Cumulative Cost Savings Research Articles

Consumer-focused solar-grid net zero energy buildings: A multi-objective weighted sum optimization and application for India

Abstract Buildings account for nearly 40% of the world's energy consumption. Renewable energy sources can help decarbonization by facilitating the achievement of Net Zero Energy Buildings (NZEB). NZEB can be achieved by efficient coordination of the grid-connected load in the building tuned to a consumer's energy demand, usage pattern, and available energy sources. An effective NZEB system calls for an energy-efficient management technique. This paper proposes a novel mathematical strategy for electrical energy management in a residential building. The suggested method establishes a Net Zero Energy (NZE) in a residential building with maximum electrical energy comfort and minimum drain on electrical energy. We validate the concept using a Multi-Objective Differential Evolution optimization methodology using a consumer-controlled approach to obtain Pareto points to guarantee optimal solutions in an NZEB. The proposed scheme delineates the net cumulative electrical energy cost savings of the consumer, ensuring minimum electrical energy discomfort, and minimization of carbon footprints in an NZE Photovoltaic-Grid tied residential building. We highlight the socioeconomic benefits of adopting the methodology in identifying the true potential of NZEBs in meeting global challenges. This research provides insights to the engineers and policy makers to increase consumer participation in the energy performance in an NZEB.

Does Biosimilar Bevacizumab Offer Affordable Treatment Options for Cancer Patients in the USA? A Budget Impact Analysis from US Commercial and Medicare Payer Perspectives.

BackgroundBevacizumab remains the most widely used and most thoroughly characterized angiogenesis inhibitor for a range of advanced cancers. Bevacizumab-bvzr (Zirabev®), a biosimilar of bevacizumab, was recently approved by the US Food and Drug Administration (FDA), which provides a less costly option. This study aimed to evaluate the financial impact of introducing bevacizumab-bvzr from US commercial and Medicare payer perspectives.MethodsA Microsoft Excel-based budget impact model was developed over a 5-year time horizon. Target population was patients to be treated with bevacizumab for FDA-approved indications. Drug costs (2020 US$) were based on average sales price and wholesale acquisition cost, accounting for payer-specific reimbursement models and provider settings. Drug dosing and duration were based on prescribing information and pivotal trial publications.ResultsIn a hypothetical 10-million-member health plan, 503 and 723 patients were estimated to be treated with bevacizumab in year 1 and year 5, respectively. Assuming an annual market shift of 1.7%, 3.6%, 6.7%, 9.4%, and 11.9% to bevacizumab-bvzr, an annual cost saving of $313,363 ($0.003 per member per month [PMPM]) was estimated for a commercial payer and $92,880 ($0.001 PMPM) for Medicare in year 1. Cumulative 5-year cost savings were $7,030,924 ($0.012 PMPM) for a commercial payer and $4,059,257 ($0.007 PMPM) for Medicare. More than half of the cost savings was attributed to patients with metastatic colorectal cancer.ConclusionsThe introduction of biosimilar bevacizumab-bvzr was estimated to provide substantial cost savings for US payers, which would allow additional patients access to bevacizumab treatment.

Biosimilar pegfilgrastim may offer affordable treatment options for patients in France: a budget impact analysis on the basis of clinical trial and real-world data

