250,675). CONCLUSIONS: Children requiring ECMO continue to have a significant in-hospital mortality, but reassuringly, there is little decrease in long-term survival at 1 year. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs. This information provides value to providers and health systems, allowing for prognostication of short- and long-term outcomes, as well as long-term healthcare-related expenses for pediatric ECMO survivors.


Asunto(s)
Enfermedad Crítica/mortalidad , Oxigenación por Membrana Extracorpórea/economía , Oxigenación por Membrana Extracorpórea/mortalidad , Costos de la Atención en Salud , Mortalidad Hospitalaria , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Ontario , Alta del Paciente
9.
Am Surg ; 86(3): 195-199, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223797

RESUMEN

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion (P = 0.56). Statewide data similarly demonstrated no change (P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients' decision to seek breast cancer screening and care.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer/economía , Costos de la Atención en Salud , Medicaid/economía , Evaluación de Resultado en la Atención de Salud , Adulto , Anciano , Neoplasias de la Mama/economía , Neoplasias de la Mama/mortalidad , Bases de Datos Factuales , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Ohio , Patient Protection and Affordable Care Act , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Estados Unidos
10.
Am Surg ; 86(3): 256-260, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223807

RESUMEN

Minimally invasive sigmoid colectomy via the laparoscopic approach (LA) has numerous benefits. We seek to compare outcomes between laparoscopic and robotic sigmoid colectomies. We analyzed the data using the National Inpatient Sample database between 2008 and 2014. Utilization and outcome measures were compared. The seven-year average number of patients who underwent elective sigmoid colectomy in the United States from 2008 to 2014 was estimated to be 197,053. Of these, 95.1 per cent were conducted using the LA. The mean age was 58.33 + 13.6 years and 58.23 + 12.8 years in laparoscopic and robotic approaches, respectively. No significant differences existed in respect to morbidities. Postoperative complications were comparable with respect to other complications. Length of hospital stay was statistically significantly shorter in the robot-assisted approach compared with the LA (mean 4.8 + 4 vs 5.7 + 5 days, respectively, P < 0.001). Patients who underwent robotic surgery had significantly higher total hospital charges than those who underwent laparoscopic surgery (median $45,057 vs $57,871 USD, P < 0.001). The advent of robot-assisted surgery has provided more options for patients and surgeons. Compared with laparoscopy, robot-assisted sigmoid colectomy has no clinical advantages in morbidity and mortality. However, the robotic approach has a significantly higher total charge to the patient.


Asunto(s)
Colectomía/métodos , Costos de Hospital , Laparoscopía/métodos , Tiempo de Internación/economía , Procedimientos Quirúrgicos Robotizados/economía , Adulto , Anciano , Colectomía/economía , Colon Sigmoide/cirugía , Análisis Costo-Beneficio , Bases de Datos Factuales , Procedimientos Quirúrgicos Electivos/economía , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud , Humanos , Laparoscopía/economía , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Medición de Riesgo , Procedimientos Quirúrgicos Robotizados/métodos , Estados Unidos
12.
N Engl J Med ; 382(12): 1166-1174, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32187475
14.
Medicine (Baltimore) ; 99(11): e19009, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176029

RESUMEN

Quick diagnosis units (QDU) have become an alternative hospital-based ambulatory medicine strategy to inpatient hospitalization for potentially serious illnesses in Spain. Whether diagnosis of pancreatic cancer is better accomplished by an ambulatory or inpatient approach is unknown. The main objective of this retrospective study was to examine and compare the diagnostic effectiveness of a QDU or inpatient setting in patients with pancreatic cancer.Patients with a diagnosis of pancreatic adenocarcinoma who had been referred to a university, tertiary hospital-based QDU or hospitalized between 2005 and 2018 were eligible. Presenting symptoms and signs, risk and prognostic factors, and time to diagnosis were compared. The costs incurred during the diagnostic assessment were analyzed with a microcosting method.A total of 1004 patients (508 QDU patients and 496 inpatients) were eligible. Admitted patients were more likely than QDU patients to have weight loss, asthenia, anorexia, abdominal pain, jaundice, and palpable hepatomegaly. Time to diagnosis of inpatients was similar to that of QDU patients (4.1 [0.8 vs 4.3 [0.6] days; P = .163). Inpatients were more likely than QDU patients to have a tumor on the head of the pancreas, a tumor size >2 cm, a more advanced nodal stage, and a poorer histological differentiation. No differences were observed in the proportion of metastatic and locally advanced disease and surgical resections. Microcosting revealed a cost of &OV0556;347.76 (48.69) per QDU patient and &OV0556;634.36 (80.56) per inpatient (P < .001).Diagnosis of pancreatic cancer is similarly achieved by an inpatient or QDU clinical approach, but the latter seems to be cost-effective. Because the high costs of hospitalization, an ambulatory diagnostic assessment may be preferable in these patients.


