Considerable Differences In Costs Research Articles

Republication of "First Metatarsophalangeal Joint Arthrodesis: Functional Outcomes Using 2 Different Fixation Techniques. Is More Expensive Better?"

First metatarsophalangeal (MTP) joint arthrodesis can be fixed using either a dorsal plate or crossed screws. However, there is considerable difference in the cost of these implants, and it is not known if there is sufficient difference in outcome that might justify this cost difference. Our aim was to compare the functional results and patient satisfaction rates after first MTP joint arthrodesis in a group of patients using the same surgical technique except for the fixation devices. A prospective cohort of 27 patients who underwent first MTP joint fusion by the same surgeon using 2 crossed screws or a single screw with a dorsal plate was recruited over a 3-year period. Demographic information, patient satisfaction rates, complications, and union rates were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems were used pre- and postoperatively to compare the functional outcomes. Thirty consecutive procedures (screws, n = 15; plate, n = 15) were performed. Age (55.8 ± 11.1 vs 63.3 ± 12.4 years for screws and plate respectively; P = .091) and female gender percentages (80% and 73%, P = .666) were similar between groups. The overall union rate was 93% with no differences between groups. AOFAS and VAS scores improved significantly postoperatively for each technique, and no differences were found between the two in the improvement in AOFAS (42.4 ± 8.0 vs 44.3 ± 8.2, screws and plate respectively; P = .520) and VAS scores (66.0 ± 5.4 vs 69.0 ± 6.9;P = .195). The implant cost for screws was $40 and for dorsal plate, $328. First MTP joint fusion using either screws or plate fixation results in an improvement in AOFAS and VAS scores. Functional improvement and patient satisfaction did not differ between the 2 techniques, despite a considerable difference in cost between the two methods of fixation. Level III, prospective comparative study.

El método de costeo basado en actividades y su incidencia en la fijación del precio en las empresas agroindustriales vitivinícolas

El presente estudio tuvo como objetivo determinar si la implementación de un método de costeo basado en actividades incide en la fijación del precio en las empresas agroindustriales vitivinícolas de la provincia de Tacna. Para implementar este método, se desglosó el proceso de elaboración del vino en actividades, se determinó los inductores de costo, que fueron asignados en función del nivel de uso de recursos por actividad. La implementación de este método demostró mayor exactitud y eficiencia en la asignación de costos de producción, al identificar la variedad de vino más costosa y la más económica, favoreció la reducción de costos, fue efectivo y personalizado para determinar el margen de ganancia por variedad de vino, en consecuencia, incidió en la fijación del precio por resultar más competitivo, real y diferenciado por producto. En contraste con el sistema tradicional, que proporcionó resultados distorsionados, al efectuar una distribución equivocada del costo en base al volumen de producción, fue inexacto en procesos con distintas variedades de vino, lo que generó diferencias considerables en los costos.

First Metatarsophalangeal Joint Arthrodesis

Background: First metatarsophalangeal (MTP) joint arthrodesis can be fixed using either a dorsal plate or crossed screws. However, there is considerable difference in the cost of these implants, and it is not known if there is sufficient difference in outcome that might justify this cost difference. Our aim was to compare the functional results and patient satisfaction rates after first MTP joint arthrodesis in a group of patients using the same surgical technique except for the fixation devices. Methods: A prospective cohort of 27 patients who underwent first MTP joint fusion by the same surgeon using 2 crossed screws or a single screw with a dorsal plate was recruited over a 3-year period. Demographic information, patient satisfaction rates, complications, and union rates were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems were used pre- and postoperatively to compare the functional outcomes. Thirty consecutive procedures (screws, n = 15; plate, n = 15) were performed. Age (55.8 ± 11.1 vs 63.3 ± 12.4 years for screws and plate respectively; P = .091) and female gender percentages (80% and 73%, P = .666) were similar between groups. Results: The overall union rate was 93% with no differences between groups. AOFAS and VAS scores improved significantly postoperatively for each technique, and no differences were found between the two in the improvement in AOFAS (42.4 ± 8.0 vs 44.3 ± 8.2, screws and plate respectively; P = .520) and VAS scores (66.0 ± 5.4 vs 69.0 ± 6.9; P = .195). The implant cost for screws was $40 and for dorsal plate, $328. Conclusions: First MTP joint fusion using either screws or plate fixation results in an improvement in AOFAS and VAS scores. Functional improvement and patient satisfaction did not differ between the 2 techniques, despite a considerable difference in cost between the two methods of fixation. Level of Evidence: Level III, prospective comparative study.

