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1.
PLoS Negl Trop Dis ; 13(7): e0007598, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31306412

RESUMO

BACKGROUND: Melioidosis is a frequently fatal disease requiring specific treatment. The yield of Burkholderia pseudomallei from sites with a normal flora is increased by culture using selective, differential media such as Ashdown's agar and selective broth. However, since melioidosis mainly affects people in resource-poor countries, the cost effectiveness of selective culture has been questioned. We therefore retrospectively evaluated this in two laboratories in southeast Asia. METHODOLOGY/PRINCIPAL FINDINGS: The results of all cultures in the microbiology laboratories of Mahosot Hospital, Vientiane, Laos and Angkor Hospital for Children, Siem Reap, Cambodia, in 2017 were reviewed. We identified patients with melioidosis who were only diagnosed as a result of culture of non-sterile sites and established the total number of such samples cultured using selective media and the associated costs in each laboratory. We then conducted a rudimentary cost-effectiveness analysis by determining the incremental cost-effectiveness ratio (ICER) per DALY averted and compared this against the 2017 GDP per capita in each country. Overall, 29 patients in Vientiane and 9 in Siem Reap (20% and 16.9% of all culture-positive patients respectively) would not have been diagnosed without the use of selective media, the majority of whom (18 and 8 respectively) were diagnosed by throat swab culture. The cost per additional patient detected by selective culture was approximately $100 in Vientiane and $39 in Siem Reap. Despite the different patient populations (all ages in Vientiane vs. only children in Siem Reap) and testing strategies (all samples in Vientiane vs. based on clinical suspicion in Siem Reap), selective B. pseudomallei culture proved highly cost effective in both settings, with an ICER of ~$170 and ~$28 in Vientiane and Siem Reap, respectively. CONCLUSIONS/SIGNIFICANCE: Selective culture for B. pseudomallei should be considered by all laboratories in melioidosis-endemic areas. However, the appropriate strategy for implementation should be decided locally.


Assuntos
Burkholderia pseudomallei/isolamento & purificação , Técnicas de Laboratório Clínico/economia , Análise Custo-Benefício , Meios de Cultura/economia , Melioidose/diagnóstico , Técnicas Bacteriológicas/economia , Técnicas Bacteriológicas/métodos , Burkholderia pseudomallei/crescimento & desenvolvimento , Camboja , Técnicas de Laboratório Clínico/métodos , Hospitais , Humanos , Laos , Estudos Retrospectivos , Manejo de Espécimes
2.
Hosp Top ; 97(3): 99-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166151

RESUMO

The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.


Assuntos
Técnicas de Laboratório Clínico/métodos , Laboratórios/economia , Informática Médica/normas , Sistemas de Identificação de Pacientes/métodos , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Laboratórios/normas , Laboratórios/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Informática Médica/métodos , Medicare/estatística & dados numéricos , Sistemas de Identificação de Pacientes/economia , Sistemas de Identificação de Pacientes/normas , Indicadores de Qualidade em Assistência à Saúde , Análise de Regressão , Estados Unidos
3.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31171587

RESUMO

BACKGROUND: Overuse of laboratory testing contributes substantially to health care waste, downstream resource use, and patient harm. Understanding patterns of variation in hospital-level testing across common inpatient diagnoses could identify outliers and inform waste-reduction efforts. METHODS: We conducted a multicenter retrospective cohort study of pediatric inpatients at 41 children's hospitals using administrative data from 2010 to 2016. Initial electrolyte testing was defined as testing occurring within the first 2 days of an encounter, and repeat testing was defined as subsequent testing within an encounter in which initial testing occurred. To examine if testing rates correlated across diagnoses at the hospital level, we compared risk-adjusted rates for gastroenteritis with a weighted average of risk-adjusted rates in other diagnosis cohorts. For each diagnosis, linear regression was performed to compare initial and subsequent testing. RESULTS: In 497 719 patient encounters, wide variation was observed across hospitals in adjusted, initial, and repeat testing rates. Hospital-specific rates of testing in gastroenteritis were moderately to strongly correlated with the weighted average of testing in other conditions (initial: r = 0.63; repeat r = 0.83). Within diagnoses, higher hospital-level initial testing rates were associated with significantly increased rates of subsequent testing for all diagnoses except gastroenteritis. CONCLUSIONS: Among children's hospitals, rates of initial and repeat electrolyte testing vary widely across 8 common inpatient diagnoses. For most diagnoses, hospital-level rates of initial testing were associated with rates of subsequent testing. Consistent rates of testing across multiple diagnoses suggest that hospital-level factors, such as institutional culture, may influence decisions for electrolyte testing.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Eletrólitos/análise , Laboratórios Hospitalares/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Técnicas de Laboratório Clínico/economia , Feminino , Gastroenterite/diagnóstico , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Laboratórios Hospitalares/economia , Masculino , Utilização de Procedimentos e Técnicas , Melhoria de Qualidade , Estudos Retrospectivos , Procedimentos Desnecessários/economia
4.
Pediatr Rheumatol Online J ; 17(1): 20, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060557

