Cost Comparison Study Research Articles

PCN25 - Obinutuzumab vs. Ibrutinib in the Treatment of Treatment-Naïve Patients with Chronic Lymphocytic Leukemia —A Cost-Comparison Study in Colombia

PCN25 - Obinutuzumab vs. Ibrutinib in the Treatment of Treatment-Naïve Patients with Chronic Lymphocytic Leukemia —A Cost-Comparison Study in Colombia

Impact de la conservation des branches du nerf intercostobrachial sur la qualité de vie des patientes opérées pour un cancer du sein

The aim of this study was to assess the impact of the preservation of the intercostobrachial nerve on the quality of life of patients operated for breast cancer. This study was ancillary to cost comparison study of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. It was a prospective multicenter, observational, non-randomized study. The quality of life was assessed using two questionnaires: QLQ-C30 and specific module QLQ-BR23 Surveys have been performed before initiation of surgery, one week, and 1 month, 8 months and 12 months after discharge from hospitalization for the first surgical procedure. Five hundred and seventy-eight patients with preservation of intercostobrachial nerve without axillary lymph node dissection (C-P+), 85 without preservation of nerve and axillary lymph node dissection (C+P-) and 57 with preservation of nerve and axillary lymph node dissection (C+P+) have been included in the study. The changing arm symptoms score was significantly different during follow-up between the three groups (P<0.001). This difference between the two groups C-P+ and C+P+ was significant clinically at one week [16.9, IC95%: 11.9 to 22 (P<0.01)], and persisted for up to 12 months [9.9, IC95%: 3.2 à16.6 (P=0.022)]. There was no difference between the group C+P- and C+P+. Results for physical functioning score were similar. Preservation of the intercostobral nerve is not associated with better quality of life. Only axillary lymph node dissection has an impact on quality of life.

Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy

To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy (PCNL) and to determine which method can be performed at a lower cost per case. A cost comparison study was performed utilizing clinical data from a prospectively maintained research database. We included the most recent 33 consecutive ultrasound-guided PCNL cases in 2016 and the most recent 40 consecutive fluoroscopy-guided PCNL cases before the operative surgeon transitioned to ultrasound guidance in May 2014. The total operative time and clinical outcomes were examined. Costs were extracted from the institution accounting systems and given a uniform multiplier to protect institutional financial reporting confidentiality. Comparisons were made using the Student t test and the chi-squared test. After excluding outliers, 71 PCNL procedures were included in the analysis. Demographic data and stone characteristics were not different between ultrasound-guided and fluoroscopy-guided groups. However, the mean operative time for ultrasound-guided PCNL was significantly shorter (99.8 ± 27.0 vs 144.9 ± 55.1 minutes, P < .05). When capital equipment costs were included, the mean total cost per case of ultrasound-guided PCNL was approximately 30% less than fluoroscopy-guided PCNL (simulated costs with a uniform multiplier; $5258.90 ± 957.12 vs $7508.60 ± 1163.83, P < .05). Postoperative clinical outcomes were comparable between the 2 groups. When capital costs are included, ultrasound-guided PCNL can produce comparable clinical outcomes to fluoroscopy-guided procedures at a lower cost to the institution. Shorter operative time drives significant savings with the adoption of ultrasound guidance, which may be magnified with increasing case volume. Using ultrasound imaging during PCNL may be more cost-effective compared to fluoroscopy and warrants further study.

A cost comparison study of using global positioning system technology (electronic monitoring) in a medium secure forensic psychiatric service

‘Electronic Monitoring’ (EM) uses devices to monitor individuals’ whereabouts. In 2010, South London and Maudsley medium secure unit introduced EM to monitor individuals on leave. Analysis after two years revealed EM was associated with increased unescorted leave and reduced leave violation; however, comparative costs were not established. This study aims to compare costs of EM for patients on leave by comparing average total cost per patient with and without EM. Costs were compared before and after implementation of EM. Total cost of leave for each group was divided by number of patients to generate average total cost per patient. The average total cost per patient without EM was £1702; £1617 with EM. Although cost decreased, this was not statistically significant. The results showed no significant difference between average total costs per patient before and after EM. The finding of EM being cost-neutral is cautiously optimistic. Further trials are recommended.