Background NYVEPRIA, a pegfilgrastim (a long-acting granulocyte colony-stimulating factor [G-CSF]) biosimilar, was recently recommended for marketing authorization in Europe for decreasing the incidence of febrile neutropenia (FN) in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs. The present study aimed to evaluate the financial impact of introducing a new pegfilgrastim biosimilar from a French healthcare system perspective. Methods An Excel-based budget impact model was developed to estimate the financial impact by introducing a new pegfilgrastim biosimilar (NYVEPRIA) to France over a 5-year time horizon. Comparators included existing long-acting and short-acting G-CSFs. The burden of FN was obtained from existing literature. Costs (2021 Euros) included drug acquisition and administration, estimated based on drug dosage in both clinical trial and real-world settings. Scenario analyses were conducted to examine the robustness of key model assumptions. Results In a total French population of 67.19 million, 79,873 patients were estimated to be treated with G-CSFs annually. The annual number of patients to be treated with NYVEPRIA was estimated to be 1593, 3195, 3674, 3782, and 4052 in years 1 to 5, respectively. Using real-world data, NYVEPRIA resulted in total annual cost savings of €8,620, €868,498, €868,498, €814,102, and €958,952 over years 1 to 5, respectively, leading to a cumulative 5-year cost savings of €3,518,669. Using data from clinical trials, NYVEPRIA resulted in total annual cost savings of €14,366, €1,447,496, €1,447,496, €1,356,836, and €1,598,253 over years 1 to 5, respectively, leading to a cumulative 5-year cost savings of €5,864,448. Conclusions The introduction of a new pegfilgrastim biosimilar (NYVEPRIA) is potentially associated with substantial cost savings for the French healthcare system.

Benefits of fracture liaison services (FLS) in four Latin American countries: Brazil, Mexico, Colombia, and Argentina

Aims Fracture liaison services (FLS) use a multidisciplinary approach to treat patients who have experienced an osteoporotic fracture to reduce the risk of subsequent fractures. To date, there has been minimal FLS implementation in Latin America where fractures continue to be undertreated. This study aims to estimate the number of fractures averted, bed days avoided, and costs saved resulting from universal FLS implementation in Brazil, Mexico, Colombia, and Argentina. Materials and methods A calculator was developed to estimate the annual benefits of FLS programs in Brazil, Mexico, Colombia, and Argentina from a public hospital perspective. It was assumed all patients with a hip, vertebral, or wrist fracture were referred to an FLS program. Country-specific data were obtained from a previous systematic review and interviews with osteoporosis experts. Hospitalization and post-hospitalization costs were expressed in 2019 USD without discounting. Costs of FLS implementation were not considered. Results In 2019, the number of FLS patients prevented from having a subsequent hip, vertebral, or wrist fracture was estimated as 15,607 in Brazil, 8,168 in Mexico, 5,190 in Argentina, and 2,435 in Colombia with total bed days saved of 142,378 in Brazil, 75,877 in Mexico, 52,301 in Argentina, and 21,725 in Colombia. The annual cost savings in 2019 were highest in Argentina (28.1 million USD), followed by Mexico (19.6 million USD), Brazil (7.64 million USD) and Colombia (3.04 million USD). Over five years (2019–2023) the cumulative cost savings were 145 million USD in Argentina, 106 million USD in Mexico, 40.5 million USD in Brazil, and 16.1 million USD in Colombia. Conclusion Universal FLS implementation in Brazil, Mexico, Colombia, and Argentina was predicted to prevent 31,400 fractures, avoid 292,281 bed days, and save 58.4 million USD in 2019, though caution is warranted in the interpretation of these results due to high uncertainty. Increased implementation of FLS programs in Latin American countries may help to realize these benefits.

Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France.

AimCardiogenic shock (CS), if not diagnosed and treated rapidly, can lead to irreversible multiorgan damage and death. An economic analysis was conducted to determine the budget impact of the introduction of Impella 5.0®, a mechanical circulatory support (MCS) device that directly unloads the left ventricle, into clinical practice in patients with left ventricular CS in France.MethodsA budget impact model was developed to compare the cost of Impella 5.0 with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) from the perspective of the French national healthcare insurer. Costs associated with Impella 5.0, plus complication-related costs for VA-ECMO or Impella 5.0 from 2019 were included and clinical input data relating to complication rates and time spent on device were sourced from published literature. Extensive scenario and one-way deterministic sensitivity analyses were performed to explore the influence of uncertainty around key input parameters.ResultsOver a time horizon of 5 years, the introduction of Impella 5.0 was associated with cumulative savings of EUR 4.3 million. The results were driven by the lower risk of device-related complications associated with Impella 5.0. Savings were apparent from Year 1 onwards, with savings in excess of EUR 375,000 projected in Year 1 alone. On a per-patient level, in Year 1, estimated savings with the introduction of Impella 5.0 totaled EUR 616 per patient. Sensitivity analyses showed that the findings of the analysis were robust.ConclusionThe Impella 5.0 device was associated with cumulative cost savings in excess of EUR 4 million over a 5-year period compared with current practice. Projected savings were driven by a lower rate of device-related complications with Impella 5.0 compared with VA-ECMO.