RESUMO

BACKGROUND: This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). METHODS: A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. RESULTS: Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. CONCLUSIONS: Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.


Assuntos
Artrite Juvenil/terapia , Recursos em Saúde/estatística & dados numéricos , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Artrite Juvenil/economia , Cuidadores/economia , Cuidadores/estatística & dados numéricos , Criança , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Eficiência , Utilização de Instalações e Serviços , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos
5.
Pathology ; 51(3): 313-315, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30808509

RESUMO

Over-utilisation of pathology requests can incur unnecessary costs and be detrimental to patient care. The choosing wisely campaign has helped to reduce the use of tests with limited or no value. This report describes the estimated benefits and costs of implementing a triage process of infectious serology requests in a single mixed hospital and community laboratory. Data analysis of triaging of send away infectious serology was conducted from 1 November 2016 to 31 October 2017. A total of 618 tests were triaged over a 1-year period. Of these 379 (61.3%) were declined. The total gross savings was $45,066. The total cost for implementing this change was estimated to be $4220 per year. The total saving was $40,846.37. There was significant cost saving secondary to this intervention, with other more difficult to measure tangible benefits including fostering communication between laboratory staff and clinicians.


Assuntos
Comportamento de Escolha , Técnicas de Laboratório Clínico/economia , Doenças Transmissíveis/diagnóstico , Sorologia/economia , Análise Custo-Benefício , Humanos
6.
Clin Chem Lab Med ; 57(6): 802-811, 2019 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-30710480

RESUMO

Automation is considered one of the most important breakthroughs in the recent history of laboratory diagnostics. In a model of total laboratory automation (TLA), many analyzers performing different types of tests on different sample matrices are physically integrated as modular systems or physically connected by assembly lines. The opportunity to integrate multiple diagnostic specialties to one single track seems effective to improve efficiency, organization, standardization, quality and safety of laboratory testing, whilst also providing a significant return of investment on the long-term and enabling staff requalification. On the other hand, developing a model of TLA also presents some potential problems, mainly represented by higher initial costs, enhanced expenditure for supplies, space requirements and infrastructure constraints, staff overcrowding, increased generation of noise and heat, higher risk of downtime, psychological dependence, critical issues for biospecimen management, disruption of staff trained in specific technologies, along with the risk of transition toward a manufacturer's-driven laboratory. As many ongoing technological innovations coupled with the current scenario, profoundly driven by cost-containment policies, will promote further diffusion of laboratory automation in the foreseeable future, here we provide a personal overview on some potential advantages and limitations of TLA.


Assuntos
Automação Laboratorial/economia , Técnicas de Laboratório Clínico/economia , Acreditação , Automação Laboratorial/normas , Técnicas de Laboratório Clínico/normas , Análise Custo-Benefício , Satisfação no Emprego , Manejo de Espécimes , Inquéritos e Questionários
7.
J Med Microbiol ; 68(3): 290-291, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30628880