PIN44 - A Systematic Review Of The Cost-Effectiveness Of Quadrivalent Influenza Vaccine

Quadrivalent influenza vaccines (QIVs) contain one extra influenza B-lineage as compared with currently often used trivalent influenza vaccines (TIVs). This should overcome a reduced vaccine protection due to mismatches between TIV and the circulating B-lineage or due to co-circulation of both B-lineages. In this study we systematically reviewed the available literature on the cost-effectiveness of switching from TIV to QIV. The databases of Pubmed and Embase were searched in order to find economic evaluations of QIV versus TIV that were published before April 2016. A total of ten studies were included, nine cost-utility analyses (CUAs) and one cost-comparison analysis. Two studies were using dynamic transmission models which are able to include herd effects, beyond vaccinated persons only. All CUAs concluded that, if adhering to national cost-effectiveness guidelines and applying nationally accepted cost-effectiveness thresholds, QIV would be a cost-effective intervention as compared with TIV. The cost-comparison study and one of the CUAs predicted that QIV would be cost-saving. Often reported parameters with high impact on cost-effectiveness outcomes included incremental vaccine price, degree of mismatch between TIV and the circulating B-lineage, and vaccine-induced cross-protection against the mismatched B-lineage. Seasonal influenza vaccination with QIV seems to be a valuable intervention from an economic perspective. The use of dynamic models is advocated in order to estimate the full impact of QIV on influenza transmission, including herd effects. More understanding regarding cross-protection of TIV to the mismatched B-lineage and availability of data on disease outcomes and costs specified for influenza B would be desirable to further optimize the estimation of the cost-effectiveness of QIV.

Economic and Clinical Burden of Cytomegalovirus (CMV) Infections in Hematopoietic Cell Transplant (HCT) Recipients: A Cost Comparison Study Across 9 Major Cancer Centers in the U. S

Economic and Clinical Burden of Cytomegalovirus (CMV) Infections in Hematopoietic Cell Transplant (HCT) Recipients: A Cost Comparison Study Across 9 Major Cancer Centers in the U. S

The Economic and Clinical Burden of Respiratory Viral Infections in Hematopoietic Cell Transplant (HCT) Recipients: A Cost Comparison Study Across 19 Major Cancer Centers in the U. S

Results: Based on the 43 patients enrolled, a comparable treatment success rates between the 3 arms was observed. Progression to pneumonia occurred in 10% (2/20) of pts in the no therapy arm, 8% (1/13) in the OR arm, and 30% (3/10) in the AR arm. A total cost-savings of $1,830,348 was estimated for this current trial alone. Conclusions: If proven non-inferior, OR is a good and costeffective alternative to AR for management of RSV infections in HCT recipients. Application of ISI-RSV may lead to significant cost-savings by avoiding antiviral therapy in low-risk patients but needs further validation in multi-center studies.

Unilateral Pulmonary Oedema

Objectives: To evaluate the economic impact of the combined effect of minimally invasive surgery (MIS) and a multimodal analgesia regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing total knee arthorplasty (TKA) or total hip arthroplasty (THA). Patients and Methods: A retrospective cohort, cost comparison study from the hospital prospective was performed on Mayo Clinic patients (n=37) undergoing MIS TKA or THA using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional surgical and anesthetic (non- TJRA) techniques. Hospital-based direct costs were collected for each patient and analyzed in standardized infl ationadjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups and a subgroup analysis was performed based upon ASA physical status classification. Results: The estimated mean direct medical costs were signifi cantly reduced among MIS with TJRA patients compared to controls (cost difference: $4582; 95% CI $3299-$5864; P < .001). A signifi cant reduction was found in both the hospital-based (Medicare Part A) costs and the physician-based (Medicare Part B) costs. Conclusions: The combined use of minimally invasive surgical (MIS) approaches and a multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement provides a signifi cant reduction in the estimated mean medical costs. A signifi cant reduction occurs in both the hospital based (Medicare Part A) and the physician based (Medicare Part B) costs. In subgroup analysis, the greatest difference was found among the patients with signifi cant comorbidities (ASA III-IV patients).

