Lower Patient Costs Research Articles

Analysis of Determining Inpatient Room Rates Using the Activity-Based Costing Method in a Healthcare Setting

Background: Hospitalization rate determination is crucial for healthcare cost management, yet traditional methods often lead to cost distortions. Specific Background: Muhammadiyah Tuban Hospital has historically utilized conventional costing methods, which have resulted in higher than necessary charges for hospital services. Knowledge Gap: There is limited research comparing traditional costing methods with more accurate and modern approaches like Activity Based Costing (ABC) in the Indonesian healthcare context. Aim: This study aims to compare hospitalization rates at Muhammadiyah Tuban Hospital using traditional methods and the ABC method, to highlight discrepancies and propose a more accurate costing framework. Results: The ABC method yielded significantly lower hospitalization rates across various classes (VIP, Class 1, Class 2, and Class 3) compared to traditional methods. For instance, the ABC rate for the VIP class was IDR 270,619, compared to IDR 495,000 set by traditional methods. Novelty: This study introduces the application of ABC in an Indonesian hospital setting, providing a clear contrast in cost-efficiency against traditional costing. Implications: The findings suggest that adopting the ABC method can lead to more precise and lower hospitalization rates, potentially reducing healthcare costs for patients and improving financial management within hospitals.Highlights: Cost Accuracy: ABC method offers more precise hospitalization rates than traditional methods. Economic Impact: Adoption of ABC can lower patient costs and improve hospital financial management. Innovation: Introduces a modern costing method to Indonesian healthcare, suggesting a shift from outdated practices. Keywords: Activity Based Costing, Hospitalization Rates, Cost Management, Healthcare Economics

Comparing Mobile-Based to Group-Based Education for Weight Reduction in a Developing Country: A Randomized Study.

This study compared the impact of Short Message Service (SMS)-based education with traditional group-based education and the control group on body mass index, weight, and lifestyle in obese and overweight patients in a limited-resource country. It also compared the direct financial costs between the two intervention groups. In this controlled randomized educational study, 90 overweight or obese adults from four family physician clinics in Shiraz, Iran were randomly allocated to three training groups: SMS-based education, group-based education, and a control group. The participants' weight, body mass index (BMI), and waist circumference were measured at baseline, and the Physical Activity Scale questionnaire was completed. Group-based training was conducted in 1-hour weekly sessions. The SMS group received a text message each morning. The control group received routine care from a family physician. The intervention lasted 12 weeks. All participants were re-examined for the studied variables. Additionally, the direct costs were estimated, calculated, and compared. The mean weight, BMI, and waist circumference changed significantly after 3 months compared to baseline in each group. The mean weight change differed significantly among the three groups (P-value=0.04), and the mean BMI changes were near significant (P-value=0.06). A post hoc comparison of changes in weight and BMI showed a significant difference between the control and SMS groups. SMS education incurred much lower costs for patients and healthcare services than group-based education. The study showed that SMS is an effective and cost-saving educational method for weight loss compared to group-based education, especially in developing countries.

Efficacy and safety of gemcitabine plus raltitrexed or S-1 versus standard third-line therapies in metastatic colorectal cancer: a retrospective cohort study.

After the failure of standard first- and second-line treatments, including oxaliplatin, irinotecan, and 5-fluorouracil (5-FU) combined with targeted drugs, the currently recommended third-line regimens for metastatic colorectal cancer (mCRC) include TAS-102, regorafenib, and fruquintinib. However, these regimens have the drawbacks of mediocre efficacy, substantive side effects, and high cost. Therefore, more effective, economical regimens with fewer side effects are needed in clinical practice. In this study, we assessed the efficacy and safety of gemcitabine plus raltitrexed or S-1 as a third- or later-line treatment in comparison to those of standard third-line therapies for patients with mCRC. Patients with previous failures of at least two lines of standard therapy with oxaliplatin, 5-FU, irinotecan, or capecitabine combined with targeted drugs were included. The participants received standard third-line therapies (including TAS-102, regorafenib, and fruquintinib) or gemcitabine plus raltitrexed or S-1 until disease progression, death, or intolerable toxicity arose. Imaging follow-up was performed every 3 months during their treatment. Progression-free survival (PFS) and overall survival (OS) were recorded. Cox regression analysis was used to investigate the potential predictors of survival. From April 2018 to October 2022, 60 patients with mCRC were enrolled in our study. The numbers of patients in the chemotherapy, fruquintinib, regorafenib, and TAS-102 groups were 13, 15, 17, and 15, respectively; the median OS of the four groups was 7.4, 6.1, 8.3, and 6.7 months (P=0.384), respectively; the median PFS was 4.1, 3.4, 4.4, and 2.3 months (P=0.656), respectively; the overall response rate was 7.69%, 6.67%, 0.00%, and 13.33%, respectively; and the disease control rate was 61.54%, 60.00%, 70.59%, and 60.00%, respectively. Additionally, multivariate analysis revealed that primary lesion located in the rectum was adverse independent prognostic factors for OS. A typical case is presented in this article. The gemcitabine plus raltitrexed or S-1 regimen is a potential regimen with tolerable adverse reactions and low cost for patients with mCRC.

