Follow-up Costs Research Articles

The Financial Burden of Aspirin versus Oral Factor Xa Inhibitors for Thromboprophylaxis Following Total Knee Arthroplasty

BackgroundAspirin and oral factor Xa inhibitor thromboprophylaxis regimens are associated with similarly low rates of venous thromboembolism following total knee arthroplasty (TKA). However, the rate of prosthetic joint infection (PJI) is lower with aspirin use. This study aimed to compare the cost differential between aspirin and factor Xa inhibitor thromboprophylaxis with respect to PJI management. MethodsWe used previously published rates of PJI following aspirin and factor Xa inhibitor thromboprophylaxis in primary TKA patients at a single, large institution. Prices for individual drugs were obtained from our hospital’s pharmacy service. The cost of PJI included that of 2-stage septic revision, with or without the cost of 1-year follow-up. National data were obtained to determine annual projected TKA volume. ResultsThe per-patient costs associated with a 28-day course of aspirin versus factor Xa inhibitor thromboprophylaxis were $17.36 and $3,784.20, respectively. Including cost of follow-up, per-patient costs for a 28-day course of aspirin versus factor Xa inhibitors increased to $73,358.76 and $77,125.60, respectively. The weighted average per-patient costs for a 28-day course were $237.38 and $4,370.93, respectively. The annual cost difference could amount to over $14.1 billion in the United States by 2040. ConclusionsThe per-patient cost associated with factor Xa inhibitor thromboprophylaxis is as much as 1,980.6% higher than that of an aspirin regimen due to increased costs of primary treatment, differential PJI rates, and high costs of management. In an era of value-based care, the use of aspirin is associated with major cost advantages.

Central Venous Access Devices for the Delivery of Systemic Anticancer Therapy: An Economic Evaluation

ObjectivesPatients undergoing long-term anticancer therapy typically require one of 3 venous access devices: Hickman-type device (HICK), peripherally inserted central catheter (PICC), or implantable chest wall port (PORT). Recent evidence has shown PORT is safer and improves patient satisfaction. However, PORT did not show improvement in quality-adjusted life-years and was more expensive. Decisions regarding cost-effectiveness in the United Kingdom are typically informed by a cost-per-quality-adjusted life-year metric. However, this approach is limited in its ability to capture the full range of relevant outcomes, especially in the context of medical devices. This study assessed the potential cost-effectiveness of HICK, PICC, and PORT in routine clinical practice. MethodsThis is a cost-consequence analysis to determine the trade-offs between the following outcomes: complication, infection, noninfection, chemotherapy interruption, unplanned device removals, health utilities, device insertion cost, follow-up cost, and total cost, using data from the Cancer and Venous Access clinical trial. We conducted value of implementation analysis of a PORT service. ResultsPORT was superior in terms of overall complication rate compared with both HICK (incidence rate ratio 0.422; 95% CI 0.286-0.622) and PICC (incidence rate ratio 0.295; 95% CI 0.189-0.458) and less likely to lead to an unplanned device removal. There was no difference in chemotherapy interruption or health utilities. Total cost with device in situ was lower on PORT than HICK (−£98.86; 95% CI −189.20 to −8.53) and comparable with PICC −£48.57 (95% CI −164.99 to 67.86). Value of implementation analysis found that PORT was likely to be considered cost-effective within the National Health Service. ConclusionDecision makers should consider including PORT within the suite of venous access devices available within in the National Health Service.

The Erlangen model of tinnitus development-New perspective and treatment strategy

About one sixth of the population of western industrialized nations suffers from chronic, subjective tinnitus, causing socioeconomic treatment and follow-up costs of almost 22billion euros per year in Germany alone. According to the prevailing view, tinnitus develops as aconsequence of amaladaptive neurophysiological process in the brain triggered by hearing loss. The Erlangen model of tinnitus development presented here is intended to propose acomprehensive neurophysiological explanation for the initial occurrence of the phantom sound after hearing loss. Based on the model, anew treatment strategy will be developed. The model summarized here is based on various animal and human physiological studies conducted in recent years. The Erlangen model considers subjective tinnitus as aside effect of aphysiological mechanism that permanently optimizes information transmission into the auditory system by means of stochastic resonance (SR) even in the healthy auditory system. In fact, hearing-impaired patients with tinnitus hear better on average than those without tinnitus. This unfamiliar perspective on the phantom percept may already help affected patients to cope better with their suffering. In addition, based on the model, low intensity noise tinnitus suppression (LINTS) has been developed as anew, individually adapted treatment strategy for tonal tinnitus and has already been successfully tested in patients. Apossible limiting factor for the model and treatment strategy is the pitch of the tinnitus percept, which may require adjustments to the treatment strategy for frequencies above about 5 kHz.

Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study.

Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Eligible patients (n= 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p= 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p= 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.

The Medical Costs of Firearm Injuries in the United States: A Systematic Review

BackgroundFirearm injury poses a significant public health burden in the United States. ObjectivesThe purpose of this systematic review was to provide a comprehensive accounting of the medical costs of firearm injuries in the United States. MethodsA systematic literature review was conducted to identify studies published between January 1, 2000 and July 13, 2022 that reported medical costs of firearm injuries. A search of Embase, PubMed, and the Cochrane Library databases was performed by a medical librarian. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate for risk of bias. Health care-related charges and costs per firearm injury were presented and trends were identified. ResultsSixty-four studies were included in the analysis. Study sample sizes ranged from 18 to 868,483 patients. Reported costs per injury ranged from $261 to $529,609. The median cost reported was $27,820 (interquartile range [IQR] $15,133–$40,124) and median charge reported was $53,832 (IQR $38,890–$98,632). Studies that divided initial hospitalization costs and follow-up medical costs identified that initial hospitalization accounts for about 60% of total costs. ConclusionsWe found a significant volume of literature about the medical costs of firearm injury, which identified a highly heterogeneous cost burden. A significant amount of cost burden occurs after the index hospitalization, which is the only cost reported in most studies. Limitations of this study include reporting bias that favors hospitalized patients as well as a large focus on hospital charges as measurements of cost identified in the literature.

Costs associated with adverse drug reactions in an older population admitted to hospital: a prospective cohort study

PurposeThis study examines healthcare costs associated with adverse drug reactions (ADR) in an older population admitted acutely to an Irish tertiary hospital. MethodsProspective cohort study involving older persons admitted to hospital with and without an ADR. Data was collected at baseline, during hospitalisation and post-discharge. Participants provided information on healthcare resource use three months before admission (baseline) and three months after discharge (follow-up). For each healthcare resource, unit costs were derived and applied. The average cost (standard deviation (SD)) associated with the hospital admission for the ADR and non-ADR are presented. In addition, baseline and follow-up care costs were compared using difference-in-difference analysis and presented with 95% confidence intervals (CI). Costs by preventability and severity of ADR are also presented.ResultsA total of n = 230 participants were included (n = 93 ADR and n = 137 without ADR). The average cost associated with hospital admission for an ADR was €9538 (SD €10442) and €9828 (SD €11770) for non-ADR. The additional follow-up costs (difference-in-difference) associated with the ADR was estimated at €2047 (95% CI: -€889 to €4983). The mean incremental follow-up cost of definite preventable ADRs was estimated at €1648 (95% CI: -€4310 to €7605), possible preventable ADRs €2259 (95 CI: -€1194 to €5712) and unavoidable ADRs €1757 (95% CI: -€3377 to €6890). The mean incremental follow-up cost associated with moderate severe ADRs was estimated at €1922 (95% CI: -€1088 to €4932) and €3580 (95% CI: -€4898 to €12,058) for severe ADRs. ConclusionADRs leading to hospital admission are associated with modest incremental healthcare costs during and three months after admission. Severe and possibly preventable ADRs were associated with higher costs.

Analysis of the costs associated with the follow-up of HIV patients discontinuing antiretroviral treatment due to lack of effectiveness or unacceptable toxicity in Spain