Cost Consequences Of Single-Use And Re-Use Of Urinary Catheters Among Patients Performing Daily Intermittent Catheterization

The material cost for reusing intermittent urinary catheters is lower than to use single-use catheters. These cost savings are misleading since complications may increase and lower compliance to the therapy can be expected, necessitating use of the second choice therapy form with even more complications, i.e. an indwelling catheter. The purpose of this cost-comparison study was to compare single-use of coated catheters to re-use of non-coated catheters in a group of individuals performing intermittent catheterization where some of them fail their first choice therapy and switch to an indwelling catheter. A 1-year Markov simulation model with monthly cycles was developed for users of daily intermittent catheterization. Individuals who used 4 catheters/day (single-use) were compared to individuals who re-used their catheters (1 catheter/day). After one month’s use, 18% of the patients in the single-use group were assumed to fail their treatment and switch to indwelling catheter. The corresponding frequency in the re-use group was 35%. The model was populated with risks from the literature for complications (e.g. symptomatic UTI, UTI resistant to antibiotics, pyelonephritis, bacteremia, epididymitis, strictures, bladder stones) as well as catheter and healthcare costs for single-use, re-use and indwelling catheters, respectively. The total annual catheter cost per patient was 2188 euros (including 163 euros for indwelling catheters) in the single-use group and 817 euros (including 317 euros for indwelling catheters) in the re-use group. The total annual cost per patient for complications was 1243 euros in the single-use group and 2067 euros in the re-use group. Almost two thirds of the additional catheter cost associated with the single-use strategy in comparison to re-using catheters was offset from savings due to fewer complications. The decrease in patient suffering from fewer complications would also add to the benefits of single-use strategy.

FOC6-7LAT SOFTWARE INDUCED SAVINGS ON HOSPITAL COSTS OF ALCOHOL ADDICTS' CARE

Lesch Alcoholism Typology (LAT) is one of the most widely used clinical typologies of alcohol addiction. Study tested whether introduction of LAT software in clinical practice leaded to improved outcomes and reduced costs. Retrospective matched-pairs case-control cost comparison study was conducted at the Regional Addiction Center of the …

A cost comparison study between recommendations from the American Optometric Association and recommendations from the American Association for Pediatric Ophthalmology and Strabismus on the correction of hyperopia in children

A cost comparison study between recommendations from the American Optometric Association and recommendations from the American Association for Pediatric Ophthalmology and Strabismus on the correction of hyperopia in children

LAT software induced savings on medical costs of alcohol addicts' care--results from a matched-pairs case-control study.

Lesch Alcoholism Typology (LAT) is one of the most widely used clinical typologies of alcohol addiction. Study tested whether introduction of LAT software in clinical practice leaded to improved outcomes and reduced costs. Retrospective matched-pairs case-control cost comparison study was conducted at the Regional Addiction Center of the University Clinic in Serbia involving 250 patients during the four-year period. Mean relapse frequency followed by outpatient detoxification was 0.42±0.90 vs. 0.70±1.66 (LAT/non-LAT; p = 0.267). Adding relapses after inpatient treatment total mean-number of relapses per patient was 0.70±1.74 vs. 0.97±1.89 (LAT/non-LAT; p = 0.201). However, these relapse frequency differentials were not statistically significant. Total hospital costs of Psychiatry clinic based non-LAT addicts' care (€54,660) were significantly reduced to €36,569 after initiation of LAT. Mean total cost per patient was reduced almost by half after initiation of LAT based treatment: €331±381 vs. €626±795 (LAT/non-LAT; p = 0.001). Mean cost of single psychiatry clinic admission among non-LAT treatment group was €320±330 (CI 95% 262–378) and among LAT €197±165 (CI 95% 168–226) (p = 0.019). Mean LAT software induced net savings on psychiatric care costs were €144 per patient. Total net savings on hospital care including F10 associated somatic co-morbidities amounted to €295 per patient. More sensitive diagnostic assessment and sub-type specific pharmacotherapy and psychotherapy following implementation of LAT software lead to significant savings on costs of hospital care.