Dermatologists' Perspectives on Biosimilars.

Biosimilars are biologic agents the Food and Drug Administration (FDA) has deemed to have no clinical difference from their reference biologics. In dermatology,  biosimilars are approved for the treatment of psoriasis and hidradenitis suppurativa. Although dermatologists are high prescribers of biologics, they are more reluctant to prescribe biosimilars than other specialists. This survey-based study sought to characterize dermatologists’ current perspectives on biosimilars.  Methods: A 27-question survey was distributed via email to dermatologists between September and October of 2022.  Results: Twenty percent of respondents would not prescribe a biosimilar for an FDA-approved indication. When asked about the greatest barriers to biosimilar adoption, 61% had concerns about biosimilar safety and efficacy, 24% reported uncertainty about state laws for interchangeability and substitutions, and 20% had concerns about biosimilar safety without concerns about efficacy. Thirty-five percent of respondents felt moderately or extremely knowledgeable about biosimilar interchangeability.  Conclusion: Biosimilars are safe and effective for treating approved dermatological conditions and may lower patient costs compared to their reference products. Patients are not always offered biosimilar therapy as an option, which may be due to unfamiliarity among dermatologists.  This survey suggests a need for more research and educational initiatives, such as modules and workshops that focus on biosimilar safety, efficacy, and interchangeability guidelines. J Drugs Dermatol. 2024;23(4):doi:10.36849/JDD.7755.

First experience in laparoscopic surgery in low and middle income countries: A systematic review.

Laparoscopic surgery has reduced morbidity and mortality rates, shorter postoperative recovery periods and lower complication rates than open surgery. It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources. However, introducing laparoscopic surgery in low-and-middle-income countries (LMIC) can be expensive and requires resources, equipment, and trainers. To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources. MEDLINE, EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published between 1996 and 2022 with full text available in English. Exclusion criteria were studies considering only open surgery, ear, nose, and throat, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery. Ten studies out of 3409 screened papers, from eight LMIC were eligible for inclusion in the final analysis, totaling 2497 patients. Most reported challenges were related to costs of equipment and training programmes, equipment problems such as faulty equipment, and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including a reduction in hospital stay, complications, and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors. Despite financial and technical challenges, many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients. While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported, more support is critically required, in particular regarding training.

Rapid detection of non-normal teeth on dental X-ray images using improved Mask R-CNN with attention mechanism.

Dental health has been getting increased attention. Timely detection of non-normal teeth (caries, residual root, retainer, teeth filling, etc.) is of great importance for people's health, well-being, and quality of life. This work proposes a rapid detection of non-normal teeth based on improved Mask R-CNN, aiming to achieve comprehensive screening of non-normal teeth on dental X-ray images. An improved Mask R-CNN based on attention mechanism was used to develop a non-normal teeth detection method trained on a high-quality annotated dataset, which can segment the whole mask of each non-normal tooth on the dental X-ray image immediately. The average precision (AP) of the proposed non-normal teeth detection was 0.795 with an intersection-over-union of 0.5 and max detections (maxDets) of 32, which was higher than that of the typical Mask R-CNN method (AP = 0.750). In addition, validation experiments showed that the evaluation metrics (AP, recall, precision-recall (P-R) curve) of the proposed method were superior to those of the Mask R-CNN method. Furthermore, the experimental results indicated that proposed method exhibited a high sensitivity (95.65%) in detecting secondary caries. The proposed method took about 0.12s to segment non-normal teeth on one dental X-ray image using the laptop (8G memory, NVIDIA RTX 3060 graphics processing unit), which was much faster than conventional manual methods. The proposed method enhances the accuracy and efficiency of abnormal tooth diagnosis for practitioners, while also facilitating early detection and treatment of dental caries to substantially lower patient costs. Additionally, it can enable rapid and objective evaluation of student performance in dental examinations.