RESUMO

The move towards pathology networks and hub-and-spoke models of medical laboratory service provision has significantly changed the flow of samples, and the impact of results on patients, over recent years. At the same time advances in technology, including rapid, simple to use molecular platforms, are changing the way microbiology results can be utilized. Like many other medical microbiology laboratories, we struggle with this balance for many different sample types and test requests. Work published by Neilson et al. in Journal of Medical Microbiology last year looked at this balance for methicillin-resistant Staphylococcus aureus (MRSA) genotypic diagnostics and suggested significant cost savings when a whole-healthcare economy perspective was adopted. However, as with all changes, implementing MRSA molecular diagnostics in different clinical settings must be considered carefully. We add to this discussion in our accompanying letter, detailing our experience (in a hub-and-spoke medical microbiology laboratory setting) of 'rapid' MRSA molecular diagnostics for day-case surgery where pre-operative assessment had been missed, exploring the impact and costs of these tests. We find no impact on patient care, but at considerable additional cost. We hope this will add a cautionary note to those considering implementing molecular microbiology diagnostics, and reopen the debate on where, in hub-and-spoke laboratory models, such devices should be situated.


Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Patologia Molecular/economia , Reação em Cadeia da Polimerase/economia , Infecções Estafilocócicas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Portador Sadio , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Procedimentos Cirúrgicos Operatórios , Reino Unido , Adulto Jovem
8.
PLoS Med ; 16(1): e1002716, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620729

RESUMO

BACKGROUND: There is little systematic assessment of how total health expenditure is distributed across diseases and comorbidities. The objective of this study was to use statistical methods to disaggregate all publicly funded health expenditure by disease and comorbidities in order to answer three research questions: (1) What is health expenditure by disease phase for noncommunicable diseases (NCDs) in New Zealand? (2) Is the cost of having two NCDs more or less than that expected given the independent costs of each NCD? (3) How is total health spending disaggregated by NCDs across age and by sex? METHODS AND FINDINGS: We used linked data for all adult New Zealanders for publicly funded events, including hospitalisation, outpatient, pharmaceutical, laboratory testing, and primary care from 1 July 2007 to 30 June 2014. These data include 18.9 million person-years and $26.4 billion in spending (US$ 2016). We used case definition algorithms to identify if a person had any of six NCDs (cancer, cardiovascular disease [CVD], diabetes, musculoskeletal, neurological, and a chronic lung/liver/kidney [LLK] disease). Indicator variables were used to identify the presence of any of the 15 possible comorbidity pairings of these six NCDs. Regression was used to estimate excess annual health expenditure per person. Cause deletion methods were used to estimate total population expenditure by disease. A majority (59%) of health expenditure was attributable to NCDs. Expenditure due to diseases was generally highest in the year of diagnosis and year of death. A person having two diseases simultaneously generally had greater health expenditure than the expected sum of having the diseases separately, for all 15 comorbidity pairs except the CVD-cancer pair. For example, a 60-64-year-old female with none of the six NCDs had $633 per annum expenditure. If she had both CVD and chronic LLK, additional expenditure for CVD separately was $6,443/$839/$9,225 for the first year of diagnosis/prevalent years/last year of life if dying of CVD; additional expenditure for chronic LLK separately was $6,443/$1,291/$9,051; and the additional comorbidity expenditure of having both CVD and LLK was $2,456 (95% confidence interval [CI] $2,238-$2,674). The pattern was similar for males (e.g., additional comorbidity expenditure for a 60-64-year-old male with CVD and chronic LLK was $2,498 [95% CI $2,264-$2,632]). In addition to this, the excess comorbidity costs for a person with two diseases was greater at younger ages, e.g., excess expenditure for 45-49-year-old males with CVD and chronic LLK was 10 times higher than for 75-79-year-old males and six times higher for females. At the population level, 23.8% of total health expenditure was attributable to higher costs of having one of the 15 comorbidity pairs over and above the six NCDs separately; of the remaining expenditure, CVD accounted for 18.7%, followed by musculoskeletal (16.2%), neurological (14.4%), cancer (14.1%), chronic LLK disease (7.4%), and diabetes (5.5%). Major limitations included incomplete linkage to all costed events (although these were largely non-NCD events) and missing private expenditure. CONCLUSIONS: The costs of having two NCDs simultaneously is typically superadditive, and more so for younger adults. Neurological and musculoskeletal diseases contributed the largest health system costs, in accord with burden of disease studies finding that they contribute large morbidity. Just as burden of disease methodology has advanced the understanding of disease burden, there is a need to create disease-based costing studies that facilitate the disaggregation of health budgets at a national level.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Doenças não Transmissíveis/economia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Assistência Ambulatorial/economia , Animais , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doença Crônica/economia , Doença Crônica/epidemiologia , Técnicas de Laboratório Clínico/economia , Comorbidade , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Custos de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/economia , Doenças Musculoesqueléticas/epidemiologia , Neoplasias/economia , Neoplasias/epidemiologia , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/epidemiologia , Nova Zelândia/epidemiologia , Doenças não Transmissíveis/epidemiologia , Pitheciidae , Fatores Sexuais
9.
Clin Biochem ; 65: 58-60, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30615855