CC-486 Reduces Hospitalization and Associated Estimated Costs in Patients with Acute Myeloid Leukemia (AML) in First Remission after Intensive Chemotherapy: Results from the QUAZAR AML-001 Maintenance Trial

CC-486 Reduces Hospitalization and Associated Estimated Costs in Patients with Acute Myeloid Leukemia (AML) in First Remission after Intensive Chemotherapy: Results from the QUAZAR AML-001 Maintenance Trial

Demand response through reject water scheduling in water resource recovery facilities: A demonstration with BSM2

The objective of this paper is to determine the importance of integrating peak demand mitigation and future energy pricing structures for process modelling of conventional water resource recovery facilities (WRRFs) when evaluating energy cost and control strategies. The well-established benchmark simulation model (BSM2) is used to monitor energy usage, and a detailed holistic study of different flow streams is performed in order to establish potential opportunities for flexible control of WRRF energy demand. Secondly, a detailed framework is introduced to optimize scheduling control strategies for the reject water stream while considering peak electricity demand avoidance as well as completing a comprehensive energy cost model based on current and anticipated future energy tariff structures. The reject water scheduling strategies, without other active controls (e.g. aeration), revealed 63.4% average peak demand mitigation and €10,755 cumulative annual energy cost savings on a 100k population equivalent WRRF without a deterioration in effluent quality. Analysis of different reject water scheduling control strategies shows that reject water scheduling can be an effective tool for energy cost optimisation under alternative electricity tariff structures. These strategies also deliver electricity peak demand mitigation.

Would weight parity on interstate highways improve safety and efficiency of timber transportation in the US South?

ABSTRACT In the US, weight limits on interstate highways are established by the federal government while weight limits on other roadways are established by state or local governments. State weight limits for log trucks exceed federal interstate highway weight limits in all major timber-producing states. This disparity discourages log trucks from traveling loaded on interstate highways. This study compared the safety and efficiency of log truck transportation on current routes to routes utilizing interstate highways in eight wood baskets in the US South. Timber harvest and delivery locations were collected from logging businesses, log truck owners, and forest landowners. GPS truck tracking software and ArcGIS were used to estimate travel distance and travel time on optimal interstate routes and current routes that avoided interstate highways. The sample included 907 unique routes from 257 harvest sites. An average of 39% of routes would benefit from interstate highway access and 66% of harvest sites had at least one load that would benefit from interstate access. Evidence suggests that interstate routes would be safer than current routes because log trucks would encounter 41% fewer intersections, 33% fewer stop signals, and approximately one fewer school zone per route. Despite no significant change in average haul distance, interstate highway access would result in estimated cumulative annual travel cost savings of $7.4 million (USD) in the wood baskets analyzed. Findings suggest that allowing state-legal, loaded log trucks to operate on interstate highways would improve the safety and efficiency of timber transportation in the US South.