ObjectiveTo assess the use of resources and the costs associated with following up patients infected with the human immunodeficiency virus after discontinuation of an antiretroviral treatment and initiation of a new one due to a lack of effectiveness or unacceptable toxicity, as compared to the costs involved in the routine follow-up of patients on antiretroviral treatment, from the Spanish National Health System perspective. MethodThe use of resources (clinical tests, medical visits, and hospital pharmacy visits) associated with following three profiles of patients infected with the human immunodeficiency virus (stable ones, those discontinuing an existing antiretroviral treatment and being switched to a new one due to a lack of effectiveness, and those discontinuing an existing antiretroviral treatment and being switched to a new one due to unacceptable toxicity) was identified, based on clinical practice guidelines and the findings of a multidisciplinary expert panel (n = 5). The experts agreed on the main adverse events leading to discontinuation, classifying them into gastrointestinal, renal, osseous, musculoskeletal, dermatological, hepatic, lipid profile-related, neuropsychiatric and sexual alterations. Unit costs were identified from official healthcare costs databases. The cost (€, 2020) of following up each patient profile was estimated, excluding the cost of the antiretroviral treatment itself, with a time horizon of two years. ResultsThe per-patient cost of following up stable patients over two years was estimated at €4,148 (tests: €2,293; visits: €1,855). Patient follow-up after discontinuation of an existing antiretroviral treatment and initiation of a different one due to a lack of effectiveness was estimated at €5,434 (tests: €2,777; visits: €2,657). The cost of follow-up after discontinuation of an existing regimen and initiation of a new one due to unacceptable toxicity varied according to the adverse event prompting the switch, ranging from €4,690 for lipid profile dysregulation, to €5,304, for musculoskeletal alterations. In this patient profile, the cost of tests ranged from €2,403 to €3,017, and that of visits from €2,287 to €2,842. ConclusionsThe cost associated with following up of patients infected with the human immunodeficiency virus after discontinuation of an existing antiretroviral regimen and initiation of a new one is higher than that of routine follow-up, without taking the cost of drugs into account. The treatment discontinuation rate is a relevant factor when selecting the most appropriate therapy for each patient.

Societal burden and quality of life in patients with Lisfranc Injuries

BackgroundThe incidence of Lisfranc fractures is rising, along with the incidence of foot fractures in general. These injuries can lead to long-term healthcare use and societal costs. Current economic evaluation studies are scarce in Lisfranc fracture research, and only investigate the healthcare costs. The aim of the present study was to accurately measure the monetary societal burden of disease and quality of life in the first 6 months after the injury in patients with Lisfranc fractures in the Netherlands. Materials and methodsThis study used a prevalence-based, bottom-up approach. Patients were included through thirteen medical centres in the Netherlands. Both stable and unstable injuries were included. The societal perspective was used. The costs were measured at baseline, 12 weeks and 6 months using the iMTA MCQ and PCQ questionnaires. Reference prices were used for valuation. Quality-of-life was measured using the EQ-5D-5 L and VAS scores. Results214 patients were included. The mean age was 45.9 years, and 24.3% of patients had comorbidities. The baseline questionnaires yielded approximately €2023 as the total societal costs in the 3 months prior to injury. The follow-up questionnaires and surgery costs assessment yielded approximately €17,083 as the total costs in the first 6 months after injury. Of these costs, approximately two thirds could be attributed to productivity losses. The EQ-5D-5 L found a mean index value of 0.449 at baseline and an index value of 0.737 at the 6-month follow-up. ConclusionThe total monetary societal costs in the first 6 months after injury are approximately €17,083. Approximately two thirds of these costs can be attributed to productivity losses. These costs appear to be somewhat higher than those found in other studies. However, these studies only included the healthcare costs. Furthermore, the baseline costs indicate relatively low healthcare usage before the injury compared to the average Dutch patient. The mean QoL index was 0.462 at baseline and 0.737 at 6 months, indicating a rise in QoL after treatment as well as a long-lasting impact on QoL. To our knowledge, this is only the first study investigating the societal costs of Lisfranc injuries, so more research is needed.

Study on the Reflective Principle and Long-Term Skid Resistance of a Sustainable Hydrophobic Hot-Melt Marking Paint

Road marking is very important for driving safety and reducing the accident rate as a basic component of highway construction. However, traditional road marking paints are prone to be worn after short-term application and have poor durability and reflective performance. To address these problems, the marking paint was modified using the organic polymer material polytetrafluoroethylene to create a durable hydrophobic hot-melt marking paint. The factors affecting the reflective performance of marking lines are analyzed, and artificial accelerated abrasion tests were carried out to analyze the skid resistance and marking retroreflection coefficient of hydrophobic coatings. Results show that the texture of the glass beads and the quality of the coating plays a major role in the reflective performance of the marking line. The friction coefficient value of the modified marking paint is 4.62% higher than that of the traditional hot-melt marking paint. The retroreflection performance of the marking paint with 4% hydrophobic material is 8.45% higher than the initial value of the retroreflection coefficient of the traditional hot-melt marking paints. This sustainable hydrophobic hot-melt marking paint is safer and more durable than traditional pavement marking paints, which may save follow-up maintenance resources and cost from the sustainable aspect.

