Reduction In Medical Costs Research Articles

PCV22 Estimating the Reduction in Medical Care Costs Associated with Ticagrelor and Aspirin in Patients with Acute Ischemic Stroke or TIA

The efficacy of ticagrelor 90mg and aspirin (ticagrelor-aspirin) for the prevention of stroke following an ischaemic stroke (IS) or transient ischaemic attack (TIA) was evaluated in the Acute STroke or Transient IscHaemic Attack Treated With TicAgreLor and ASA for PrEvention of Stroke and Death (THALES, NCT03354429) trial. Ticagrelor-aspirin resulted in a 17% reduction in the risk of stroke or death over 30 days versus aspirin, but with more bleeding events. Ticagrelor 90mg is approved to reduce stroke risk in patients with acute IS (NIH Stroke Scale score ≤5) or high-risk TIA by the Food and Drug Administration. The objective of this study was to estimate the reduction in medical care costs associated with ticagrelor-aspirin from a US payer perspective. THALES event rates were used to estimate incidence of IS, intracranial haemorrhage, other severe bleeding and death in a modelled cohort of 1,000 patients with IS or TIA over 30 days. Acute stroke management costs were derived using US claims from IBM® MarketScan® Databases 2019 and applied to the incidence of events. Ticagrelor-aspirin was associated with 12 fewer IS compared to aspirin (49 versus 61) and three additional severe bleeding events (4 versus 1) per 1,000 treated patients. Total estimated medical care costs were $311,000 lower per 1,000 patients treated with ticagrelor-aspirin ($2.26M) versus aspirin ($2.57M); a per-patient reduction of $311. The reduction of IS events resulted in a per-patient reduction of $496 with ticagrelor-aspirin, primarily driven by a decrease in the incidence of IS resulting in disability, while additional bleeding events resulted in additional costs of $185 per patient treated with ticagrelor-aspirin. IS and TIA impose a significant burden on both patients and payers; treatment with ticagrelor-aspirin has the potential to improve patient outcomes and result in cost-savings through the reduced incidence of subsequent ischaemic stroke.

66-LB: Real-Time Continuous Glucose Monitor (RTCGM) Use Associated with Decreased Diabetes Medical Costs for Patients with Type 2 Diabetes (T2D)

Background: RtCGM allows patients with type 2 diabetes to improve blood glucose control and reduce risk of serious acute and chronic complications of diabetes through continuous monitoring of real-time glucose levels, however little is known about the impact of rtCGM on diabetes-related medical costs in this population. Methods: A retrospective analysis of administrative claims data from the Optum Research Database was conducted. The T2D cohort included those on intensive insulin therapy (IIT), and non-intensive therapies, including basal insulin only, and non-insulin medications. Patients initiated treatment with rtCGM between October 1, 2017 and February 28, 2019 (index date= earliest observed pharmacy claim). Continuous health plan enrollment of 12 months prior to, and 6 months after index date was required. Individuals with evidence of pregnancy, or type 1 diabetes were excluded. Total diabetes-related medical costs were assessed during the pre-and post-index periods and expressed as change in per-person-per-month (PPPM) costs. Results: A total of 571 T2D patients met study inclusion criteria (average age = 51.2 (sd = 11.9) years, 46% female, 80% IIT). Average PPPM diabetes-related medical costs decreased by -$424, 95% CI -$816, -$31, p<0.035 after initiating rtCGM treatment (pre-index mean (SD) PPPM costs: $1,680 ($4,519); post-index: $1,256 ($3,679)). These reductions were driven, in part, by reductions in diabetes-related inpatient medical costs (-$358, 95% CI -$706, -10. p<.-044). Inpatient hospital stays were reduced on average -.006 PPPM and hospital days were reduced an average of -.042 PPPM. Conclusions: These findings provide real-world evidence that rtCGM use was associated with diabetes-related medical cost reductions in patients with T2D. Increased access to rtCGM for patients with T2D may help to reduce diabetes-related cost of care. Disclosure G. J. Norman: Employee; Self; Dexcom, Inc. M. L. Paudel: None. T. Bancroft: None. P. M. Lynch: Employee; Self; Dexcom, Inc.

