Mean Cost Of Treatment Research Articles

A growing problem: cycling referrals to the National Centre for Pelvic and Acetabular Fracture Management in Ireland.

Popularity in cycling continues to grow. In Ireland, in the last 5years, 42% more people now use it to travel to work. This has been mirrored by a rise in cycling-related trauma and deaths. The popularity amongst men has led to the term middle-aged men in Lycra (MAMIL) being coined. The purpose of our study was to quantify cycling-related pelvic and acetabular fracture referrals in Ireland and determine injury patterns, cost and functional outcomes following these injuries. A retrospective cohort study was conducted of all referrals to our institution, the National Centre for Pelvis and Acetabular Fracture Management, in 2016 and 2017. Demographic, mechanism of injury, concomitant trauma and treatment data were analysed. Patients were contacted to assess return to work, sport and quality of life (EQ-5D-3L). Cycling injury referrals increased by 90% between 2016 and 2017 with a greater number of cycling than motorbike injury referrals. Twenty-nine patients sustained a pelvic and acetabular (PA) injury while cycling. The mean patient age was 51.7years of which 86.2% were male with 41% suffering a concomitant injury. Fourteen patients (48.3%) required surgery of which 60% have returned to cycling. Mean cost of treatment was €11,757. The median EQVAS was 80. The rise in popularity of cycling has been mirrored by an increase in PA injuries and deaths. These injuries are associated with significant costs to the patient, hospital and society. Greater investment in safety and awareness is needed to protect this vulnerable group.

PIH7 - A Cost-Benefit Analysis of A Kindergarten-Based Fluoride Varnish Program Among 3-Year Old Children: Some Preliminary Results

We aimed to evaluate the cost-effectiveness of a kindergarten-based fluoride varnish (FV) program for caries prevention among 3-year old children. The program was part of a larger public health project from 2015-2017 to improve oral health of pre-school children in Shanghai, China. Specifically, from January 2016, FV (50 mg/ml Sodium Fluoride, Duraphat, Colgate-Palmolive, USA) was applied every 6 months to all primary teeth of every 3-year old child (with parental/guardian’s consent) in all public kindergartens in Shanghai. A cost-benefit analysis was conducted from the perspective of the municipal healthcare system to compare with a historic cohort before the program launched. The effectiveness outcomes (proportion of children having caries, mean number of decayed, missing, or filled teeth surfaces (dmfs)) were measured at end of 2017 as part of a routine yearly dental screening from a representative sample of all 5-year old children attending public kindergartens in Shanghai. The mean cumulative cost of the program over the 3-year implementation was calculated for one FV application. Cost-benefit ratio (CBR) was estimated by using treatment cost per carious surface for monetary valuation of effectiveness. The prevalence of caries among 5-year old children in Shanghai was 62.82% in 2017, 2.36 percent points lower than that in 2015. The mean dmfs was 2.64 in 2017 vs 3.14 in 2015. Incremental cost-effectiveness ratios (ICERs) were CNY 2833 per child remaining caries free, and CNY 134 per carious surface avoided. Given that the mean treatment cost was estimated at CNY 127 per carious surface, the CBR was 0.95. The sensitivity analysis indicated that CBR would reach 1.0 if the mean dmfs was improved to 2.61, or the cost per FV application was cut by 5%. With a high CBR, the program seemed to be value for money. Further analysis was warranted to evaluate uncertainties.

Defibrotide for the treatment of severe hepatic sinusoidal obstruction syndrome: a single-centre experience

ObjectivesDetermine the effectiveness and cost of defibrotide in patients with severe hepatic sinusoidal obstruction syndrome following haematopoietic stem cell transplantation in a tertiary hospital.MethodsA retrospective observational study. Adults or children...

