Average Cost Savings Research Articles

Economic Evaluation of a Disease Management Program for Chronic Obstructive Pulmonary Disease

Background: The data on cost savings with disease management (DM) in chronic obstructive pulmonary disease (COPD) is limited. A multicomponent DM program in COPD has recently shown in a large randomized controlled trial to reduce hospitalizations and emergency department visits compared to usual care (UC). The objectives of this study were to determine the cost of implementing the DM program and its impact on healthcare resource utilization costs compared to UC in high-risk COPD patients. Materials and Methods: This study was a post-hoc economic analysis of a multicenter randomized, adjudicator-blinded, controlled, 1-year trial comparing DM and UC at 5 Midwest region Department of Veterans Affairs (VA) medical centers. Health-care costs (hospitalizations, ED visits, respiratory medications, and the cost of the DM intervention) were compared in the COPD DM intervention and UC groups. Results: The composite outcome for all hospitalizations or ED visits were 27% lower in the DM group (123.8 mean events per 100 patient-years) compared to the UC group (170.5 mean events per 100 patient-years) (rate ratio 0.73; 0.56–0.90; p < 0.003). The cost of the DM intervention was $241,620 or $650 per patient. The total mean ± SD per patient cost that included the cost of DM in the DM group was 4491 ± 4678 compared to $5084 ± 5060 representing a $593 per patient cost savings for the DM program. Conclusions: The DM intervention program in this study was unique for producing an average cost savings of $593 per patient after paying for the cost of DM intervention.

Financial and environmental consequences of a voluntary farm environmental assurance program in Michigan

The Michigan Agriculture Environmental Assurance Program is a voluntary environmental management program for Michigan farms. The Michigan Agriculture Environmental Assurance Program encourages farm managers to become better environmental stewards through writing Comprehensive Nutrient Management Plans and incorporating changes to comply with regulations as well as generally accepted management practices and recommendations. Early-adopting livestock producers with verified operations were interviewed to identify and measure costs incurred, environmental outcomes achieved, and producer attitudes and perceptions as a result of verification. The average total cost to become verified was $120,600 per farm, of which the average producer paid $104,423, with the remaining $16,177 provided through cost-share funds. Much of this cost was for long-term investments such as manure storage and facilities improvements. Producers realized an average postverification annual cost savings of $2,792 by curtailing unnecessary use of commercial fertilizer. The financial values had large amounts of variation in every case. The per animal unit costs of verification were generally in the same range as the US Environmental Protection Agency estimates for cost of compliance with similar (but mandatory) proposed regulations. With respect to environmental outcome, after verification, average operation mass balance improved. The primary motivation to participate in the program stemmed from existing or potential environmental regulations.

It takes an intensivist

Background Our institution initiated the implementation of the Surviving Sepsis Campaign guidelines in 2006. We hypothesize that the addition of a surgical intensivist improved results more than the implementation of the guidelines alone. Methods We collected data on 273 patients who were admitted to the surgical intensive care unit for sepsis. The groups were divided into pre-bundle, n = 19; bundle, n = 186; and bundle-plus, n = 68, to denote the method by which the patients were treated for sepsis. Results There was no difference in age or sex between groups. There was a statistically significant decrease in length of stay (LOS) between the 3 groups, and in mortality between the bundle and bundle-plus treatment groups ( P < .01). In addition, there was an average cost savings between each group. Conclusions Implementation of evidence-based guidelines decreased LOS and decreased cost in our surgical intensive care unit. By adding the expertise of a surgical intensivist, we reduced LOS, cost, and relative risk of death even further than using the guidelines alone.