Outcomes of the use of infliximab biosimilars in rheumatology and gastroenterology clinics.

The originator infliximab product, Remicade, was approved by the US Food and Drug Administration in August 1998 for the management of Chron's disease. Since this time, several infliximab biosimilar agents have entered the market to introduce competition and lower costs for patients as well as health care systems. Clinical trials comparing infliximab biosimilars with the originator product have consistently demonstrated noninferiority, along with similar adverse effect profiles, leading to the approval of 3 additional biosimilars: Renflexis (infliximab-abda), Avsola (infliximab-axxq), and Inflectra (infliximab-dyyb). In 2021, the University of North Carolina rheumatology and gastroenterology outpatient clinics began an initiative to convert patients from the originator infliximab product to biosimilar agents Renflexis or Avsola based on market costs. Subsequently, a retrospective evaluation was conducted to analyze the clinical outcomes of patients that were switched to a biosimilar agent compared with those that were only ever using either the originator or biosimilar agent. A total of 180 patients were analyzed, of which half were prescribed a biosimilar as a result of the conversion initiative. Of these 90 patients, 79 (87.8%) were maintained on a single biosimilar agent without requiring a switch to an alternative infliximab product. We conclude that the effort to convert clinically stable patients to a biosimilar product resulted in a significant increase in biosimilar use within the health system. This is thought to have resulted in significant financial advantages both to our institution as well as patients, without sacrificing overall clinical control.

Anatomic total shoulder arthroplasty is cost-effective in patients over 67 years of age with glenohumeral osteoarthritis and an intact rotator cuff: a decision-analytic Markov model-based cost-utility analysis

BackgroundAnatomic total shoulder arthroplasty (aTSA) has historically been considered the gold-standard surgical strategy for patients with end-stage glenohumeral osteoarthritis (GHOA). However, reverse shoulder arthroplasty (RSA) is increasingly used for shoulders with GHOA with an intact rotator cuff due to concerns regarding late cuff failure, anatomic glenoid component loosening, and the impact of bone loss and severe soft-tissue balance in aTSA. With substantial differences in cost between aTSA and RSA, it remains unclear whether the increased risk of late rotator cuff dysfunction in older adults justifies the increased cost of RSA. Therefore, the objective of this study was to utilize a decision-analytic Markov model to 1) quantify the cost-effectiveness of aTSA vs. RSA in patients with GHOA and intact rotator cuff and 2) determine whether an age exists at which RSA is more cost-effective than aTSA. MethodsA Markov model was developed to determine accumulated costs and quality-adjusted life years (QALYs) over a lifetime horizon for patients with end-stage GHOA and an intact rotator cuff who undergo either aTSA or RSA. Costs, health utility values, and transition probabilities were derived from the published literature. Sensitivity analyses were performed to identify age cutoffs at which one treatment option is more cost-effective than the other. ResultsFor the baseline case of a 72-year-old patient, aTSA resulted in 9.43 QALYs and $29,077 in accumulated costs, while RSA produced 9.44 QALYs at a total cost of $31,199 (incremental cost-utility ratio (ICER) comparing rTSA to aTSA: $188,222.94/QALY). Because the ICER for rTSA fell above the $50,000 willingness-to-pay (WTP) threshold, aTSA was determined to be the most cost-effective strategy for patients of this age. Within the age-based sensitivity analysis, RSA was the most cost-effective option for those 67 years of age or younger, while aTSA was the dominant strategy at 77 years and older, resulting in both equal QALYs and lower costs for patients in this age group. ConclusionsBased on this analysis, aTSA is a cost-effective treatment strategy for GHOA with an intact rotator cuff in adults over 67 years of age. For patients between the ages of 67 and 77, RSA resulted in marginally higher QALYs, but this increase was not enough to offset the increased costs to be considered cost-effective. In this model, RSA was cost-effective for individuals 67 years of age or younger.

Combining atezolizumab 1200 mg with bevacizumab 15 mg/kg: based on science or just revenues?

