Cost Analysis Research Research Articles

1004. Dalbavancin Use and Associated Cost-Savings: An Update

Abstract Background Dalbavancin provides an alternative to standard of care intravenous (IV) antibiotics for the treatment of complicated infections, although clinical data continues to evolve In the United States, the use of dalbavancin as an alternative for patients requiring long courses of IV therapy can result in reduction of hospital days, and thus significant cost-savings to health systems. Methods We conducted a retrospective review of dalbavancin use at our institution and resulting cost avoidance from 2015 to 2021. We identified all patients age 18 years or older who received > one dose of dalbavancin via medication records. Cost calculation was based on the number of outpatient dalbavancin days as a measure of avoided inpatient days. Results 189 patients received at least one dose of dalbavancin over the study period. The mean age 47.6 years and the most common infections were non-vertebral bone and joint infections (85; 45%), vertebral osteomyelitis (28; 14.8%) and skin and soft tissue infections (27; 14.3%). The most commonly isolated organism was Staphylococcus aureus (109; 57.6%), MRSA (60; 31.7%) and MSSA (49; 25.9%). Dalbavancin dosing regimens varied over the study period. Reasons for selection of dalbavancin included history of injection drug use (67; 35.4%), lack of a safe home environment to receive daily IV antibiotics (26; 13.8%), and patient declining PICC or daily outpatient IV antibiotics (26; 13.8%). 84 patients (44%) received at least one dose of dalbavancin in the inpatient setting. Adverse effects were documented for 21 (11%) of patients. Readmission within 30 days of dalbavancin dose occurred for 27 (14.2%) patients, 14 (7.4%) of which were related to either infection or dalbavancin adverse effect. Relapse or recurrence of infection at 30 days was documented for 9 patients (4.8%). A total of 4,273 out-of-hospital dalbavancin days were identified, resulting in a cost savings of $10,464,382 or a mean of $55,367.10 per patient. Conclusion As the use of dalbavancin for complicated infections continues to increase, the potential for health system cost-savings increases, driven by reduction in length of hospital stay. Prospective cost-analysis research is needed to further describe the cost benefits associated with dalbavancin use to patients and health systems in the United States. Disclosures Monica K. Sikka, MD, F2G: Site research investigator James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant.

PERBANDINGAN EFISIENSI BIAYA PRODUKSI LISTRIK PER KWH ANTARA PENGGUNAAN B30 (BIO DIESEL+HSDF) DAN MFO

Production cost analysis research was conducted to determine the comparison of production costs produced by fuel types B30 (Bio Diesel+HSDF) and MFO . So that the efficiency of the fuel can be known. Data on usage is taken from the daily report on the operation of the plant on December 31, 2021 at the Ampenan ULPLTD. From the data analysis, it was found that MFO fuel is more efficient than B30 (Bio Diesel+HSDF) fuel. Because to produce 1 kWh using B30 (Bio Diesel+HSDF) fuel requires a production cost of Rp. 4,144.29,- /kWh, while for 1 kWh MFO requires a production cost of Rp. 2,189,655,-/kWh. And specific Fuel Consumption ( SFC ) the fuel required by DO (B30+HSDF) fuel is 0.3166 Ltr/kWh producing a power of 1,143 kWh which is higher than the Specific Fuel Consumption at MFO of 0.18715 Ltr/kWh producing a power of 4974,785 kWh.

A PROPOSED CASE STUDY FIELD RESEARCH METHODOLOGY TO TEST COST DRIVERS: AN EXAMPLE OF PROPOSED FIELD STUDY AT A NUCLEAR MEDICINE UNIT

This paper illustrates how to use case study method to conduct the cost driver research at hospitals by identifying activity-based cost drivers at the nuclear medicine unit (NMU) of a teaching hospital. I argue that recognizing the activity-based cost could improve the accuracy of estimating costs by identifying the underutilized resources and value-added and non-value-added cost drivers, to reduce non-value-added costs; thereby, facilitating the management to make better informed managerial decisions (e.g., improving pricing practices and using resources more efficiently). Therefore, I believe that this study may provide a useful inference to hospitals to improve the quality and quantity of the service, which they (or would) provide. Furthermore, this paper possibly provides an informative research methodology for researchers by showing how to extend the current literature by applying the same cost analysis research model on a different dataset for the health care industry research.

