Calculated Cost Savings Research Articles

Cost Analysis of High-Signal Approach in Otolaryngology-Head and Neck Surgery Residency.

The objective of this study is to analyze a high-signal approach for otolaryngology-head and neck surgery (OHNS) residency applicants and calculate cost savings for programs and applicants. Data from both the 2022-2024 Electronic Residency Application Service (ERAS) and a data model were used to demonstrate cost savings with a high-signal approach. Modeled data assumed that the number of applications per applicant would be equal to the number of signals allowed. Predicted and real-world cost savings across the five other specialties participating in a high-signal approach were calculated. ERAS data cost savings for the entire OHNS applicant pool amounted to $365,950. In the modeled data, cost savings amounted to $825,921. When extrapolated to include all five high-signal specialties, total cost savings amounted to $2,570,464 (ERAS data) and $6,359,478 (modeled data). Otolaryngology programs were predicted to experience significant time savings, resulting in cost savings of $437,883 and $1,113,342 for ERAS data and modeled data, respectively. The study highlights the advantages of a high-signal approach, including financial advantages or increased time for programs to engage in holistic review and diversify the pool of interview candidates. Cost savings in this study were shown to be significant when extrapolated across all specialties using a high-signal approach. Further research is needed to optimize the signaling system and confirm the favorable interview distribution and equity data from the low-signal OHNS experience with a high-signal approach. N/A Laryngoscope, 134:2684-2688, 2024.

Repurposing empagliflozin in individuals with glycogen storage disease Ib: A value-based healthcare approach and systematic benefit-risk assessment.

Off-label repurposing of empagliflozin allows pathomechanism-based treatment of neutropenia/neutrophil-dysfunction in glycogen storage disease type Ib (GSDIb). From a value-based healthcare (VBHC) perspective, we here retrospectively studied patient-reported, clinical and pharmacoeconomic outcomes in 11 GSDIb individuals before and under empagliflozin at two centers (the Netherlands [NL], Austria [AT]), including a budget impact analysis, sensitivity-analysis, and systematic benefit-risk assessment. Under empagliflozin, all GSDIb individuals reported improved quality-of-life-scores. Neutrophil dysfunction related symptoms allowed either granulocyte colony-stimulating factor cessation or tapering. Calculated cost savings per patient per year ranged between € 6482-14 190 (NL) and € 1281-41 231 (AT). The budget impact analysis estimated annual total cost savings ranging between € 75 062-225 716 (NL) and € 37 697-231 790 (AT), based on conservative assumptions. The systematic benefit-risk assessment was favorable. From a VBHC perspective, empagliflozin treatment in GSDIb improved personal and clinical outcomes while saving costs, thereby creating value at multiple pillars. We emphasize the importance to reimburse empagliflozin for GSDIb individuals, further supported by the favorable systematic benefit-risk assessment. These observations in similar directions in two countries/health care systems strongly suggest that our findings can be extrapolated to other geographical areas and health care systems.

ANALISIS RUGI-RUGI HEAT RATE PLTU BANTEN 3 LONTAR AKIBAT DEVIASI PARAMETER PADA KONDISI AKTUAL MENGGUNAKAN ANALISIS GAP

Steam power plant (PLTU) is one type of energy conversion technology to generate electricity from fossil materials. The performance of a PLTU unit will begin to decline as the unit ages. In addition to age, performance degradation can also be caused by deviation of operating parameters, which can cause heat rate losses. The purpose of this study is to determine the performance of PLTU Banten 3 Lontar unit 2 by analyzing heat rate losses due to parameter deviations according to actual conditions and calculating cost savings and possible improvements. The research methodology used is an evaluation method where the actual data of operating parameters will be compared with the baseline data. The comparison will produce a deviation value, which is then used to obtain the value of heat loss, cost loss, and improvement recommendations for the plant. Baseline data is obtained from the interpolation equation of commissioning testing at 3 different variation loads. From the study, it is known that there was an increase in Nett Plant Heat Rate (NPHR) with an average of 561 kCal / kWh. The increase in NPHR occurred due to heat rate losses, where the decrease in turbine HP efficiency was the main cause, with an average loss of 87.96 kCal / kWh or 24.53% of total losses. Assuming that all heat rate losses during testing can be corrected, the average potential energy savings per day is 8,604,802 kCal/kWh, while the average cost savings are Rp1,534,046,000/month.