Costs associated with febrile neutropenia in Japanese patients with primary breast cancer: post-hoc analysis of a randomized clinical trial

Febrile neutropenia (FN), a decrease in blood neutrophils accompanied by fever, is a major adverse event (AE) associated with cancer chemotherapy. We aimed to estimate the direct medical costs associated with FN management in breast cancer patients within a clinical trial with pegfilgrastim, a pegylated form of recombinant granulocyte colony-stimulating factor (G-CSF). We obtained data from 346 Japanese breast cancer patients in a randomized, placebo-controlled clinical trial comparing FN incidence due to TC adjuvant chemotherapy (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2) between pegfilgrastim-treated and placebo groups. We estimated mean costs for chemotherapy drugs, drugs for all AEs and FN, and hospitalization for all AEs and FN. We also calculated mean costs associated with drugs and hospitalization for FN specifically for patients who developed FN in the placebo group. For the pegfilgrastim and placebo groups, the total cost during the first cycle of chemotherapy was ¥189 135 and ¥98 106. This difference is associated with prophylactic use of pegfilgrastim. Our analysis clarified in the placebo group that FN incidents of 119/173 (68.6%), the mean drug cost related to all AEs and hospitalization caused by the first cycle of chemotherapy were ¥14 411and ¥11 180, respectively. The cost of each for FN treatment was ¥16 429 for the placebo group. The mean treatment cost for patients who developed FN in placebo group, was ¥11 145 for drugs and ¥28 420 for drugs and hospitalization. Pegfilgrastim reduced the costs incurred for both drugs and hospitalization for AEs as well as FN, although the total medical cost during the chemotherapy increased. Our study constitutes baseline data for further health economic evaluations of pegfilgrastim.

Cycling injuries and alcohol

BackgroundMost of the cycling accidents that occur in Finland do not end up in the official traffic accident statistics. Thus, there is minimal information on these accidents and their consequences, particularly in cases in which alcohol was involved. The focus of the present study is on cycling accidents and injuries involving alcohol in particular. MethodsData on patients visiting the emergency department at North Kymi Hospital because of a cycling accident was prospectively collected for two years, from June 1, 2004 to May 31, 2006. Blood alcohol concentration (BAC) was measured on admission with a breath analyser. The severity of the cycling injuries was classified according to the Abbreviated Injury Scale (AIS). ResultsA total of 217 cycling accidents occurred. One third of the injured cyclists were involved with alcohol at the time of visiting the hospital. Of these, 85% were males. A blood alcohol concentration of ≥ 1.2 g/L was measured in nearly 90% of all alcohol-related cases. A positive BAC result was more common among males than females (p < 0.001), and head injuries were more common among cyclists where alcohol was involved (AI) (60%) than among sober cyclists (29%) (p < 0.001). Two thirds (64%) of the cyclists with AI were not wearing a bicycle helmet. The figure for serious injuries (MAIS ≥ 3) was similar in both groups. Intoxication with an alcohol level of more than 1.5 g/L and the age of 15 to 24 years were found to be risk factors for head injuries. The mean cost of treatment was higher among sober cyclists than among cyclists with AI (€2143 vs. €1629), whereas in respect of the cost of work absence, the situation was the opposite (€1348 vs. €1770, respectively). ConclusionsCyclists involved with alcohol were, in most cases, heavily intoxicated and were not wearing a bicycle helmet. Head injuries were more common among these cyclists than among sober cyclists. As cycling continues to increase, it is important to monitor cycling accidents, improve the accident statistics and heighten awareness of the risks of head injuries when cycling under the influence of alcohol.

Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer.