Dose optimisation is increasingly important in oncology, as exemplified by the US Food and Drug Administration’s Project Optimus initiative, which is aligned with similar initiatives in other countries. In parallel, multiple stakeholders have raised concerns about anticancer drug prices, affordability, and access. This is of particular concern to government payers as well as patients and physicians in low- and middle-income countries. As anticancer drugs have historically been approved at the maximally tolerated dose, it is now highly relevant to question whether lower doses are equally effective and can be delivered at lower doses, resulting in less toxicity for patients, and lower costs for patients and payers. We illustrate this opportunity by discussing the combination of atezolizumab and bevacizumab, approved in multiple countries for both non-small cell lung cancer and hepatocellular cancer. Our conclusion is that the cost of this regimen can be reduced by more than 80%, an opportunity that should be considered by patients, prescribers, payers, and policymakers.

Telehealth utilization barriers among Alabama parents of pediatric patients during COVID-19 outbreak

BackgroundTelehealth can improve access to evidence-based care at a lower cost for patients, especially those living in underserved and remote areas. The barriers to the widespread adoption of telehealth have been well documented in the literature. However, the barriers may not be the same for pediatric patients, who must rely on their parents or guardians to make healthcare decisions. This paper presents some of the leading barriers parents or guardians of pediatric patients report in using telehealth to meet their children’s healthcare needs.MethodsThis cross-sectional survey was conducted in a tertiary care pediatric Emergency Department (ED) at a children’s hospital in Alabama between September 2020 to December 2020. The parents or guardians of pediatric patients were asked about their reasons for not using telehealth despite having healthcare needs for their children, whether they canceled or rescheduled healthcare provider visits and facility visits, and whether the child’s health conditions changed over the past three months. Descriptive analyses were conducted that explored the distribution of telehealth use across the variables listed above.ResultsFive hundred ninety-seven parents or guardians of pediatric patients participated in the survey, and 578 answered the question of whether they used telehealth or not over the past three months. Of them, 33.1% used telehealth, 54.3% did not, and 12.6% did not have healthcare needs for their child. The leading reason for not using telehealth was that the doctor or health provider did not give them a telehealth option, the second main reason was that they did not know what telehealth is, and the third leading reason was that the parents did not think telehealth would help meet healthcare needs for their child.ConclusionsThis study highlights the telehealth utilization barriers among underserved pediatric populations, including the need for physicians to proactively offer telehealth options to parents or guardians of pediatric patients. Improving health literacy is of paramount importance, given that a substantial proportion of parents were not familiar with telehealth. Policymakers and healthcare organizations should raise awareness about the benefits of telehealth which can improve healthcare access for underserved pediatric patients.

Integrating On-Treatment Modified Glasgow Prognostic Score and Imaging to Predict Response and Outcomes in Metastatic Renal Cell Carcinoma

In the era of immuno-oncology, imaging alone seems to be insufficient to capture treatment responses, as patients with stable disease treated with immunotherapy have a wide range of clinical outcomes. There is an unmet need for complementary (ideally cost-efficient) markers that enable assessment of therapy response and outcomes in conjunction with imaging. To examine whether longitudinal changes in the modified Glasgow prognostic score (mGPS), which is based on C-reactive protein and albumin, can predict responses and outcomes in patients with metastatic renal cell carcinoma (mRCC). This post hoc analysis, conducted from October 2022 to April 2023, evaluated the prognostic and predictive performance of on-treatment mGPS in patients with mRCC being treated with atezolizumab (plus bevacizumab) or sunitinib in 2 randomized clinical trials: the phase 3 IMmotion151 study (discovery cohort) and the phase 2 IMmotion150 study (validation cohort). Outcomes were investigator-assessed progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1 and overall survival (OS) for survival analyses. To compare the prognostic value of the on-treatment mGPS with radiologic staging, we used RECIST assessed by the Independent Review Committee (IRC-RECIST) to ensure high data quality. Of the 915 patients with mRCC in the IMmotion151 discovery cohort, baseline mGPS was available for 861 patients and on-treatment mGPS for 691. The IMmotion150 validation cohort included 305 patients with mRCC, and on-treatment mGPS could be evaluated for 199. In the IMmotion150 study, on-treatment mGPS predicted outcomes as early as 6 weeks following therapy initiation, thereby opening a window for early therapy adjustments. In both clinical trials, on-treatment mGPS provided valuable prognostic information regardless of imaging-assessed treatment response at first staging. Of note, in the disease control subgroup, on-treatment mGPS exhibited superior and independent prognostic information compared with IRC-RECIST (available for 611 patients; C-index, 0.651 [95% CI, 0.588-0.714] for the mGPS during treatment vs 0.574 [95% CI, 0.528-0.619] for IRC-RECIST). These data support the concept of integrating on-treatment mGPS for more holistic and patient-centered therapy monitoring in addition to radiologic staging to improve clinical care at a low cost for patients with mRCC.

