Costs Of Other Services Research Articles

Long-acting injectable cabotegravir: implementation science needed to advance this additional HIV prevention choice.

Long-acting injectable cabotegravir: implementation science needed to advance this additional HIV prevention choice.

Health and economic outcomes of newborn screening for infantile-onset Pompe disease

To estimate health and economic outcomes associated with newborn screening (NBS) for infantile-onset Pompe disease in the United States. A decision analytic microsimulation model simulated health and economic outcomes of a birth cohort of 4 million children in the United States. Universal NBS and treatment was compared with clinical identification and treatment of infantile-onset Pompe disease. Main outcomes were projected cases identified, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) over the life course. Universal NBS for Pompe disease and confirmatory testing was estimated to cost an additional $26 million annually. Additional medication costs associated with earlier treatment initiation were $181 million; however, $8 million in medical care costs for other services were averted due to delayed disease progression. Infants with screened and treated infantile-onset Pompe disease experienced an average lifetime increase of 11.66 QALYs compared with clinical detection. The ICER was $379,000/QALY from a societal perspective and$408,000/QALY from the health-care perspective. Results were sensitive to the cost of enzyme replacement therapy. Newborn screening for Pompe disease results in substantial health gains for individuals with infantile-onset Pompe disease, but with additional costs.

Impact on the use and cost of other services following intervention by an inpatient pathway homelessness team in an acute mental health hospital

Background Mental illness in people experiencing homelessness is common and a key reason for attendance at emergency departments and admission to hospital. Aims This paper describes how the KHP Pathway homeless team impacted use and cost of health and wider services. The Pathway model had never been adopted by a mental health hospital, and there had never been an economic analysis to evaluate service use before and after intervention. Method Service use was measured using an adapted version of the Client Service Receipt Inventory (CSRI) with a simple before and after design at admission, 3 months and 6 months after discharge from hospital. Results During the first 3-month follow-up, over half the participants saw a GP, with an increase in the proportion seeing a psychiatrist, social worker and a mental health nurse. Attendance at emergency departments was substantially lower than at baseline. The mean total service cost was £818 at base line and £414 at 3 months. Conclusions The adapted version of the CSRI demonstrates that patients seen by the Pathway Homelessness Team were supported to use community and scheduled health and care services. The service overcomes barriers, frequently experienced by people experiencing homelessness, in accessing support and community healthcare in the UK.

Cost-effectiveness of Housing First Intervention With Intensive Case Management Compared With Treatment as Usual for Homeless Adults With Mental Illness

In the At Home/Chez Soi trial for homeless individuals with mental illness, the scattered-site Housing First (HF) with Intensive Case Management (ICM) intervention proved more effective than treatment as usual (TAU). To evaluate the cost-effectiveness of the HF plus ICM intervention compared with TAU. This is an economic evaluation study of data from the At Home/Chez Soi randomized clinical trial. From October 2009 through July 2011, 1198 individuals were randomized to the intervention (n = 689) or TAU (n = 509) and followed up for as long as 24 months. Participants were recruited in the Canadian cities of Vancouver, Winnipeg, Toronto, and Montreal. Participants with a current mental disorder who were homeless and had a moderate level of need were included. Data were analyzed from 2013 through 2019, per protocol. Scattered-site HF (using rent supplements) with off-site ICM services was compared with usual housing and support services in each city. The analysis was performed from the perspective of society, with days of stable housing as the outcome. Service use was ascertained using questionnaires. Unit costs were estimated in 2016 Canadian dollars. Of 1198 randomized individuals, 795 (66.4%) were men and 696 (58.1%) were aged 30 to 49 years. Almost all (1160 participants, including 677 in the HF group and 483 in the TAU group) contributed data to the economic analysis. Days of stable housing were higher by 140.34 days (95% CI, 128.14-153.31 days) in the HF group. The intervention cost $14 496 per person per year; reductions in costs of other services brought the net cost down by 46% to $7868 (95% CI, $4409-$11 405). The incremental cost-effectiveness ratio was $56.08 (95% CI, $29.55-$84.78) per additional day of stable housing. In sensitivity analyses, adjusting for baseline differences using a regression-based method, without altering the discount rate, caused the largest change in the incremental cost-effectiveness ratio with an increase to $60.18 (95% CI, $35.27-$86.95). At $67 per day of stable housing, there was an 80% chance that HF was cost-effective compared with TAU. The cost-effectiveness of HF appeared to be similar for all participants, although possibly less for those with a higher number of previous psychiatric hospitalizations. In this study, the cost per additional day of stable housing was similar to that of many interventions for homeless individuals. Based on these results, expanding access to HF with ICM appears to be warranted from an economic standpoint. isrctn.org Identifier: ISRCTN42520374.

