Hospital Budget Impact Research Articles

PMD74 - Effects of Autologous fat grafting systems on inpatient operating room time and costs: a Hospital budget impact analysis

PMD74 - Effects of Autologous fat grafting systems on inpatient operating room time and costs: a Hospital budget impact analysis

The economic impact of rapid Candida species identification by T2Candida among high-risk patients.

This study estimates the cost-effectiveness and hospital budget impact of rapid candidemia identification using T2Candida, a novel diagnostic panel with same-day species-specific results. A 1-year decision-tree model estimates hospital costs (2013 US$) and effects (candidemia-related deaths) for faster diagnostics versus blood culture (BC), accounting for disease prevalence, distribution of Candida species, test characteristics (sensitivity/specificity/time to result), antifungal medication and differential length-of-stay and mortality by appropriate treatment timing. The model estimates a hospital with 5100 annual high-risk patients could possibly save $5,858,448 with T2Candida versus BC, a 47.6% decrease in candidemia diagnosis and treatment budget ($1149/patient tested), while averting 60.6% of candidemia-related mortality. Hospitals may observe lower candidemia-related inpatient costs and mortality with rapid Candida diagnosis.

Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain).

BackgroundAssessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service.MethodsA retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type.ResultsA total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages.ConclusionsThis study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

A hospital budget impact model to compare stem cell mobilisation strategies: impact of primary research and direct stakeholder engagement

ObjectivesThere is a dearth of published health economic evidence on stem cell mobilisation (SCM) that can be leveraged effectively for decision making. Our objective was to develop a budget impact...

Ceftaroline fosamil use in hospitalized patients with acute bacterial skin and skin structure infections: Budget impact analysis from a hospital perspective

The budgetary impact of adding ceftaroline fosamil to a hospital formulary for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) was evaluated. A three-year hospital budget impact model was constructed with three initial treatment options for ABSSSIs: ceftaroline fosamil, vancomycin plus aztreonam, and other vancomycin-containing regimens. The target population was hospitalized adult patients with an ABSSSI. Clinical cure rates with initial treatment were assumed to be similar to those from ceftaroline fosamil clinical trials. Patients who did not respond to initial treatment were assumed to be treated successfully with second-line antimicrobial therapy. Length of stay and cost per hospital day (by success or failure with initial treatment) were estimated based on a large database from more than 100 U.S. hospitals. Other model inputs included the annual number of ABSSSI admissions, projected annual case growth rate, proportion of ABSSSI target population receiving vancomycin-containing regimen, expected proportion of ABSSSI target population to be treated with ceftaroline fosamil, drug acquisition cost, cost of antibiotic administration, and cost of vancomycin monitoring. Sensitivity analysis using 95% confidence limits of clinical cure rates was also performed. The estimated total cost of care for treating a patient with an ABSSSI was $395 lower with ceftaroline fosamil ($15,087 versus $15,482) compared with vancomycin plus aztreonam and $72 lower ($15,087 versus $15,159) compared with other vancomycin-containing regimens. Model estimates indicated that adding ceftaroline fosamil to the hospital formulary would not have a negative effect on a hospital's budget for ABSSSI treatment.

PCV42 - Hospital budget impact of readmission penalties and bundled payments: Potential impact of coronary stent platforms

PCV42 - Hospital budget impact of readmission penalties and bundled payments: Potential impact of coronary stent platforms

Cost‐efficacy analysis of darunavir/r monotherapy in clinical practice

Purpose of the studyTo evaluate the economic impact of a swiching strategy to DRV/r mx in clinical practice using Spanish prices.MethodsMulticenter retrospective study of four tertiary hospitals in Spain. The analysis includes 147 patients switching to DRV/r mx mainly due to toxicity or simplification from March 2009 to June 2011. The Spanish costs (ex‐factory price+VAT) per patient with HIV RNA<50 copies/ml were calculated, accounting for additional/ switch antiretroviral taken after initial treatment failure and management of adverse events. Cost of adverse events were based on a Spanish publication [1] (updated by the inflation rate until april 2012) The horizon of the analysis was of 48 weeks.Summary of resultsBaseline characteristics were: women (30.6%), median age (49 yr), IDU (45%), AIDS stage (32%), HCV coinfected (48%, 40% with advanced fibrosis), length of HIV‐RNA<1.7 before DRV/rtv mtx 67.6. Most frequent reasons for switching to DRVr mx were toxicity (62.6%) and simplification (23.8%). If a hospital with 600 patients in ART treatment, switched from 10% to 20% of its patients to DRV/r mx, there is a potential to save up to 448,000€/year.ConclusionsSwitching to DRV/r mx is a cost‐effective strategy that allows more patients to be treated for a fixed budget. Higher cost saving is expected when toxicity is the reason for switching. Baseline HAART DRV/r Monotherapy Difference Mean cost per patient (ARV) 8.471€ 5.773€ ‐ 2.698€ Mean cost per patient (AEs) 70€ 5€ ‐ 65€ Total Mean cost per patient* 8.541€ 5.778€ ‐ 2.762€ Number treated for 1,000,000 117 173 56 % HIV RNA<50 copies/ml (OTT) 93,10% 93,10% 0,00% Cost per success 9.174€ 6.207€ ‐ 2.967€ Number of success 109 161 52 ICER (Incremental Cost Efficacy Ratio) Dominated Includes ARV and AEs treatment costs. 48 Weeks Cost‐Efficacy analysis: Simplification strategy to DRV/r monotherapy % of patients that Switches to DRV/r monotherapy 10% 15% 20% Number of patients in ARV treatment 600 600 600 Number of patients in DRV/r Monotherapy 60 90 120 Before Switch: 1 year cost 512.441€ 768.662€ 1.024.883€ After Switch: 1 year cost 346.698€ 520.048€ 693.397€ Total Cost Saving 165.743€ 248.614€ 331.486€ Hospital Budget Impact Analysis: assuming that 10%–20% of 600 patients in ARV treatment simplifies to DRV/r monotherapy

