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1.
Scand J Rheumatol ; 48(4): 300-307, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30836033

RESUMO

Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.


Assuntos
Artrite Juvenil , Artrite Psoriásica , Artrite Reumatoide , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Espondilartrite , Adulto , Artrite Juvenil/economia , Artrite Juvenil/epidemiologia , Artrite Psoriásica/economia , Artrite Psoriásica/epidemiologia , Artrite Reumatoide/economia , Artrite Reumatoide/epidemiologia , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Alocação de Recursos para a Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Espondilartrite/economia , Espondilartrite/epidemiologia
4.
Neuromodulation ; 22(2): 208-214, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30536992

RESUMO

OBJECTIVES: The aim of the current project was to evaluate the spinal cord stimulation (SCS) screening trial success rate threshold to obtain the same cost impact across two identical sets of patients following either a prolonged screening trial prior to implantation strategy or a full implant without a screening trial. MATERIALS AND METHODS: A cost impact analysis was carried out from a health care perspective and considered trial to implant rates reported in the literature. Items of resource use were costed using national averages obtained from the National Health Service (NHS) reference cost data base. Cost components were added up to derive total patient level costs for the NHS. Only the costs associated with the screening trial procedures and devices were considered. RESULTS: The most conservative of our estimates suggest that a failure rate of less than 15% is cost saving to the NHS. A failure rate as high as 45% can also be cost saving if the less expensive nonrechargeable SCS devices are used. All the thresholds observed represent a considerably higher screening failure rate than that reported in the latest randomized controlled trials (RCTs) of SCS. A trial to implant ratio of 91.6% could represent savings between £16,715 (upper bound 95% CI of rechargeable implantable pulse generator [IPG] cost) and £246,661 (lower bound 95% CI of nonrechargeable IPG cost) per each 100 patients by adopting an implantation only strategy. CONCLUSIONS: Considerable savings could be obtained by adopting an implantation strategy without a screening trial. It is plausible that accounting for other factors, such as complications that can occur with a screening trial, additional savings could be achieved by choosing a straight to implant treatment strategy. Nevertheless, additional evidence is warranted to support this claim.


Assuntos
Custos e Análise de Custo/métodos , Neuralgia/economia , Neuralgia/terapia , Estimulação da Medula Espinal/economia , Estimulação da Medula Espinal/métodos , Medicina Estatal/economia , Dor Crônica/terapia , Feminino , Humanos , Masculino , Reino Unido/epidemiologia
5.
Int J Health Plann Manage ; 34(1): 241-250, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30109902

RESUMO

Primary care redesign for older adult patients is currently ongoing in countries with aging populations. One of the main challenges of this type of transformations is how to estimate implementation costs in different types of health care delivery organizations. This study compares start-up and incremental expenses of implementing a primary care redesign across 2 organization types: integrated group (n = 31) practices and independent practice association (IPA) sites (n = 213). Administrators involved with implementing the redesign completed a cost capture template to quantifying expenses. The potential impact of measurement error, recollection bias, and implementation models across sites and geographic regions was examined in sensitivity analyses. Marginal start-up and incremental expenses were higher for Group sites ($122-$328) compared to IPA sites ($31-$227). Group and IPA sites, however, implemented the redesign with different intensities. According to our analyses, if IPA sites implemented the redesign with the same intensity as Group sites, marginal costs would have been $5 to $13 higher for IPA sites than for Group sites. This study shows how a flexible approach to estimate the cost of a wellness care redesign is needed when the intensity of the transformation differs across 2 different types of health care organizations.


Assuntos
Organizações de Assistência Responsáveis , Custos e Análise de Custo/métodos , Prática de Grupo , Promoção da Saúde/economia , Atenção Primária à Saúde/economia , Prática Privada , Idoso , Prestação Integrada de Cuidados de Saúde , Humanos , Estados Unidos
6.
Am Surg ; 85(12): 1405-1408, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31908227