RESUMO

INTRODUCTION: Test cost display has been shown to reduce inappropriate laboratory test ordering practices in the United States. Unfortunately, such a system is limited in the Canadian publically funded healthcare environment. Many Canadian physicians inaccurately estimate the cost of laboratory tests, which may contribute to mis-utilization. Here, we provide an estimated cost of over 50 commonly ordered laboratory tests in Canada as an educational tool for physicians. METHODS: Test volume data was collected from Calgary Laboratory Services' Laboratory Information System in order to determine which laboratory and diagnostic tests are most commonly ordered in Calgary and its surrounding area. Reference median cost (RMC) of fifty one commonly ordered test was calculated by determining the price list of all-inclusive indirect costs from six different clinical laboratories across Canada. RESULTS: Of the 51 laboratory tests included, the minimum RMC was $5 CAD (eg: albumin, calcium, urea), and the maximum RMC was $300 (surgical pathology report). CONCLUSIONS: A caveat to the provided list of test costs is that it is only an estimate and may differ from what each individual clinical laboratories charges to third parties or for research purposes. However, this list can serve as an educational tool and raise awareness for Canadian physicians on the relative costs of laboratory tests.


Assuntos
Técnicas de Laboratório Clínico/economia , Testes Diagnósticos de Rotina/economia , Canadá , Custos e Análise de Custo , Humanos
10.
Arch Pathol Lab Med ; 143(1): 115-121, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29790786

RESUMO

CONTEXT.­: Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm. OBJECTIVE.­: To identify differences when outpatient tests are performed at the Children's Healthcare of Atlanta (Children's) Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing. DESIGN.­: Outpatient testing was sent to 3 different laboratories specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual. RESULTS.­: The median time from phlebotomy to result was 0.7 hours for testing at the Children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and reporting for testing performed at commercial labs was approximately $640,000 per year. CONCLUSIONS.­: Tangible monetary costs, plus intangible costs related to delayed results, occur when the laboratory testing system is disrupted.


Assuntos
Técnicas de Laboratório Clínico , Assistência à Saúde , Criança , Técnicas de Laboratório Clínico/economia , Custos e Análise de Custo , Tomada de Decisões , Hospitais Pediátricos , Humanos , Flebotomia , Fatores de Tempo
11.
J Immunoassay Immunochem ; 40(1): 40-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30404580

RESUMO

Immunoassay technique performs a fast, simple, reliable, and sensitive analysis of different compounds, being applied in several areas of interest such as clinical analysis for medical diagnosis, as well as in environmental analysis, and food quality control. The latest research activities in this field are represented by the attempts to achieve a low limit of detection by developing of new signal amplification strategies, eliminate the interferences, and decrease the cost of analysis.


Assuntos
Técnicas Biossensoriais , Técnicas de Laboratório Clínico , Imunoensaio , Técnicas Biossensoriais/economia , Técnicas de Laboratório Clínico/economia , Humanos , Imunoensaio/economia
13.
Eur J Emerg Med ; 26(3): 205-211, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29176456