PIN8 The Economic Impact of Adding Ceftaroline Fosamil to Hospital Formulary for Community Acquired Bacterial Pneumonia: A Hospital Budget Impact Analysis in the United States

PIN8 The Economic Impact of Adding Ceftaroline Fosamil to Hospital Formulary for Community Acquired Bacterial Pneumonia: A Hospital Budget Impact Analysis in the United States

PIN9 A German Hospital Budget Impact Model Comparing Antibiotic Therapies in Complicated Skin and Skin Structure Infections and Bacteremia

Daptomycin is a cyclic lipopeptide antibiotic that has been commercially available in Europe since 2006. Daptomycin has rapid bactericidal activity against MRSA and is indicated for gram-positive infections including complicated skin and skin structure infections (cSSSI), right-sided infective endocarditis and Staphylococcus aureus bacteremia (BSI). This study aims to quantify the budgetary impact of utilizing Daptomycin for suspected gram-positive cSSSI and BSI in Germany. A budget impact model was developed to compare the total direct costs of utilizing vancomycin, linezolid, daptomycin, and “other antibiotics” as a single category. A decision tree was constructed on the basis of clinical guidelines and validated by clinicians. Clinical data and laboratory utilization and cost data were derived from a comprehensive review of over 40 publications. Antibiotic utilization and net drug costs were derived using syndicated data from Arlington Medical Resources (AMR). On average, the total direct costs (drug acquisition, lab monitoring, and hospital) of treating a cSSSI patient with the following agents were: vancomycin €2598 (4%, 12% and 84%), linezolid €2742 (37%, 5%, and 58%), daptomycin €3,171 (30%, 7%, and 63%), and other antibiotics €1835 (2%, 10%, and 88%). For BSI patients, total direct costs were: vancomycin €2359 (5%, 13% and 82%), linezolid €3951 (37%, 5%, and 58%), daptomycin €2135 (37%, 7%, and 56%), and other antibiotics €3087 (4%, 10%, and 86%). Extrapolating these costs to an average German hospital with 300 BSI and 1000 cSSSI patients and increasing daptomycin use in BSI from 1% to 6% and in cSSSI from 0.3% to 1.4% would save the hospital €30,151 and €2,971 per year, respectively. Using daptomycin for treating cSSSI is budget neutral and using it for bacteremia patients is associated with favorable economic outcomes when compared with other antibiotics.

Budget impact of using midnight salivary cortisol in the diagnosis of hypercortisolism

BackgroundA single midnight serum cortisol (MSC) test has been reported to possess the best sensitivity and specificity for diagnosing Cushing's syndrome (CS). However, this test requires patient hospitalization, making it costly. This paper aims to compare the hospital budget impact and accuracy of using midnight salivary cortisol (MSVC), as opposed to MSC, in the diagnosis of hypercortisolism. Methods77 patients with at least two high urinary free cortisol (UFC) values (>360nmol/24h) were selected from 611 patients with clinical symptoms of CS. The costs of the method to confirm the diagnosis of hypercortisolism was calculated comparing Option A using MSC (UFCx2, low-dose dexamethasone suppression test [LDDST]) that requires patient hospitalization versus Option B using MSVC (UFCx2, LDDST) in which the evaluation is done outside the Hospital. A budget impact analysis for one year was developed, and a sensitivity analysis in different scenarios was performed. Reproducibility and diagnostic performance of MSVC and MSC were also measured. ResultsSalivary cortisol is a sound analytical method for evaluating free serum cortisol due to its classification accuracy, good imprecision, linearity, and stability. AUCROC comparison between MSVC and MSC shows no significant differences. The substitution of the MSC for MSVC in our hospital could save between €16,762 and €132,804 in one year. ConclusionsThe use of MSVC in the diagnosis of hypercortisolism can result in a substantial decrease in the budget impact, without losing diagnosis accuracy and reliability, a significant advantage considering the current emphasis on reducing the financial burden of health care.