Cost-effectiveness and budget impact analysis of a patient visit support system for blindness reduction in Japanese patients with glaucoma

Aim To evaluate the cost-effectiveness (CE) and budget impact (BI) of introducing a patient visit support system (ACT Pack) along with standard of care (SoC), in glaucoma treatment in Japan. Methods A Markov model was designed to estimate the CE and BI of introducing the support system from Japanese payer and governmental perspective, respectively. Inputted data for CE and BI analysis were referred from published literature and based on medical specialists’ inputs. Base case scenario for CE considered the support system cost of 30,000 yen per patient per year and a time horizon of 45 years. BI analysis compared the financial impact due to introduction of support system with SoC compared to SoC alone scenario on Japanese healthcare system with a time horizon of 20 years. Results The base case of CE analysis showed the incremental cost per quality-adjusted life years (QALYs) gained with the support system was 3,241,729 yen/QALY (29,470 USD/QALY). The sensitivity analysis showed that the probability of this support system being cost-effective at a threshold of 5 million yen/QALY (45,455 USD/QALY) was 53.26%. Blindness reduction after introduction of this support system was 8.68%. The BI analysis showed that the introduction of support system will lead to a cumulative cost savings of 1,132 billion yen (10 billion US dollars) for Japanese healthcare system over 20 years of time horizon. Limitation Due to paucity of similar comparative studies, some assumptions were made based on medical specialists’ inputs. Death status was not considered in the analysis. Conclusion Introduction of this support system with SoC is cost-effective and will lead to blindness reduction in Japanese patients with glaucoma. Over a 20 year period, it will lead to an overall cost savings of 1,132 billion yen (10 billion US dollars) for the Japanese healthcare system.

The impact of antimicrobial stewardship program implementation at four tertiary private hospitals: results of a five-years pre-post analysis

BackgroundAntimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the consumption and cost of antimicrobial agents using defined daily dose (DDD) and direct cost of antibiotics before and after the AMS program implementation. Secondary objective was to determine the rate of HAIs [Clostridium difficile (C. difficile), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLABSI) before and after the AMS program implementation.MethodsThis is a pre-post quasi-experimental study. Adult inpatients were enrolled in a prospective fashion under the active AMS arm and compared with historical inpatients who were admitted to the same units before the AMS implementation. Study was conducted at four tertiary private hospitals located in two cities in Saudi Arabia. Adult inpatients were enrolled under the pre- AMS arm and post- AMS arm if they were on any of the ten selected restricted broad-spectrum antibiotics (imipenem/cilastatin, piperacillin/tazobactam, colistin, tigecycline, cefepime, meropenem, ciprofloxacin, moxifloxacin, teicoplanin and linezolid).ResultsA total of 409,403 subjects were recruited, 79,369 in the pre- AMS control and 330,034 in the post- AMS arm. Average DDDs consumption of all targeted broad-spectrum antimicrobials from January 2016 to June 2019 post- AMS launch was lower than the DDDs use of these agents pre- AMS (233 vs 320 DDDs per 1000 patient-days, p = 0.689). Antimicrobial expenditures decreased by 28.45% in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at S.R. 6,286,929 and negligible expenses of S.R. 505,115 (p = 0.648). Rates of healthcare associated infections involving C. difficile, VAP, and CLABSI all decreased significantly after AMS implementation (incidence of HAIs in 2015 compared to 2019: for C. difficile, 94 vs 13, p = 0.024; for VAP, 24 vs 6, p = 0.001; for CLABSI, 17 vs 1, p = 0.000; respectively).ConclusionImplementation of AMS program at HMG healthcare facilities resulted in reduced antimicrobials use and cost, and lowered incidence of healthcare associated infections.

Implementing Value-Based Primary Care Delivery in Federally Qualified Health Centers.