Food as medicine? Exploring the impact of providing healthy foods on adherence and clinical and economic outcomes

BackgroundChronic disease prevalence is increasing. Adherence to dietary guidelines is low (<50%) despite positive impacts in disease progression, clinical outcomes, and medical costs. It is important to summarize the impact of providing medically-tailored meals to patients on adherence rates, clinical outcomes, and potential economic outcomes. MethodsA systematic review was conducted to identify, extract, and appraise food-provision studies from January 1, 2013-May 1, 2018 for heart disease, diabetes (DM), and chronic kidney disease (CKD). The key findings related to adherence and clinical outcomes were compiled. Published literature was utilized to determine the economic impact of key clinical outcomes. ResultsAcross diseases, 100 articles (N = 43,175 patients) were included. Dietary adherence was considered “compliant” or ≥ 90% consistently. Significant (p < 0.05) clinical outcomes included 5–10% LDL reduction, 4-11 mmHg SBP reduction, 30% reduction in metabolic syndrome prevalence, 3–5% weight reduction, 56% lower CKD mortality rates, and increased dialysis-free time (2 years:50%, 5 years:25%, calculated cost savings of 80.6–94.3%). Literature review showed these outcomes would result in decreased: cardiovascular (CV) event risk (20–30% reduction: $5–11 billion annually), hospitalization costs ($1–8 billion), and dialysis rates (25–50% reduction: $14–29 billion annually). For heart failure patients, results include: 16% fewer readmissions (saving $234,096 per 100 patients) and a 38-day shorter length of stay (saving $79,425 per hospitalization). ConclusionProviding medically-tailored meals significantly increases dietary adherence above 90% and allows patients to realize significantly better chronic disease control. Through this, patients could experience fewer complications (CV events, hospital readmissions and dialysis), resulting in significant annual US healthcare cost reduction of $27–48 billion.

Patient-Directed Home Drain Removal in Head and Neck Surgery.

The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients. The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes. One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved. The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal. 4 Laryngoscope, 131:2471-2477, 2021.

Costs and Benefits of Vegetable Gardening

Home vegetable gardening has numerous documented benefits, including savings on the family food bill. How can a gardener calculate cost savings from a garden? Which vegetables cost more to grow in the garden and which cost less? This 10-page fact sheet written by Kevin Athearn, Hannah Wooten, Liz Felter, Catherine G. Campbell, Jessica M. Ryals, Matthew C. Lollar, Juanita Popenoe, Lorna Bravo, LuAnn Duncan, Christa Court, and Wendy Wilber and published by the UF/IFAS Food and Resource Economics Department helps home gardeners estimate the costs and cost savings from vegetable gardening

Splitting the Difference: Using Synthetic and Biologic Mesh to Decrease Cost in Prepectoral Immediate Implant Breast Reconstruction.

Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant reconstruction remains limited by high material costs. The authors describe a technique in which anterior implant coverage in prepectoral reconstruction is split into acellular dermal matrix inferolaterally and synthetic, absorbable mesh superiorly. Use of acellular dermal matrix inferiorly provides coverage and reinforces the inframammary fold, whereas the absorbable mesh is trimmed and sutured to the acellular dermal matrix at the appropriate tension to support the implant and relieve pressure on mastectomy flaps. A retrospective review was performed on all consecutive prepectoral one-stage breast reconstructions using this technique at a single institution. Patient demographics, mastectomy and reconstruction characteristics, reconstructive outcomes, and cost of support materials were queried and analyzed. Eleven patients (21 breasts) underwent prepectoral immediate implant reconstruction with Vicryl and acellular dermal matrix anterior coverage. Average mastectomy weight was 775.8 g. Smooth, round cohesive implants were used in all cases and average implant size was 514.5 ml. Overall complication rates were low and included one minor infection (4.8 percent) and one case of minor mastectomy flap and partial nipple necrosis each (4.8 percent). Calculated cost savings of Vicryl and acellular dermal matrix anterior coverage was up to $3415 in unilateral and $6830 in bilateral cases. Prepectoral breast reconstruction using acellular dermal matrix inferiorly and Vicryl mesh superiorly is a safe technique that decreases material costs associated with support materials and allows the surgeon to precisely control the implant pocket and position. Therapeutic, IV.