The Association Between Out-of-Pocket Costs and Adherence to Adjuvant Endocrine Therapy Among Newly Diagnosed Breast Cancer Patients.

To determine how out-of-pocket costs for adjuvant endocrine therapy (AET) medication affects adherence among newly diagnosed breast cancer survivors with private health insurance who initiate therapy. We examined medical and pharmacy claims for the 1-year period after initiating AET using the Truven Health Analytics MarketScan database. Adherence was defined as ≥80% proportion of days covered. Mean out-of-pocket costs for AET fill were measured as the sum of copayments, coinsurance, and deductibles and adjusted to 30-day amounts. Using a multivariable logistic regression model we calculated adjusted risk ratios controlling for age, comorbidities, type of surgery, use of chemotherapy and/or radiation therapy, average out-of-pocket costs for other services, and pharmacy use characteristics. Of the 6863 women 64 years and younger who were diagnosed with breast cancer and initiated AET, 73.9% were adherent (proportion of days covered≥80%). A total of 19% of patients had <$5 monthly out-of-pocket costs for AET, 30% had $5 to $9.99, 17% had $10 to $14.99, 10% had $15 to $19.99, and 25% had $20 or greater. Patients with out-of-pocket costs for AET between $10 and $14.99, $15 and $19.99, and >$20 were 6% to 8% less likely to be adherent compared with patients paying <$5.00, after controlling for covariates (P<0.05). Out-of-pocket costs for inpatient, outpatient, and other pharmacy services were not associated with adherence. A substantial proportion of privately insured patients are nonadherent to AET and out-of-pocket costs for AET medication are significantly associated with a greater likelihood of nonadherence.

PUK8 - Transplanting Kidneys from HCV Positive Donors into HCV Negative Recipients in the Era of Direct Acting Antiviral Therapy: A Cost Effectiveness Analysis

To compare cost and effectiveness between two choices: 1) renal transplantation (RT) from a HCV+ donor (D+) into HCV- recipient (R-) followed by immediate direct acting antiviral (DAA) therapy; 2) R- continuing dialysis and waiting for RT from a HCV- donor (D-). A decision tree model was developed for the comparison over a 5-year time frame, using a payer’s perspective. Effectiveness was measured in expected years of life (YOL) using data extracted from United States Renal Data System (USRDS) 2016 Annual Report. Costs (adjusted in 2017 USD) included direct expenditures for RT and immediate care post-RT, immunosuppressive therapy, dialysis and associated medication costs while awaiting RT, and 12 weeks of DAA for D+/R- patients. Indirect and intangible costs were not modeled. National Average Drug Acquisition Costs were used to estimate DAA costs. Costs for other services were extracted from either the USRDS 2016 Annual Report or the Centers for Medicare & Medicaid Services payment database. D-/R- patients were examined at the end of year 2, year 3, and year 4 during the 5-year frame, assuming that the probability of getting a RT increased each year (25% in year 2, 50% in year 3, and 75% in year 4). The D+/R- strategy resulted in an expected 4.6 YOL with an expected total cost of $153k compared to 3.6 YOL and $264k for the D-/R- strategy. The D+/R- strategy remained dominant after one-way sensitivity analyses on RT survival probability, DAA therapy cure rate, waiting time on dialysis in D+/R- strategy, cost of kidney transplant and DAA treatment, year during which dialysis patients received a RT, and dialysis survival probability while awaiting RT in D-/R- strategy. The innovative D+/R- strategy followed by treating the HCV with DAA is less costly and more effective compared to the traditional D-/R- strategy.

Cost of Schizophrenia in the Medicare Program

Medicare beneficiaries diagnosed with non-schizoaffective schizophrenia (MBS) in a 5% national Medicare fee-for-service sample from 2003-2007 were followed for 1-6 years. Medicare population and cost estimates also were made from 2001-2009. Service utilization and Medicare (and beneficiary share) payments for all services except prescription drugs were analyzed. Although adults with schizophrenia make up approximately 1% of the US adult population, they represent about 1.5% of Medicare beneficiaries. MBSs are disproportionately male and minority compared to national data describing the overall schizophrenia population. They also are younger than the general Medicare population (GMB): males are 9 years younger than females on average, and most enter Medicare long before age 65 through eligibility for social security disability, remaining in the program until death. The cost of care for MBSs in 2009 was, on average, 80% higher than for the average GMB per patient year (2010 dollars), and more than 50% of these costs are attributable to a combination of psychiatric and medical hospitalizations, concentrated in about 30% of MBSs with 1 or more hospitalizations per year. From 2004-2009, total estimated Medicare fee-for-service payments for MBSs increased from $9.4 billion to $11.5 billion, excluding Part D prescription drugs and payments for services to MBSs in Medicare for less than 1 year. Study results characterize utilization and costs for other services and suggest opportunities for further study to inform policy to improve access and continuity of care and decrease costs to the Medicare program associated with this population.

Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience

ObjectivesTo review the literature on the potential efficiency gains of integrating HIV services with other health services.DesignSystematic literature review. Search of electronic databases, manual searching and snowball sampling. Studies that...

Cost of treatment of schizophrenia in six European countries

Background and aims As part of an RCT in six European sites, the direct mental health care cost for 422 patients with schizophrenia was analysed according to how total and medication costs differed across sites and which variables were likely to predict total or service-specific costs. Method Service use was recorded continuously during a 12-month follow-up. Prescribed psychotropic medication was recorded at baseline and 12 months later. Service use data were transformed into EURO, log-transformed and analysed using linear regression models. Results Although samples were homogeneous, large inter-site cost differences were found (annual means ranging from 2958 € in Spain up to 36978 € in Switzerland). Psychopharmacologic costs were much more constant across sites than costs for other services. Total costs were associated more with region or socio-demographic characteristics than with disorder related parameters. Conclusions The findings confirm remarkable differences in direct costs of patients with schizophrenia across Europe. However, the relative stability of medication costs suggests a need to analyse mechanisms that influence service-specific costs for schizophrenia.

Costing maternal health services in South Tanzania

The following paper presents the methodology and results of a costing exercise of maternal health services in Tanzania. The main objective of this study was to determine the actual costs of antenatal and obstetric care in different health institutions in a district in Tanzania as a basis of more efficient resource allocation. A costing tool was developed that allows the calculation of costs of service units, such as deliveries and antenatal care, and separates these costs from the costs of other services. Time consumed by each activity was used as an allocation key. For that purpose, we recorded the personnel consumption with different time-study methodologies. This approach was tested and implemented in Mtwara Urban District, South Tanzania. The results were analyzed by a spreadsheet program. The paper presents average costs for different costing units of maternal care. Among other findings, we found that the cost of a normal vaginal delivery is US $12.30 in a dispensary and US $6.30 in the hospital--a result that needs explanation, as usually one would expect that hospitals are more cost-intensive than first-line facilities. However, dispensaries are grossly underutilized so that the costs per service unit are rather high. The cost for surgical delivery (only in hospitals) was found to be US $69.26 and the average cost per antenatal care consultation (only at dispensaries) was US $2.50. We conclude that improved planning of elective services is a prerequisite for more effective and efficient use of personnel resources. In addition, the definition of medically and economically sound standards, in particular staffing standards, is critical to make cost analysis an effective management tool to guide rational resource allocation.

Infant feeding and cost of health care: A cohort study

Abstract Aim: To compare the use and cost of health care in infants with different feeding patterns. Methods: Observational study on a cohort of 842 infants born in ten hospitals in northern Italy and followed up to age 12 months. Data on feeding gathered through telephone interviews with 24‐hour recall. Data on use of health services reported by mothers and checked against records. Data on hospital cost derived from Disease Related Groups codes. Data on cost of other services obtained from maternal reports and available price lists. Results: At three months, 56% of infants were fully breastfed, 17% complementary fed and 27% not breastfed. Infants fully breastfed at three months had 4.90 episodes of illness requiring ambulatory care and 0.10 hospital admissions per infant/year compared with 6.02 and 0.17, respectively, in infants not or not fully breastfed. They had also a lower cost of health care: €34.69 versus 54.59 per infant/year for ambulatory care, and €133.53 versus 254.03 per infant/year for hospital care. Higher cost of health care was significantly associated with having a hospital admission and being a twin; cost of health care decreased with each additional gram of birth weight, each month of delayed return of the mother to work after the third month, and each extra month of breastfeeding. Conclusion: Lack of breastfeeding and higher use and cost of health care are significantly associated.

Infant feeding and cost of health care: A cohort study

To compare the use and cost of health care in infants with different feeding patterns. Observational study on a cohort of 842 infants born in ten hospitals in northern Italy and followed up to age 12 months. Data on feeding gathered through telephone interviews with 24-hour recall. Data on use of health services reported by mothers and checked against records. Data on hospital cost derived from Disease Related Groups codes. Data on cost of other services obtained from maternal reports and available price lists. At three months, 56% of infants were fully breastfed, 17% complementary fed and 27% not breastfed. Infants fully breastfed at three months had 4.90 episodes of illness requiring ambulatory care and 0.10 hospital admissions per infant/year compared with 6.02 and 0.17, respectively, in infants not or not fully breastfed. They had also a lower cost of health care: 34.69 euro versus 54.59 per infant/year for ambulatory care, and 133.53 euro versus 254.03 per infant/year for hospital care. Higher cost of health care was significantly associated with having a hospital admission and being a twin; cost of health care decreased with each additional gram of birth weight, each month of delayed return of the mother to work after the third month, and each extra month of breastfeeding. Lack of breastfeeding and higher use and cost of health care are significantly associated.