Pharmaceutical cost analysis of dental diseases: An Indian scenario.

Medicines are an integral part of the health system and the accessibility hugely depends on affordability and availability of medicines. Oral health is an integral component of overall well-being but is ironically often one of the most neglected areas of healthcare. There is paucity of data on the pharmaceutical cost components of dental disease, so this study aims to address this lacuna on the pricing of medicines. This research study can be considered a partial economic evaluation that focuses on an estimation of costs associated with medicines used in the treatment of selected oral diseases to suggest policy measures to reduce out-of-pocket expenditure on medicines. Using cost analysis research design on the PharmaTrac dataset and cross-comparing it with public procurement rates of the Rajasthan Medical Services Corporation (RMSC) indicates that the pharmaceutical cost of treating caries and periodontitis is approximately three times higher if median retail prices are considered instead of RMSC public procurement costs. Medicine cost of treating a single episode of caries or periodontitis using RMSC medicine rates at all levels of care is approximately 1.9-2.5 times lower than retail prices of the same formulations. Our results strongly suggest that centralized public procurement of dental medicines with an efficient monitoring and control can reduce the out-of-pocket expenditure.

Comparison of direct medical cost between ramipril and candesartan in hospitalized acute decompensated heart failure at West Nusa Tenggara Regional Hospital

Introduction: Pharmacoeconomy is the field of study regarding costs analysis associated with the use of drugs in health care. The purpose of pharmacoeconomics is to compare a different drug used in the treatment with the same condition or can be the opposite, i.e. comparing different treatments in different circumstances. The purpose of this study is to determine and compare the average efficiency of direct medical costs between ramipril and candesartan combination drug in hospitalized heart failure patients with a payer perspective at the West Nusa Tenggara Regional General Hospital, Mataram, Indonesia.Method: This study is part of an economic evaluation of direct medical cost analysis research in hospitalized heart failure patients with a payer perspective. Study design using a retrospective approach involving 45 patients with heart failure who met the study inclusion criteria and exclusion criteria. Independent t-test was used to compare the direct medical cost between ramipril and candesartan.Results: The average gross total cost of using ramipril combination was Rp. 4,197,011 while the average total cost of using candesartan combination was Rp. 3,099,088. These results indicate there are savings in the average total cost of treatment for heart failure using candesartan that is Rp. 1,097,923. Candesartan combination provides the lowest value and is a more efficient choice compared to ramipril combination. Meanwhile, after t-test comparison reveal no significant different average direct medical costs in patients using the ramipril combination compared with the candesartan combination (p>0.05).Conclusion: The results of this study indicate that there is no significant difference between the average direct medical costs in patients using ramipril compared with candesartan combination.

Changing practice patterns: the impact of a cost analysis project on surgeons' preference for treatment of pediatric displaced humeral lateral condyle fractures.

A 2012 publication regarding the surgical management of pediatric lateral humeral condyle fractures (PLHCF) found that leaving pins exposed produced an average savings of $3442 per patient compared to burying pins, with fewer complications. The primary objective of this present study was to determine the impact of this cost analysis on surgeons' treatment preferences at the same hospital. The secondary aim was to verify that leaving pins exposed continued to be a cost-effective and safe treatment strategy. We reviewed all PLHCF treated with open reduction and internal fixation at our institution between 2004 and 2017. The Clavien-Dindo Classification was used to grade complications. Variations in treatment course were evaluated using a chi-squared test to compare the proportions of buried and exposed pins, pre- and postcost analysis report publication. Two hundred forty-eight patients were included. The mean age was 5.9 years (range 1-12 years). In 174 (70%) cases, the pins were buried and in the remaining 30% the pins were exposed. Between 2004 and 2012, the majority of pins were buried (90%) compared to between 2013 and 2017, when the majority of pins were exposed (62%) (P < 0.001). There was no difference detected in complication rate (P = 0.75) or complication severity (P = 0.61) across groups. The demonstrated cost-effectiveness of exposing the pins in the treatment of PLHCF has had a statistically significant impact on surgeon behavior at our institution. Publishing cost analysis research can change physician practice to improve quality, safety and value of care delivery.