Unilateral Multicystic Dysplastic Kidney Management: A National Survey.

Risks of contralateral kidney abnormalities and chronic kidney disease necessitate follow-up for unilateral multicystic dysplastic kidneys (MCDK). A nationwide survey of senior UK pediatricians was conducted. Of the 60 responses obtained, 62% routinely perform a dimercaptosuccinic acid scan to confirm diagnosis. Eight percent routinely perform a cystogram to investigate contralateral vesicoureteric reflux. Sixty-two percent would routinely measure renal function (frequency ranging from once only to "every 2 years"). Twenty-five percent recalled MCDK nephrectomy being performed within the previous 5 years. Respondents voiced concerns that national guidance may result in an overcautious approach but could balance consensus and safe variation, and offer families choice and reassurance. The mean estimated cost of follow-up from birth to 18 years ranged from £258 to £3854. Results demonstrate significant variation in management, highlighting the need for a clear pathway to decrease unwanted variability and to ensure those at high risk of renal sequelae are recognized early, without undue investigatory burden.

Face time with physicians: How do patients assess providers in video-visits?

IntroductionThe COVID-19 pandemic has triggered a massive acceleration in the use of virtual and video-visits. As more patients and providers engage in video-visits over varied digital platforms, it is important to understand how patients assess their providers and the video-visit experiences. We also need to examine the relative importance of the factors that patients use in their assessment of video-visits in order to improve the overall healthcare experience and delivery. MethodsA data set of 5149 reviews of patients completing a video-visit was assembled through web scraping. Sentiment analysis was performed on the reviews and topic modeling was used to extract latent topics embedded in the reviews and their relative importance. ResultsMost patient reviews (89.53%) reported a positive sentiment towards their providers in video-visits. Seven distinct topics underlying the reviews were identified: bedside manners, professional expertise, virtual experience, appointment scheduling and follow-up process, wait times, costs, and communication. Communication, bedside manners and professional expertise were the top factors patients alluded to in the positive reviews. Appointment-scheduling and follow-ups, wait-times, costs, virtual experience and professional expertise were important factors in the negative reviews. DiscussionTo improve the overall experience of patients in video-visits, providers need to engage in clear communication, grow excellent bedside and webside manners, promptly attend the video-visit with minimal delays and follow-up with patients after the visit.

EE497 Healthcare Costs Associated with Hematopoietic Stem-Cell Transplantation in Patients with Acute Myeloid Leukemia: A Population-Based Retrospective Cohort Study in Korea

Hematopoietic stem-cell transplantation(HSCT) is considered an important treatment strategy in medically eligible acute myeloid leukemia(AML) patients, but the cost is substantial. This study aimed to estimate the hospitalization costs and follow-up costs of HSCT procedure in AML patients.

Association of lymph node examination during resection with overall survival (OS) and healthcare costs in patients with early non–small-cell lung cancer (eNSCLC).

e20567 Background: To evaluate the effect of LN examination status on OS and healthcare costs in patients (pts) with eNSCLC. Methods: Retrospective observational study of pts with resected stage IA-IIIB NSCLC (AJCC 7th ed) from SEER data linked with Medicare claims. Eligible pts were ≥65 years at diagnosis (Jan 2010-Dec 2017), had surgery ≤1 month before or 12 months after diagnosis and were continuously enrolled in Medicare Parts A and B for ≥6 months before diagnosis and in Parts A, B and D up to 6 months post-surgery or date of death. Pts were analyzed by LN examination status: no examination (pNX), examination and no LN metastasis (pN0) and examination with N1 (pN1) or N2 (pN2) metastasis. Extended Cox proportional hazards models presented OS hazard ratios (HRs) for specific time periods. Total healthcare costs per patient per month (PPPM) were analyzed using a gamma-log regression model. Results: A total of 9448 pts were included: 996 pNX (11%), 6457 pN0 (68%), 1003 pN1 (11%) and 992 pN2 (10%). pNX pts were slightly older with lower median income, more comorbidities and more baseline smoking history vs other LN examination status cohorts. Stage distribution in pNX and pN0 pts appeared similar. Grade 3/4 tumors were less prevalent in pNX (n = 301, 30%) and pN0 (n = 1934, 30%) pts relative to pN1 (n = 482, 48%) and pN2 pts (n = 424, 43%; P< 0.001). Unadjusted OS was worse for pN1 and pN2 vs pN0 pts and was similar between pNX and pN2 pts. Adjusted OS showed higher risk of death for pN1 and pN2 vs pN0 pts; this risk decreased over time. pNX pts also had higher risk of death vs pN0 pts. Adjusted marginal mean follow-up costs were lowest for pN0 and highest for pN2 pts (All P < 0.001). Costs were higher, but not statistically significant ( P= 0.591) in pNX vs pN0 pts. The majority of total healthcare costs (62-65%) were due to inpatient services. Conclusions: Stage distribution in pNX pts was more similar to that of pN0 than pN1/2 pts, likely due to understaging from lack of LN examination. However, prognosis in pNX pts was nearly identical to that of pN2 pts, suggesting missed LN metastasis diagnosis in a substantial proportion of pNX pts. Despite worse OS in pNX vs pN0 pts, healthcare costs in pNX pts were not significantly higher, which may reflect underutilization of systemic therapy in pts with resected eNSCLC. [Table: see text]