RESUMO

Instrument choices are influenced primarily by a surgeon's training and individual preference. Cost is often of secondary interest, particularly in the absence of any contracted fiscal obligation to the hospital. The purpose of this study was to evaluate how a simple intervention involving dissemination of cost data among a surgeon peer group influenced behavior with respect to surgical instrument choice. Cost data for laparoscopic appendectomies between July-December 2016 were disseminated to surgeons belonging to the same department of a teaching hospital. Each surgeon was provided his or her own cost data along with blinded data for his or her peers for comparison. Cost for each disposable instrument used among the group was provided for reference. Costs of laparoscopic appendectomy performed after the intervention (June-December 2017) were compared with costs before the intervention, for both individual surgeons and the group as a whole. A random effects linear regression model clustered on surgeon was then used to assess the average cost saving of the intervention while accounting for the intracorrelation of surgeon costs. One outlier was removed from the analysis, resulting in a cohort of 89 cases before the intervention and 74 postintervention. After outlier removal, data were normally distributed. The mean cost per case decreased for 10 of the 11 surgeons analyzed (minimum decrease of $7 to maximum decrease of $725). The remaining surgeon increased from an average of $985 ± 235 pre-intervention to $1003 ± 227 postintervention. The average cost saving for the group was $238 ± 226 and was associated with an average reduction in cost of 21 per cent. A linear regression analysis clustered on surgeon suggested the intervention was associated with an average saving of $260 (ß = -260, SE = 39, P < 0.001). After dissemination of cost data among surgeon peers, a reduction in costs was observed. Most notably, significant savings occurred in the absence of any mandate or incentive to reduce costs. Providing cost data to surgeons to facilitate natural competition among peers is a simple and effective tool for reducing operating room costs.


Assuntos
Apendicectomia/economia , Redução de Custos/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Laparoscopia/economia , Apendicectomia/métodos , Redução de Custos/economia , Custos e Análise de Custo/métodos , Humanos , Disseminação de Informação/métodos , Laparoscopia/métodos , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões
8.
J Neurosurg ; 131(2): 561-568, 2018 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-30485235

RESUMO

OBJECTIVE: Microsurgical resection and radiosurgery remain the most widely used interventions in the treatment of vestibular schwannomas. There is a growing demand for cost-effectiveness analyses to evaluate these two treatment modalities and delineate the factors that drive their total costs. Here, the authors evaluated specific cost drivers for microsurgical and radiosurgical management of vestibular schwannoma by using the Value Driven Outcomes system available at the University of Utah. METHODS: The authors retrospectively reviewed all cases involving microsurgical and radiosurgical treatment of vestibular schwannomas at their institution between November 2011 and September 2017. Patient and tumor characteristics, subcategory costs, and potential cost drivers were analyzed. RESULTS: The authors identified 163 vestibular schwannoma cases, including 116 managed microsurgically and 47 addressed with stereotactic radiosurgery (SRS). There were significant differences between the two groups in age, tumor size, and preoperative Koos grade (p < 0.05), suggesting that indications for treatment were markedly different. Length of stay (LOS) and length of follow-up were also significantly different. Facility costs were the most significant contributor to both microsurgical and SRS groups (58.3% and 99.4%, respectively); however, physician professional fees were not specifically analyzed. As expected, microsurgical treatment resulted in an average 4-fold greater overall cost of treatment than for SRS cases (p < 0.05), and there was a greater variation in costs for open cases as well. Costs remained stable over time for both open resection and SRS. Multivariable analysis showed that LOS (ß = 0.7, p = 0.0001), discharge disposition (ß = 0.2, p = 0.004), nonserviceable hearing (ß = 0.1, p = 0.02), and complications (ß = 0.2, p = 0.005) affected cost for open surgery, whereas no specifically examined factor could be identified as driving costs for SRS. CONCLUSIONS: This analysis identified the fact that facility utilization constitutes the majority of total costs for both microsurgery and SRS treatment modalities of vestibular schwannomas. LOS, discharge disposition, nonserviceable hearing, and complications contributed significantly to the total costs for the microsurgical group, whereas none of the factors could be identified as driving total costs for the SRS group. This information may be used to establish policies and protocols to reduce facility costs, with the goal of decreasing the total costs without jeopardizing patient care.