RESUMO

OBJECTIVE: Laboratory test requests in the emergency department (ED) are increasing worldwide. We evaluated whether a multilevel intervention on the basis of the optimization of test profiles and educational meetings with physicians could reduce the number of tests ordered. PATIENTS AND METHODS: In a single-center before and after study design, the 8-month intervention period was compared with the 8-month preintervention period. Laboratory test profiles were reduced from 6 to 2 and the number of tests in each profile was reduced by 50%. All physicians received education about the costs and appropriate use of the tests. Primary outcomes were the number of laboratory blood tests and their costs, with a focus on high-cost tests. Secondary outcomes were ED and laboratory performances (patients' waiting time, number of deaths in ED, re-entry, laboratory turn-around time, and add-on tests). RESULTS: Overall, 61 976 and 61 154 patients were evaluated, respectively, during the intervention and the preintervention period. Laboratory blood test requests were decreased by 207 637 (-36.3%) in the intervention period (P < 0.05), which corresponds to a reduction of 337.3 tests/100 patients. Costs were decreased by 608 079&OV0556; ( - 29.6%, P < 0.05), leading to a cost reduction of 981.2&OV0556;/100 patients. High-cost test requests decreased by 11 457 ( - 27.3%) and contributed toward the overall reduction in costs with 197 206&OV0556; ( - 30.5%). No significant differences were found in ED and laboratory performances between intervention and preintervention periods. CONCLUSIONS: Optimization of test profiles and education on the costs and appropriate use of the tests significantly reduced laboratory test ordering and costs without affecting ED and laboratory performances.


Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Padrões de Prática Médica/economia , Procedimentos Desnecessários/estatística & dados numéricos , Técnicas de Laboratório Clínico/economia , Redução de Custos , Testes Diagnósticos de Rotina/economia , Feminino , Custos Hospitalares , Hospitais Universitários , Humanos , Itália , Masculino , Melhoria de Qualidade , Medição de Risco
14.
Diagn Microbiol Infect Dis ; 93(2): 136-139, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30293678

RESUMO

OBJECTIVE: In an era of rising healthcare expenditures, it is critical to find ways to decrease cost. The objective of this study is to evaluate the number of repeated tests and the associated cost savings in a university-affiliated hospital. METHODS: The following 7 microbiology analysis were assessed for nonrepeat testing: HCV antibody, HBV core antibody, CMV IgG, rubella IgG, Treponema pallidum antibodies, Clostridioides difficile toxin detection, and vancomycin-resistant enterococci PCR. Presence of a prior positive result leads to the cancellation of subsequent orders. RESULTS: Percentages of not repeated test ranged from 0.1% to 21.4%. Rubella IgG had the highest proportion of unnecessary repeat testing. Total cost savings were estimated at $33,627 for 2016. CONCLUSION: Unnecessary repeated microbiologic test can account for a non-negligible part of total volume test. Use of an automated software to detect unnecessary repeated microbiologic test through laboratory information system can generate important savings.


Assuntos
Sistemas de Informação em Laboratório Clínico/economia , Técnicas de Laboratório Clínico/economia , Redução de Custos/economia , Procedimentos Desnecessários/economia , Sistemas de Informação em Laboratório Clínico/estatística & dados numéricos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Redução de Custos/estatística & dados numéricos , Humanos , Procedimentos Desnecessários/estatística & dados numéricos
16.
Biochem Med (Zagreb) ; 28(3): 030706, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30429674

RESUMO

Introduction: Most of clinical laboratories are not properly reimbursed for their activity related to clinical trials (CTs) conducted in their institutions due to a lack of measurement strategies. We implemented a specific computer physician order entry (CPOE) environment for CTs in order to facilitate ordering to providers and estimate the associated costs to be compared with the standard of care (SOC). Materials and methods: Four specific electronic formularies, restricted to two new virtual CTs clinical services (onco - CT and haemo - CT), were implemented in January 2015. For each clinical trial displayed in the panels there were several box-cells that contained several profiles based on the different phase of the trials. Tests included in the profiles were the tests required by protocol. Laboratory costs (€) per patient were compared between the CTs services and their regular outpatients clinical services (onco - Out and haemo - Out, considered the SOC) for three years. Results: Costs per patient were higher for CTs services and increased progressively each year (25%, 70% and 70% and 0.6%, 2.7% and 17% in 2015, 2016 and 2017 for Oncology and Haematology, respectively). Taking into account all these differences and the number of patients attending a total difference in expense of + 130,377.7 € for the period 2015-2017 was obtained between CTs and outpatients services. Conclusions: Strategies through CPOE systems based on restricted and specific profiles for CTs ordering are a promising tool that can improve laboratory associated costs estimation and provide robust evidence in reimbursement negotiation processes with CTs sponsors.