Stereotactic body radiation therapy (SBRT) is emerging as a new treatment option for early-stage prostate cancer, theoretically providing clinical and economic benefits compared to conventionally fractionated external-beam radiation therapy (CF-EBRT). This review aimed to evaluate available published data to determine if the proposed theoretical benefits translate clinically. A systematic search strategy was employed across three databases using predefined search terms, inclusion and exclusion criteria to identify relevant articles. Sixteen articles were included. Biochemical progression-free survival rates of 77.1-100% were reported in SBRT studies compared to 55-98% in CF-EBRT studies. Incidence of acute grade 1, 2, and 3 genitourinary toxicities were reported in the range of 13.3-71%, 12-25% and 0-3%, respectively, in the SBRT cohort in comparison to 28.7-51.9%, 15.6-41.4%. and 1.1-8.1%, respectively, in the CF-EBRT cohort. Incidence of acute grade 1, 2, and 3 gastrointestinal toxicities were reported in the range of 13-67%, 1-27% and 0-9%, respectively, of the SBRT cohort compared to 16.1- 51.1%, 6.3-20.7% and 0-3%, respectively, of the CF-EBRT cohort. Mean treatment costs estimates associated with SBRT ranged from $22,152 to $24,873 and $33,068 to $35,431 for CF-EBRT. Available data support the hypothesis of lower rates of acute toxicity and reduced economic burden associated with SBRT compared to CF-EBRT, however, randomised data with longer follow-up are needed to determine whether SBRT is clinically more effective than CF-EBRT.

The Economic Challenge of Centralised Treatment of Patients with Periprosthetic Infections

Periprosthetic infection (PJI) is one of the most severe complications in joint arthroplasty. Correct diagnosis and adequate therapy represent an enormous interdisciplinary challenge. The necessary interdisciplinarity and complexity of treatment require therapy in centres. However, the high costs have not yet been analysed or discussed and are problematic. The aim of this work is therefore to compare the costs within a year of treatment in a department specialised in the treatment of periprosthetic infections. A retrospective evaluation of the patients who were hospitalised in our Centre for Septic Surgery in 2015 was carried out using data from the hospital information system and medical controlling. Demographic data, diagnoses, the length of hospital stay, the number of surgical interventions and the pathogen spectrum were recorded and the costs of treatment were determined. These were compared to the DRG revenues. A total of 281 patients were treated in 2015 due to an infection of the musculoskeletal system, 144 of these with a periprosthetic infection of the knee or hip joint (ratio 1.5 : 1). The mean duration of treatment was 16 days; the mean treatment costs per day and patient were approximately 820 €. The total cost of the 281 treatments was 3.3 million €, of which only 2.7 million were covered by DRG revenues (underfill of approx. - 20%). This corresponded to a deficit of 633,000 €, with a mean deficit per treatment case of 2300 €. The deficit for infected THA was 8585 € on average and was five times greater than for infected TKA - with 1638 €. The main reasons for the high treatment costs were the length of hospital stay, multiple surgical interventions and the isolation treatment. The increasing number of PJI requires interdisciplinary treatment in centres. However, the costs not covered by the DRG system prevent such highly specialised treatment in centres, implying a loss of quality in treatment. There is an urgent need for social discussion and resolution.

Cost of illness due to typhoid Fever in pemba, zanzibar, East Africa.

The aim of this study was to estimate the economic burden of typhoid fever in Pemba, Zanzibar, East Africa. This study was an incidence-based cost-of-illness analysis from a societal perspective. It covered new episodes of blood culture-confirmed typhoid fever in patients presenting at the outpatient or inpatient departments of three district hospitals between May 2010 and December 2010. Cost of illness was the sum of direct costs and costs for productivity loss. Direct costs covered treatment, travel, and meals. Productivity costs were loss of income by patients and caregivers. The analysis included 17 episodes. The mean age of the patients, was 23 years (range=5-65, median=22). Thirty-five percent were inpatients, with a mean of 4.75 days of hospital stay (range=3-7, median=4.50). The mean cost for treatment alone during hospital care was US$ 21.97 at 2010 prices (US$ 1=1,430.50 Tanzanian Shilling─TSH). The average societal cost was US$ 154.47 per typhoid episode. The major expenditure was productivity cost due to lost wages of US$ 128.02 (83%). Our results contribute to the further economic evaluation of typhoid fever vaccination in Zanzibar and other sub-Saharan African countries.

