Single-use versus reusable medical devices in spinal fusion surgery: a hospital micro-costing analysis.

PURPOSE: Healthcare facilities could minimize the cost of surgical instrument and implant processing by using single-use devices. The main objective was to prospectively compare the total cost of a single-use and reusable device used in short lumbar spine fusion. METHODS: A 1-year, single-centre, prospective study was performed on patients requiring a one- or two-level lumbar arthrodesis. Patients were randomized in two groups treated with either reusable or single-use device. A cost minimization analysis was performed using a micro-costing approach from a hospital perspective. Every step of the preparation process was timed and costed based on hourly wages of hospital employees, cleaning supplies and hospital waste costs. RESULTS: Forty cases were evaluated. No significant difference in operation time was noted (reusable 176.1 ± 68.4 min; single use 190.4 ± 71.7 min; p = 0.569). Mean processing time for single-use devices was lower than for reusable devices (33 min vs. 176 min) representing a cost of 14€ versus 58€ (p < 0.05). Pre-/post-sterilization and spinal set recomposing steps were the most time-consuming in reusable device group. A total cost saving of 181€ per intervention resulted from the use and processing of the single-use device considering an additional sterilization cost of 137€ with the reusable device. The weight of the reusable device was 42 kg for three containers and 1.2 kg for the single-use device. CONCLUSIONS: Owing to the absence of re-sterilization, single-use devices in one- and two-level lumbar fusion allow significant money and time savings. They may also avoid delaying surgery in case of reusable device unavailability.

Healthcare utilization and costs associated with autologous haematopoietic stem cell transplantation in Norwegian patients with relapsing remitting multiple sclerosis.

Multiple sclerosis (MS) patients experience long-term deterioration of neurological function, reduced quality of life, long-lasting treatment cycles, and an increased risk of early workability loss imposing an economic burden to society. Autologous haematopoietic stem cell transplantation (AHSCT) has shown promising treatment effects for relapsing remitting MS (RRMS). This study employs a micro-costing approach to estimate healthcare utilization and costs associated with AHSCT in Norwegian RRMS patients. Patient-level data were extracted from medical journals of 30 RRMS patients receiving AHSCT treatment at Haukeland University Hospital in the period from January 2015 to January 2018. The time horizon for the analysis was from the pretransplant screening until one year after AHSCT. A correlation was found between patient body weight and total healthcare cost. The average total healthcare cost of AHSCT for RRMS patients was estimated to EUR 66 304 (95% CI: EUR 63 598 - EUR 69 010) including costs associated with the pre-AHSCT period, AHSCT treatment phases and one-year follow-up. The majority of the costs, EUR 64 329, occurred during the treatment phase and within the first 100 days after AHSCT. The results indicate that long-term healthcare cost savings may be achieved using AHSCT in selected patients with aggressive RRMS. This is due to the high costs of most used disease modifying treatments. Further research including long-term clinical data is needed to determine the cost-effectiveness of this treatment.

Resource utilization and disaggregated cost analysis of bariatric surgery in the Australian public healthcare system.

OBJECTIVES: To present a comprehensive real-world micro-costing analysis of bariatric surgery. METHODS: Patients were included if they underwent primary bariatric surgery (gastric banding [GB], gastric bypass [GBP] and sleeve gastrectomy [SG]) between 2013 and 2019. Costs were disaggregated into cost items and average-per-patient costs from the Australian healthcare systems perspective were expressed in constant 2019 Australian dollars for the entire cohort and subgroup analysis. Annual population-based costs were calculated to capture longitudinal trends. A generalized linear model (GLM) predicted the overall bariatric-related costs. RESULTS: N = 240 publicly funded patients were included, with the waitlist times of ≤ 10.7 years. The mean direct costs were $11,269. The operating theatre constituted the largest component of bariatric-related costs, followed by medical supplies, salaries, critical care use, and labour on-costs. Average cost for SG ($12,632) and GBP ($15,041) was higher than that for GB ($10,049). Operating theatre accounted for the largest component for SG/GBP costs, whilst medical supplies were the largest for GB. We observed an increase in SG and a decrease in GB procedures over time. Correspondingly, the main cost driver changed from medical supplies in 2014-2015 for GB procedures to operating theatre for SG thereafter. GLM model estimates of bariatric average cost ranged from $7,580 to $36,633. CONCLUSIONS: We presented the first detailed characterization of the scale, disaggregated profile and determinants of bariatric-related costs, and examined the evolution of resource utilization patterns and costs, reflecting the shift in the Australian bariatric landscape over time. Understanding these patterns and forecasting of future changes are critical for efficient resource allocation.

Pierre Robin Sequence: Cost-Analysis and Qualitative Assessment of 89 Patients at the Hospital for Sick Children.

INTRODUCTION: Children with Pierre Robin sequence (PRS) have a complex clinical presentation and requires many health-care providers. Thus, multiple clinical pathways have been proposed on how to manage this population, with some opting for conservative measures while others opting for a surgical approach. However, no consensus has been reached on the most appropriate protocol. OBJECTIVE: To present the treatment protocol for PRS at the Hospital for Sick Children. This will be evaluated through a qualitative examination of the approach from the patient's perspective, and a micro-costing analysis of the financial aspects of providing care. METHODS: A retrospective cohort study was conducted to evaluate infants who were admitted with PRS and failure to thrive from January 2004 to December 2015. This was followed by a micro-costing analysis to evaluate the cost of the management protocol. Finally, a qualitative evaluation of the parent's perspective was done. RESULTS: Eighty-nine patients were admitted with failure to thrive during the study period. Fourteen patients underwent surgical management. Fourteen patients required readmission for airway or feeding issues secondary to PRS. The average cost per patient was Can$105 996. With regard to the qualitative evaluation, key themes that were generated included stress upon hospital admission, variable methods of understanding PRS, good level of communication with the team, excellent hospital process, and challenging transition home. CONCLUSION: These results will aid in the continual evolution of a protocol and provide important information on PRS to both families and centers that manage these children.