Economic Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk: Results from the PARTNER 3 Trial.

In patients with severe symptomatic aortic stenosis at low surgical risk, transfemoral transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve has been shown to reduce the composite of death, stroke, or rehospitalization at 2-year follow-up compared with surgical aortic valve replacement (SAVR). Whether TAVR is cost-effective compared with SAVR for low-risk patients remains uncertain. Between 2016 and 2017, 1000 low-risk patients with aortic stenosis were randomly assigned to TAVR with the SAPIEN 3 valve or SAVR in the PARTNER 3 trial (Placement of Aortic Transcatheter Valves). Of these patients, 929 underwent valve replacement, were enrolled in the United States, and were included in the economic substudy. Procedural costs were estimated using measured resource use. Other costs were determined by linkage with Medicare claims or by regression models when linkage was not feasible. Health utilities were estimated using the EuroQOL 5-item questionnaire. With the use of a Markov model informed by in-trial data, lifetime cost-effectiveness from the perspective of the US health care system was estimated in terms of cost per quality-adjusted life-year gained. Although procedural costs were nearly $19 000 higher with TAVR, total index hospitalization costs were only $591 more with TAVR compared with SAVR. Follow-up costs were lower with TAVR such that TAVR led to 2-year cost savings of $2030/patient compared with SAVR (95% CI, -$6222 to $1816) and a gain of 0.05 quality-adjusted life-years (95% CI, -0.003 to 0.102). In our base-case analysis, TAVR was projected to be an economically dominant strategy with a 95% probability that the incremental cost-effectiveness ratio for TAVR would be <$50 000/quality-adjusted life-year gained (consistent with high economic value from a US health care perspective). These findings were sensitive to differences in long-term survival, however, such that a modest long-term survival advantage with SAVR would render SAVR cost-effective (although not cost saving) compared with TAVR. For patients with severe aortic stenosis and low surgical risk similar to those enrolled in the PARTNER 3 trial, transfemoral TAVR with the SAPIEN 3 valve is cost saving compared with SAVR at 2 years and is projected to be economically attractive in the long run as long as there are no substantial differences in late death between the 2 strategies. Long-term follow-up will be critical to ultimately determine the preferred treatment strategy for low-risk patients from both a clinical and economic perspective.

Cardiovascular Event Recurrence and Costs after First Myocardial Infarction, Ischemic Stroke, or Intracerebral Hemorrhage in Taiwan.

We aimed to assess the incidence of recurrent cardiovascular (CV) events after the first myocardial infarction (MI), ischemic stroke (IS), or intracerebral hemorrhage (ICH) and to estimate acute and follow-up medical costs. Using Taiwan's National Health Insurance Research Database, we identified patients with their first MI, IS, or ICH between 2011 and 2017. The cumulative incidence rates of second CV events (including events of the same type [recurrent] or of the other two types) were estimated. The costs for hospitalization and all-cause follow-up were calculated for the first and recurrent CV events and are presented as median (Q1~Q3) in 2017 US dollars. We identified 70,428 patients with a first MI, 123,857 with a first IS, and 41,347 with a first ICH. The cumulative incidence rates of recurrence during the first year and after six years were 3.9% and 10.1% for MI, 5.3% and 13.8% for IS, and 3.9% and 8.9% for ICH, respectively. For first and recurrent nonfatal events, acute hospitalization costs were $4,729 (3,737~5,985) and $4,459 (2,887~6,026) for MI; $1,136 (756~2,183) and $1,224 (774~2,412) for IS; and $2,985 (1,264~8,831) and $2,170 (1,183~4,675) for ICH, respectively. Total annual costs for nonfatal first events in the first year and second year of follow-up were $2413 (1,393~6,120) and $1,293 (654~2,868) for MI, $2,174 (1,040~5,472) and $1,394 (602~3,265) for IS, and $2,963 (995~8,352) and $1,185 (405~3,937) for ICH, respectively. In patients with a first MI, IS, and ICH, recurrent CV events continue to substantially impact public health and escalate the economic burden.