Studi Pekerjaan Pasangan Bata Berdasarkan Produktivitas Jumlah Tenaga Kerja Dengan Metode Work Study

Research on the comparative analysis of masonry unit price based on SNI and Work Study was conducted by the method of analysis SNI and analysis Work Research Study. The object of this study is a simple home construction project in Nurasa Regency Nganjuk. Calculation method using the coefficient existing SNI SNI Work Study while the calculation using the coefficient obtained through the research and the results shown in the method Work Study. After processing, the results obtained in the development. the method used is the analysis of ISO 6897-2008 with the number 6.9 to work 1 m2 couple red brick wall size (5 x 11 x 22) ½ cm thick brick, a mixture of species 1 PC: 4 PP. In the implementation of a method of the materials used are ISO methods but to the number of workers and working time adjusted to the field conditions where there may be differences between SNI and the field. The method of implementation in current research project is not in accordance with the SNI, because at the time of the field research used several different work groups. This certainly affects the cost of the implementation, where the number of different artisan or worker resulted in considerable cost difference anyway. In addition some of the things that makes the price to be much different and are beyond boundary problem should be eliminated in order to get the correct result - really can be compared with the SNI. Some things are omitted or overlooked include job preparation, work benangan, foreman, and the foreman. Budget plan masonry work per square meter according to SNI is USD 86,472.50. Budget plans masonry work costs per square meter with a method Work Study is USD 77,395.50. So the comparison difference masonry work cost per square meter between SNI and methods Work Study is Rp 9,076.50.

Prescription of antibiotics: does it alter the outcome for patients who have fractures of the angle of the mandible?

We retrospectively studied 708 consecutive patients at the Queen Elizabeth Hospital, Birmingham, to find out whether one of the four antibiotic protocols in use conferred any advantage (or disadvantage) on a patient who had a fractured angle of the mandible, and there was none. However, the time from initial injury until the time of the first dose of antibiotic was important. Clinically, if patients waited more than 72hours after the injury before the first dose of antibiotic was given, they had a three times higher rate of postoperative infection than patients who were given their first dose between 24 and 72hours after the injury. Morbidity was more than five times higher during the postoperative period if the patient had waited for three days before their first dose, compared with those given the first dose within eight hours of injury. The overall rate of malunion or non-union of the fracture was between five and 10 times higher if the patient had waited more than 72hours after injury compared with all the other groups. There was a considerable difference in cost between the intravenous and oral versions of the antibiotics used (Augmentin® and metronidazole) so, if it could be shown that the oral doses are as efficacious as intravenous doses, a great deal of money could be saved.

Design and Development of Logistics Models for Residential and Commercial Biomass Pellets for Heat and Power Generation in the U.S.

The U.S. is an important wood pellets producer for Europe, but in recent years there is special attention in the domestic market. This project developed mathematical logistics models in MatLab® that estimate distribution channels, transportation, and volumes for the domestic wood pellet demand. The models consider only demand in the northeastern U.S. based on current production in the Southeast. Two cases were studied: distribution to power plants and distribution to retail stores. Once the market needs were identified, logistics engineering principles and models were run to predict the distribution to different markets. Tools used in facility location and freight transportation analysis were run to provide an estimated logistic cost. One bulk pellet with 2 scenarios and 3 bagged pellet models (RISI 2016; 2017; 2018) with 2 scenarios were developed. After analyses for each model, it was concluded that wood pellet industry should direct its efforts to negotiate lower transport rates, which could represent a 70% cost reduction. While the wood pellet industry volume is smaller than the coal and chemical industries, the considerable cost difference indicates an opportunity to negotiate lower rates. The models developed can be used as tools to minimize the cost of distributing wood pellets to the northeast.