Ultrasonic Shears in Free‐Tissue Transfer

The harvest of some microvascular free flaps for head and neck reconstruction entails tedious and time-consuming dissection of multiple perforating vessels and/or muscular attachments. The objective of this study is to investigate the use of ultrasonic shears as a means to decrease operative time and increase surgical efficiency in the harvest of microvascular free flaps. Prospective cohort study. Tertiary referral center. A prospective study of all people undergoing fibula (FFF) or anterolateral thigh (ALT) free flap reconstruction of head and neck defects was conducted from October 1, 2005, through December 30, 2009. There were 69 FFF and 39 ALT free flaps performed by a single surgeon during the study period. Ultrasonic shears were used in 53 (76.8%) FFF and 26 (80.6%) ALT free flaps, whereas traditional dissection techniques were used in 16 (23.2%) FFF and 13 (19.4%) ALT free flaps. The use of ultrasonic shears significantly decreased the harvest time of FFF and ALT free flaps an average of 14.5 and 16.3 minutes, respectively. The average cost savings associated with the use of ultrasonic shears was $492 for FFF and $543 for ALT free flaps compared to traditional dissections techniques. Similar rates of complications were observed when ultrasonic shears were used compared to traditional techniques. The use of ultrasonic shears in the harvest of microvascular free flaps decreases operative time, leading to significantly decreased costs without an increased risk of complications compared to traditional dissection techniques.

Estimation of Cost Synergies from Mergers: Application to U.S. Radio

This paper develops a way to estimate fixed-cost efficiencies from mergers. The estimates might be used to assess the total welfare impact of retrospective and counterfactual mergers. The procedure uses a structural model in which companies play a dynamic game with endogenous mergers and product-repositioning decisions. This formulation corrects for a sample selection of more profitable mergers and captures follow-up mergers as well as post-merger product repositionings. The basic idea behind the estimator is to treat mergers as endogenous, thereby allowing for a comparison between mergers observed in the data and counterfactual ones, based on simulated long-run gains for different levels of cost efficiencies. The framework is applied to estimate cost efficiencies after the 1996 de-regulation of U.S. radio. I find that average cost savings (across all owners), over the period 1996-2006, only from mergers after 1996, amount to about $1.2 billion per year (roughly $0.6b from economies of scale and another $0.6b from within-format cost synergies).

Accurate ECG Diagnosis of Atrial Tachyarrhythmias Using Quantitative Analysis: A Prospective Diagnostic and Cost‐Effectiveness Study

Quantitative ECG Analysis. Optimal atrial tachyarrhythmia management is facilitated by accurate electrocardiogram interpretation, yet typical atrial flutter (AFl) may present without sawtooth F-waves or RR regularity, and atrial fibrillation (AF) may be difficult to separate from atypical AFl or rapid focal atrial tachycardia (AT). We analyzed whether improved diagnostic accuracy using a validated analysis tool significantly impacts costs and patient care. We performed a prospective, blinded, multicenter study using a novel quantitative computerized algorithm to identify atrial tachyarrhythmia mechanism from the surface ECG in patients referred for electrophysiology study (EPS). In 122 consecutive patients (age 60 ± 12 years) referred for EPS, 91 sustained atrial tachyarrhythmias were studied. ECGs were also interpreted by 9 physicians from 3 specialties for comparison and to allow healthcare system modeling. Diagnostic accuracy was compared to the diagnosis at EPS. A Markov model was used to estimate the impact of improved arrhythmia diagnosis. We found 13% of typical AFl ECGs had neither sawtooth flutter waves nor RR regularity, and were misdiagnosed by the majority of clinicians (0/6 correctly diagnosed by consensus visual interpretation) but correctly by quantitative analysis in 83% (5/6, P = 0.03). AF diagnosis was also improved through use of the algorithm (92%) versus visual interpretation (primary care: 76%, P < 0.01). Economically, we found that these improvements in diagnostic accuracy resulted in an average cost-savings of $1,303 and 0.007 quality-adjusted-life-years per patient. Typical AFl and AF are frequently misdiagnosed using visual criteria. Quantitative analysis improves diagnostic accuracy and results in improved healthcare costs and patient outcomes.