There’s no place like home—Integrating a pharmacist into the hospital-in-home model

BackgroundHospital-in-home (HIH) is an innovative model that provides hospital-level care in a patient’s home. Pharmacists can enhance the HIH model through medication reconciliation and medication optimization. ObjectivesTo integrate a clinical pharmacist into the HIH model and to conduct a formative evaluation of pharmacist contributions, including medication discrepancy resolution, cost savings, and cost avoidance. Practice descriptionThis is a prospective quality improvement study conducted at the Veterans Affairs Boston Healthcare System. Practice innovationWe integrated a pharmacist into the HIH model. The pharmacist conducted a medication reconciliation at hospital discharge and after discharge through home video telehealth and provided longitudinal medication management. Evaluation methodsWe adapted the PRECEDE-PROCEED model to guide program implementation. We conducted a formative evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, evaluating the reach, efficacy, adoption, and implementation of the pharmacist in the HIH team. We calculated cost savings associated with pharmacist-managed home intravenous (IV) therapy, cost avoidance from deprescribing, and cost avoidance from earlier hospital discharge. ResultsThe HIH program enrolled 102 patients from May 2019 to March 2020. The pharmacist completed 99 (97%) discharge and 95 (93%) postdischarge medication reconciliations, most of which 71 (75%) were conducted using home video telehealth. The pharmacist identified and resolved a total of 453 medication discrepancies: 181 (40%) at discharge and 272 (60%) during postdischarge medication reconciliation. A total of 84 (19%) discrepancies were considered high risk. The pharmacist managed 104 days of home IV therapy, resulting in a cost savings of approximately $17,000. The cost avoided by identifying and deprescribing 145 inappropriate medications was approximately $51,000. The cost avoided by earlier hospital discharge was $1.2 million. ConclusionIntegrating a pharmacist into the HIH model enables the detection and resolution of medication discrepancies. Cost savings from medication deprescribing, cost avoided from pharmacist-managed home IV therapy, and cost avoided from early hospital discharge totaled $1268 million.

Successful combined application of reoperation protocol with target-guided hemostatic therapy for the treatment of severe bleeding in cardiac surgical patients

Bleeding and transfusions following cardiac surgery significantly increase the rate of complications. Early diagnosis of "surgical" and "coagulopathic" bleeding is a prerequisite for effective treatment. Thromboelastometry with targeted hemostasis therapy can help in setting up the indication for reoperation and reduction of blood loss, transfusions and costs. We aimed to develop a local "reoperation for bleeding" protocol derived from the data of our former patients. Based on data from 1011 cardiac surgical patients (control group), we developed a statistical algorithm to distinguish between "coagulopathic" and "surgical" bleeding. We used viscoelastic coagulation test and risk stratification. In 112 consecutive patients (study group), we examined the reoperations, and the impact of the protocol on the rates of transfusions and treatment costs. There was no difference in the rate of reoperations between the two groups (6.2% vs. 5.4%; p = 0.584). No coagulopathic bleeding occurred in the study group, compared to 12.7% in the control group. In the study group, we experienced reduction in bleeding (p = 0.026), an increased application of fibrinogen (p<0.001), prothrombin complex concentrate (p<0.001), and tranexamic acid (p<0.001). Red blood cell transfusions decreased by 30% (1.7±2.6 E vs. 2.3 ± 3.3 E; p = 0.012). No difference was found in the amounts of fresh frozen plasma or platelet transfusions used. Calculated cost savings were HUF -20,333 per patient. Using this algorithm, reoperations were performed only in cases of surgical bleeding. The amount of bleeding, requirement for transfusions and treatment costs were reduced. Orv Hetil. 2020; 161(34): 1414-1422.

A quality improvement initiative for COPD patients: A cost analysis.