Provision of specialist‐led minor oral surgery service in Scottish NHS dental practices – analysis of benefits and costs

AbstractThis article evaluates the benefits of specialist‐led minor oral surgery service in Scottish primary care dental practice.ObjectivesThe aims of the study were to: Study practice‐based minor oral surgery service delivery. Estimate waiting times for these patients. Explore complications. Evaluate cost allocated for procedures in minor oral surgery in primary and secondary sector. Materials and MethodsRetrospective analysis of procedures carried out, waiting times, complications and comparative cost in minor oral surgery from two NHS dental practices located in Lothian health board area.ResultsA total of 1896 procedures in 982 patients having minor oral surgery were analysed across two sites. Of procedures, 51% (971) were simple extractions; 31% (580) of the procedures were surgical removal of non‐third molar teeth; 15% (275) of the procedures were surgical extraction of third molars; and 3% (70) of the procedures were complex procedures such as surgical exposure of canines, removal of simple cysts and closure of oroantral communication. Two hundred and nine procedures were carried out under intravenous sedation. It was difficult to estimate waiting times although all patients were treated within 4 weeks. The overall complication rate was 8.1%. There is a considerable difference in cost allocated to similar procedures in primary and secondary care and the money allocated for carrying out minor oral surgery in primary care is not cost neutral.ConclusionsIt is cost efficient to treat minor oral surgery patients in primary care. Like for like procedures in minor oral surgery are expensive and potentially wait longer before receiving treatment in secondary care.

Prospective evaluation of 2% (w/v) alcoholic chlorhexidine gluconate as an antiseptic agent for blood donor arm preparation.

Aim:A prospective study was undertaken to evaluate the use of 2% (w/v) alcoholic chlorhexidine gluconate (2% AlcCHG) in donor arm preparation, to monitor the contamination rate of blood products after the collection and to find incidence of transfusion associated bacteremia.Settings and Design:Optimal skin antisepsis of the phlebotomy site is essential to minimize the risk of contamination. Food and Drug Administration (FDA) in India has recommended antisepsis with three-step regimen of spirit-10% povidone iodine-spirit for donor arm antisepsis, but not with chlorhexidine, which is recommended by many other authors.Material and Methods:A total of 795 donors were studied from July 2011 to January 2012. Spirit-10% povidone iodine-spirit was used for 398 donors and 2% AlcCHG was used for 397 donors with the two-step method for arm antisepsis. Swabs were collected before and after use of antiseptic agents for all the donors. All the blood products collected from donors with growth in post-antisepsis swabs were cultured. A total of 123 various blood products were cultured irrespective of the method and result of antisepsis was observed. A total of seven patients had mild transfusion reaction. The transfused blood products, blood and urine specimen of the patients who had transfusion reaction were also cultured.Results:Seven donors out of 398 donors had growth in post-antisepsis swab with spirit-10% povidone iodine-spirit protocol and three donors out of 397 donors had growth in post-antisepsis swab with 2% AlcCHG protocol. All blood products collected from donors who had growth in post-antisepsis swabs when cultured had no growth. There was no contamination of blood products.Conclusions:Two percent (w/v) alcoholic chlorhexidine gluconate with two-step protocol can be used as an antiseptic agent for donor arm preparation without considerable cost difference. It is at par with spirit 10% povidone iodine spirit protocol as suggested by FDA in India. There was no reported transfusion associated bacteremia in the study period.

Economic evaluations of pharmacogenetic and genomic screening programs: update of the literature