Cost comparison studies: Their value, validity and future from an international perspective

Physical, economic, social, political or cultural factors are commonly defined as factors businesses consider when selecting a new site to locate. This paper examines which selection factors are considered important by potential investors and their advisors by analyzing the value of international cost comparison studies, specifically looking at cost-related site selection factors. This research analyses the site selection process on an international level and concludes that sponsorship is an influencing factor. The author argues that locations that do not have the ability to financial contribute to the development of the cost comparison study are at an unfair advantage. Keywords : site selection, sponsorship, location decision

가선집재작업에서의 작업 생산성 및 비용 분석

본 연구에서는 임목수확작업에 사용되는 집재기계의 작업효율성을 분석하여 경사가 급한(<TEX>$20^{\circ}$</TEX> 이상) 작업조건에 적합한 가선계 집재기계를 선정하는데 기초 정보를 제공하고자, 타워야더(RME-300T), 트랙터부착형 집재기(일명 : 춘천집재기), 트랙터윈치(FARMI) 등에 의한 집재작업에서의 작업생산성 및 비용을 비교 분석하였다. 평균 흉고직경이 20 cm, 집재거리 60 m, 가로집재거리 10 m, 그리고 기계이용률이 70%인 동일한 작업 조건에서 작업이 이루어질 경우, 타워야더의 1일 집재작업 생산성은 <TEX>$33.04m^3$</TEX>/일, 트랙터부착형 집재기는 <TEX>$38.47m^3$</TEX>/일, 그리고 트랙터윈치는 <TEX>$14.17m^3$</TEX>/일으로 분석되었으며, 이에 따른 집재작업비용은 각각 25,105원/<TEX>$m^3$</TEX>, 20,520원/<TEX>$m^3$</TEX>, 37,835원/<TEX>$m^3$</TEX>으로 나타났다. 동일한 작업조건에서 집재거리에 따른 각 집재기계별 작업효율성을 비교하였을 경우, 집재거리가 40 m 이내로 짧을 경우에는 트랙터윈치에 의한 집재작업이 효율적이며, 40~140 m의 집재거리에서는 춘천집재기가, 140 m 이상의 장거리 집재작업에서는 타워야더가 가장 효율적인 것으로 나타났다. This study was conducted to provide field-based harvesting study information which can be used to select an optimal cable system for certain work conditions on steep grounds (> <TEX>$20^{\circ}$</TEX> ground slope) in Korea. To accomplish this study objectives, we evaluated three cable yarding systems (RME-300T tower-yarder, Chuncheon tower-yarder, FARMI tractor winch) working in typical work conditions for their yarding productivity and operational efficiency. Those yarders are commonly used for removing logs or trees on steep grounds in Korea. Under the same work conditions (average DBH of tree to be cut, 20 cm; yarding distance, 60 m; lateral yarding distance, 10 m; and machine utilization rate, 70%), the average productivities were <TEX>$33.04m^3$</TEX>/day, <TEX>$38.47m^3$</TEX>/day, and <TEX>$14.17m^3$</TEX>/day for RME-300T, Chuncheon tower-yarder, and FARMI, respectively. Our standardized cost comparison study also showed that the yarding cost was highest at <TEX>$37,835won/m^3$</TEX> with FARMI, followed by RME-300T at <TEX>$25,105won/m^3$</TEX> for the same work conditions. We found the lowest yarding cost with the Chuncheon tower-yarder at <TEX>$20,520won/m^3$</TEX> which was resulted primarily from high yarding productivity at the yarding distance (60 m). Our analysis suggested that a small machine such as FARMI could be a low-cost yarding machine option for a cable yarding job with a short yarding distance (40 m or less). The Chuncheon tower-yarder is well suited for a mid-range yarding distance job in Korea, ranged between 40 to 140 m. If yarding distance were longer than 140 m, the RME-300T tower yarder appears to be most cost-effective.

PUK6 - Catheter-Associated Urinary Tract Infections: Cost Comparison Study from the Public Payer Perspective

PUK6 - Catheter-Associated Urinary Tract Infections: Cost Comparison Study from the Public Payer Perspective

Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study

BackgroundEmergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated...