Federally Qualified Health Centers (FQHCs), like many health systems, are in transition toward alternative/advanced payment and reimbursement models. Gradually, fee-for-service reimbursements will be replaced by value-based payments with shared accountability for patients' health care outcomes. This article provides a description of an FQHC Primary Care Collaborative (FPCC) model and preliminary outcomes. This collaborative is an advanced payment model resulting from a partnership between Priority Partners Managed Care Organization (PPMCO), Maryland Community Health System, LLP, and 7 Maryland FQHCs. The FPCC model builds on shared measurable health care outcomes to establish an advanced care delivery model that is tailored to the needs of providers and their patients. PPMCO provided prospective payments to the 7 FQHCs based on their patient population size and total historical cost. Each FQHC had specific health outcomes targets for each fiscal year (FY) to maintain funding. Although FQHC implementation approaches varied, the FQHCs used their payments primarily for outreach and care coordination resources, and to develop processes and structures to improve care delivery outcomes. A 3-year assessment of this program revealed a 35% reduction in emergency department visits and an 11% reduction in hospitalizations for Medicaid beneficiaries across all 7 FQHCs. The FPCC 3-year investment of $4.4M yielded a cumulative cost savings of $19.4M, resulting in a cumulative 3:1 return on investment. There is limited evidence for implementation and outcomes of non-state, Medicaid payer-specific, advanced payment models in FQHCs. This article provides a collaborative framework other Medicaid managed care organizations can adopt and build on.

Value and Cost Effectiveness of Storing Peripheral Blood Progenitor Cells for Salvage Autologous Stem Cell Transplant in Multiple Myeloma

<h3>Introduction</h3> Salvage autologous stem cell transplant (sASCT) may be associated with improved survival in multiple myeloma (MM) and is an option for patients with long time to relapse (TTR) after initial Autologous transplant (ASCT1). Due to potential mobilization failure after maintenance therapy (MT), adequate peripheral blood progenitor cells (PBPC) are frequently collected for later sASCT. <h3>Objectives</h3> Evaluate utilization of stored PBPC in MM. Provide a cost analysis of collecting and storing PBPC for sASCT. Determine utilization of sASCT in those eligible who had a prolonged TTR. <h3>Methods</h3> We included MM patients who received ASCT1 at our institution between 2009 and 2016. Extra day of collection (EDC) was defined as additional collection of ≥2 × 10⁶ cells/kg PBPC for a second transplant. TTR was calculated as months from ASCT1 to relapse. Eligibility for sASCT was defined as TTR ≥18 months without MT or ≥36 months on MT. Patients who underwent tandem transplant (tASCT) (defined as two transplants within 6 months) were excluded from relapse analysis. Patients with inadequate relapse data defined as death or lost to follow up (LTFU) at ≤36 months prior to relapse, or ≤6 months follow up after relapse were excluded. Costs were obtained from the institution charge master. Descriptive statistics were calculated for the final cost benefit analysis. <h3>Results</h3> 154 MM patients received ASCT1 from 2009-2016. Median age was 59 years. Median follow up was 151 months. Median TTR was 20 months. 58% were male. Ethnicity was 76% Caucasian and 24% Black. 62% had IgG MM subtype, 23% IgA MM and 15% other. Majority (95%) were European Cooperative Oncology Group (ECOG) 0 or 1. 13% had high risk cytogenetics. 53% received MT. 137(89%) had PBSC stored for sASCT. 3 were used for sASCT and 10 for tASCT. 124 (90.5%) did not use stored cells. 54 (39%) met collection targets for two transplants in single collection while 83 (%) required ≥1 EDC with cumulative 108 EDC. (Figure 1) Cumulative cost savings for plerixafor use, cell collection, processing, analysis and storage was estimated at $2,252,244. (Figure 2). Total 60 doses of plerixafor were used for EDC. (31 patients with 1EDC, 10 with 2EDC and 3 with 3 EDC). 97 patients were studied for relapses. 54 (77.5%) relapsed. 5 deaths and 8 LTFU occurred within ≤6 months of relapse. 42 patients were further analyzed. 25 of them met criteria for sASCT based on TTR and only 2 received sASCT.1 patient with sASCT did not have MT data and was excluded. (Figure 3) <h3>Conclusion</h3> Only 25% (24/98) patients who underwent ASCT1 were eligible for sASCT. Only 2% (2/98) received sASCT. Collecting and storing PBPC for sASCT is associated with high cost, but overall utilization at our institution is low. Our findings should be compared against practices at other institutions to help develop guidelines for selection of subset of MM where this practice may be of higher value.