Health and Housing Energy Expenditures: A Two-Part Model Approach

Interest in the interaction between energy and health within the built environment has been increasing in recent years, in the context of sustainable development. However, in order to promote health and wellbeing across all ages it is necessary to have a better understanding of the association between health and energy at household level. This study contributes to this debate by addressing the case of Portugal using data from the Household Budget Survey (HBS) microdata database. A two-part model is applied to estimate health expenditures based on energy-related expenditures, as well as socioeconomic variables. Additional statistical methods are used to enhance the perception of relevant predictors for health expenditures. Our findings suggest that given the high significance and coefficient value, energy expenditure is a relevant explanatory variable for health expenditures. This result is further validated by a dominance analysis ranking. Moreover, the results show that health gains and medical cost reductions can be a key factor to consider on the assessment of the economic viability of energy efficiency projects in buildings. This is particularly relevant for the older and low-income segments of the population.

Introduction of an Ambulatory Care Medication Reconciliation Service in Dialysis Patients: Positive Impact on Medication Prescribing and Economic Benefit.

The aim of the study was to assess the implementation of medication reconciliation (MedRec) and medication-related costs in dialysis-dependent patients. Completed best possible medication history and reconciliation forms were collected within 6 months from 77 patients' file at the dialysis center. Outcome measures were number and types of medication discrepancies, medication-related problems (MRPs), and their potential to cause harm, in addition to the type and number of interventions conducted during MedRec and the resulted medication costs reduction. The mean number of medications was 11 ± 4, which was reduced to 8 ± 3 (P < 0.0001) after MedRec. Medication discrepancies accounted for 55, and MRPs were raised by pharmacists 216 times, and 55% had the potential to cause moderate patient discomfort. Mediations were held in 1.2%, discontinued in 21.2%, and changed in 5.4%, which led to €75.665 (U.S. $85.33) and €459.93 (U.S. $511.979) reduction in medication costs per patient for 1 and 6 months, respectively. Several discrepancies and MRPs were identified in the present study that put patients undergoing dialysis at risk for potential harm and adverse drug events. Regularly performing ambulatory MedRec and involving pharmacists in the model of care can improve the quality of healthcare delivered to dialysis-dependent patients and reduce cost.

PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study.

A multicenter, prospective, observational study was performed between August 2018 and January 2019. Community and academic hospitals in the United States. Emergency medicine clinical pharmacists. Recommendations classified into one of 38 intervention categories associated with cost avoidance. Eighty-eight emergency medicine pharmacists at 49 centers performed 13,984 interventions during 917 shifts that were accepted on 8,602 patients and generated $7,531,862 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established categories were as follows: adverse drug event prevention (1,631 interventions; $2,225,049 cost avoidance), resource utilization (628; $310,582), individualization of patient care (6,122; $1,787,170), prophylaxis (24; $22,804), hands-on care (3,533; $2,836,811), and administrative/supportive tasks (2,046; $342,881). Mean cost avoidance was $538.61 per intervention, $875.60 per patient, and $8,213.59 per emergency medicine pharmacist shift. The annualized cost avoidance from an emergency medicine pharmacist was $1,971,262. The monetary cost avoidance to pharmacist salary ratio was between $1.4:1 and $10.6:1. Pharmacist involvement in the care of patients presenting to the emergency department results in significant avoidance of healthcare costs, particularly in the areas of hands-on care and adverse drug event prevention. The potential monetary benefit-to-cost ratio for emergency medicine pharmacists is between $1.4:1 and $10.6:1.

4-(2,5-Dimethyl-1H-pyrrol-1-yl)-N-(2,5-dioxopyrrolidin-1-yl) benzamide improves monoclonal antibody production in a Chinese hamster ovary cell culture.