Assuntos
Técnicas de Laboratório Clínico/economia , Ensaios Clínicos como Assunto/economia , Análise Custo-Benefício/métodos , Sistemas de Registro de Ordens Médicas/estatística & dados numéricos , Neoplasias/economia , Humanos , Interface Usuário-Computador
17.
BMJ Open ; 8(9): e020394, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-30201794

RESUMO

OBJECTIVES: To quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing. DESIGN: Modelling study. SETTING: Genitourinary medicine (GUM) services in England. POPULATION: A hypothetical cohort of 965 988 people, representing the annual number attending GUM services symptomatic of lower genitourinary tract infection. INTERVENTIONS: The decision tree model considered costs and reimbursement to GUM services associated with diagnosing and managing STIs. Three strategies using hypothetical point-of-care tests (POCTs) were compared with standard care (SC) using laboratory-based testing. The strategies were: A) dual POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG); B) triplex POCT for CT-NG and Mycoplasma genitalium (MG); C) quadruplex POCT for CT-NG-MG and Trichomonas vaginalis (TV). Data came from published literature and unpublished estimates. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were total costs and benefits (quality-adjusted life years (QALYs)) for each strategy (2016 GB, £) and associated incremental cost-effectiveness ratios (ICERs) between each of the POC strategies and SC. Secondary outcomes were inappropriate treatment of STIs, onward STI transmission, pelvic inflammatory disease in women, time to cure and total attendances. RESULTS: In the base-case analysis, POC strategy C, a quadruplex POCT, was the most cost-effective relative to the other strategies, with an ICER of £36 585 per QALY gained compared with SC when using microcosting, and cost-savings of £26 451 382 when using tariff costing. POC strategy C also generated the most benefits, with 240 467 fewer clinic attendances, 808 fewer onward STI transmissions and 235 135 averted inappropriate treatments compared with SC. CONCLUSIONS: Many benefits can be achieved by using multipathogen POCTs to improve STI diagnosis and management. Further evidence is needed on the underlying prevalence of STIs and SC delivery in the UK to reduce uncertainty in economic analyses.


Assuntos
Técnicas de Laboratório Clínico/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Sistemas Automatizados de Assistência Junto ao Leito/economia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/economia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/economia , Redução de Custos , Análise Custo-Benefício , Árvores de Decisões , Feminino , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Gonorreia/economia , Humanos , Prescrição Inadequada/economia , Modelos Econômicos , Infecções por Mycoplasma/diagnóstico , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/economia , Anos de Vida Ajustados por Qualidade de Vida , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/transmissão , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/tratamento farmacológico , Vaginite por Trichomonas/economia
18.
Am Surg ; 84(7): 1185-1189, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30064585

RESUMO

Approximately 18 billion dollars is spent annually on preoperative testing. The purpose of this study was to determine whether implementation of an algorithm aimed at minimizing preoperative tests resulted in decreased costs without compromising care. We performed a pre-post trial comparing January 2016 to April 2016 with May 2016 to July 2017. In May 2016, an algorithm was instituted in which laboratories were canceled based on an algorithm that incorporated patient and procedural factors. Total number of laboratories canceled before orthopedic, urologic, or general surgical procedures was documented. Case cancellations during this time were recorded. There were 22,175 laboratories during the study time frame. There was a significant decrease of 2.4 per cent in expected laboratories in the post-intervention group. There was an overall cost savings of $33,032.00. The per cent of patients who were seen in preoperative testing clinic and still needed medical optimization decreased after algorithm implementation (3.3% vs 2.1% P < 0.01). No cases were canceled because of lack of laboratory information. An algorithm for selective preoperative laboratory testing provides overall cost savings. Decreasing the number of unnecessary laboratories ordered reduced case cancellations. Instituting an algorithm for preoperative laboratory testing is cost-effective without compromising care.