The cost of a combination Anti-Retroviral Therapy (cART) optimization pathway as maintenance therapy in HIV-1 infected patients

BACKGROUND: In order to reduce/prevent combination Anti-Retroviral Therapy (cART)-related toxicity, while maintaining its therapeutic effectiveness over time, the optimization of the antiretroviral therapy could be performed.AIM: To estimate the economic impact on the Italian National Health Service (NHS) of a cART optimization pathway as maintenance therapy in HIV-1 infected patients over one-year period.METHODS: Patient data were retrieved from the electronic medical record system in use (year 2015) in a reference HIV Center in Northern Italy. The analysis considered naïve patients and non-naïve patients. To estimate the actual ART expenditure charged to the Center we calculated the cost of cART received during 12 months for each patient. Subsequently, referring to the same patients, a "potential" cART expenditure was estimated. This potential expenditure was estimated taking in consideration the adoption of a specific optimization pathway aimed at maintaining over the time the cART efficacy. Lastly, to assess the sustainability of the optimization pathway, we compared the actual cART expenditure with the potential one. We considered only drug costs (ex-factory prices, included all discounts and VAT) from the perspective of the Italian NHS.RESULTS: In the 2015, the total expenditure for 564 enrolled HIV-1 patients treated with cART was € 4,042,983. The mean treatment cost per patient was € 7,168. If the Center adopted a specific optimization pathway, the total expenditure would be € 3,914,855 (€ -128,128).CONCLUSIONS: From the Italian NHS’s perspective, the adoption of a specific cART optimization pathway represents a cost-saving option as maintenance antiretroviral therapy in HIV-1 infected patients.

PD VS HD in Post-Economic Crisis Greece—Differences in Patient Characteristics and Estimation of Therapy Cost

The aim of this study was to investigate patient characteristics and make an estimation of the cost of peritoneal dialysis (PD) and hemodialysis (HD) to Greek society during the economic crisis. We recorded the characteristics and the total cost of dialysis treatment in 100 patients on PD and 100 on HD. Total costs included dialysis procedure, consumables, drugs, laboratory tests, food, and transportation fees (only HD), covered by patients' insurance. Also included were medical and administrative salaries, purchase and maintenance of equipment and sanitary material, all covered by the state hospital. The mean patient age was 64.5 ± 16.8 years (PD) and 62.8 ± 15.1 (HD) (p < 0,001). The most common cause of end-stage renal disease (ESRD) was diabetes (32% for PD and 24% for HD patients). A total of 35% of the PD patients were employed vs 4% of the HD patients (p < 0,001). The mean distance from home for PD patients was 41.6 ± 17.3 km, while for HD patients, it was 9.4 ± 1.5 km (p < 0,001). Mean monthly cost for PD and HD treatment per patient was €4,019.20 ± 1,126.30 and €3,254.30 ± 37.50, respectively, both fully covered by patients' insurance. Mean monthly cost for PD or HD dialysis unit maintenance was €11,660.80 and €56,270.50, respectively, also fully covered by the state. There is likely to be a considerable difference in terms of total cost of PD vs HD therapy, owing to the fact that the operational cost of a PD unit appears to be significantly lower than that of a HD unit.

Management of ventilator associated pneumonia with a new antibiotic adjuvant entity (ceftriaxone + sulbactam + disodium edetate) - A novel approach to spare carbapenems

BackgroundVentilator associated pneumonia (VAP) is one of the most serious nosocomial infections in Intensive Care Unit (ICU). The aim of this study was to evaluate a new approach to spare the carbapenems for the management of patients diagnosed with VAP due to Acinetobacter baumannii (A. baumannii). MethodThis retrospective study was conducted on VAP patients presenting for treatment at tertiary care centre between May 2014 and March 2016. The case sheets of patients who have been treated for VAP with meropenem, antibiotic adjuvant entity (AAE) and colistin were analysed. ResultsOut of 113 patients analysed, 24 (21.3%) patients were having VAP due to MDR A. baumannii. Microbial sensitivity has shown that 87.5% of patients were sensitive to AAE and colistin whereas all of them were resistant to meropenem, imipenem and gentamycin. The mean treatment durations were 12.4±2.1, 13.2±2.4 and 14.3±2.1days for AAE, meropenem+colistin and AAE+colistin treatment groups. In AAE susceptible patients, the mean treatment duration and cost could be reduced by 23–24% and 43–53% if AAE is used empirically. In AAE-resistant patients, the mean treatment duration and cost could be reduced by 21% and 26% if AAE+colistin regime is used empirically instead of meropenem followed by AAE+colistin. ConclusionsClinical assessment with microbial eradication and pharmaco-economic evaluation clearly shows benefits in using AAE empirically in the management of A. baumannii infected VAP cases.