The health and economic burden of osteoporotic fractures in Singapore and the potential impact of increasing treatment rates through more pharmacological options.

This study aims to estimate the health and economic burden of osteoporosis in Singapore from 2017 to 2035, and to quantify the impact of increasing the treatment rate of osteoporosis. Population forecast data of women and men aged 50 and above in Singapore from 2017 to 2035 was used along with prevalence rates of osteoporosis to project the osteoporosis population over time. The population projections by sex and age group were used along with osteoporotic fracture incidence rates by fracture type (hip, vertebral, other), and average direct and indirect costs per case to forecast the number of fractures, the total direct health care costs, and the total indirect costs due to fractures in Singapore. Data on treatment rates and effects were used to model the health and economic impact of increasing treatment rate of osteoporosis, using different hypothetical levels. Between 2017 and 2035, the incidence of osteoporotic fractures is projected to increase from 15,267 to 24,104 (a 57.9% increase) F 10,717 to 17,225 (a 60.7% increase) and M 4550 to 6878 (a 51.2% increase). The total economic burden (including direct costs and indirect costs to society) associated with these fractures is estimated at S$183.5 million in 2017 and is forecasted to grow to S$289.6 million by 2035. However, increasing the treatment rate for osteoporosis could avert up to 29,096 fractures over the forecast period (2017-2035), generating cumulative total cost savings of up to S$330.6 million. Efforts to improve the detection, diagnosis, and treatment of osteoporosis are necessary to reduce the growing clinical, economic, and societal burden of fractures in Singapore.

PRO18 BUDGET IMPACT ANALYSIS OF DAMOCTOCOG ALFA PEGOL IN SEVERE HEMOPHILIA A IN GREECE

To estimate the impact on the Greek public payer budget from the use of damoctocog alfa pegol (DaPeg), an extended half-life recombinant factor VIII, for prophylactic and on-demand (OD)-treatment of patients ≥12 years with severe haemophilia A (HemA) having received previous treatment in Greece. A 5-year budget impact model (BIM) was adapted with local data. The BIM compares a market scenario where a proportion of HemA patients receives DaPeg to an alternative market scenario where DaPeg is not available and patients are treated with available comparators, namely efmoroctocog-alfa, turoctocog-alfa, moroctocog-alfa and octocog-alfa (rAHF-PFM, BAY 81-8973). Epidemiologic data were derived by combining data from three Greek hemophilia centers and the World Hemophilia Federation (2017). Assuming equivalent efficacy (bleeding rates) across all comparators, clinical outcomes were not modelled. Current and future market shares for prophylaxis and OD-treatment were provided by the manufacturer. Only treatment costs were considered for prophylaxis and OD-treatment (€, 2019) with the doses obtained from the SPC and clinical trials, respectively. The difference between the total costs in each market scenario was the net budget impact. For a total of 231 patients with severe HemA, the introduction of DaPeg with a market share ranging from 5% to 27% in prophylaxis and 3% to 9% in OD-treatment from year 1 to 5, respectively, results in cost savings compared to the world without DaPeg. The budget saving magnitude increases with each successive year of the model horizon, driven by the lower annual per-patient costs of DaPeg. The cost savings increase from €99,510 in year 1 to €833,567 in year 5. The cumulative cost-savings over the modelled period exceed €2.5million. The introduction of DaPeg into the Greek market of severe HemA results in a negative budget impact, generating cost savings for the public payer in the first 5 years of its use.