Control ambulatorio de los pacientes con trombosis venosa profunda y cáncer: estudio de seguridad, costes e impacto presupuestario

Background and objectiveThis is a safety and cost comparison study with an analysis of budgetary impact of ambulatory management of patients with cancer and deep vein thrombosis (DVT) compared with hospital management. Material and methodsProspective observational study of patients with known malignancy and diagnosed with DVT from 2003 to 2007. The outcome variables were mortality, relapse and bleeding in one month. We conducted an economic analysis to evaluate the comparative cost of ambulatory patients. ResultsThree hundred and seventeen patients, 55 (17%) had cancer. The mean age of patients was 63±11 years. There were 2 hemorrhagic events, 2 recurrences and 6 deaths in one month of follow-up. Of all patients, only 7 (13,7%) required hospitalization. All but one deaths were due to progression of the underlying disease. Economic analysis concluded that outpatient management is 6 times less expensive than hospital management, which would imply a cost reduction of 85%. ConclusionsSpecialized outpatient treatment of cancer patients with DVT is safe and could save significant financial resources.

PIN40 Linezolid Versus Vancomycin for Skin and Soft Tissue Infections by Methicilin-Resistant Staphylococcus Aureus: A Cost Comparison Analysis Under the Public Hospital Perspective in Brazil

Seventy-nine percent of the skin and soft tissue infections (SSTI) are caused by staphylococcus aureus, from which 1/3 is methicilin-resistant staphylococcus aureus (MRSA). This study aims to compare SSTI-MRSA treatment costs with linezolid versus branded and generic vancomycin under the Brazilian public payer perspective. A cost comparison study was performed to compare linezolid versus generic and branded vancomycin. As supported by clinical studies, overall treatment duration of 15 days with linezolid and 14 days with vancomycin was considered, using PO linezolid after a minimum 4-days cycle of IV infusion while vancomycin (1g bid) was entirely IV. A decision-tree model simulated SSTI-MRSA treatment assuming linezolid (600mg bid) IV can be switched to PO after 4-days and patients can be discharged if PO is implemented at physician discretion. Length of stay (LOS) and IV linezolid duration were ranged in one-way sensitivity analysis. Only direct medical costs were included in the analysis (hospital charges, medical visits, medical supplies and drug acquisition costs) and unit costs were obtained from Brazilian official price lists (2010 USD values). The linezolid scheme with 4-days IV (LOS=4 days) and 11-days PO resulted in overall costs per patient of 2,540 USD, while branded and generic vancomycin exhibited 3466 USD and 3663 USD, respectively. The incremental cost of vancomycin-treated patients was driven by hospital daily charges, responsible for over 60% of the overall vancomycin costs. One-way sensitivity analysis revealed cost-savings for linezolid up to LOS≥9 days, with overall costs per patient ranging from 2540-4548 USD even if IV therapy was maintained throughout the inpatient period (LOS=15 days). Linezolid exhibited a cost-saving profile over branded or generic vancomycin for the treatment of SSTI-MRSA under the Brazilian public payer perspective. This economic benefit was a direct result of potential early discharge of patients receiving PO linezolid.

Preoperative screening strategies for bacterial vaginosis prior to elective hysterectomy: a cost comparison study

The purpose of this study is to compare costs of 3 strategies for women undergoing hysterectomy: (1) test all patients for bacterial vaginosis; treat if positive; (2) treat all patients for bacterial vaginosis; (3) neither test nor treat patients for bacterial vaginosis. For comparison purposes, a fourth strategy is examined: (4) no surgical site infection prophylaxis or bacterial vaginosis treatment. A cost minimization model was created using estimates obtained from the published literature, Medicare reimbursement data, and wholesale drug costs. In the base case, the optimal strategy was to treat all patients for bacterial vaginosis, with a cuff infection rate of 4.0% and mean cost of $593. The "test all patients for bacterial vaginosis; treat if positive" strategy was also inexpensive, with a mean cost of $623 and 4.2% cuff infection rate. "Neither test nor treat patients for bacterial vaginosis" and "no surgical site infection prophylaxis or bacterial vaginosis treatment" were more expensive and less effective than other strategies. This model suggests that consideration should be given to adding metronidazole to standard surgical site infection prophylaxis before hysterectomy.

P1-S4.30 Point-of-Care HIV Testing with OraQuick Advance HIV-1/2 antibody assay: a systematic review of cost outcomes

BackgroundRecently Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group called for a shift from diagnostic accuracy to emphasis on patient-centred outcomes for making policy recommendations. While meta-analyses have...