There is a continuous demand to improve monoclonal antibody production for medication supply and medical cost reduction. For over 20 years, recombinant Chinese hamster ovary cells have been used as a host in monoclonal antibody production due to robustness, high productivity and ability to produce proteins with ideal glycans. Chemical compounds, such as dimethyl sulfoxide, lithium chloride, and butyric acid, have been shown to improve monoclonal antibody production in mammalian cell cultures. In this study, we aimed to discover new chemical compounds that can improve cell-specific antibody production in recombinant Chinese hamster ovary cells. Out of the 23,227 chemicals screened in this study, 4-(2,5-dimethyl-1H-pyrrol-1-yl)-N-(2,5-dioxopyrrolidin-1-yl) benzamide was found to increase monoclonal antibody production. The compound suppressed cell growth and increased both cell-specific glucose uptake rate and the amount of intracellular adenosine triphosphate during monoclonal antibody production. In addition, the compound also suppressed the galactosylation on a monoclonal antibody, which is a critical quality attribute of therapeutic monoclonal antibodies. Therefore, the compound might also be used to control the level of the galactosylation for the N-linked glycans. Further, the structure-activity relationship study revealed that 2,5-dimethylpyrrole was the most effective partial structure of 4-(2,5-dimethyl-1H-pyrrol-1-yl)-N-(2,5-dioxopyrrolidin-1-yl) benzamide on monoclonal antibody production. Further structural optimization of 2,5-dimethylpyrrole derivatives could lead to improved production and quality control of monoclonal antibodies.

Assessment of Annual Cost of Substance Use Disorder in US Hospitals

A persistently high US drug overdose death toll and increasing health care use associated with substance use disorder (SUD) create urgency for comprehensive estimates of attributable direct costs, which can assist in identifying cost-effective ways to prevent SUD and help people to receive effective treatment. To estimate the annual attributable medical cost of SUD in US hospitals from the health care payer perspective. This economic evaluation of observational data used multivariable regression analysis and mathematical modeling of hospital encounter costs, controlling for patient demographic, clinical, and insurance characteristics, and compared encounters with and without secondary SUD diagnosis to statistically identify the total attributable cost of SUD. Nationally representative hospital emergency department (ED) and inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample were studied. Statistical analysis was performed from March to June 2020. International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) principal or secondary SUD diagnosis on the hospital discharge record according to the Clinical Classifications Software categories (disorders related to alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, and other substances). Annual attributable SUD medical cost in hospitals overall and by substance type (eg, alcohol). The number of encounters (ED and inpatient) with SUD diagnosis (principal or secondary) and the mean cost attributable to SUD per encounter by substance type are also reported. This study examined a total of 124 573 175 hospital ED encounters and 33 648 910 hospital inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample. Total annual estimated attributable SUD medical cost in hospitals was $13.2 billion. By substance type, the cost ranged from $4 million for inhalant-related disorders to $7.6 billion for alcohol-related disorders. This study's results suggest that the cost of effective prevention and treatment may be substantially offset by a reduction in the high direct medical cost of SUD hospital care. The findings of this study may inform the treatment of patients with SUD during hospitalization, which presents a critical opportunity to engage patients who are at high risk for overdose. Aligning incentives such that prevention cost savings accrue to payers and practitioners that are otherwise responsible for SUD-related medical costs in hospitals and other health care settings may encourage prevention investment.

Cost-effectiveness analysis of active psoriatic arthritis treatment with ixekizumab in adult patients in Russian Federation health care system