A decision support system for cost-effective diagnosis

Speed, cost, and accuracy are three important goals in disease diagnosis. This paper proposes a machine learning-based expert system algorithm to optimize these goals and assist diagnostic decisions in a sequential decision-making setting. The algorithm consists of three components that work together to identify the sequence of diagnostic tests that attains the treatment or no test threshold probability for a query case with adequate certainty: lazy-learning classifiers, confident diagnosis, and locally sequential feature selection (LSFS). Speed-based and cost-based objective functions can be used as criteria to select tests. Results of four different datasets are consistent. All LSFS functions significantly reduce tests and costs. Average cost savings for heart disease, thyroid disease, diabetes, and hepatitis datasets are 50%, 57%, 22%, and 34%, respectively. Average test savings are 55%, 73%, 24%, and 39%, respectively. Accuracies are similar to or better than the baseline (the classifier that uses all available tests in the dataset). We have demonstrated a new approach that dynamically estimates and determines the optimal sequence of tests that provides the most information (or disease probability) based on a patient's available information.

Measuring technical and allocative efficiencies for banks in the transition countries using the Fourier flexible cost function

The transition economies are known to have quite different market structures from the market economies. State-owned banks accounts for a major part of the financial sector in East European countries before the transition period. Since the input prices of the sector are frequently under the control of those governments, the misallocated resources may incur the loss of economic efficiency. This paper attempts to gauge the technical and allocative efficiency using unbalanced panel data of 340 banks from 14 transition countries under the framework of the Fourier flexible shadow cost function. Accommodating technical and allocative efficiencies simultaneously, as suggested by Atkinson and Cornwell (Int Econ Rev 35:231–243, 1994a) and Kumbhakar and Wang (J Econom 134:317–340, 2006a), avoids potential specification errors and leads to consistent parameter estimates. The average total cost savings resulting from greater technical and allocative efficiency are around 28.31 and 7.13%, respectively. Foreign-owned banks are found to be the most economically efficient. The enforcement of financial liberalization does gradually improve upon the sample banks’ technical efficiency. The allocative inefficiency arises from over capitalization and excess funds. Scale diseconomies appear to prevail in the sample states with a few exceptions.

EClasSkeduler: A Course Scheduling System for the Executive Education Unit at the Universidad de Chile

Each October, the Executive Education Unit at the Universidad de Chile develops its course schedules for the following year. By 2008, the complexities of increasing enrollments and course offerings had rendered its manual timetabling process unmanageable. Inconvenient and inflexible scheduling decisions were causing discontent among instructors and students, making the need for a more efficient system of assigning classrooms patent. Three characteristics distinguish the unit's situation from the classic university course timetabling problem. First, its courses vary in duration, ranging between 15 and 30 weeks. Second, its course start dates are spread over the academic year. Finally, each course's start date is flexible and must fall within a window defined by the earliest and latest start dates. This paper presents an automated computational system that generates optimal timetables and classroom assignments for all the unit's courses, minimizing both operating costs and schedule conflicts. When we compared the schedules it generated with the unit's manually generated timetables, we found that our system yielded average cost savings of 35 percent; in addition, it reduced execution times (for generating schedules) from two weeks to less than 30 minutes.

New Policies for the Stochastic Inventory Control Problem with Two Supply Sources

We study an inventory system under periodic review in the presence of two suppliers (or delivery modes). The emergency supplier has a shorter lead-time than the regular supplier, but the unit price he offers is higher. Excess demand is backlogged. We generalize the recently studied class of dual index policies [Veeraraghavan, S., A. Scheller-Wolf. 2008. Now or later: Dual index policies for capacitated dual sourcing systems. Oper. Res. 56(4) 850–864] by proposing two classes of policies. The first class consists of policies that have an order-up-to structure for the emergency supplier. We provide analytical results that are useful for determining optimal or near-optimal policies within this class. This analysis and the policies we propose leverage our observation that the classical “lost sales inventory problem” is a special case of this problem. The second class consists of policies that have an order-up-to structure for the regular supplier. Here, we derive bounds on the optimal order quantity from the emergency supplier, in any period, and use these bounds for finding effective policies within this class. Finally, we undertake an elaborate computational investigation to compare the performance of the policies we propose with that of dual index policies. One of our policies provides an average cost-saving of 1.1% over the best dual index policy and has the same computational requirements. Another policy that we propose has a cost performance similar to the best dual index policy, but its computational requirements are lower.