Economic Impact of Emergency Visits due to Drug-Related Morbidity on a Brazilian Hospital

ObjectivesTo estimate the cost of managing drug-related morbidity (DRM) that leads to visits to the emergency department of a Brazilian hospital. MethodsThis is a cost-of-illness study based on a retrospective cross-sectional analysis of patients’ medical records. A questionnaire and analysis of medical records were used to identify patients who were being admitted to the emergency department because of DRM. The direct medical costs of patient management were estimated using a microcosting analysis, and a sensitivity analysis was conducted using the emergency department visit rates due to DRM reported in the literature. ResultsOf the total patients interviewed, 14.6% sought emergency care because of DRM and 58.9% were considered preventable. Mean treatment costs were US $900 ± $1,569 (range US $18–$10,847). An extrapolation based on all emergency visits in the last year resulted in annual total treatment costs of US $7.5 million (US $1.1–$1.4 million). It was observed that 39.3% of the total cost of DRM was attributed to adverse drug reactions, 36.9% to nonadherence to treatment, and 16.9% to incorrect dosages. ConclusionsAdverse drug reactions and nonadherence to treatment are important causes of morbidity and cost to the health service. Much of this resource is spent to treat preventable cases of DRM, which represents a great waste of resources.

A Randomized Controlled Trial on the Outcome in Comparing an Alginate Silver Dressing With a Conventional Treatment of a Necrotizing Fasciitis Wound

Necrotizing fasciitis (NF) is a high morbidity and mortality disease and also demands high economic resources. The standard treatment of NF is surgical debridement and proper dressing for wound bed preparation. The efficacy of silver alginate dressing can inhibit the growth of microorganisms and keep the environment clean for wound bed preparation. However an optimal dressing to manage such wounds has yet to emerge. NF patients who were admitted between April 2013 and May 2016 were randomized to have wound dressing using either silver dressing (Ag group) or normal saline solution gauze (NSS group). The 4 main outcomes for comparison between the 2 groups were the duration of wound bed preparation, total cost during hospital stay, the duration of hospital stay, and the pain score. Thirty-nine patients were included in the study: 19 patients in the NSS group and 20 patients in the Ag group. The mean duration of wound bed preparation in the NSS group was 31.87 days, and in Ag group it was 21.39 days, but this trend was not statistically significant ( P = .057). The mean cost of treatment in the NSS and Ag groups was not significantly different ( P = .434; US$3308.83 and US$2647.82, respectively). The duration of hospital days in the 2 groups was not significantly different either (29.19 days [NSS group] and 20.99 days [Ag group]; P = .222). The pain score was significantly lower in the Ag group than those in the NSS group. Although silver dressing seems to be expensive, the cost of total treatment during hospital stay and the duration of hospital stay were not significantly different between groups. However, the mean duration of wound bed preparation seems to trend favoring toward the silver dressing group.