AbstractPharmacogenetics and pharmacogenomics show great potential for developing individual treatment modalities to achieve optimal therapy effectiveness. Economic analyses are performed to determine whether pharmacogenetic screening strategies provide good value for money. The current review provides an update of published economic studies. Economic analyses of pharmacogenetic screening programs published between 2000 and July 2010 were included in the review. Information was extracted on research area, genetic information, type of economic analysis, key aspects of adherence to economic guidelines, costs and commercial availability of genetic tests, and the role of the funding party. A total of 42 economic studies on pharmacogenetic screening strategies were included. Over time, more cost‐utility analyses were performed, longer time windows were employed, and more extensive sensitivity analyses were conducted. Considerable differences in costs of screening tests for the same polymorphism were found, which often, but not always, had a large influence on the costs of screening strategies. Most studies were conducted from an academic or hospital perspective without direct links to pharmaceutical or diagnostic manufacturers. The quality of economic analyses of pharmacogenetic screening programs has improved over time. However, input variables are not always clearly described. In particular, substantial variation exists in the reported costs of the pharmacogenetic tests. Often these test costs are considered a major cost driver and could therefore be of particular importance for the interpretation of cost‐effectiveness results. Furthermore, the economic studies seem to be conducted to increase awareness of possibilities and perspectives of genetic testing rather than to influence policy decisions on reimbursement. Drug Dev Res 71: 492–501, 2010. © 2010 Wiley‐Liss, Inc.

Costing of severe pneumonia in hospitalized infants and children aged 2–36 months, at a secondary and tertiary level hospital of a not‐for‐profit organization

To determine health care provider cost and household cost of the treatment of severe pneumonia in infants and young children admitted to secondary and tertiary level health care facilities. The study was done in a private, not-for-profit medical college hospital, in Vellore, India, in mid-2008. Children aged 2-36 months admitted with severe pneumonia with no underlying chronic disease were included in the study. The relatives were interviewed daily on matters relating to patients' view point of the costs. These were direct medical costs, direct non-medical costs which comprised travel, accommodation and special food during the period of illness, and indirect costs of productivity loss for family members. Patient specific resource consumption and related charges were recorded from charts, nursing records, pharmacy lists and hospital bills, and the providers view point of the costs was estimated. Unit cost estimates for bed days, treatment and investigation inputs were calculated. Total cost to health care provider for one episode of hospitalized childhood pneumonia treated at secondary level was US$ 83.89 (INR 3524) and US$ 146.59 (INR 6158) at tertiary level. At both levels the greatest single cost was the hospital stay itself, comprising 74% and 56% of the total cost, respectively. Diagnostic investigations were a large expense and supportive treatment with nebulization and oxygen therapy added to the costs. Mean household expenditure on secondary level was US$ 41.35 (INR 1737) and at tertiary level was US$ 134.62 (INR 5655), the largest single expense being medicines in the former and the hospitalization in the latter. (one US$=INR 42.1 at time of study) A considerable cost difference exists between secondary and tertiary level treatment. Admission at lowest possible treatment level for appropriate patients could decrease the costs borne by the provider and the patient.

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system

This study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP). To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts' opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. The total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US$ 97,058,159 for the acute treatment alone ($4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. Costs of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.

The Clinical and Fiscal Impact of Endovascular Repair of Abdominal Aortic Aneurysms

This study analyzed cost, reimbursement, application, and outcome differences between endovascular (ER) and open repair (OR) of abdominal aortic aneurysms (AAA) in a community hospital. A total of 187 consecutive elective AAA repairs by both methods (69 ER, 118 OR) performed at a single center between July 2001 and March 2003 were analyzed. Average values in postoperative clinical and fiscal demographics were calculated for this period. The average length of stay was higher for OR than ER (9.38 days versus 1.94 days, P < .001). Significant reductions in operative time (4 hours versus 2.67 hours) and intensive care unit use (100% versus 4.05%) were seen in the ER population. Total hospital costs were slightly higher for OR than ER (21,989 dollars versus 19,668 dollars) despite a considerable difference in cost of the grafts (>11,000 dollars for ER versus <500 dollars for OR). However, hospital charges were much lower for ER than OR (32,660 dollars versus 48,877 dollars), and there was an average loss of 4986 dollars on ER cases versus a profit of 2064 dollars on OR procedures. Thirty-day mortality was not significantly improved in the ER population (1.45% versus 2.54%, P = .05). Our data suggest that ER offers improvements in hospital convalescence and operating room times but no improvements in fiscal impact or overall morbidity/ mortality rates when similar preoperative medical risks exist.