Estimation of Prostate Cancer Cost in Egypt From a Societal Perspective.

The main objective of this study was to assess the cost of prostate cancer over a 1-year period from a societal perspective. We constructed a cost-of-illness model to assess the cost of different health states of prostate cancer, metastatic or nonmetastatic, among Egyptian men. Population data and clinical parameters were extracted from the published literature. We relied on different clinical trials to extract clinical data. We considered all direct medical costs, including the costs of treatment and required monitoring, in addition to the indirect costs. The unit costs were captured from Nasr City Cancer Center and Egyptian Authority for Unified Procurement, Medical Supply, and Management of Medical Technology, and resource utilization were collected from clinical trials and validated by the Expert Panel. One-way sensitivity analysis was conducted to ensure model robustness. The number of targeted patients with nonmetastatic hormone-sensitive prostate cancer, hormone-sensitive prostate cancer, and metastatic castration-resistant prostate cancer was 215,207, 263,032, and 116,732, respectively. The total costs, in Egyptian pounds (EGP) and US dollars (USD), for the targeted patients, including drug costs and nondrug costs over a time horizon of 1 year, were EGP 41.44 billion (USD 9.010 billion) for localized prostate cancer; for metastatic prostate cancer, they doubled to EGP 85.14 billion (USD 18.510 billion), which reflects a huge burden on the Egyptian healthcare system. The drug costs for localized and metastatic prostate cancer are EGP 41,155,038,137 (USD 8.946 billion) and EGP 81,384,796,471 (USD 17.692 billion), respectively. A significant difference in nondrug costs between localized and metastatic prostate cancer was demonstrated. Nondrug costs were estimated at EGP 293,187,203 (USD 0.063 billion) for localized prostate cancer and EGP 3,762,286,092 (USD 0.817 billion) for metastatic prostate cancer. This significant difference in nondrug costs highlights the importance of early treatment due to the increased costs of progression and the burden of follow-up and productivity loss associated with metastatic prostate cancer. Metastatic prostate cancer has a huge economic burden on the Egyptian healthcare system compared with localized prostate cancer owing to the increased costs of progression, follow-up, and productivity loss. This highlights the necessity of early treatment of these patients to save costs and lighten the burden of the disease on the patient, society, and economy.

Effect of Smartphone App Postoperative Home Monitoring After Oncologic Surgery on Quality of Recovery

There has been an increase in health care-focused smartphone apps, including those for encouraging healthy behaviors and managing chronic conditions, but app-assisted postsurgical care has yet to be fully explored. To compare quality of recovery and patient satisfaction between conventional in-person follow-up and smartphone app-assisted follow-up for patients following Enhanced Recovery After Surgery Society (ERAS) protocols. This randomized clinical trial, conducted from June 2019 to April 2021, included women older than 18 years undergoing oncologic breast reconstruction or major gynecologic oncology surgery following ERAS protocols with the care of 2 surgeons at an academic tertiary care center. Patients were randomized 1:1 to receive smartphone app-assisted follow-up or conventional in-person follow-up. The smartphone group used a surgeon-monitored app to record Quality of Recovery 15 (QoR15) scores, European Organisation for Research and Treatment of Cancer-selected adverse events, drain outputs, and surgical site photographs over 6 weeks. Patient satisfaction scores were assessed using validated Patient Satisfaction Questionnaire III (PSQ-III) subscales at 2 and 6 weeks postoperatively. The conventional follow-up group also completed the QoR15 and PSQ-III questionnaires at these intervals. The primary outcomes were quality of recovery and patient satisfaction, as measured by the QoR15 and PSQ-III, respectively. Secondary outcomes were costs of follow-up; the number of contacts with the medical system, complications, and surgeons' contacts with patients; and surgeons' perceptions of app-assisted care. Of 72 patients included in the trial, 36 underwent breast reconstruction (mean [SD] age, 45.30 [9.13] years) and 36 underwent gynecologic oncology surgery (mean [SD] age, 54.90 [11.18] years). Three patients dropped out (2 who underwent breast reconstruction [1 in the app group, 1 in the control group], 1 who underwent gynecologic oncology surgery [control group]). The app group had significantly higher mean (SD) QoR15 scores than the control group (2 weeks: 127.58 [22.03] vs 117.68 [17.52], P = .02; 6 weeks: 136.64 [17.53] vs 129.76 [16.42], P = .03). Patients were equally satisfied between groups in all subsets of the PSQ-III at these intervals. The mean (SD) number of complications was similar in both groups, and a similar number of surgeon contacts per patient occurred (1.6 [1.2] vs 2.1 [2.0], P = .16). Surgeons appreciated early identification of complications with the app. In this randomized clinical trial, postoperative follow-up for patients undergoing breast reconstruction and gynecologic oncology surgery using smartphone app-assisted monitoring led to improved quality of recovery and equal satisfaction with care compared with conventional in-person follow-up. ClinicalTrials.gov Identifier: NCT03456167.