Assuntos
Custos e Análise de Custo/métodos , Microcirurgia/economia , Neuroma Acústico/economia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/economia , Radiocirurgia/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Artigo em Inglês | MEDLINE | ID: mdl-30453588

RESUMO

More and more countries employ the Carbon Cap and Trade mechanism (CCT-mechanism) to stimulate the manufacturer to produce much more eco-friendly products. In this paper, we study how the CCT-mechanism affects competitive manufacturers' product design and pricing strategies. Assume that there are two competitive manufacturers; we give the optimal closed form solutions of the carbon emission reduction rates and retail prices in the Nash game model and the Stackelberg game model with CCT-mechanism, respectively. Additionally, we also discuss the impacts of CCT-mechanism, consumer environmental awareness (CEA), and the sensitivity of switchovers toward price on the optimal carbon emission reduction rates, retail prices, and manufacturers' profits. We find that (i) when the carbon quota is not enough, there is a trade off between investing in producing much greener product and purchasing carbon quota; when the carbon price is not high, the manufacturer tends to purchase the carbon quota; and when the carbon price is much higher, the manufacturer is more willing to increase the environmental quality of the product; (ii) manufacturer's size affects product's emission reduction rate and manufacturer's optimal profit; larger manufacturer tends to produce much greener product, but it does not mean that he could obtain much more money than the small manufacturer; and (iii) the decision sequence changes manufacturer's strategies; the optimal emission reduction rate in Nash and Stackelberg game models are almost the same, but the differences of prices and profits between Nash and Stackelberg model's are much bigger.


Assuntos
Carbono/economia , Custos e Análise de Custo/métodos , Competição Econômica , Comportamento do Consumidor , Tomada de Decisões
10.
Health Policy ; 122(12): 1283-1286, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30389185

RESUMO

The German market for innovative medicines is characterized by simultaneous underuse and overuse. In order to address these deficits and improve decision making by physicians, the German parliament recently passed a law which mandates implementing reimbursement decisions on innovative medicines in the prescription software for physicians. This article discusses the political process leading to the law as well as its rationale in view of economic theory. Based on the considerably larger extent of underuse than overuse of innovative medicines in Germany this article predicts that the law will lead to an increase in sales by the pharmaceutical industry. It argues that legislation to increase prescription rates through information technology is questionable in a market where competitive forces should prevail. The correct approach, in line with economic theory, is either to improve information availability for patients or change existing regulation in the case of government failure. The latter may include revoking penalties for physician prescriptions and imposing prescription exclusions.


Assuntos
Custos e Análise de Custo/métodos , Difusão de Inovações , Regulamentação Governamental , Medicamentos sob Prescrição/economia , Custos e Análise de Custo/economia , Aprovação de Drogas/legislação & jurisprudência , Indústria Farmacêutica/economia , Alemanha , Humanos , Tecnologia da Informação , Modelos Econômicos , Política
11.
Trop Med Int Health ; 23(12): 1326-1331, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30286256

RESUMO

OBJECTIVES: Pharmaceutical pricing is an important and contentious issue in middle- and low-income countries. The present study evaluated a value-based pricing system for estimating the price of interferon-beta (IFN-ß). METHODS: Prices were estimated through the Willingness to Pay (WTP) system using the Discrete Choice Experiment (DCE) from the viewpoint of MS patients, levels of attributes and patients' willingness to pay for these attributes. RESULTS: The results indicate that the new approach to pricing medicines leads to more integrated prices than the current system. The current prices of four brands were higher than their pharmaceutical market price; the prices of other brands were consistent with it. CONCLUSION: Application of the proposed pricing system will help pharmaceutical companies make realistic price estimates of their products while accounting for patient preferences, which may enhance patients' adherence to treatment.


Assuntos
Custos e Análise de Custo/economia , Custos de Medicamentos/estatística & dados numéricos , Interferon beta/economia , Preferência do Paciente/estatística & dados numéricos , Comércio/economia , Comércio/métodos , Comércio/estatística & dados numéricos , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Humanos , Irã (Geográfico) , Inquéritos e Questionários
12.
J Neurosurg ; 131(2): 507-516, 2018 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-30239321