The Effect of Telephone Support Groups on Costs of Care for Veterans With Dementia

Few studies have addressed the effects of caregiver interventions on the costs of care for the care recipient. This study evaluated the effects of a caregiver education and support group delivered via the telephone on care recipient health care utilization and cost. The Telehealth Education Program (TEP) is a manualized program of education and support designed for caregivers of veterans with moderate-to-severe dementia. One hundred fifty-eight spousal caregivers were randomly assigned to either the ten 1-hr sessions of TEP or the usual care (UC). Health care utilization and cost data were extracted from veterans Information System Technology Architecture databases and included outpatient, inpatient, and nursing home data within the VA. Total health care cost data showed a significant (p = .039) average cost savings of $2,768 per patient at 6 months for TEP as compared with UC, but these were not maintained at 1 year. All costs included in the total costs measure contributed to this difference. Inpatient, outpatient, and nursing home costs were all assessed separately, but only nursing home costs reached significance (p = .009), with a savings of $1,057 per patient at 6 months. The TEP caregiver intervention resulted in short-term cost savings for veteran care recipients. Future studies of caregiver interventions should examine their effects on costs of care for the care recipients in addition to their effects on caregiver outcomes.

Effects of contracting on cost efficiency in US fixed-route bus transit service

Contracted service comprises a significant proportion of total operating expenses in the provision of fixed-route bus transit service in the US. Despite its importance, the literature on the economic effects of transit service contracting has been limited to only a few studies since the mid-1990s, and is inconclusive due to problems with the nature and methodology of the past studies. This paper examines how the cost efficiency of providing fixed-route bus transit service varies by the degree of contracting. I make several improvements to previous studies and conduct a regression analysis that: (1) addresses the endogeneity problem between the contracting decision and cost efficiency, (2) differentiates between agencies that contract out only a portion of service from those that contract out all service, (3) takes into account the moderating effects of several factors on the effect of contracting on cost efficiency, and (4) uses a relatively larger set of cross-sectional time-series data constructed from the National Transit Database from 1992 to 2000. The analysis results show that the combined effects of contracting lower operating costs by $4.09 and $2.89 per vehicle hour for partial and full-contracting agencies, respectively, in the average case. These average cost savings translate into 7.8% and 5.5%, using the average operating cost per vehicle hour of $53.06. However, this improvement is not universal, because the effects of contracting on cost efficiency vary by factors such as peak-to-base ratio, agency size, the wage gap between bus operators in the public and private sectors, and agency type.

Retrospective analysis of community pharmacists’ recommendations in the North Carolina Medicaid medication therapy management program

ObjectivesTo determine the economic impact of cost-saving alternatives on prescription drug costs for the North Carolina Medicaid medication therapy management (MTM) program and to assess the acceptance of recommendations made by pharmacists to prescribers and the implementation of accepted recommendations. DesignRetrospective analysis. Setting92 Kerr Drug pharmacies in North Carolina from August 1, 2006, to July 31, 2007. Participants88 North Carolina Medicaid beneficiaries who received at least 12 prescriptions each month and who completed four quarterly medication reviews by a Kerr Drug pharmacist. InterventionAssessed recommendations made by Kerr Drug pharmacists. Main outcome measuresRate of acceptance of pharmacist recommendations and overall economic impact of changing from brand-name medications to cost-saving alternatives. ResultsAcceptance rate of pharmacist recommendations ranged from 42% to 60%. The rate at which the pharmacists’ accepted recommendations were implemented at Kerr Drug pharmacy ranged from 62% to 86% across the four quarterly reviews. Overall economic impact resulted in an average cost savings of $107 per beneficiary to North Carolina Medicaid per year. Quarterly economic impact results revealed that the highest impact occurred during the first quarterly review at $63 per beneficiary. ConclusionPrescriber acceptance and pharmacy implementation of cost-savings alternatives provided an annual average cost savings of $9,444 to North Carolina Medicaid. After pharmacist reimbursement, this savings totaled $2,724.

Contracting in highway maintenance and rehabilitation: Are spatial effects important?