Cost-effectiveness of IMI/CIL/REL for the treatment of carbapenem non-susceptible Gram-negative bacterial infections

Objective: The objective of this analysis was to evaluate the cost-effectiveness of imipenem/cilastatin/relebactam compared to colistin-imipenem in the treatment of hospitalized patients with Gram-negative bacterial infections caused by imipenem-resistant pathogens. The perspective was both that of the National Health Service (NHS) and the social one. Methodology: A mixed model was developed to simulate a cohort of patients capable of highlighting the impacts of the disease on the quality of life and the absorption of economic resources of the patients in analysis. Modelled patients were those with hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP), complicated intra-abdominal infection (cIAI) or complicated urinal tract infection (cUTI) caused by carbapenem-resistant Gram-negative (GN) pathogens. The model begins with a short-term decision tree describing possible treatment routes and outcomes for patients during the hospitalization period. Patients who are healed in the decision tree enter the long-term Markov model, designed to capture the follow-up costs and health-related quality of life (HRQL) of patients healed over their lifetime. Results: The analysis, conducted on a hypothetical cohort of 1,000 patients, highlights how the use of imipenem/cilastatin/relebactam is advantageous both in terms of diagnosis and treatment in the short term and in terms of cost-effectiveness. In fact, it is dominant compared to colistin-imipenem both in the NHS and in the social perspective since, compared to an average saving of € 2,800.15 and € 3,174.63 respectively, it would generate an increase of 4.76 years of life and of 4.12 QALYs per patient.

MP39-12 IMPACT OF BPH SURGICAL MANAGEMENT ON PATIENT AND HEALTH PLAN COSTS

You have accessJournal of UrologyCME1 Apr 2023MP39-12 IMPACT OF BPH SURGICAL MANAGEMENT ON PATIENT AND HEALTH PLAN COSTS Kevin Wymer, Gopal Narang, Daniel Heidenberg, Viengneesee Thao, Bijan Borah, Scott Cheney, and Mitchell Humphreys Kevin WymerKevin Wymer More articles by this author , Gopal NarangGopal Narang More articles by this author , Daniel HeidenbergDaniel Heidenberg More articles by this author , Viengneesee ThaoViengneesee Thao More articles by this author , Bijan BorahBijan Borah More articles by this author , Scott CheneyScott Cheney More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A multitude of surgical treatment options exist for BPH - with differences in the level of invasiveness, complications, and durability. Despite the high prevalence of BPH treatment and its significant economic impact, limited data are available comparing the financial burden of specific surgical interventions. METHODS: We identified all commercially insured patients with a diagnosis of BPH who underwent a procedure of interest (SP, TURP, HoLEP, PVP, PUL, or WVTT) between 2015-2020 with the OptumLabs Data Warehouse, which includes commercial insurance and Medicare Advantage data. Patients were matched to a non-BPH control group based on demographic and clinical characteristics. The primary outcomes were patient out-of-pocket (OOP) costs and health plan paid (HPP) costs for the index procedure and combined follow-up years 1-5. A generalized linear model was used to estimate adjusted costs controlling for baseline demographic and clinical characteristics. Patients undergoing WVTT and SP were dropped from follow-up cost analyses due to limited data. RESULTS: Among 21,844 patients with BPH, 10,387 (48%) underwent TURP, 5,300 (24%) underwent PVP, 3,751 (17%) underwent PUL, 1,331 (6%) underwent SP, 906 (4%) underwent HoLEP, and 169 (.7%) underwent WVTT. Average costs for index procedure varied significantly by procedure with WVTT being the least costly with an aggregate cost of $3,516 ($441 OOP; $3,075 HPP), and SP being the most costly with an aggregate cost of $17,155 ($1,293 OOP; $15,862 HPP) (Figure 1). When evaluating combined 5-year follow-up costs, HoLEP was the least costly with an aggregate cost of $11,579 ($2,161 OOP; $9,418 HPP), and PVP was the most costly with an aggregate cost of $16,015 ($2,298 OOP; $13,717 HPP) (Figure 2). CONCLUSIONS: BPH treatment modality has a significant impact on patient and system level costs. Minimally invasive options, such as WVTT, may offer initial cost reductions; however, with the inclusion of longer-term follow up, HoLEP was associated with the lowest patient and HPP costs. Source of Funding: Robert D and Patricia E Kern Center for the Science of Health Care Delivery. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e539 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Wymer More articles by this author Gopal Narang More articles by this author Daniel Heidenberg More articles by this author Viengneesee Thao More articles by this author Bijan Borah More articles by this author Scott Cheney More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement PDF downloadLoading ...