Assessing mail-in cryopreservation for fertility preservation.

1525 Background: Over 90% of oncologists agree that sperm banking should be offered to all men at risk of subfertility associated with cancer treatment, but fewer than 50% bring up the topic. Barriers cited include lack of time for the discussion, perceived high cost, and lack of convenient facilities. The advent of mail-in semen analysis (SA) testing and cryopreservation may improve access to this service via lower patient cost, decreased required oncologist logistical support, and home rather than local lab collection. That said, average sperm recovery rate after sample thaw is ~50% with immediate banking, and sperm recovery rate after delayed cryopreservation with a mail-in approach remains unknown. Methods: This is a prospective preliminary study assessing freeze-thaw total motile count at 3 time points of cryopreservation: upon receipt of sample, at 24 hours, and at 48 hours post collection. We collected 39 fresh semen samples from 13 healthy adult volunteers. Samples were diluted with 5mL of Fellow Health preservation solution and analyzed (World Health Organization guidelines V5). Samples were divided into 3 aliquots: Aliquot #1, T0 was immediately frozen with equal part cryoprotectant. Aliquot #2, T24 and aliquot #3, T48 were left at room temperature for 24 and 48 hrs respectively, analyzed, and then frozen. Aliquots were then thawed on a heat block at 37C for 10 minutes and analyzed. Results: Baseline SA values were: volume 3.3ml +/- 1.3, concentration 138.3 +/-57.4 x 106, motility 49% +/-6%; Total Motile Count (TMC) 213 +/- 110 million. TMC was the primary endpoint as measured by baseline semen volume, concentration, and motility at 3 time points (T0, T24, T48). The average loss from freeze/thaw in TMC at T0 was 45%, at T24 was 55% relative to T24 pre-freeze, and at T48 was 59% relative to T48 pre-freeze (p = 0.013). On average, samples with starting TMC between 50-100 million had enough motile sperm for six intrauterine insemination (IUI) cycles when frozen and thawed at T0, two at T24, and two at T48. Samples with starting TMC between 100-200 million had enough motile sperm for 16 IUI cycles when frozen and thawed at T0, eight at T24, and four at T48. Samples with starting TMC > 200 million had enough motile sperm for 42 IUI cycles when frozen and thawed at T0, 21 at T24, and nine at T48. All samples had ample viable cells ( > 50,000) at all three time points for in vitro fertilization (IVF). Conclusions: Mail-in cryopreservation using our improved methodology may increase access to this service for oncological patients while still facilitating reasonable assisted reproductive technology care relative to in-person cryopreservation.

The Unbearable Cost of Drug Development

The Unbearable Cost of Drug Development

Consumer preferences for telehealth in Australia: A discrete choice experiment.

This study aims to elicit consumer preferences regarding telehealth and face-to-face consultations in Australia. It used a discrete choice experiment, presenting participants with a series of hypothetical choices, and based on their responses, infer what is most important to them. Data were analysed using conditional logit regression and latent class analysis. A total of 1,025 participants completed the survey, considering four different clinical scenarios. Face-to-face contacts were, on average, preferred to either telephone or video services. However, telehealth was identified as an attractive option if it prevents significant travel and can be conducted with a familiar doctor. Participants were strongly driven by cost, particularly greater than $30. Telehealth was least preferred for situations involving a new and unknown physical symptom, and relatively more preferred for surgical follow-up. The latent class analysis demonstrates only 15.9% of participants appeared unwilling to consider telehealth. The findings of this study suggest that meeting the needs of the Australian population requires a blended approach to service delivery, with telehealth being valued in a range of clinical scenarios. Price sensitivity was evident, therefore if telehealth services can be delivered with lower patient cost, then they are likely to be attractive.

Patient Out-of-Pocket Costs Following the Availability of Biosimilar Versions of Infliximab.