Asunto(s)
Adenocarcinoma/diagnóstico , Atención Ambulatoria/métodos , Hospitalización/estadística & datos numéricos , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/economía , Anciano , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Costos de la Atención en Salud , Hospitalización/economía , Humanos , Persona de Mediana Edad , Neoplasias Pancreáticas/economía , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , España , Listas de Espera
15.
N C Med J ; 81(2): 95-99, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32132248

RESUMEN

BACKGROUND Health care costs are on the rise and causing financial burden for many patients. Price transparency has been proposed as a tool to control health care costs. New federal legislation requires all hospitals to publish their chargemasters, or price lists, on their websites as of January 1, 2019.METHOD All general acute care hospitals in North Carolina were contacted in 2017 to request price information. After mandatory chargemaster publication was in effect in 2019, all hospitals previously contacted had their websites evaluated for chargemaster availability. Price information collected in 2019 was compared to information collected in 2017.RESULTS Zero percent of hospitals provided access to chargemasters in 2017, and 72% provided access in 2019. Average price per queried item decreased from 2017 to 2019. Price variability also decreased. However, there was no statistical significance when comparing price means.LIMITATIONS In 2017, price data was limited due to low hospital participation when queried for prices. In 2019, this study's definition of "access to chargemaster" inadvertently excluded some North Carolina hospitals from qualifying as providing price access.CONCLUSION After mandated chargemaster publication, consumer access to hospital price lists greatly increased in North Carolina. Price data, although limited, reveals decreased mean prices and decreased price variability for queried procedures after chargemaster publication was required.


Asunto(s)
Revelación/legislación & jurisprudencia , Precios de Hospital , Control de Costos/métodos , Costos de la Atención en Salud , Precios de Hospital/estadística & datos numéricos , Humanos , North Carolina
17.
BMC Infect Dis ; 20(1): 233, 2020 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-32192436

RESUMEN

BACKGROUND: This study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries. METHODS: Adult patients with at least one of the selected surgeries from 2012 to 2015 captured in a German sickness fund database were included. SAI were identified using S. aureus-specific ICD-10 codes. Patients with certain prior surgeries and infections were excluded. Cumulative incidence and incidence density of post-surgical SAI were assessed. Risk factors, mortality, healthcare resource utilization and direct costs were compared between SAI and non-SAI groups using multivariable analyses over the 1 year follow-up. RESULTS: Overall, 74,327 patients who underwent a knee (28.6%), hip (39.6%), or spine surgery (31.8%) were included. The majority were female (61.58%), with a mean age of 69.59 years and a mean Charlson Comorbidity Index (CCI) of 2.3. Overall, 1.92% of observed patients (20.20 SAI per 1000 person-years (PY)) experienced a SAI within 1 year of index hospitalization. Knee surgeries were associated with lower SAI risk compared with hip surgeries (Hazard Ratio (HR) = 0.8; p = 0.024), whereas spine surgeries did not differ significantly from hip surgeries. Compared with non-SAI group, the SAI group had on average 4.4 times the number of hospitalizations (3.1 vs. 0.7) and 7.7 times the number of hospital days (53.5 vs. 6.9) excluding the index hospitalization (p < 0.001). One year post-orthopedic mortality was 22.38% in the SAI and 5.31% in the non-SAI group (p < 0.001). The total medical costs were significantly higher in the SAI group compared to non-SAI group (42,834€ vs. 13,781€; p < 0.001). Adjusting for confounders, the SAI group had nearly 2 times the all-cause direct healthcare costs (exp(b) = 1.9; p < 0.001); and 1.72 times higher risk of death (HR = 1.72; p < 0.001). CONCLUSIONS: SAI risk after orthopedic surgeries persists and is associated with significant economic burden and risk of mortality. Hence, risk reduction and prevention methods are of utmost importance.


Asunto(s)
Procedimientos Ortopédicos/efectos adversos , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/epidemiología , Infecciones Estafilocócicas/economía , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Costos de la Atención en Salud , Hospitalización/economía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/mortalidad
18.
PLoS One ; 15(2): e0227961, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023267