The underreporting of cost perspective in cost-analysis research: A systematic review of the plastic surgery literature

Cost-analysis research can influence healthcare policies and practices. There is inherent bias depending on the chosen cost perspective (hospital, third-party payer, societal), and conclusions can change based on the perspective used. These perspectives may or may not be well declared or justified when performing cost-analysis research. The goal of this study was to perform a literature review of cost-analysis research in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias. A systematic review was completed to retrieve cost-utility and cost-effectiveness research within the scope of Plastic Surgery. The search was limited to English-language studies in North America and Europe published between 2006 and 2016. Articles were selected using predefined data fields and specific inclusion criteria. A total of 2304 abstracts were identified, of which 47 met inclusion criteria. Seventy-two percent of studies (n = 34) declared a cost perspective. Of the studies that identified a cost perspective, 32% incorrectly identified the cost perspective. Only 49% of all studies (n = 23) both accurately declared and justified their chosen perspective. Only half of studies correctly declare their cost perspective and justify why the perspective was chosen. Not doing so potentially hides bias from the reader. Future efforts when performing cost-analysis studies should require a clear declaration and justification of the cost perspective taken. A table of our recommendations for reporting cost perspective is provided.

Hidden Bias in Cost-Analysis Research: What Is the Prevalence of Under-Reporting Cost Perspective in the General Surgical Literature?

Hidden Bias in Cost-Analysis Research: What Is the Prevalence of Under-Reporting Cost Perspective in the General Surgical Literature?

Abstract: Cost-Analysis Research in Plastic Surgery: What Is the Prevalence of Underreporting Cost Perspective?

INTRODUCTION: Cost-analysis research can influence healthcare policies and practice patterns. There are three major perspectives in cost analysis research: the third-party payer, the hospital, and societal. Cost-analysis research has inherent bias depending on the chosen cost perspective. Subsequent conclusions based on cost-analysis research can change based on the perspective used.1 These perspectives may or may not be well declared or further justified when performing cost analysis research. PURPOSE: The goal of this study was to perform a literature review of cost-utility and cost-effectiveness research performed in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias. Our hypothesis is that there is underreporting of cost-analysis perspectives which may hide bias. METHODS: A systematic review of English literature was completed in accordance with PRISMA guidelines to retrieve cost-utility and cost-effectiveness research within the scope of plastic surgery. The search was limited to studies in North America and Europe published between 2006 and 2016. Articles were selected using predefined data fields and specific inclusion criteria. A bibliography review of retrieved review articles was performed to identify additional articles meeting inclusion criteria. RESULTS: A total of 2304 abstracts were identified, of which 47 met inclusion criteria. Seventy-two percent of studies (n=34) declared a cost perspective. Of the studies that identified a cost perspective, 32% incorrectly identified the cost perspective. Only 49% of all studies (n=23) both accurately declared and justified their chosen perspective. CONCLUSION: While several cost-utility and cost-effectiveness studies within plastic surgery provide clear descriptions of cost calculations that allow a reader to reliably infer a cost perspective, many do not. Only half of studies correctly declare their cost perspective and justify why the perspective was chosen. Not doing so potentially hides bias from the reader. Future efforts when performing cost-analysis studies should require a clear declaration and justification of the cost perspective taken. Reference Citations: 1. Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses. JAMA. 2016;316(10):1093. doi:10.1001/jama.2016.12195.

활동기준원가계산(Activity-Based Costing; ABC) 기반 간호원가분석 연구의 방법론적 질 평가

활동기준원가계산(Activity-Based Costing; ABC) 기반 간호원가분석 연구의 방법론적 질 평가

Cost and value analyses in medical education: common errors to avoid.