RESUMO

OBJECTIVE: Efficient allocation of resources in the healthcare system enables providers to care for more and needier patients. Identifying drivers of total charges for transsphenoidal surgery (TSS) for pituitary tumors, which are poorly understood, represents an opportunity for neurosurgeons to reduce waste and provide higher-quality care for their patients. In this study the authors used a large, national database to build machine learning (ML) ensembles that directly predict total charges in this patient population. They then interrogated the ensembles to identify variables that predict high charges. METHODS: The authors created a training data set of 15,487 patients who underwent TSS between 2002 and 2011 and were registered in the National Inpatient Sample. Thirty-two ML algorithms were trained to predict total charges from 71 collected variables, and the most predictive algorithms combined to form an ensemble model. The model was internally and externally validated to demonstrate generalizability. Permutation importance and partial dependence analyses were performed to identify the strongest drivers of total charges. Given the overwhelming influence of length of stay (LOS), a second ensemble excluding LOS as a predictor was built to identify additional drivers of total charges. RESULTS: An ensemble model comprising 3 gradient boosted tree classifiers best predicted total charges (root mean square logarithmic error = 0.446; 95% CI 0.439-0.453; holdout = 0.455). LOS was by far the strongest predictor of total charges, increasing total predicted charges by approximately $5000 per day.In the absence of LOS, the strongest predictors of total charges were admission type, hospital region, race, any postoperative complication, and hospital ownership type. CONCLUSIONS: ML ensembles predict total charges for TSS with good fidelity. The authors identified extended LOS, nonelective admission type, non-Southern hospital region, minority race, postoperative complication, and private investor hospital ownership as drivers of total charges and potential targets for cost-lowering interventions.


Assuntos
Adenoma/cirurgia , Custos e Análise de Custo/tendências , Custos de Cuidados de Saúde/tendências , Aprendizado de Máquina/tendências , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Adenoma/economia , Adenoma/epidemiologia , Adulto , Idoso , Custos e Análise de Custo/métodos , Bases de Dados Factuais/economia , Bases de Dados Factuais/tendências , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/economia , Neoplasias Hipofisárias/epidemiologia , Estados Unidos/epidemiologia
13.
Clin Drug Investig ; 38(10): 967-976, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30143953

RESUMO

BACKGROUND AND OBJECTIVE: Immuno-oncology therapies represent a new treatment opportunity for patients affected by metastatic melanoma. The purpose of this study was to estimate the costs of immune-related adverse events (irAEs) associated with the new anti-PD1 immuno-oncology therapies, with the anti-CTLA-4 immuno-oncology therapy and with the combined therapy (CTLA4 + anti-PD1) in patients affected by metastatic melanoma. MATERIALS AND METHODS: A probabilistic cost-of-illness (COI) model was developed to estimate the management costs of grade ≥ 3 adverse events associated with the new anti-PD1 therapies (pembrolizumab and nivolumab), the anti-CTLA-4 therapy (ipilimumab) and the combined therapy CTLA4 + anti-PD1 (nivolumab + ipilimumab) for the treatment of patients with metastatic melanoma from the National Health Service (NHS) perspective in Italy. Identification of the epidemiological and cost parameters was carried out through a systematic literature review (SLR). Univariate and probabilistic sensitivity analyses were performed to account for uncertainty and variation in the model results. RESULTS: The model estimated a cost associated with the management of grade ≥ 3 immune-related adverse events in patients with metastatic melanoma equal to €176.2 (95% CI 63.5-335.0) for anti-CTLA-4 therapy, €48.6 (95% CI 40.1-58.5) for the new anti-PDI therapies and €276.8 (95% CI 240.4-316.2) for the combined therapy. Among the innovative therapies for the considered metastatic melanoma, the combined therapy was the most expensive innovative treatment in terms of event management of immune-related grade ≥ 3 adverse events. CONCLUSION: This study may represent a useful tool to understand the economic burden associated with the management of irAEs associated with patients affected by metastatic melanoma.


Assuntos
Antineoplásicos Imunológicos/economia , Custos e Análise de Custo/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Melanoma/economia , Terapias em Estudo/economia , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/economia , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Antígeno CTLA-4/administração & dosagem , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Ipilimumab/administração & dosagem , Ipilimumab/efeitos adversos , Ipilimumab/economia , Itália/epidemiologia , Melanoma/tratamento farmacológico , Melanoma/epidemiologia , Nivolumabe/administração & dosagem , Nivolumabe/efeitos adversos , Nivolumabe/economia , Terapias em Estudo/efeitos adversos
14.
Int J Health Plann Manage ; 33(4): e1160-e1178, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30109898