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes. A budget impact model was developed to calculate cost savings directly from objective data collected during this initiative. The model estimated payer annual savings over 5 years. Patients were classified for analysis based on whether or not they received noninvasive ventilation. Scenario analyses calculated savings for payers covering different COPD cohort sizes. The base case revealed annual per patient savings of $11,263 for patients treated through the quality improvement program versus traditional care. The model projected cumulative savings of $52 million over a 5-year period. Clinical incorporation of non-invasive ventilation (NIV) resulted in $20,535 annual savings per patient and projected $91 million over 5 years. We conclude that an integrated management program for COPD patients across the care continuum is associated with substantial cost savings and significantly reduced hospital readmissions.

Cytomegalovirus Immune Globulin (CMV-Ig): An Old Drug with Fewer Tricks - Removal of Prophylactic CMV-Ig Administration in CMV Mismatched Lung Transplant Recipients

The routine use of cytomegalovirus immune globulin (CMV-Ig) to provide passive immunity to cytomegalovirus (CMV) in patients is not supported in published literature. International guidelines do not advocate for the use of CMV-Ig alone in thoracic transplant and provide only weak recommendations for its role in combination with antiviral therapy for prevention of CMV. The utilization of CMV-Ig incurs significant cost, and carries the potential for infusion related toxicities. Furthermore, in 2012, an international survey reported only 38 % of thoracic transplant centers utilized CMV-Ig as part of a universal prophylaxis protocol. We evaluated the safety and cost efficiency of the removal of CMV-Ig from standard practice. Prior to September 2018, CMV-Ig 150mg/kg x1 was given to all CMV high-risk lung transplant recipients on postoperative day two in conjunction with intravenous ganciclovir (GCV) followed by prophylaxis with oral valganciclovir (vGCV) for 12 months per institution protocol. After September 2018, CMV-Ig was removed from our institution protocol and high-risk patients received GCV/vGCV prophylaxis alone. Serum CMV PCRs were monitored per institution protocol. All patients post-intervention were retrospectively reviewed for occurrence of CMV viremia, seroconversion, and a cost savings analysis was performed. Twelve CMV high-risk lung transplant recipients were observed after the removal of CMV-Ig administration from standard practice. None of these patients experienced a detectable serum CMV PCR. Median follow up time was 163 days (IQR 111-301) post-transplant. All patients received antiviral prophylaxis immediately post-operatively, and had at least 8 weeks of follow up. Seroconversion was observed in three patients at post-operative day 7, 76, and 80 respectively. Using average wholesale price, the calculated cost savings was approximately $5,700 per patient and $68,400 across the entire cohort. Our results demonstrate that removal of CMV-Ig administration from standard practice, even in CMV high-risk patients, did not increase the risk of CMV viremia and led to significant cost savings. These data allude to the decreasing utility of CMV-Ig for CMV prophylaxis in the GCV/vGCV era.

Clinical and economic impact of clinical pharmacist intervention in a hematology unit.

Medication errors can lead to preventable adverse drug events and associated hospitalization and healthcare cost to patients. Pharmacotherapy in patients with hematologic malignancies is more complex than that in general medicine patients. This study evaluated the clinical and economic impact of clinical pharmacist intervention in a hematology unit. This retrospective study compared the number of pharmacist interventions and the economic impact for one year before and after a clinical pharmacist was deployed in a hematology unit. The clinical pharmacist joined the ward rounds and gave patient counseling and recommendations on medication use. For pharmacist intervention analysis, we compared the number and type of interventions. For cost analysis, we calculated the cost savings, estimated the cost avoidance, and compared the benefit-cost ratio between the two periods. The average length of hospitalization reduced from 19.27 days to 16.69 days after clinical pharmacist deployment. The rate of pharmacist interventions in medication orders increased from 143 out of 42,501 prescriptions (0.34%) to 826 out of 44,175 prescriptions (1.87%) (P < 0.00001). The calculated cost savings (NT$37,080 and NT$252,280), cost avoidance (NT$582,100 and NT$2,304,600), and benefit-cost ratio (0.77 and 3.19) increased after clinical pharmacist deployment. This study demonstrated that the number of interventions significantly increased after clinical pharmacist deployment. This service could reduce medication errors, preventable adverse drug events, and costs of both medications and potential adverse drug events.