INTRODUCTION: Les enfants ayant un syndrome de Pierre-Robin (SPR) ont une présentation clinique complexe, qui exige l'apport de nombreux professionnels de la santé. Ainsi, de multiples trajectoires cliniques sont proposées pour prendre cette population en charge. Certains optent pour des mesures prudentes et d'autres pour une approche chirurgicale. Cependant, il n'y a pas de consensus quant au protocole le mieux adapté. OBJECTIF: Présenter le protocole de traitement du SPR utilisé au Hospital for Sick Children. Il sera évalué par un examen qualitatif de l'approche selon le point de vue des parents et une analyse des aspects financiers de la prestation des soins. MÉTHODOLOGIE: Les chercheurs ont mené une étude de cohorte rétrospective pour évaluer les nourrissons qui avaient été hospitalisés à cause d'un SPR et d'un retard staturopondéral entre janvier 2004 et décembre 2015. Ils ont ensuite effectué une analyse pour évaluer le coût du protocole de prise en charge et ont terminé par une évaluation qualitative du point de vue des parents. RÉSULTATS: Pendant la période de l'étude, 89 patients ont été hospitalisés à cause d'un retard staturopondéral, dont 14 ont subi une opération. De plus, 14 patients ont été réhospitalisés à cause de problèmes respiratoires ou alimentaires liés au SPR. Le coût moyen par patient s'élevait à 105 996 Can$. Dans le cadre de l'évaluation qualitative, les principaux thèmes soulevés étaient le stress à l'hospitalisation, la méthodologie variable pour comprendre le SPR, le bon niveau de communication avec l'équipe, l'excellent processus hospitalier et une transition difficile à la maison. CONCLUSION: Les présents résultats contribueront à l'évolution d'un protocole et fournissent de l'information importante sur le SPR, à la fois pour les familles et les centres qui prennent ces enfants en charge.

Costs of coronary heart disease and mortality associated with near-roadway air pollution.

BACKGROUND: Emerging evidence indicates that the near-roadway air pollution (NRAP) mixture contributes to CHD, yet few studies have evaluated the associated costs. OBJECTIVE: We integrated an assessment of NRAP-attributable CHD in Southern California with new methods to value the associated mortality and hospitalizations. METHODS: Based on population-weighted residential exposure to NRAP (traffic density, proximity to a major roadway and elemental carbon), we estimated the inflation-adjusted value of NRAP-attributable mortality and costs of hospitalizations that occurred in 2008. We also estimated anticipated costs in 2035 based on projected changes in population and in NRAP exposure associated with California's plans to reduce greenhouse gas emissions. For comparison, we estimated the value of CHD mortality attributable to PM less than 2.5µm in diameter (PM2.5) in both 2008 and 2035. RESULTS: The value of CHD mortality attributable to NRAP in 2008 was between $3.8 and $11.5 billion, 23% (major roadway proximity) to 68% (traffic density) of the $16.8 billion attributable to regulated regional PM2.5. NRAP-attributable costs were projected to increase to $10.6 to $22 billion in 2035, depending on the NRAP metric. Cost of NRAP-attributable hospitalizations for CHD in 2008 was $48.6 million and was projected to increase to $51.4 million in 2035. CONCLUSIONS: We developed an economic framework that can be used to estimate the benefits of regulations to improve air quality. CHD attributable to NRAP has a large economic impact that is expected to increase by 2035, largely due to an aging population. PM2.5-attributable costs may underestimate total value of air pollution-attributable CHD.

Cost saving potential in cardiovascular hospital costs due to reduction in air pollution.

OBJECTIVE: We describe a methodological framework to estimate potential cost savings in Belgium for a decrease in cardiovascular emergency admissions (ischemic heart disease (IHD), heart rhythm disturbances (HRD), and heart failure) due to a reduction in air pollution. METHODS: Hospital discharge data on emergency admissions from an academic hospital were used to identify cases, derive risk functions, and estimate hospital costs. Risk functions were derived with case-crossover analyses with weekly average PM10, PM2.5, and NO2 exposures. The risk functions were subsequently used in a micro-costing analysis approach. Annual hospital cost savings for Belgium were estimated for two scenarios on the decrease of air pollution: 1) 10% reduction in each of the pollutants and 2) reduction towards annual WHO guidelines. RESULTS: Emergency admissions for IHD and HRD were significantly associated with PM10, PM2.5, and NO2 exposures the week before admission. The estimated risk reduction for IHD admissions was 2.44% [95% confidence interval (CI): 0.33%-4.50%], 2.34% [95% CI: 0.62%-4.03%], and 3.93% [95% CI: 1.14%-6.65%] for a 10% reduction in PM10, PM2.5, and NO2 respectively. For Belgium, the associated annual cost savings were estimated at € 5.2 million, € 5.0 million, and € 8.4 million respectively. For HRD, admission risk could be reduced by 2.16% [95% CI: 0.14%-4.15%], 2.08% [95% CI: 0.42%-3.70%], and 3.46% [95% CI: 0.84%-6.01%] for a 10% reduction in PM10, PM2.5, and NO2 respectively. This corresponds with a potential annual hospital cost saving in Belgium of € 3.7 million, € 3.6 million, and € 5.9 million respectively. If WHO annual guidelines for PM10 and PM2.5 are met, more than triple these amounts would be saved. DISCUSSION: This study demonstrates that a model chain of case-crossover and micro-costing analyses can be applied in order to obtain estimates on the impact of air pollution on hospital costs.