Highway agencies around the world strive to improve practices for infrastructure maintenance and rehabilitation, using project delivery policies that range from total ‘in-house’ responsibility to complete privatization, with a number of flexible contracting policies such as performance-based contracting, variants of design-build-maintain, and lane rentals among others between these two extremes. In this paper, we present a methodology that duly accounts for underlying spatial effects and estimates the expected cost savings of innovative contracting policies for highway maintenance and rehabilitation relative to in-house execution of these activities. Spatial econometric modeling is used to analyze highway contract data from 49 countries. We also investigate the marginal effects of key explanatory variables on contract cost savings using spatial multipliers. Our findings show that there are significant relationships between cost savings and contract characteristics, and that there is an apparent direct relationship between the average cost savings of contracts in a country and contract average cost savings and contract sizes in neighboring countries.

A cost-utility analysis of antenatal screening to prevent congenital rubella syndrome

In low vaccination coverage regions (LVR) in The Netherlands people often reject participation in the National Immunization Programme for religious reasons. During a rubella epidemic in 2004-2005, 32 pregnant women were notified with rubella, and 11 babies were born with defects related to maternal infection. This study presents a cost-utility analysis of a screening and vaccination programme for rubella focusing on three scenarios: (1) screening non-vaccinated pregnant women in LVR; (2) screening all pregnant women in LVR; (3) screening all non-vaccinated pregnant women in The Netherlands (including pregnant first-generation non-Western immigrant women). Cost-utility was estimated over a 16-year period which included two rubella outbreaks. Observed complications from the 2004-2005 epidemic were used to estimate average cost savings and quality-adjusted life-years (QALY) gained. The programme would be cost-effective (euro1100/QALY gained) when assuming an acceptability of vaccination of 20% in women belonging to orthodox protestant risk groups.

State Infrastructure Banks and Intergovernmental Subsidies for Local Transportation Investment

This study reviews State Infrastructure Banks (SIBs) as an innovative financing mechanism for federal and state governments to support transportation financing for local governments, and determines the cost savings realized by local governments from receiving SIB loans rather than financing through the municipal bond market. The study finds that SIBs provide a mechanism through which local governments receive subsidized loans for their transportation investments. With the Ohio SIB, localities realized average borrowing cost savings between 34 and 184 basis points. Under the worst‐ and best‐case scenarios, 83 and 98 percent of projects, respectively, benefited from lower borrowing costs.

Identification of medication-related problems and health care provider acceptance of pharmacist recommendations in the DiabetesCARE program

To evaluate the efficacy of pharmacist recommendations to health care providers, as part of PharmacistCARE, a single-center, pharmacist-run, diabetes medication therapy management (MTM) service. If the recommendation was accepted, a secondary objective was to measure the length of time for acceptance. Prospective assessment. University of Kentucky (UK), from March 2003 through December 2006. 172 adult patients with diabetes enrolled in the UK Health Plan who participated in the DiabetesCARE program. Pharmacists provided medication therapy-related recommendations to health care providers. Acceptance of pharmacist recommendations by health care providers, length of time to acceptance, and cost savings attained with formulary recommendations. A total of 692 recommendations were sent to health care providers; 425 (61.4%) were accepted. A total of 578 clinical recommendations were related to drug therapy problems; 348 (60.2%) were accepted by health care providers. Median time to acceptance for clinical recommendations was 13.5 days (0-229). Formulary recommendations accounted for 114 (16%) of the total recommendations, 77 (67.5%) were accepted, and median time to acceptance was 47.2 days (0-172). Average monthly cost savings per accepted formulary recommendation was $13.59 for the health plan and $13.85 for the patient. A similar percentage of health care provider acceptance (61.4%) was seen compared with previous studies of pharmacists' interventions in different practice settings. To our knowledge, this is the first study to evaluate time to acceptance of pharmacist recommendations to health care providers, including the resolutions made through collaborative drug therapy management. Lastly, the current study reinforces the assertion that pharmacists can positively affect cost savings for both the patient and health plan, through formulary management.