275 Annual Ultrasound Screening Value in Patients With Familial Adenomatous Polyposis

INTRODUCTION: Patients with familial adenomatous polyposis (FAP) are at an increased risk for developing papillary thyroid cancer (PTC). The American College of Gastroenterology clinical guidelines have recommended annual thyroid ultrasound screening (TUS) for FAP patients. The goal of this study is to investigate the cost effectiveness of annual TUS screening in this patient population using a novel financial and epidemiologic model. METHODS: A cost analysis was performed to determine the financial viability of annual TUS compared to biennial (every 2 years) or triennial (every 3 years) screens. Population growth was modeled using a variable growth rate based on previous trends in the United States growth rate. Key modeling parameters including TUS sensitivity/specificity, prevalence of FAP, and risk of PTC in FAP patients were extracted from the literature. Treatment protocols based on early versus late detection were adopted from the American Thyroid Association and the National Comprehensive Cancer Network guidelines. Costs for each component were ascribed using either the Centers for Medicare &amp; Medicaid Physician Fee Schedule or literature values. The cumulative cost savings was derived as a function of these parameters and time. RESULTS: The prevalence of FAP was estimated at 3 in 100,000 with a 6.8% risk of PTC. The cost for early detection was $10,582 compared to $37,277 for late detection. TUS sensitivity/specificity were found to be 0.83 and 0.90. Using these parameters, our model revealed that annual TUS screening is only financially viable for a short interval. A maximum cumulative cost savings of over $10.3 million is observed after 2 years of implementation. After this time, the cumulative cost savings decreases at a rate of $780,000 per year and becomes negative after 15 years. Biennial and triennial screening intervals extend the period of financial viability to 30 and 45 years, respectively. Triennial screening results in a maximum cost savings of $10.4 million after 4 years. CONCLUSION: FAP patients are at an increased risk of developing PTC. TUS screening is warranted for early detection and treatment, but annual TUS screening may not be financially viable in the long term. Guidelines for annual screening may need to be re-examined and extended to every 2 or 3 years.

Lost cost savings to the NHS in England due to the delayed entry of multiple generic low-dose transdermal buprenorphine: a case scenario analysis

ObjectiveOriginator pharmaceutical companies prolonging the patent of a medicine prevents rivals’ entry to the market and competition. As the entry of generic alternatives usually results in price reduction, any delay...

Two-Year Follow-up of a Sequential Mixed-Mode Experiment in the U.S. National Monitoring the Future Study.

This study examines the two-year follow up (data collected in 2016 at modal age 21/22) of an original mixed-mode longitudinal survey experiment (data collected at modal age 19/20 in 2014). The study compares participant retention in the experimental conditions to retention in the standard Monitoring the Future (MTF) control condition (participants who completed an in-school baseline survey in 12th grade in 2012 or 2013 and were selected to participate in the first follow-up survey by mail in 2014, N=2,451). A supplementary sample who completed the 12th grade baseline survey in 2012 or 2013 but were not selected to participate in the main MTF follow-up (N=4,950) were recruited and randomly assigned to one of three experimental conditions: 1: Mail Push, 2: Web Push, 3: Web Push + Email in 2014 and again in 2016. Results from the first experiment indicated that Condition 3 (Web Push + Email) was promising based on similar response rates and lower costs (Patrick et al. 2018). The current study examines how experimental condition and type of 2014 response were associated with response in 2016, the extent to which response mode and device type changed from 2014 to 2016, and cumulative cost comparisons across conditions. Results indicated that responding via web in 2014 was associated with greater odds of participation again in 2016 regardless of condition; respondents tended to respond in the same mode although the "push" condition did move respondents toward web over paper; device type varied between waves; and the cumulative cost savings of Web Push + Email grew larger compared to the MTF Control. The web push strategy is therefore promising for maintaining respondent engagement while reducing cost.

Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement

ABSTRACT Background: To examine contemporary clinical and economic outcomes with the implementation of a minimalist program (MP) for transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. TAVR continues to evolve with the adoption of methods intended to maximize cost-savings while maintaining clinical effectiveness, patient safety, and satisfaction. Methods: A multidisciplinary collaboration was undertaken to develop a MP for transfemoral TAVR using conscious sedation anesthesia (CS) and resource optimization. Outcomes for 107 patients treated with MP were compared to 107 univariate-matched control patients who underwent TAVR with general anesthesia (GA). Results: There were no differences between the two groups with respect to demographics, aortic stenosis severity, morbidities, symptoms, or frailty. Procedural success, major adverse complications and quality of life were also comparable. During the use of MP, there were no conversions to GA. In comparison to control patients, those who had TAVR with MP had shorter median hospital length-of-stay (LOS) (2.0 days [1.6, 2.7] vs. 3.0 days [2.0, 5.1]; p < 0.001). Implementation of MP was associated with a significant decrease in total variable costs of 17.9%, an increase in patients with a positive contribution margin (from 30% in 2015 to 65% in 2017), and cumulative cost savings of $3.6 million over 2 years. Conclusions: The implementation of a multidisciplinary minimalist TAVR program is associated with significant reductions in LOS and hospital costs, without compromising clinical outcomes or quality of life.

A modelling study of the budget impact of improved glycaemic control in adults with Type 1 diabetes in the UK.

To develop a novel interactive budget impact model that assesses affordability of diabetes treatments in specific populations, and to test the model in a hypothetical scenario by estimating cost savings resulting from reduction in HbA1c from ≥69 mmol/mol (8.5%) to a target of 53 mmol/mol (7.0%) in adults with Type 1 diabetes in the UK. A dynamic, interactive model was created using the projected incidence and progression over a 5-year horizon of diabetes-related complications (micro- and macrovascular disease, severe hypoglycaemia and diabetic ketoacidosis) for different HbA1c levels, with flexible input of population size, complications and therapy costs, HbA1c distribution and other variables. The model took a National Health Service and societal perspective. The model was developed, and in the proposed hypothetical situation, reductions in complications and expected costs evaluated. Achievement of target HbA1c in individuals with HbA1c ≥69 mmol/mol (8.5%) would reduce expected chronic complications from 6.8 to 1.2 events per 100 person-years, and diabetic ketoacidosis from 14.5 to 1.0 events per 100 person-years. Potential cumulative direct cost savings achievable in the modelled population were estimated at £687 m over 5 years (£5,585/person), with total (direct and indirect) savings of £1,034 m (£8,400/person). Implementation of strategies aimed at achieving target glucose levels in people with Type 1 diabetes in the UK has the potential to drive a significant reduction in complication costs. This estimate may provide insights into the potential for investment in achieving savings through improved diabetes care in the UK.

Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting.

Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting is described. The University of Arizona Cancer Center and Banner-University Medical Center Tucson are affiliated not-for-profit academic medical centers in Tucson, Arizona, whose facilities include a hospital and ambulatory care clinics that maintain 3 outpatient infusion centers. The cancer center pharmacy currently employs 25 pharmacists, with 4 clinical pharmacists serving both the inpatient and outpatient treatment sites. A multidisciplinary team of staff members was assembled to address the transition of chemotherapy from inpatient to outpatient that included physicians, ambulatory clinical oncology pharmacists, finance, social workers, pharmacy staff, nursing staff, and information technology. The program was initiated in May 2014, with a 2-year postimplementation evaluation of our transition of chemotherapy to the outpatient setting. Chemotherapy order sets were developed in our electronic medical record for transitioning rituximab to the outpatient setting for inpatient chemotherapy orders as well as transitioning leukemia, lymphoma, and solid tumor chemotherapy regimens to be administered in the outpatient setting. Eighteen rituximab-containing regimens and 14 chemotherapy protocols were switched to the outpatient setting, with numerous variants of these regimens also created for outpatient only administration. The realized savings for high-cost chemotherapy transitioned to the outpatient setting with rituximab and clofarabine was $1,902,890. Over 747 inpatient bed days were saved, with an approximated cost savings to the health system of $1,402,866, with a cumulative cost savings to our health system of $3,305,756. This model for transitioning chemotherapy from the hospital to the outpatient setting enhanced access to care, decreased bed utilization in the hospital, and improved clinical and financial metrics.