Medical education is associated with substantial cost, so there are a growing number of cost analysis research projects in medical education. Superficially at least these projects should be straightforward, but many errors can occur in their execution. This article highlights some errors that commonly occur and explains how to avoid them.

Cost-Effectiveness of Lumbar Spondylolisthesis Surgery at Two-Year Follow-Up

Comparative effectiveness as well as cost analysis research are gaining popularity within the field of spinal surgery. In general, prior studies have shown that surgical interventions with a cost per Quality Adjusted Life Year (QALY) less than $100,000 are cost-effective for our society. Cost-effectiveness studies for surgical management of spondylolisthesis are lacking.

Differences in home-based palliative care service utilisation of people with cancer and non-cancer conditions.

To identify home-based palliative care service utilisation by people with cancer and non-cancer conditions. Palliative care knowledge and skill have been derived from working with people with cancer. People with chronic conditions are now referred for home-based palliative care; however, there has been few studies published that have explored the impact of service utilisation by people with end-stage chronic conditions. The Australia-modified Karnofsky Performance Status (AKPS) scale was calculated for each person upon referral for home-based palliative care services to determine the functional capacity of the individual at the point of referral. Clients were divided into those with cancer diagnosis and those with non-cancer diagnosis. Service utilisation of the individual client was determined until separation from the palliative care service. The study was undertaken in 2007. The majority of people with cancer (63%) and non-cancer (71%) were assessed as having an AKPS score between 50-60. Thirty-one cancer clients (18·7%) and three non-cancer clients (7·1%) had an AKPS score between 70-90. This suggests that people with cancer are referred to palliative care services earlier than people with non-cancer conditions. People with non-cancer conditions were substantially higher users of home-based palliative care services over a longer period of time. Home-based palliative care service utilisation was higher for people with non-cancer conditions. Cost analysis research is recommended to delineate the actual costs of home-based palliative care service provision between people with cancer and non-cancer conditions. There is growing awareness of the need for palliative care services for people with non-cancer conditions. However, these services are provided for longer periods of time for this client group. Implications for practice are that the palliative care needs of people with non-cancer conditions may not be met within current palliative care service provision. There may be funding implications for home-based palliative care services that intend to meet the needs of people at end of life with non-cancer conditions.

Methodologic principles of cost analyses in the nursing, medical, and health services literature, 1990-1996.

Cost analyses are needed to inform resource decisions. Oftentimes, however cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), cost-minimization analysis (CMA), and cost-utility analysis (CUA) are performed using untested techniques and adhering to a variety of questionable principles. To analyze, compare, and present a set of useful principles for the main types and methods of cost analyses through a synthesis of current information in the published literature. The area of interest included all reports of cost research published as full articles in professional journals from January 1990 to August 1996 in the nursing, medical, and health services fields. In all, 88 sampled articles met the criteria for inclusion. A four-page data collection guide with 28 items grouped as demographics, cost-analysis types, methods, and principles was designed for the review. Incremental testing for interrater reliability using the kappa statistic for two raters was performed. Sampling, process-oriented, construct, and correlational validity were assessed. The 88 articles included 4 from nursing, 59 from medical, and 25 from health services journals. Of these articles, 45 (51%) reported CBA, 36 (41%) CEA, 2 CMA, 4 CUA, and 1 both CBA and CEA. Three nursing studies were authored only by nurses. Three fourths of the medical and four fifths of the health services publications had interdisciplinary authorship. Existing databases were the primary source of data in 61 (69%) publications. Adherence to six main methodologic principles was apparent in 19 (22%) articles. None of the nursing studies adhered to all six principles, whereas 16% of the health services and 25% of the medical studies did. Funded cost analyses of nursing interventions that adhere to the six known methodologic principles are needed to inform policy-level health care decisions. Because of the complexity of cost analysis methodology, including sensitivity analysis, future interdisciplinary efforts using existing databases may prove most effective. The six methodologic principles presented in this article can be useful for future nursing education and cost-analysis research designed to control cost and increase the quality of health care.