Cost-Effectiveness of Pediatric Cancer Treatment in Tanzania: An Economic Analysis

Abstract 52 Background: Despite the high burden of pediatric cancer in low- and middle-income countries, the number of facilities at which children can obtain treatment remains distressingly low. Understanding the costs and economic value of pediatric cancer treatment may assist policy makers to maximize the value of investments in health with informed resource allocation decisions. We examined the direct and indirect costs, cost-effectiveness, and societal economic benefit of diagnosing and treating children with cancer in Tanzania at the Bugando Medical Center, one of only two hospitals in the country with a pediatric oncology unit. Methods: A retrospective chart review of hospital admissions and clinic visits from January 2010 to August 2014 was performed. Costs were recorded for all items that were billed to the patient for laboratory studies, medications, imaging, pathology, surgeries, and hospital stay. Travel costs were estimated for each patient on the basis of a self-reported home address. All costs were converted from Tanzanian shillings to 2016 US dollars. Health outcomes were measured as disability-adjusted life-year (DALY) averted. We calculated the cost-effectiveness ratio of treatment versus performing no intervention as well as the societal economic benefit using a human capital approach and considering the per capita gross national product in Tanzania. Results: We identified costs for a subset of 127 patients, 64% of which were male (n = 81). Mean age at first clinical presentation was 6.9 years. Mean cost for treatment was $218 ± $145, with an average of 10.4 ± 8.9 DALYs averted per patient. Total cost-effectiveness ratio was $21/DALY, and the mean societal economic benefit was $27,118 ± $23,412. Conclusion: Our findings show that pediatric cancer treatment in Tanzania is cost-effective and offers substantial economic value. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

A Clinicoepidemiological Profile of Chronic Wounds in Wound Healing Department in Shanghai

The aim of the study was to update the clinical database of chronic wounds in order to derive an evidence based understanding of the condition and hence to guide future clinical management in China. A total of 241 patients from January 1, 2011 to April 30, 2016 with chronic wounds of more than 2 weeks' duration were studied in wound healing department in Shanghai. Results revealed that among all the patients the mean age was 52.5 ± 20.2 years (range 2-92 years). The mean initial area of wounds was 30.3 ± 63.0 cm2 (range 0.25-468 cm2). The mean duration of wounds was 68.5 ± 175.2 months (range 0.5-840 months). The previously reported causes of chronic wounds were traumatic or surgical wounds (n = 82, 34.0%), followed by pressure ulcers (n = 59, 24.5%). To study the effects of age, patients were divided into 2 groups: less than 60 years (<60), and 60 years or older (≥60). The proportion of wounds etiology between the 2 age groups was analyzed, and there was significant statistical difference ( P < .05, 95% confidence interval [CI] = 0.076-0.987). To study the associations between outcome and clinical characteristics in chronic wounds, chi-square test was used. There were significant differences in the factor of wound infection. ( P = .035, 95% CI = 0.031-0.038) Regarding therapies, 72.6% (n = 175) of the patients were treated with negative pressure wound therapy. Among all the patients, 29.9% (n = 72) of them were completely healed when discharged while 62.7% (n = 150) of them improved. The mean treatment cost was 12055.4 ± 9206.3 Chinese Yuan (range 891-63626 Chinese Yuan). In conclusion, traumatic or surgical wounds have recently become the leading cause of chronic wounds in Shanghai, China. Etiology of the 2 age groups was different. Infection could significantly influence the wound outcome.

Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management

BackgroundTo evaluate the functional and radiographic outcomes, as well as the treatment costs, of closed displaced intra-articular distal radius fractures treated with either open reduction internal fixation (ORIF) with volar locking plates or nonoperative treatment with plaster cast immobilisation.Materials and methodsA total of 60 patients (32 receiving ORIF, 28 receiving nonoperative treatment) with closed intra-articular distal radius fractures were included. The mean age was 52.1 and 57.4, respectively. Functional and radiographic assessments were carried out at 12 months post-injury. Patients’ treatment costs, median salaries and lengths of medical leave were obtained.ResultsDASH and MAYO wrist score in the ORIF group did not differ significantly from those in the nonoperative group. Apart from superior ulnar deviation in the ORIF group (p = 0.0096), differences in the range of motion of the injured wrists were not significant. Similarly, there were no significant differences in grip strength and visual analog scale for pain. Volar tilt (p = 0.0399), radial height (p = 0.0087), radial inclination (p = 0.0051) and articular step-off (p = 0.0002) were all significantly superior in the ORIF group. There was a 37-fold difference in mean treatment costs between ORIF (SGD 7951.23) and nonoperative treatment (SGD 230.52).ConclusionOur study shows no difference in overall functional outcomes at 12 months for closed displaced intra-articular distal radius fractures treated with either ORIF with volar locking plates or plaster cast immobilisation, and this is independent of radiographic outcome. A longer follow-up, nevertheless, is needed to determine whether the development of post-traumatic arthritis will have an effect on function. The vast difference in treatment costs should be taken into consideration when deciding on the treatment option.Level of evidenceLevel 3.