Management of NSAID-induced gastropathy: an economic decision analysis

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a 2% to 4% annual incidence of serious gastrointestinal complications. These adverse clinical outcomes, and the strategies used to prevent their occurrence, translate into a significant economic burden. A decision-analysis model was constructed to contrast the 6-month costs associated with various approaches to preventing and managing NSAID-induced gastropathy and to evaluate the economic impact of two treatment regimens using fixed-dose formulations of diclofenac/misoprostol. After incorporating expected medical outcomes and predicted practice patterns, 6-month per-patient costs were derived from the model for each of five treatment regimens: (1) NSAID alone; (2) NSAID with a histamine 2-receptor antagonist; (3) NSAID with coprescribed misoprostol; (4) diclofenac/misoprostol 50 mg/200 μg TID/BID; and (5) diclofenac/misoprostol 75 mg/200 μg BID. The combined diclofenac/misoprostol regimens demonstrated an 18.6% per-patient cost advantage compared with the combined NSAID regimens. Based on a 6-month period, this cost savings translated into a $214.00 per-patient overall cost savings ($1153.00 per patient for NSAID regimens versus $939.00 for diclofenac/misoprostol regimens). The magnitude of this difference was verified by Monte Carlo simulation. Despite the considerable cost difference, sensitivity analyses revealed that our model was robust and that no single variation substantially influenced the results. Given the lack of long-term prospective, comparative clinical-outcomes studies in this area, this decision analysis provides guidance to clinicians in developing a rational and cost-effective approach to the treatment of patients requiring chronic NSAID therapy.

Options and costs of controlling ammonia emissions in Europe

Ammonia emissions contribute to acidification in Europe. The major emission sources are livestock and fertiliser use. This study presents the costs of controlling ammonia emissions in 33 regions in Europe. Abatement options include low nitrogen feed, stable adaptations, covering manure storage, cleaning stable air, and low ammonia applications of manure. Cost estimates are based on country- and technology-specific data. Variations in average costs, and the structure of livestock population and fertiliser use, cause considerable differences in costs between countries for applying similar reductions ortechniques. Allowing countries to choose their own mix of control options would be more cost-effective

Quality of research measured by citation method and by peer review — A comparison

A comparison has been performed between two methods of evaluating the quality of research as applied to seven areas of research in Sweden. The first method is that of peer review performed by specially appointed international experts; the other method is citation analysis. The comparison indicates a very considerable difference in cost between the two methods, the citation method being about 200 times less costly in terms of money as well as time. The citation method measures only one parameter of the quality of research, that of international visibility, and has a rank correlation coefficient of about 0.6 compared to peer review.

Pharmacy personnel activities and costs in decentralized and centralized unit dose drug distribution systems

Pharmacy personnel activities and labor costs directly associated with concurrent decentralized and centralized unit dose drug distribution systems in the same institution were compared. A work-sampling observation technique was used for the activity survey. Analysis of the data showed that: (1) the activities of pharmacy personnel vary significantly between the decentralized and centralized systems, (2) pharmacists in the decentralized area spent a significantly greater portion of their productive time performing therapy-related activities than did those pharmacists in the centralized system, (3) multiple staffing patterns associated with the centralized unit dose system afforded a significantly greater participation in educational activities by all pharmacy personnel staffing that area, (4) dispensing activities accounted for most nonpharmacist personnel time in both systems, and (5) based on cost/unit dose and existing staffing patterns, there was no appreciable difference in personnel labor costs associated with the two systems. However, it was determined that a considerable cost difference could be expected if the decentralized system's hours of service were equivalent to those associated with the centralized system.

STABILITY OF U. S. P. ETHER AFTER THE METAL CONTAINER IS OPENED

While examining a record of the drugs dispensed in one of the hospital pharmacies, we observed that ether was listed under two headings: (1) Ether U. S. P. in 27 pound drums at 11 cents a pound, and (2) Ether for anesthesia in ¼ pound cans at 63 cents a pound. The cost of ether in the small cans was therefore nearly six times as much as that in the large drums, although the latter had been filled with ether which complied with standards for purity set up by the United States Pharmacopeia for ether of anesthetic quality. Our interest was aroused in this matter by the fact that the considerable difference in cost implies essential differences in the quality of the two kinds of ether, and we undertook to look into it further. The latest edition of the United States Pharmacopeia (U. S. P. X) makes the following statement