Embolization of the Internal Iliac Artery: Cost-Effectiveness of Two Different Techniques

The purpose of this study was to compare the cost-effectiveness of coils versus the Amplatzer Vascular Plug (AVP) for occlusion of the internal iliac artery (IAA). Between 2002 and January 2006, 13 patients (mean age 73 +/- 13 years) were referred for stent-grafting of abdominal aortic aneurysm (n = 6); type I distal endoleak (n = 3), isolated iliac aneurysm (n = 3), or rupture of a common iliac aneurysm (n = 1). In all patients, extension of the stent-graft was needed because the distal neck was absent. Two different techniques were used to occlude the IIA: AVP in seven patients (group A) and coil embolization in six patients (group C). Immediate results and direct material costs were assessed retrospectively. Immediate success was achieved in all patients, and simultaneous stent-grafting was successfully performed in two of six patients in group C versus five of seven patients in group A. In all group A patients, a single AVP was sufficient to achieve occlusion of the IIA, accounting for a mean cost of 485 euros, whereas in group C patients, an average of 7 +/- 3 coils were used, accounting for a mean cost of 1,745 euros. Mean average cost savings using the AVP was 1,239 euros. When IIA occlusion is needed, the AVP allows a single-step procedure at significant cost savings.

Hospitalization rates before and after initiation of paliperidone ER in patients with schizophrenia: results from open-label extensions of the US double-blind trials

ABSTRACTObjective: To assess differences in the number of days hospitalized among schizophrenic patients receiving paliperidone extended-release (paliperidone ER) during the open-label extension (OLE) phases, compared to a similar time period prior to the screening for entry into the double-blind (DB) trials conducted in the United States.Methods: Mental health-related hospital days during the 52 weeks before entering the DB trials and during the OLE phases were compared. The mean number of hospital days per person per year in the pre- and post-periods was calculated and the statistical significance of pre-post differences was assessed using bootstrap resampling methods. Total person-years were also calculated for the pre- and post-periods to account for different lengths of observation.Results: Patients' (n = 215) mean ( ± SD) age was 41.2 ( ± 11.0) years; most were male (73.0 % ); and black (52.1 vs. 45.1 % white). The mean ( ± SD) paliperidone ER treatment duration during the OLE phase was 167.0 ( ± 145.0) days and the mean ( ± SD) daily dose was 10.5 ( ± 2.0) mg. Overall, paliperidone ER patients spent an average ( ± SD) of 13.2 ( ± 1.6) and 3.1 ( ± 0.7) hospital days per person-year in the pre-and post-periods, respectively (mean ± SD change 10.0 ± 1.8, 95 % CI 6.5, 13.4, p < 0.001). Using the 2007 Federal Per Diem Base Rate (i.e., $595.09 per day), this reduction in hospital days would result in an average ( ± SD) cost savings of $5951 ( ± 1071) per person per year.Conclusions: Patients had significantly fewer hospital days in the OLE phase compared to the 1-year period prior to entering the DB trial. Paliperidone ER may play a role in reducing mental health-related hospital days and associated costs. Important study limitations include the lack of a control group, the pre-post design comparing historical data with data collected in the trials which could create a bias due to the mismatch in settings, and patients having more frequent contact with treating physicians and investigators during the trial period, which could favor the outcomes in the OLE phase. Further studies are needed to confirm these findings.

Cost-effectiveness of citicoline versus conventional treatment in acute ischemic stroke

In the framework of an integral assessment (effectiveness and cost) of the use of neuroprotection in stroke, a cost-effectiveness study was conducted to compare the potential advantages of citicoline with conventional therapy (without neuroprotection or placebo) in patients with acute ischemic stroke. The literature was searched for systematic reviews and meta-analyses evaluating the effectiveness of citicoline versus placebo in the hospital setting and during 12 weeks after discharge from hospital. Data on the use of resources were obtained from a panel of experts of four acute-care teaching hospitals in Spain. The study was performed from the perspective of the Spanish National Health System. Two meta-analyses were included (Cochrane Stroke Review Group and a pooling analysis). Treatment with citicoline resulted in 99 or 50 more patients recovered per 1000 patients treated (depending on selection criteria of the Cochrane study and the pooled analysis), with average cost savings between €101.2 and €126.4 per patient treated of the type of those included in the Cochrane study. In patients with acute ischemic stroke, treatment with placebo was more expensive and less effective in the scenarios of inpatient care and inpatient plus outpatient care after discharge from the hospital.