Abstract TP148: Characteristics and Estimated Rehabilitation Costs for Stroke Survivors Treated in a Community-Based Interdisciplinary Outpatient Rehabilitation Program Who Return to Work

Background: Return to work is a motivating goal for many stroke survivors. Little is known about the cost, length of treatment, and characteristics of patients returning to work. Methods: Prospective observational study of stroke patients treated between 12/2014-6/2016 in an interdisciplinary outpatient rehabilitation program addressing physical, psychosocial, cognitive, communicative, driving, and vocational issues. The estimated average cost of treatment was calculated from reimbursement amounts received for skilled PT, OT, ST, and Nurse Practitioner services, including services received after patients returned to work. Results: Of 96 consecutive patients, 48% were working prior to their stroke. Of these, 9% of patients were work capable and 44% returned to work (n=20) by rehabilitation discharge (mean program length was 8 months, maximum of 34 months). Returning workers were 70% men, mean age of 56 years, 75% ischemic strokes (4 Left, 4 Right, 3 Bi-lateral hemisphere, 4 posterior circulation), and on program admit had an average NIHSS score of 3.4 (range 0-9), 40% were aphasic, 65% needed ADL assistance (55% mRS=3, 10% mRS=4). All patients working prior to their stroke were also driving and 90% of those who returned to work also returned to driving. All patients demonstrated improvements in multiple standardized rehab outcome measures. Mean treatment cost for patients who returned to work was $17,730 (60% had costs less than $7,500; 25% had costs from $7,501-$21,000; 15% had costs from $50,000-$92,000). Services continued for 75% of patients after returning to work for an average of 3.7 months(included in mean program length of 8 months). Almost half of these patients (47%) were aphasic. Mean treatment cost for patients not returning to work was $22,561, with mean program length of 6.5 months. Conclusions: These findings demonstrate that interdisciplinary, outpatient rehabilitation programs can promote successful return to work at a reasonable cost, with 60% of patients who returned to work costing less than $7500. Aphasic patients needed longer treatment, but were able to successfully return to work. Additional outcomes research is needed to understand mechanisms supporting stroke patients’ return to work and other patient-centered goals.

Fenestrated and chimney endovascular aneurysm repair versus open surgery for complex abdominal aortic aneurysms

Many patients with complex abdominal aortic aneurysms are unfit for open repair. New endovascular technologies and bailout techniques are being used for managing these complex anatomies. The purpose of this study is to compare the results obtained with advanced endovascular aneurysm repair (a-EVAR) techniques (fenestrated and chimney endografts) to those obtained with open repair for the treatment of complex abdominal aortic aneurysms not anatomically suitable for standard endovascular exclusion (infrarenal neck <10 mm, juxtarenal, suprarenal and Crawford's type IV thoracoabdominal aneurysms). All patients that underwent open surgery (OS cohort; historical, January 1994-December 2015) or a-EVAR (a-EVAR cohort; prospective, January 2006-December 2015) at our institution for complex abdominal aortic aneurysms that meet the anatomical criteria described above on the preoperatory contrast-enhanced computed tomography scan were included. Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (V-POSSUM) was employed for risk-assessment. A total of 108 patients were included, all of them male: 56 in the OS cohort and 52 in the a-EVAR cohort (mean age: 67.5±6.7 vs. 72.65±6.4 years, respectively; P=0.000). V-POSSUM predicted 4 deaths for the OS cohort and 3 deaths for the a-EVAR cohorts within the postoperative period and morbidity rates of 57% and a 44.4%, respectively. All-cause 30-day mortality rates were 9 patients (16%) for the OS cohort and 2 patients (3.8%) for the a-EVAR cohort (P=0.038). Thirty-day morbidity rates were 59% for the OS cohort and 44% for the a-EVAR cohort (P=0.09). Mean cost of treatment was € 15,707 per patient for the OS cohort (median: € 11,516; inter-quartilic range [IQR]: € 7901; min-max: € 5069-11,0052) and € 33,457 per patient for the a-EVAR cohort (median: € 29,663; IQR: € 5979; min-max: € 13,865-19,3536), P=0.000. A-EVAR is a feasible alternative to open surgery for complex abdominal aortic aneurysms at our institution, with lower 30-day mortality rates, yet increasing double the amount the total cost of the therapy.