129th ENMC International Workshop: Clinical Trials for Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Multifocal Motor Neuropathy, 27th October 2004, Schiphol airport, The Netherlands

There is uncertainty about the best immunosuppressive treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) and consequently a wide variation in practice. CIDP affects between 2 and 8 per 100,000 and MMN has a prevalence about 10 times lower. Both conditions are economically important because intravenous immunoglobulin (IVIg) is often used in their treatment and is very expensive especially because of the need for repeated courses. Multicentre trials are necessary to provide sufficient participants for adequately powered trials and need to be conducted at a multinational level. The evidence for treatment has been systematically reviewed in Cochrane reviews [1,2] and a previous ENMC workshop had already considered MMN [3]. In CIDP steroids, IVIg or plasma exchange (PE) and in MMN IVIg provide short-term benefit but the value of immunosuppressant treatment has not been adequately evaluated. Encouragingly there are four ongoing trials in CIDP and one in MMN. A Bayer trial compares IVIg with placebo over a longer period than has been tested before (M MaasEnriquez, personal communication). A Biogen-Idec trial tests whether interferon-beta 1a will reduce the requirement for IVIg [4]. A Dutch trial aims to find out whether pulsed high dose dexamethasone induces remissions more often and more rapidly and is more effective than standard prednisolone treatment (I van Schaik personal communication). An Italian trial aims to compare IVIg and high dose

When It's Smart to Turn Away Business

Most directors of marketing intuitively know that accepting some business has an opportunity cost of not being able to accept potentially more lucrative business. The decision becomes particularly critical when the prospective contract is for a large event, such as a conference. Some hotels address this matter by, for instance, requiring executive committee approval for all large contracts or all business that involves function space. The decision can be made much earlier and more simply by individual sales representatives or sales managers, however, if they analyze the tradeoffs of any potential contract. An analytical approach can be built into a spreadsheet calculation that takes into account such variables as special room rates, potential banquet revenues and costs, and revenues and costs of other services (e.g., audio-visual support). The decision is more than quantitative, however, and must take into account such factors as the effect on other guests' perceptions of the hotel if, say, facilities are jammed by conventioneers. Those effects cannot be modeled on a spreadsheet and are subject to the marketing director's judgment.

When it's smart to turn away business

Most directors of marketing intuitively know that accepting some business has an opportunity cost of not being able to accept potentially more lucrative business. The decision becomes particularly critical when the prospective contract is for a large event, such as a conference. Some hotels address this matter by, for instance, requiring executive committee approval for all large contracts or all business that involves function space. The decision can be made much earlier and more simply by individual sales representatives or sales managers, however, if they analyze the tradeoffs of any potential contract. An analytical approach can be built into a spreadsheet calculation that takes into account such variables as special room rates, potential banquet revenues and costs, and revenues and costs of other services (e.g., audio-visual support). The decision is more than quantitative, however, and must take into account such factors as the effect on other guests' perceptions of the hotel if, say, facilities are...

The cost of cervical cancer screening provided by a women's health nurse

This study examines the cost of cervical cancer screening provided by a women's health nurse. Methods used to estimate the cost of taking a Pap smear were based on the economic principle of opportunity cost. Techniques for estimating the magnitude of some costs were developed specifically for this study because the cost of taking a Pap smear had to be isolated from the costs of other services provided by the women's health nurse. The cost of taking a Pap smear in 1989 was estimated to be between $17.68 and $17.95. A sensitivity analysis was carried out so that the results of this study could be adapted for practices which differ from the women's health nurse's practice in the Mount Druitt and Hawkesbury area of New South Wales. As a result of this analysis, the cost of taking a Pap smear ranged from $14.16 to $38.88, depending on whether the women's health nurse was a Clinical Nurse Consultant or Clinical Nurse Specialist, the number of Pap smears taken, the proportion of clients who come for postnatal examinations, length of consultations and the distance travelled. It should be noted that the cost of taking a Pap smear would rise considerably above $38.88 for women's health nurses working in remote areas.

The cost of controlling crime: A study in economies of city life

Sizeable economies and diseconomies of size exist with regard to a given quality of police protection. Our results show that the per capita social cost of crime declines slowly with larger cities until a low point is reached in cities with a population ranging from 250, 000 to 500, 000. Social costs rise sharply for cities of over 1 million inhabitants. By and large, the smaller cities are able to reduce their crime rates with an increase in police numbers while the larger cities fail to do so based on evidence from time series analysis. Thus our results underestimate the social cost of crime in large cities even though they show the cost to be lower in small cities than in large cities. The results suggest that policies of decentralization rather than increasing police rates may be the most cost-effective long-run solution to high crime rates in large cities. Recommendation of a policy, however, awaits a more definitive analysis of costs of other services by city size.