A Systematic Review of the Clinical and Economic Outcomes Associated with Guideline-recommended Food Provision Studies (P12-013-19)

ObjectivesChronic disease prevalence is increasing, and healthcare costs of heart disease, diabetes (DM), and chronic kidney disease (CKD) exceed $600 billion annually. Adherence to dietary guidelines is low (<50%) despite positively impacting disease progression and clinical outcomes. Thus, the objective was to determine the clinical and economic impact of food-provision studies in heart disease, DM, and CKD. MethodsThe protocol was registered in PROSPERO. Multiple databases, including MEDLINE/PubMed, were searched with pre-specified terms to identify food-provision studies from January 1, 2013-May 1, 2018 for heart disease, DM, and CKD. Identified articles underwent data extraction and appraisal. Since limited economic outcomes were included, published literature was utilized to determine the economic impact of key clinical outcomes. ResultsAcross diseases, 99 articles (N = 43,175 patients) were included. Dietary adherence was considered “compliant” or ≥90% consistently. Significant clinical outcomes included 5–10% LDL reduction (P < 0.05), 4–11 mmHg systolic blood pressure reduction (P < 0.05), 30% reduction in metabolic syndrome prevalence (P < 0.05), 3–5% weight reduction (P < 0.05), lower CKD mortality rates, increased dialysis-free time (2 years: 50%, 5 years: 25%), with a calculated cost savings of 80.6–94.3% over meal costs due to lower dialysis rates. Literature review showed these outcomes would result in the following costs savings: lower CV event risk (20–30% reduction: $5–11 billion annually), saved hospitalization costs ($1–8 billion), and lower dialysis rates (25–50% reduction: $14–29 billion annually). In addition, DASH diet adherence in heart failure (HF) resulted in 16% fewer readmissions, 38-day shorter length of stay, and savings of $234,096 per 100 HF patients (decreased readmissions) and $79,425 per HF hospitalization. ConclusionsProviding nutritional support and meals to patients with chronic diseases significantly increases dietary adherence above 90% and allows patients to realize better disease control and fewer complications (CV events and dialysis). The US healthcare system may realize a significant reduction of $27–48 billion annually in healthcare costs with better control of chronic disease by providing meal therapy management. Funding SourcesHealthy Meals Supreme provided a grant for this project work.

Life-cycle cost comparison of chip seal and striping: in-house workers versus private contractors

Purpose To maintain road systems in the USA, state departments of transportation (DOTs) generally use in-house workers or private contractors. Limited studies have calculated the cost savings of hiring private contractors; however, most of them have not calculated cost savings based on life-cycle costs (LCCs). The purpose of this paper is to determine whether the LCC of chip seal and stripping maintenance activities performed by in-house workers are cheaper than those performed by private contractors. Design/methodology/approach The paper collected the hard cost data of chip seal and stripping maintenance activities performed by state DOT in-house workers, as well as private contractors, from 2003 to 2016 from the Nevada DOT Maintenance and Asset Management division. Statistical tests were conducted to test the research hypothesis that the LCC of chip seal and stripping activities performed by in-house workers are significantly less than those performed by private contractors. Findings The study results showed that the cost per unit and LCC of chip seal and striping work performed by in-house workers were significantly less than those performed by private contractors in Nevada. Research limitations/implications The study only collected data from Nevada DOT, so readers should use caution in generalizing the findings of this study. Additionally, factors affecting the cost of these maintenance activities for private contractors are significantly different compared to in-house contractors. Therefore, these differences may be some of the potential reasons for cost difference between these two methods. Practical implications The practical implications of this study are that state DOT engineers need to plan for outsourcing chip seal and stripping maintenance activities only to private contractors that are cost effective, based on life-cycle cost. Originality/value The LCC analysis framework developed in this study will help state DOT engineers to determine cost savings by using in-house workers for road maintenance works.

The cost impact to Medicare of shifting treatment of worsening heart failure from inpatient to outpatient management settings.