After market exclusivity ends for biologic drugs, biosimilars-follow-on versions made by other manufacturers-can compete with lower prices. Biosimilars have modestly reduced prescription drug spending for US payers, but it is unclear whether patients have directly experienced any savings. In this study we assessed whether availability of biosimilar infliximab was associated with lower out-of-pocket (OOP) costs, using claims from a national data set of commercially insured patients from 2014 to 2018. We used two-part models, adjusting for patient demographics, clinical characteristics, insurance plan type, and calendar month. Compared with the reference biologic, there was no difference in the percentage of biosimilar claims with OOP costs (30.1% vs. 30.8%; adjusted odds ratio (aOR) 0.98, 95% confidence interval (CI), 0.84-1.15, P=0.84) or the average nonzero OOP cost (median $378 vs. $538, adjusted mean ratio (aMR) 0.97, 95% CI, 0.80-1.18, P=0.77). The percentage of claims with OOP costs was lower after biosimilar competition (30.7% vs. 35.0%, aOR 0.96, 95% CI, 0.94-0.99, P=0.003), but average nonzero costs increased (median $534 vs. $520, aMR 1.04, 95% CI, 1.01-1.07, P=0.004). Thus, early biosimilar infliximab competition did not improve affordability for patients. Policymakers need to better assure that competition in the biosimilar market translates to lower costs for patients using these medications.

Same-Day Discharge Colon Surgery: Is It Financially Worth It?

INTRODUCTION: Same day discharge (SDD) for colorectal surgery shows increasing promise in the era of enhanced recovery after surgery protocols and minimally invasive surgery. It has become increasingly relevant due to constraints of the COVID-19 pandemic. This study aims to identify the patient cost, institutional charges, net margin revenue, and contribution margins associated with SDD, and analyze financial benefits when compared with admission. METHODS: Retrospective review of colectomy performed at a single institution over a 2-year period assessed for clinical outcomes, cost, charges, and revenue. The data was divided between 2 populations, SDD and postoperative day 1 (POD1) discharge. In addition to financial data, other outcomes included readmission, complication, and operative time. RESULTS: There was a statistically significant difference favoring SDD over POD1 discharge in average: operating time (p = 0.00036), direct cost (p = 0.00000001), and charges (p = 0.00007711). SDD average patient cost were $9,186 USD compared with $11,698 USD for POD 1, and average hospital charges for SDD were $84,038 vs $97,566 for POD 1. Average net revenue was expectedly lower in SDD, $21,471, when compared with POD1, $26,719, however when comparing contribution margins (SDD $12,285 v POD1 $15,021), there was no statistically significant difference, p = 0.212. There were no statistically significant differences in readmission or operative complication between populations. CONCLUSION: Amidst pandemic-related resource constraints, we found that SDD was associated with lower patient cost and comparable contribution margin, without a significant difference in readmission and operative complication when compared with POD1 discharge.

Do-Not-Resuscitate Orders and Outcomes for Patients with Pancreatic Cancer.

The impact of the do-not-resuscitate (DNR) order on patients with pancreatic cancer remains uncertain. In this study, we evaluated whether DNR status was associated with in-hospital mortality and costs for inpatient stay among patients hospitalized with pancreatic cancer. Data were obtained from the National Inpatient Sample, Healthcare Cost and Utilization Project, which represents ∼20% of all discharges from US community hospitals; 40,246 pancreatic cancer admissions between 2011 and 2016 were included. Mortality was modeled using a logistic regression model; costs for inpatient stay were modeled using a multivariable generalized linear regression model. The sample included 6041 (15%) patients with a documented DNR order. After controlling for covariates, patients with a DNR order had approximately six times greater odds of mortality compared with patients without a DNR order (odds ratio 5.90, p < 0.0001). Compared with patients who survived without a DNR order during the hospital stay, patients who had a DNR order and died during the hospital stay had significantly lower costs (-US$983; p = 0.0270), and patients who died without a DNR order during the hospital stay had significantly higher costs (US$5638; p < 0.0001). Patients who survived with a DNR order had costs that were not significantly different from patients who survived without a DNR order. The presence of a DNR order among patients with pancreatic cancer was significantly associated with higher mortality risk as well as lower costs for patients who died during the hospital stay. However, DNR status was not significantly associated with costs for pancreatic cancer patients who were discharged alive.

Immunological markers in type 1 diabetes mellitus in Thi-Qar province, southern Iraq.