RESULTS OF A COMPARATIVE PHRMACOECONOMICS ANALYSIS OF STRATEGIES FOR THE PREVENTION OF GRAFT-VERSUS-HOST DISEASE IN CHILDREN WITH HEMATOLOGICAL MALIGNANCES: A SINGLE CENTER EXPERIENCE

The discussion around the cost of allogeneic hematopoietic stem cell transplantation and follow-up of patients, methods of calculation and cost structure, despite the breadth of application of hematopoietic stem cell transplantation in oncohematological practice, remains an unresolved problem. The discussion is complicated using various modifications of therapeutic options regarding the preparation of the patient for surgery and the prevention of complications. The purpose of this article is a comparative assessment of the clinical and economic efficiency of the two most used technological platforms – TCRαβ/CD19 depletion and ‘’in vivo’’ depletion with high doses of cyclophosphamide, having studied the features of each of these methods in the real practice of one center. Materials and Methods. For evaluation, two “match paired” groups of children were selected, who underwent transplantation according to one of the methods for hemoblastosis in the period from May 2013 to January 2021 at the National Medical Research Center for Pediatric Hematology, oncology and immunology named after Dmitry Rogachev" of the Ministry of Health of Russia. Based on the obtained indicators of clinical effectiveness (significance of differences was made using the nonparametric Mann-Whitney test), pharmacoeconomic modeling was carried out on the basis of the Markov model, the cost structure was determined and the pharmacoeconomic analysis "cost-effectiveness" was performed, incremental analysis "cost-effectiveness" ”, as well as the calculation of indicators of the cost of the operation after 5 years, taking into account discounting. The results of overall and event-free survival, as well as survival without the development of graft-versus-host disease and relapse were used as endpoints. The costs are divided into 2 time periods: stage 1 – up to 30 days after HSCT and stage 2 – from 31 days after HSCT and up to 1 year. Costs are divided into direct and indirect. For indirect costs, the average figures of the available socio-economic data are taken. Results of the study: The total costs for the two stages were comparable for both platforms: TCRa/b/CD19 deletions – 6702.094 thousand rubles; PtCy – 7325.661 thousand rubles. The costs are unevenly distributed over the stages: the 1st stage is more expensive for the TCR platform, the second for PtCy. In cost-effectiveness analysis, each unit of efficiency (1% survival per 1 year of curation will cost more for the PtCy platform. Given the WHO recommended discount factor of 3% per year, over 5 years, the annual cost for the TCR method should decrease to 5933.316 thousand rubles, and for the PtСy platform up to 6,485.355 thousand rubles without considering macroeconomic indicators. Each additional unit of efficiency (1% survival rate) of TCR will cost: survival rate of 207 855.67 rubles, for survival without GVHD and recurrence of 51 963.92 rubles. Conclusions. Pharmacoeconomically less costly for a period of 1 year of curation is the preventive TCR platform compared to the depletion platform ''in vivo'' using high doses of cyclophosphamide, despite the higher cost of its use at the 1st stage of curation.