Cost of breast cancer based on real-world data: a cancer registry study in Italy

BackgroundIn European countries, it is difficult for local health organizations to determine the resources allocated to different hospitals for breast cancer. The aim of the current study was to examine the costs of breast cancer during the different phases of the diagnostictherapeutic sequence based on real world data.MethodsTo identify breast cancer cases diagnosed between 2007 and 2011, we used the cancer registry of the Agency for Health Protection of the Province of Milan (3.2 million inhabitants). A generalized linear model controlling for patient age, cancer stage and Charlson co-morbidity index was used to calculate the adjusted mean costs for each hospital and for each study phase. Regression analyses were based on dependent variables of individual costs (diagnosis, treatment, follow-up and total cost were logtransformed. The following independent variables were included as covariates: age at diagnosis, hospital volume, stage, job category, educational level, marital status, comorbidities, deprivation index. Total and mean costs were computed for several variables and for each phase. On average for each subject, the costs were collected over 2.5 years.ResultsA total of 12,580 breast cancer cases were studied. The mean cost of diagnosis was €414, the mean cost of treatment was €8,780, the mean overall cost of follow-up was approximately €2,351, and the mean total direct medical cost was €10,970. The age of the patients, stage of tumor and employment level of the patient were significantly correlated with the variability of the costs. The highest variability in costs was observed for the follow-up costs, in which 38% of hospitals fell outside the 95% confidence interval. In the overspending-hospitals, patients received an intensive follow-up regimen with scintigraphy and thoracic CAT (computerized axial tomography).ConclusionsIn this study, which represents the first population-level study of its kind in Italy, we estimated all direct medical costs for the 6-month period before the diagnosis of breast cancer and the first two years after diagnosis. Patients were identified from the local cancer registry. The analysis offers insight into the utilization of resources incurred by one major area of interest of cancer care in Italy.

Orthopedic trauma surgery and hospital cost analysis in refugees; the effect of the Syrian civil War.

The aim of this study was to evaluate the musculoskeletal injury types, injury mechanisms, surgical techniques and treatment costs of Syrian refugees. Totally 158 patients (67 female, 91 male) treated in our clinic in 34months period between January 2012 and October 2014 were included in the study. The mean age of the patients was 39.3years (range: 18-82years). The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, injury severity score, surgical technique, complications, mortality/morbidity and treatment cost. The injuries were more frequently reported in lower extremities, upper extremities and axial skeleton, respectively. Blunt trauma was significantly higher in upper extremity injuries compared with the other types of injuries (p = 0.001). Fractures were most commonly reported in foot/ankle region and in males, hand/wrist fractures were significantly higher than that of the females. Plate fixation of upper extremity fractures and intramedullary nailing in lower extremity fractures were the most commonly preferred treatment modalities. The mean hospitalization period of patients was 5.6days and the mean treatment cost was 3844 Turkish Liras (TL). In this study, it was shown that there was a statistically significant increase in the cost of health expenses in patients with fall from heights or gunshot wound, with fractures in axial skeleton or with the ISS score between 16 and 66. The cost rise was associated with worse prognosis, complications, intensive care treatments and prolonged hospitalization periods.