Type 1 diabetes mellitus (T1D) is a chronic autoimmune illness defined as insulin insufficiency resulting from the autoimmune breakdown of pancreatic beta cells producing insulin in the islets of Langerhans. Biomarkers are markers of physiological or pathological processes that are normal or abnormal, playing a crucial function in clinical evaluation, prognosis, and therapy response monitoring. This study aimed to investigate some biomarkers associated with T1D and examine the association between glutamic acid carboxylase (GADA) antibody and islet antigen-2 autoantibody (IA-2A) for β-cell stress and death in patients with T1D. The current study included 60 patients with T1D, 32 (53.33%) males and 28 (46.67%) females between 9 to 18 years old, and 30 healthy individuals as control. Glutamic acid carboxylase, islet antigen-2 autoantibody and connecting peptide levels in the blood were evaluated. Positive results for IA-2A and GADA were shown in 89.04% and 38% of T1D patients, respectively. The normal level frequency and C-peptide titer mean were significantly lower between T1D and healthy control. However, no statistically significant changes were observed in the C-peptide level among GADA positive and negative patients. Finally, the C-peptide concentrations were significantly lower for positive IA-2A compared to negative IA-2A persons. The combination of IA-2A, GADA, and C-peptide could indicate stronger diagnostic measures at a low cost for patients with T1D.

Hospital costs and cosmetic outcome of benign and high-risk breast lesions managed by vacuum-assisted excision versus surgical excision.

Although vacuum-assisted excision (VAE) is a safe and effective alternative to surgical excision (SE), the latter is most commonly used for the management of benign and high-risk breast lesions. To evaluate the healthcare benefit of VAE, hospital costs and cosmetic outcome after VAE were compared to SE. Additionally, the impact of VAE implementation on hospital costs was investigated. This was a single-centre retrospective cohort study with two cohorts: "VAE" and "SE". All patients with a benign or high-risk lesion excised by VAE or SE from January 2016 up to December 2019 were included. Cosmetic outcome was measured with the BCTOS-cosmetic subscale, and hospital costs were presented as mean (SD) and median (IQR). During the study period, 258 patients with 295 excised lesions were included. The initial procedure was VAE in 102 patients and SE in 156 patients. Hospital costs after (median € 2324) were significantly lower than before (median € 3,144) implementation of VAE (mean difference € 1,004, p < 0.001), most likely attributable to the lower costs for patients treated with VAE (mean difference € 1,979, p < 0.001). Mean cosmetic outcome was comparable between VAE (median 1.35) and SE (median 1.44, p = 0.802). Implementing VAE as an alternative treatment option for benign and high-risk breast lesions resulted in a large decrease in hospital costs but a cosmetic benefit of VAE could not be demonstrated in this retrospective study. Costs associated with the complete patient pathway were included and not only VAE was compared to SE but also the before cohort was compared to the after cohort to demonstrate the benefit of VAE implementation in clinical practice. Additionally, cosmetic outcome was compared between VAE and SE using patient reported outcome measures.

Patient satisfaction and cost analysis of telehealth delivered by allied health oncology clinicians.

IntroductionTo compare and analyse satisfaction and costs of telehealth services for patients receiving allied health services at a quaternary oncology hospital.Material and methodsCross-sectional design survey distributed to patients who had received outpatient allied health (psych-oncology, dietetics, speech pathology) telehealth services from March November 2020. Responses regarding satisfaction and barriers relating to telehealth were examined, and costs calculated.ResultsA total of 156 surveys were distributed, 124 were completed and included in the analysis. The majority of respondents (56%) were female patients, with a median age of 57 years. Survey results revealed that 89% of respondents would access allied health consultations using telehealth again, of whom 14.5% indicated that they preferred telehealth to a face-to-face appointment. Common barriers to service delivery were internet connection, inability to perform physical examination via telehealth, and patient unfamiliarity with technology. Levels of satisfaction were high, with 92.7% of respondents either satisfied or very satisfied with the allied health telehealth service offered. Only 1.5% of the participants were dissatisfied on account of unfamiliarity with the technology and preference for face-to-face contact with their clinician.To attend a face-to-face allied health consultation 90% of respondents would have to drive to the hospital, with cost of petrol and parking per trip calculated to be an average of $ 51.25.ConclusionsAllied health service delivered via telehealth was met with high rates of satisfaction and resulted in lower patient costs.