PurposeThe aim of this study was to quantify the potential cost savings to Medicare of shifting the site of treatment for worsening heart failure (HF) from inpatient to outpatient (OP) settings for a subset of worsening HF episodes among the Medicare fee-for-service (FFS) population.Materials and methodsA cross-sectional analysis of a random 5% sample of 2014 FFS Medicare beneficiaries was conducted. Incidence and cost of worsening HF episodes in both inpatient and OP settings were identified. These results were used to calculate cost savings associated with shifting a proportion of worsening HF episodes from the inpatient to OP settings.ResultsA total of 151,908 HF beneficiaries were identified. The estimated annual cost for the treatment of worsening HF across both inpatient and OP settings ranged from US$9.3 billion to US$17.0 billion or 2.4%–4.3% of total Medicare FFS spend. The cost saving associated with shifting worsening HF treatment from inpatient hospital setting to OP settings was US$667.5 million or 0.17% of total Medicare spend when 10% of HF admissions were targeted and 60% of targeted HF admissions were successfully shifted. The cost savings increased to US$2.098 billion or 0.53% of total Medicare spend when 20% of HF admissions were targeted and 90% of targeted HF admissions were successfully shifted.ConclusionTreatment options that can shift costly hospital admissions for worsening HF treatment to less expensive OP settings potentially lead to significant cost savings to Medicare. Pursuit of OP therapy options for treating worsening HF might be considered a viable alternative.

The Use of Technology for Sexually Transmitted Disease Partner Services in the United States: A Structured Review.

Since the late 1990s, health departments and sexually transmitted disease (STD) programs throughout the United States have used technologies, such as the Internet and mobile phones, to provide services to persons with a sexually transmitted infection, including human immunodeficiency virus (HIV), and their sex partners, also known as partner services. This study reviewed the published literature to assess and compare partner services outcomes as a result of using technology and to calculate cost savings through cases averted. We conducted a structured literature review of all US studies that examined the use of technology to notify persons exposed to an STD (syphilis, chlamydia, gonorrhea), including HIV, by health care professionals in the United States from 2000 to 2017. Outcome measures, including the number of partners notified, screened or tested; and new positives identified, were captured and cost savings were calculated, when data were available. Seven studies were identified. Methods used for partner services differed across studies, although email was the primary mode in 6 (83%) of the 7 studies. Only 2 of the 7 studies compared use of technology for partner services to traditional partner services. Between 10% and 97% of partners were successfully notified of their exposure through the use of technology and between 34% and 81% were screened or tested. Five studies reported on new infections identified, which ranged from 3 to 19. Use of technology for partner serves saved programs between US $22,795 and US $45,362 in direct and indirect medical costs. Use of technology for partner services increased the number of partners notified, screened or tested, and new infections found. Importantly, the use of technology allowed programs to reach partners who otherwise would not have been notified of their exposure to an STD or HIV. Improved response times and time to treatment were also seen as was re-engagement into care for previous HIV positive patients. Data and outcome measures across the studies were not standardized, making it difficult to generalize conclusions. Although not a replacement for traditional partner services, the use of technology enhances partner service outcomes.

A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic.

A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic. We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35-1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04-4.04 metric tonnes of CO2e. Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.

PGI26 - COST SAVING ANALYSIS OF A COMMUNITY STOMA CARE SERVICE

Patients with stomas (ostomates) are at high risk of peri-stomal skin complications (PSC), leading to patient distress and financial burden. This study investigated if a community specialist nurse-led review and intervention programme conferred cost savings. Ostomates from 179 primary care practices were invited to attend a review from stoma care specialist nurses, where the; prevalence of complications and whether the patient would have sought help elsewhere, were recorded. Interventions carried out included; advice, stoma product changes and ceasing inappropriate products. A cost analysis model was used to; quantify the annual cost of treating PSC using £204.77/7 weeks × 7.4 episodes, and to quantify decreased resource usage. To calculate cost savings from avoided visits, unit costs per appointment were; £127 stoma care nurse (SCN), £37 General Practitioner (GP) and £202 Emergency Department (ED). Savings from changed product usage were based on individual product costs. Initial visits were conducted with 1968 ostomates, median age of 72 years (62-80 IQR). Demographics were; males 54% (n=1,065), cancer 40% (n=792) and stoma duration greater than 5 years 47% (n=920). PSC was reported by 24% (n=469). The annual mean cost per patient of treating PSC was £1515.27 and for the sample was £715,690.50. The mean annual cost savings from avoided appointments were; £53,523 (SCN), £6,618 (GP) and £346 (ED). A 10% decrease in product costs was seen, corresponding to £450,106 as an annual cost saving in the study group. A nurse led review programme identified previously unrecognised stoma issues reported by ostomates, including among those with long term stomas. Nurse led intervention conferred cost benefits not only from decreasing product costs but by diverting ostomates from alternative NHS resources.