Objective: to evaluate the economic impact of the use of various biologic disease-modifying antirheumatic drugs (bDMARDs) from the group of inhibitors of interleukins (iIL) 12/23 and iIL17 in adult patients with psoriatic arthritis (PsA) with insufficient response to therapy with TNFα inhibitors (TNFα inhibitors).Patients and methods. A Microsoft Excel model has been developed, it allows to calculate the average cost of treatment of 1 patient with PsA who needs a second-line bDMARD from the iIL12/23 or iIL17 group. Only direct medical costs (drug costs) were considered. Cost minimization analysis and budget impact analysis were carried out.Results and discussion. The results of a network meta-analysis demonstrate no statistically significant differences in efficacy and safety between ixekizumab (IXE) and secukinumab (SEC) and superiority SEC over ustekinumab when used in adult patients with active PsA with insufficient response to or intolerance of previous therapy with synthetic disease-modifying antirheumatic drugs or TNFα inhibitors. The analysis of cost minimization showed that the total cost of 1 patient managing for 1 year using IXE is 26% lower than treatment with SEC: on a 2 year horizon, the difference is 27%. Analysis of the impact on the budget revealed that on the horizon of 1 year the simulated distribution will lead to budget savings of 16,796,131 rubles, which will allow additional treatment of 17 patients with IXE, after 2 years the budget savings will amount to 39,289,373 rubles, which will allow to treat additionally 52 patients. The sensitivity analysis confirmed the robustness of the study results.Conclusion. Thus, in adult patients with PsA requiring second-line bDMARDs, the use of IXE is more effective than the use of SEC and provides reduction in direct medical costs. The use of IXE will not have a significant impact on costs under the State Guarantee Program, but it can increase the availability of bDMARDs in patients with active PsA who have not responded to the previous therapy, without increasing the budget.

Cost-Effectiveness Analysis of a Prescription Digital Therapeutic for the Treatment of Opioid Use Disorder

ABSTRACT The lack of adequate treatment for many patients with opioid use disorder (OUD) has led to high medical costs ($90B in 2020). An analysis of the cost-effectiveness (cost-utility) of reSET-O, the first and only FDA-approved prescription digital therapeutic (PDT) for the treatment of OUD, is needed to inform value assessments and healthcare decision making. To evaluate the cost-utility of reSET-O in conjunction with treatment-as usual (TAU) compared to TAU alone. A third-party payer-perspective decision analytic model evaluated the cost-effectiveness of reSET-O + TAU relative to TAU (i.e., oral buprenorphine, face-to-face counseling, and contingency management [immediate rewards for negative drug tests logged]) alone over 12 weeks. Clinical effectiveness data (retention in therapy and health state utilities) were obtained from the peer-reviewed literature, while resource utilization and cost data were obtained from a published claims data analyses. Over 12 weeks, the addition of reSET-O to TAU resulted in a gain of 0.003 quality-adjusted life years (QALYs), and $1,014 lower costs, resulting in economic dominance vs. TAU. reSET-O + TAU’s was economically dominant (less costly, more effective) vs. TAU alone over 12 weeks, a result that was driven by a reduction in medical costs after initiation of reSET-O observed in a recent real-world claims analysis.

Redesign the Front Shape of the Sedan Car for Pedestrian Safety and Mitigating Leg Injuries at Accidents

The number of fatal and non-fatal pedestrian injuries, due to car accidents, has increased. For this reason, design of least possible harm cars (i.e. pedestrian friendly cars) has attracted the interest of many researchers and companies in order to reduce mortality and mitigate injuries. The use of friendly cars can also lead to the reduction of the expensive medical treatment costs for pedestrian injuries and consequently alleviates the financial burdens of the governments and insurance companies. In the sedan cars accidents, the common first pedestrian body part which experiences impact is the legs. In this research, a simulation study is conducted for investigating the effects of car bumper profile and plastic grille tilt angle on the severity of collision. LS-Dyna software is used to simulate, numerically investigate and analyze the mechanism of collision between a simulated leg and a vehicle bumper. In this simulation, three parameters are considered, impact line between pedestrian leg and car bumper, the height of the bumper relative to the knee, and the plastic grille tilt angle. The results of this study showed that the increase of impact line, increase of bumper height and decrease the plastic grille tilt angle alleviate the severity of pedestrians leg injuries.