Assuntos
Técnicas de Laboratório Clínico/economia , Redução de Custos/economia , Recursos em Saúde , Preços Hospitalares , Cuidados Pré-Operatórios/economia , Algoritmos , Análise Custo-Benefício , Assistência à Saúde/normas , Recursos em Saúde/estatística & dados numéricos , Humanos , Cuidados Pré-Operatórios/normas , Estudos Retrospectivos , Estados Unidos
19.
Parasitology ; 145(13): 1733-1738, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30152296

RESUMO

With the push towards control and elimination of soil-transmitted helminthiasis and schistosomiasis in low- and middle-income countries, there is a need to develop alternative diagnostic assays that complement the current in-country resources, preferably at a lower cost. Here, we describe a novel high-resolution melt (HRM) curve assay with six PCR primer pairs, designed to sub-regions of the nuclear ribosomal locus. Used within a single reaction and dye detection channel, they are able to discriminate Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Ascaris lumbricoides, Trichuris trichiuria and Schistosoma spp. by HRM curve analysis. Here we describe the primers and the results of a pilot assessment whereby the HRM assay was tested against a selection of archived fecal samples from Ghanaian children as characterized by Kato-Katz and real-time PCR analysis with species-specific TaqMan hydrolysis probes. The resulting sensitivity and specificity of the HRM was 80 and 98.6% respectively. We judge the assay to be appropriate in modestly equipped and resourced laboratories. This method provides a potentially cheaper alternative to the TaqMan method for laboratories in lower resource settings. However, the assay requires a more extensive assessment as the samples used were not representative of all target organisms.


Assuntos
Helmintíase/diagnóstico , Helmintos/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real/métodos , Schistosoma/isolamento & purificação , Esquistossomose/diagnóstico , Solo/parasitologia , Animais , Ascaríase/diagnóstico , Ascaris lumbricoides/isolamento & purificação , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/métodos , Primers do DNA , Fezes/parasitologia , Humanos , Reação em Cadeia da Polimerase Multiplex/métodos , Necator americanus/isolamento & purificação , Necatoríase/diagnóstico , Projetos Piloto , Reação em Cadeia da Polimerase em Tempo Real/economia , Sensibilidade e Especificidade , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Temperatura de Transição
20.
PLoS One ; 13(8): e0200199, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30096177

RESUMO

BACKGROUND: To date, little information exists on the costs of providing antiretroviral therapy (ART) within maternal and child health (MCH) clinics in Kenya. The main objective of this analysis was to estimate the annual incremental cost of providing ART within a MCH clinic for adult women initiated on ART during pregnancy over the first one and two years on treatment. The study site was the District Hospital in Kericho, Kenya. METHODS: A micro-costing approach from the provider's perspective, based on a retrospective review of patient medical records, was used to evaluate incremental costs of care (2012 USD). Cost per patient in two cohorts were evaluated: the MCH clinic group comprised of adult women who initiated ART at the site's MCH clinic during pregnancy between 2008-2011; and for comparison, the ART clinic group comprised of adult, non-pregnant women who initiated ART at the site's ART clinic during 2008-2011. The two groups were matched on age and baseline CD4 count at initiation. Retention at year one/two on ART was defined as having completed a clinic visit at 365/730 days on ART +/- 90 days. RESULTS: For patients defined as retained in care at year one, average incremental costs per patient were $234 for the MCH clinic group (median: 215; IQR: 186, 282) and $292 in the ART clinic group (median: 227; IQR: 178, 357). ARV and laboratory costs were less on average for the MCH clinic group compared to the ART clinic group (due to lower cost regimens and fewer tests), while personnel costs were higher for the MCH clinic group. CONCLUSIONS: The annual incremental cost per patient of providing ART were similar in the two clinic settings in 2012. With shifts in recommended ARV regimens and lab monitoring over time, annual costs of care (using 2016 USD unit costs) have remained relatively constant in nominal terms for the MCH clinic group but have fallen substantially for the ART clinic group (from nominal $292 in 2012 to nominal $227 in 2016).


Assuntos
Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/economia , Infecções por HIV/terapia , Complicações Infecciosas na Gravidez/economia , Complicações Infecciosas na Gravidez/terapia , Adulto , Serviços de Saúde da Criança/economia , Técnicas de Laboratório Clínico/economia , Estudos de Coortes , Feminino , Custos de Cuidados de Saúde , Pessoal de Saúde/economia , Humanos , Lactente , Quênia , Serviços de Saúde Materna/economia , Gravidez , Fatores de Tempo
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