Evaluation of Heart Failure Medication Prescriptions using an Online Drug Discount Program

Introduction Drug discount card programs have emerged as an additional option for patients to offset the increasing costs of drugs. However, there is limited knowledge about online drug discount programs and their role on prescription medications. We evaluated the frequency of drug discount card utilization and estimated cost savings associated with heart failure (HF) medication prescriptions. Methods We conducted a retrospective study of all HF prescriptions filled through the NeedyMeds.org drug discount card program nationwide, from January 2009 to December 2016. We evaluated the frequency of drug discount card prescriptions (across pharmacy types, pharmacy location, by prescriber specialty and by drug class) and calculated cost savings (average per drug discount card and total program dollars saved) for entire study period and for each year (from 2009 to 2016). Results We identified 381,347 prescriptions (8.2% of all prescriptions) for medications that can be used for heart failure with drug discount cards (83.7% at national, 5.7% at regional and 9.8% at local pharmacies). Most prescriptions were filled at urban locations (89.1% in urban clusters, 7.6% in urbanized areas) and in ZIP-codes with lower median household income (65.5%). Angiotensin-converting enzyme inhibitors and selected angiotensin receptor blockers were the most prescribed drugs with discount cards (44.3%) followed by beta blockers (27.1%), diuretics (21.8%), and mineralocorticoid receptor agonists (3.5%). The prescriptions for newer drugs were limited (sacubitril-valsartan: 12; ivabradine: 27). The number of HF prescriptions with discount cards increased from 2577 in 2009 to 64,750 in 2016. Similar increases in the number of prescriptions were noted across all drug classes. A total of 224,049 prescriptions for HF medications (59% of the total) benefited from the program resulting in total savings of $4,739,204 with a median cost saving of $9.30 (41.5%) per prescription. Conclusion Drug discount prescription use increased during the study period, resulting in cost savings on HF prescription medications (approximately $9 in savings per prescription) compared to the original cost charged by pharmacies. Lack of use for newer drugs may suggest unwillingness of pharmaceutical company or pharmacy benefit manager to provide this option. Overall, while on-line drug assistance programs may reduce financial burden for generic drugs, pricing transparency remains obtuse.

Pharmacist medication therapy management in home health care: Investigation of a sustainable practice model

ObjectivesThe objective of this study was to quantify the financial impact of a pharmacist-driven pilot medication therapy management (MTM) program within a visiting nurse service (VNS) and identify types of medication-related problems affecting the home health care population. MethodsPatients were contacted to schedule a home visit with the primary investigator. At the appointment, a comprehensive medication review (CMR) was completed, and data collected included primary reason for VNS care, comorbid diagnoses, number of prescription and nonprescription medications at time of visit, and type of pharmacist-identified medication therapy intervention(s). The VNS is a nonprofit independent home health care agency serving patients of all ages and health conditions. Patients admitted with primary insurance coverage through Blue Cross Blue Shield (BCBSRI) Blue Chip for Medicare and 65 years of age and older were eligible for inclusion. Intervention categories were aligned to coordinate with current billable OutcomesMTM claim categories. Dollar allocation for each intervention severity level was assigned according to the predetermined Medicare cost savings predicted value from BCBSRI. Interventions were assigned cost-saving value by the severity level to estimate savings. ResultsTwenty-five patients received CMRs. Patients averaged 5.92 chronic health conditions, 8.48 Part D drugs, and 3.88 over-the-counter medications. Two hundred eighteen medication-related problems were identified spanning 13 intervention categories. Intervention severity level was assigned to the medication-related problems, with calculated cost savings from pharmacist interventions totaling $124,352. ConclusionThis pilot study demonstrated the positive economic impact of a pharmacist-run MTM program at VNS for patients with multiple chronic conditions and medication-related problems. Potential societal benefits include that community members admitted to VNS will continue to have access to a pharmacist as a standard of care with the continuation of this MTM program.