중국 20-30대 소비자의 건강기능식품 구매의도에 관한 연구: 확장된 목표지향행동 모델을 중심으로

Economic growth and income level improvement have improved the quality of life of consumers, and the change of population structure and extension of life expectancy are raising interest in health and food., health functional foods that can supplement various functional nutrients more easily are showing steady growth trend in major markets in the world. In particular, demands for health foods in China are gradually growing with increases in disposable income and economic development and interest is also increasing recently in health functional food, which is allowing for disease prevention and reductions in medical costs after the recent COVID-19 situation. Also, health functional food is no longer consumed only by the middle-aged and the elderly but is now being highlighted as an essential product of those in their twenties and thirties, showing that there will continuously be great demand in the future. Therefore, this study observed health functional food purchase intentions by applying the model of goal-directed behavior, expanded for Chinese consumers in their 20s-30s. In order to analyze the factors affecting the intention of purchasing health functional foods of consumers in their 20s and 30s, a survey was conducted on consumers in their 20s and 30s living in Beijing, China.,A total of 248 copies were used for the final analysis as a result of web surveys conducted through Chinese research companies for 15 days from April 28 to May 13, 2020., For data analysis, statistical processing was conducted using SPSS 24.0 program and AMOS 18.0 program. Research results showed first that, it was confirmed that perceived behavior control, purchasing attitudes, and negative expected emotions, which are variables of model of goal-directed behavior, have effects on health functional food purchasing desires and that purchasing desires have a positive effect on health functional food purchase intentions. Second, food safety perceptions have positive effects on health functional food purchasing attitudes and purchase intentions. Lastly, health functional food familiarity had positive effects on both health functional food purchasing attitudes and purchase intentions. This study will aid in the establishment of marketing strategies that are needed by health functional food-related businesses when they advance into global markets and nationally, it is anticipated to be used as empirical data in the promotion of globalization policies for the health functional food industry. In addition, it is intended to help provide information on health functional foods and provide consumer education for efficient selection and use of health functional foods of consumers in their 20s and 30s.

556: Pharmacist Avoidance or Reductions in Medical Costs Considering BPS Certification (PHARM-BPS)

Liang, Edith1; Masic, Dalila2; Rech, Megan3; Adams, William4; Niehaus, Matthew5; Balk, Robert6; Hammond, Drayton6 Author Information

1063: PHarmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill PEDiatricS

1063: PHarmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill PEDiatricS

PRS7 Economic Savings Driven By the Coupled Use of Inhalers with Apps for Asthma in Portugal

Asthma places a considerable burden on healthcare systems, particularly when uncontrolled. It is estimated that 43% of asthma patients in Portugal have their disease uncontrolled. Common causes for uncontrolled asthma are sub optimal compliance and inadequate inhaler technique. The objective of this study is to evaluate the potential economic savings achieved through the use of inhalers coupled with apps to improve the inhaler technique and compliance of asthma patients. This analysis considered the Portuguese societal perspective. Direct costs (consultations, emergency, hospitalizations, exams/tests, and transportation) and indirect costs (absenteeism) related with asthma were derived from a previous Portuguese cost-of-illness study and inflated to 2020 EUR prices. The willingness to use apps for asthma control is based on reported literature from Portugal. According to previous studies, it is assumed that up to 72% of users of apps having uncontrolled asthma will reach proper control. Asthma accounts for a total annual burden of direct healthcare resources (excluding treatments) of € 274 million and of € 15.2 million in indirect costs. The uncontrolled asthma patient population accounts for 69% of the overall burden. Under assumptions on the willingness to use an app for asthma control daily, it is considered that 20.6% of the uncontrolled asthma patients would adopt it to improve medication compliance and inhaler technique, leading to 14.8% of the uncontrolled patient population achieving control. This would lead to a reduction of the overall annual direct medical costs by €17.5 million (-6%) and of €1.8 million (-12%) in indirect costs. The adherence/adoption of interventions by asthma patients to improve disease control will potentially have a significant impact in reducing the healthcare and societal burden of asthma in Portugal. The inclusion of additional technologies, such as sensors in inhalers coupled with apps, could further improve asthma control and economic outcomes.