RESUMO

This article studies the epidemiological and economic impacts of a universal testing and treatment policy of Human Immunodeficiency Virus (HIV) in South Africa. A model of disease transmission is built to simulate several implementation scenarios of the policy. Different behavioral responses in the general population are considered. The results show that the success of a large-scale HIV testing and treatment program in South Africa depends on its implementation conditions. The policy can lead to a reduction of the HIV epidemic, even in the case of a large relapse in preventive behaviors in the general population, if implementation conditions are favorable. This is the case if the number of infected individuals who are infectious is greatly reduced. From an economic point of view, taking into account the positive externality of antiretroviral (ARV) treatments changes the traditional framework of cost-benefit analyses. A large-scale testing and treatment program would be cost-saving in the case of favorable implementation conditions, even following a large increase in risk behaviors after the scaling up of ARV treatments. By contrast, the analysis stresses out the potential perverse effects of scaling up ARV treatments in South Africa if the intervention is set up without ensuring enough resources for patients' monitoring and the availability of effective ARV drugs. Indeed, if the number of treated patients rises while adherence of patients to treatments decreases and the rate of loss to follow-up increases, the policy could extend the pool of infectious patients and lead to a long-term amplification of the epidemic.


Assuntos
Fármacos Anti-HIV/provisão & distribução , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde/economia , Algoritmos , Custos e Análise de Custo/métodos , Humanos , Formulação de Políticas
16.
Am J Health Syst Pharm ; 75(15): 1103-1109, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-29941507

RESUMO

PURPOSE: Results of a comparison of blood product use and cost outcomes with use of 3-factor versus 4-factor prothrombin complex concentrate (PCC) for indications other than warfarin reversal are presented. METHODS: Consecutive patients who received 3-factor PPC (PCC3) or 4-factor PCC (PCC4) for non-warfarin-related indications at 2 U.S. hospitals during a 19-month period were identified. The primary outcome was in-hospital blood product use, with a focus on plasma use. Total hemostasis costs, intensive care unit (ICU) and hospital lengths of stay, and other outcomes were evaluated. RESULTS: Indications for PCC3 use (n = 118) or PCC4 use (n = 64) included intraoperative bleeding, nonintraoperative bleeding, coagulopathy of liver disease, and reversal of direct-acting oral anticoagulant effects. The proportion of patients who received plasma was 56.8% with PCC3 use versus 53.1% with PCC4 use (p = 0.643); the corresponding median volumes of plasma received were 638 mL (interquartile range [IQR], 550-1,355 mL) and 656 mL (IQR, 532-1,136 mL), respectively. The median total hemostasis costs were $5,559 (IQR, $3,922-$8,159) with PCC3 use and $7,771 (IQR, $6,366-$9,205) with PCC4 use (p < 0.001). CONCLUSION: PCC3 use and PCC4 use were associated with similar blood product use, ICU length of stay, hospital length of stay, and in-hospital mortality when given for non-warfarin-related indications. However, relative to PCC3 use, PCC4 use was associated with an increase in costs that was primarily due to drug costs.


Assuntos
Fatores de Coagulação Sanguínea/economia , Substitutos Sanguíneos/economia , Custos e Análise de Custo/métodos , Uso Off-Label/economia , Fator Plaquetário 3/economia , Fator Plaquetário 4/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Anticoagulantes/economia , Fatores de Coagulação Sanguínea/uso terapêutico , Substitutos Sanguíneos/uso terapêutico , Estudos de Coortes , Feminino , Hemorragia/diagnóstico , Hemorragia/economia , Hemorragia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Fator Plaquetário 3/uso terapêutico , Fator Plaquetário 4/uso terapêutico , Estudos Retrospectivos
17.
Soc Sci Med ; 211: 114-122, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29935401

RESUMO

In 2012, the Chinese government launched a nationwide reform of county-level public hospitals with the goal of controlling the rapid growth of healthcare expenditure. The key components of the reform were the zero markup drug policy (ZMDP), which removed the previously allowed 15% markup for drug sales at public hospitals, and associated increases in fees for medical services. By exploiting the temporal and cross-sectional variations in the policy implementation and using a unique, nationally representative hospital-level dataset in 1880 counties between 2009 and 2014, we find that the policy change led to a reduction in drug expenditures, a rise in expenditures for medical services, and no measurable changes in total health expenditures. However, we also find an increase in expenditures for diagnostic tests/medical consumables at hospitals that had a greater reliance on drug revenues before the reform, which is unintended by policymakers. Further analysis shows that these results were more likely to be driven by the supply side, suggesting that hospitals offset the reductions in drug revenues by increasing the provision of services and products with higher price-cost margins. These findings hold lessons for cost containment policies in both developed and developing countries.