RESUMEN

PURPOSE: Trastuzumab (TZM) improves survival and the risk of recurrence among patients with early-stage HER2+ breast cancer (BC). TZM treatment can be given intravenously (IV-TZM) or subcutaneously (SC-TZM). Although both methods have similar efficacy and safety, they differ in dosage and administration. Previous studies of cost minimization determined that SC-TZM is associated with lower costs than IV-TZM; however, those studies did not include the costs associated with body weight-based dosage and the treatment of adverse drug reactions (ADRs). METHODS/PATIENTS: We performed a model-based cost-minimization analysis. The analysis included direct and indirect medical costs associated with TZM preparation (adjusted by body weight) and administration and also costs due to severe ADRs and non-medical costs that occurred during the total treatment course (18 cycles). We performed a sensitivity analysis to test the robustness of the results across various TZM costs and patient body weights. RESULTS: The overall cost (in USD) of IV-TZM treatment was $83,309.1 per patient compared with $77,067.7 per patient for SC-TZM. Thus, one year of SC-TZM treatment cost $6,241.4 less per patient than one year of IV-TZM treatment. The sensitivity analysis revealed that the results were mainly driven by the price of each TZM vial and body weight. CONCLUSION: SC-TZM is a cost-saving therapy for Chilean patients with early-stage HER2+ BC. Given their similar efficacy and safety, we suggest the use of SC formulations rather than IV formulations. The use of SC-TZM instead of IV-TZM may have a significant economic impact on public/private healthcare systems.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/economía , Costos y Análisis de Costo , Costos de la Atención en Salud , Receptor ErbB-2/metabolismo , Trastuzumab/economía , Trastuzumab/uso terapéutico , Administración Intravenosa , Relación Dosis-Respuesta a Droga , Femenino , Recursos en Salud , Humanos , Incidencia , Inyecciones Subcutáneas , Trastuzumab/administración & dosificación , Trastuzumab/efectos adversos
19.
PLoS One ; 15(2): e0228749, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023308

RESUMEN

More than 10% of the population will suffer from a depressive disorder during their lifetime, which represents a substantial economic and social burden for healthcare systems and societies. Nonetheless, studies suggest that an important percentage of patients receive inadequate treatment. This study aimed to evaluate the characteristics of patients with depressive disorder in Spain, the current management of these disorders and the costs of specialised care. A retrospective multicentre study was designed including admission records from patients admitted due to a depressive disorder between 2011 and 2016, extracted from a Spanish claims database. The records obtained corresponded to 306,917 patients attended in primary care centres and 27,963 patients registered in specialised care settings. The number of admissions per patient progressively increased over the study period. A correlation was found with socioeconomic factors as the unemployment rate, increased versus the general population (OR = 1.41; 95%CI = 1.38-1.43). Equally, comorbid conditions as hypertension, disorders of lipoid metabolism, diabetes type II, other mood disorders and thyroid disorders were associated with severe presentations of a depressive disorder. In terms of disease management, patients with a severe disorder were the majority in specialised care settings, and most admissions were urgent and inpatient admissions. The use of both electroconvulsive therapy and drug therapy increased during the study period. In terms of costs, specialised care represented an annual cost of €9,654 per patient, and a total annual cost of €44,839,196. Altogether, improved detection and treatment protocols could contribute in reducing the burden that depressive disorders represent for the Spanish National Healthcare System.


Asunto(s)
Trastorno Depresivo/economía , Costos de la Atención en Salud/estadística & datos numéricos , Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España
20.
PLoS One ; 15(2): e0229393, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32084236

RESUMEN

OBJECTIVE: We aimed to describe the clinical and economic burden attributable to carbapenem-nonsusceptible (C-NS) respiratory infections. METHODS: This retrospective matched cohort study assessed clinical and economic outcomes of adult patients (aged ≥18 years) who were admitted to one of 78 acute care hospitals in the United States with nonduplicate C-NS and carbapenem-susceptible (C-S) isolates from a respiratory source. A subset analysis of patients with principal diagnosis codes denoting bacterial pneumonia or other diagnoses was also conducted. Isolates were classified as community- or hospital-onset based on collection time. A generalized linear mixed model method was used to estimate the attributable burden for mortality, 30-day readmission, length of stay (LOS), cost, and net gain/loss (payment minus cost) using propensity score-matched C-NS versus C-S cohorts. RESULTS: For C-NS cases, mortality (25.7%), LOS (29.4 days), and costs ($81,574) were highest in the other principal diagnosis, hospital-onset subgroup; readmissions (19.4%) and net loss (-$9522) were greatest in the bacterial pneumonia, hospital-onset subgroup. Mortality and readmissions were not significantly higher for C-NS cases in any propensity score-matched subgroup. Significant C-NS-attributable burden was found for both other principal diagnosis subgroups for LOS (hospital-onset: 3.7 days, P = 0.006; community-onset: 1.5 days, P<0.001) and cost (hospital-onset: $12,777, P<0.01; community-onset: $2681, P<0.001). CONCLUSIONS: Increased LOS and cost burden were observed in propensity score-matched patients with C-NS compared with C-S respiratory infections; the C-NS-attributable burden was significant only for patients with other principal diagnoses.


Asunto(s)
Carbapenémicos/farmacología , Farmacorresistencia Bacteriana , Infecciones por Bacterias Gramnegativas/economía , Infecciones por Bacterias Gramnegativas/mortalidad , Costos de la Atención en Salud/estadística & datos numéricos , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/crecimiento & desarrollo , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pronóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Estudios Retrospectivos , Tasa de Supervivencia , Adulto Joven
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