Mean Cost Of Treatment Research Articles

The cost-effectiveness of treatment of short occlusive lesions in the femoropoliteal artery: Balloon angioplasty versus endarterectomy

To compare the short- and long-term outcome and the costs involved in balloon angioplasty (BA) and thromboendarterectomy (EA) of short femoropopliteal occlusions. Retrospective study. Forty-one lower limbs underwent EA from 1980 until 1988 and BA was performed in 62 limbs between 1988 and 1993. The two groups of patients were well matched for age, gender, cardiovascular risk-factors and the length of the femoropopliteal occlusions. In addition to clinical follow-up colour-Duplex scanning and intraarterial DSA were performed. Complete occlusions or significant restenoses were considered failure of the reconstruction. Actual costs were calculated by the hospital economic administration. The 3-year primary patency in EA patients was 87% and in the BA group 44% (p = 0.0002). Redo procedures were required in seven (17%) patients with EA and in 24 (39%) with BA. Patency after redo procedures, i.e. tertiary patency, was 94% and 74% after 3 years in the EA and BA group respectively (p = 0.14). The mean cost of the primary treatment was higher in EA than in BA patients (p < 0.0001). Mean total treatment costs including the expenses involved with redo procedures were also higher in the group with EA than with BA (p < 0.001). However, the cost-effectiveness expressed as the total costs per month tertiary patency, was not significantly different for the two treatment groups; in patients with EA the ratio of total treatment costs and tertiary patency was NFl 309, and in patients with BA NFl 287. Contrary to the general view the expenses associated with surgical treatment are comparable with those of an endovascular procedure, if the costs are expressed as a cost-to-patency ratio.

Screening and the costs of treating colorectal cancer

The objective of this paper is to compare the hospital costs of treating patients with colorectal cancers detected as a result of a faecal occult blood screening programme with those of patients whose cancers present symptomatically (control group). Patient-specific cost estimates are made, using case records and hospital accounts, for 360 patients over 3 years. Mean treatment costs for the group offered screening and for the control group are calculated to be 3,179 pounds and 2,966 pounds respectively, although the difference between these means is insignificant. Low treatment costs in the case of screen-detected cancers are largely accounted for by polypectomy with no subsequent readmission; in the control group case, they tend to be accounted for by early patient death. For the sample as a whole, the costs of treating very early-, and very late-, stage cancer are significantly lower than those of treating cancers in the intermediate stages. On the basis of trial evidence, the introduction of mass screening for colorectal cancer is unlikely to give rise to substantial economies in the costs of treatment.

Advanced breast cancer: use of resources and cost implications

Little information is currently available on the use of hospital resources and the resulting costs of treating any advanced cancer. Such data may be useful for planning purposes and for calculating the cost effectiveness of measures designed to reduce the incidence of advanced disease (such as the National Breast Screening Programme). A retrospective analysis of the medical records of 50 patients with advanced breast cancer who attended the Guy's Hospital Oncology Unit and who died between October 1988 and December 1990 has therefore been undertaken. For each patient, the duration of in-patient stays and principal indications for admissions were recorded, together with the number of out-patient attendances. Details of endocrine treatment, chemotherapy and radiotherapy were abstracted as were all radiological and laboratory investigations. Costs for each of these activities were calculated. The median duration of advanced disease was 17 months (mean 27 months; range 7 days-12 years). The mean cost of treatment per patients was calculated to be 7,620 pounds (range 317 pounds-27,860 pounds). Mean duration of in-patient stay was 32 days (0-133) and this accounted for 56% of total costs. The large majority (> 80%) of the time spent as an in-patient was for the care of serious illness rather than for specific antitumour treatment. Cytotoxic drugs accounted for 9% of the total cost, compared with 8% for radiotherapy and 13% for laboratory and radiological investigations.

Control of competing vegetation in planted coniferous forests in Australia and New Zealand

Summary Forestry organisations in Australia and New Zealand were canvassed for their use of weedicides in planted coniferous forests. The main expenditure was on the control of grasses on second rotation sites in New Zealand, and acacias and eucalypts on cleared native forest sites in Australia. Aerial application predominated in New Zealand where weed control costs were 1.7 times those in Australia (1983 A$ values). Non-woody weeds had a mean treatment productivity (ha man−1d−1) some 2.5 times higher than woody weeds, but high variation in treatment costs resulted in no difference between mean treatment costs for woody and non-woody weeds. Twenty chemical formulations in 46 prescriptions and six application methods were used to control only 20 weed groups. Six of the chemicals and mixtures were applied over most (78%) of the surveyed area with 78% of the expenditure. 2,4,5-T alone and in mixtures was applied to 40% of the area, and 79% of organisations were testing alternatives to 2,4,5-T. Other prominen...

The cost of radiotherapy treatments on a linear accelerator.

The cost of delivering a radiotherapy treatment on a linear accelerator is calculated. Items included in the cost are: cost of the accelerator itself, a simulator, a treatment planning computer, the treatment room, and the salaries of the radiographers and physicists concerned, as well as machine operating costs and interest charges. The cost of a beam direction shell is also calculated. The different costs are reduced to statements of cost per year (see Table IV for summary), and from these the cost of a course of treatment for a patient is arrived at on the basis of 800 patients treated per year. The cost comes out at pounds 137, plus pounds 70 for a beam direction shell, if one is used. Because the capital costs of radiotherapy treatment equipment are very substantial, it is often assumed that radiotherapy is a very expensive form of treatment. An analysis of treatment cost is presented, initially in terms of cost per year for equipment, special buildings, and staff at 1981 prices. Reduction of these figures to mean treatment cost per patient is based on the DHSS guideline for provision of radiotherapy services (HC(78)32), which suggests a figure of 800 patients to be treated per year as the number justifying the provision of a linear accelerator.

Dental needs and costs for patients from three social agencies.

This study indicates that for these patients studied from Johnson County, Iowa, the County Home residents have more unmet basic dental needs than do patients from Goodwill Industries or Community Action programs. The mean cost of treating the dental needs of a County home resident was found to be approximately twice that of providing dental services to the other two social service agencies. This cost differential comes about as a result of two major factors: (1) the County Home residents seen have more unmet basic dental needs, and (2) they have proportionately more unmet dental needs in specialty areas that cost more per unit of treatment (i.e. periodontics, fixed prosthodontics, and removable prosthodontics). The mean treatment cost per patient seen from each of these agencies is $851.77 for County Home residents, $407.97 for Goodwill Industry clients, and $341.21 for Community Action clients. A follow-up of this study in regard to specific circumstances that contribute to the higher incidence of dental treatment needs of the Johnson County Home residents is recommended. Such additional information would be helpful to the effective design of dental health programs for implementation at the community level.