Assuntos
Custos e Análise de Custo/normas , Assistência à Saúde/economia , Medicamentos sob Prescrição/economia , China , Custos e Análise de Custo/métodos , Estudos Transversais , Assistência à Saúde/métodos , Gastos em Saúde/tendências , Política de Saúde/economia , Humanos
18.
Prev Sci ; 19(6): 716-727, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29856040

RESUMO

A uniform approach for costing school-based lifestyle interventions is currently lacking. The objective of this study was to develop a template for costing primary school-based lifestyle interventions and apply this to the costing of the "Healthy Primary School of the Future" (HPSF) and the "Physical Activity School" (PAS), which aim to improve physical activity and dietary behaviors. Cost-effectiveness studies were reviewed to identify the cost items. Societal costs were reflected by summing up the education, household and leisure, labor and social security, and health perspectives. Cost inputs for HPSF and PAS were obtained for the first year after implementation. In a scenario analysis, the costs were explored for a hypothetical steady state. From a societal perspective, the per child costs were €2.7/$3.3 (HPSF) and €- 0.3/$- 0.4 (PAS) per day during the first year after implementation, and €1.0/$1.2 and €- 1.3/$- 1.6 in a steady state, respectively (2016 prices). The highest costs were incurred by the education perspective (first year: €8.7/$10.6 (HPSF) and €4.0/$4.9 (PAS); steady state: €6.1/$7.4 (HPSF) and €2.1/$2.6 (PAS)), whereas most of the cost offsets were received by the household and leisure perspective (first year: €- 6.0/$- 7.3 (HPSF) and €- 4.4/$- 5.4 (PAS); steady state: €- 5.0/$- 6.1 (HPSF) and €- 3.4/$- 4.1 (PAS)). The template proved helpful for costing HPSF and PAS from various stakeholder perspectives. The costs for the education sector were fully (PAS) and almost fully (HPSF) compensated by the savings within the household sector. Whether the additional costs of HPSF over PAS represent value for money will depend on their relative effectiveness.


Assuntos
Custos e Análise de Custo , Promoção da Saúde/economia , Comportamento de Redução do Risco , Instituições Acadêmicas , Custos e Análise de Custo/métodos
19.
World Neurosurg ; 116: e485-e490, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29758371

RESUMO

OBJECTIVE: Using a database that enabled longitudinal follow-up, we assessed the cost, outcome, complications, and readmission rate of ruptured cerebral aneurysms repaired by surgical clipping and endovascular coiling. METHODS: This study was a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of ruptured cerebral aneurysms between 1996 and 2013. The medical records and hospital cost data were all examined. RESULTS: A total of 7690 and 1380 cases were treated with clipping and coiling, respectively. Patients treated with clipping had more comorbidities and were older. The average total cost for endovascular coiling was $13,974.3, whereas the average total cost for surgical clipping was $16,581.7. Perioperative (30-day) mortality was 10.7% in patients with coiled aneurysms, compared with 12.6% in those with clipped aneurysms (P = 0.045). After 1 year of follow-up, clipping was associated with a significantly longer length of hospital stay (P < 0.001) and significantly higher total hospital costs (P < 0.001). CONCLUSIONS: In Taiwan, the total hospital costs for the surgical clipping of cerebral aneurysms were higher than for endovascular coiling, and the surgical results were associated with significant complications. We suggest that the indications for coiling might need to be expanded from the current standards dictated by the guidelines in Taiwan.


Assuntos
Aneurisma Roto/economia , Custos e Análise de Custo , Procedimentos Endovasculares/economia , Aneurisma Intracraniano/economia , Procedimentos Neurocirúrgicos/economia , Vigilância da População , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/epidemiologia , Aneurisma Roto/terapia , Custos e Análise de Custo/métodos , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Custos Hospitalares/tendências , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Vigilância da População/métodos , Estudos Retrospectivos , Taiwan/epidemiologia , Resultado do Tratamento , Adulto Jovem
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