370 Awardee Talk: Role of feed enzymes in gut health and function

Abstract Exogenous enzymes are routinely added to diets for non-ruminant animals, mainly to help enhance energy and nutrient utilization, thus contributing to efficient and sustainable production systems. Also, feed enzymes allow for effective utilization of non-traditional feedstuffs (e.g. co-products) in non-ruminant diets, with potential to mitigate feed cost. In addition to increased nutrient utilization, however, feed enzymes, through their impact on the gastrointestinal environment and microbial composition, can have a profound effect on indices of gut health and function. These effects may explain the reported reductions in medication costs and variability in animal performance and mortality rates observed with dietary enzyme supplementation. By acting on their target substrates, feed enzymes reduce the availability of non-digested substrates and in the case of carbohydrate-degrading enzymes can produce short-chain oligosaccharides with potential prebiotic effects. These changes are known to modulate the gut microbiome in favor of bacteria associated with a healthy gut, while reducing the population of pathogenic bacteria, which explains the reduced incidences of diarrhea that have been attributed to enzyme supplementation. Also, feed enzymes may reduce oxidative stress and enhance the functional capacity (e.g. maintaining barrier function) of the gastrointestinal tract. Feed enzymes by themselves may never be a single solution to mitigate gut health challenges in livestock production systems, but clearly there is a mounting body of evidence to support the role of feed enzymes in this regard. Therefore, their benefits will be maximized when used as part of an integrated solution approach for containing enteric pathogens of economic importance and eliminating the negative effects of dietary components with potential to compromise intestinal integrity.

Abstract 14854: A Primary Care Digital Therapeutic for Diabesity

Introduction: While lifestyle change is a Class I Recommendation for Metabolic Syndrome components and Type II Diabetes, implementation of such change is often not achieved in primary care. Hypothesis: Test RediCare ControlDTx, a digital therapeutic which is designed to scale the delivery of lifestyle therapy, in Obese and Type 2 Diabetic subjects. Methods: 43 subjects, 32 (75%) female and 11 (25%) male were enrolled within a primary care practice. Weight, BMI, Blood Pressure, HbA1c and lipids were analyzed pre and post intervention using a student t-test. The 16-week program combines personalized condition specific video-based health education, health coach support via unlimited one to one online consultations, peer to peer support and asynchronous messaging to optimize compliance. A prescribed dietary protocol based on consuming whole foods while emphasizing the reduction of refined carbohydrates and sugar intake, while exercising resulted in significant reductions in HbA1c, Weight, BMI, Systolic Blood Pressure and Triglycerides. Results: are presented in Fig 1 with standard deviations shown in brackets. In type 2 diabetic subjects, mean triglycerides were 216.4 mg/dL at baseline and 105.0 mg/dL at follow up, a reduction of -111.3 mg/dL (51.56%). Prediabetic subjects mean triglycerides were 137.6 mg/dL at baseline and 99.5 mg/dL at follow up, a reduction of -38.2 mg/dL (-27.72%). The average number of health coach consultations was 1.3 per participant. Conclusion: A prescribed primary care digital therapeutic confers statistically and clinically significant reductions in metabolic syndrome and diabetic parameters and is seamlessly integrated into the primary care setting. The digital intervention at &lt;$75 per participant was cost effective in both the health benefits and savings achieved in reduced medication costs.

Lupus Low Disease Activity State and Reduced Direct Health Care Costs in Patients With Systemic Lupus Erythematosus.

Treat-to-target end points for systemic lupus erythematosus (SLE) have been assessed for their impact on damage accrual and flare, but whether they have an impact on the high health care utilization and costs in SLE has not been studied. The purpose of this study was to examine our hypothesis that the recently described lupus low disease activity state (LLDAS) would be associated with reduced health care cost. Data from a single tertiary hospital longitudinal SLE cohort were assessed. Baseline demographics, disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K], physician global assessment [PhGA], and flare index), and medication use were evaluated, and direct health care utilization and cost data were obtained from hospital information systems. LLDAS was defined as previously published: briefly, SLEDAI-2K ≤4 with no new activity, PhGA ≤1, prednisolone ≤7.5 mg/day, and optimal standard immunosuppressive agents. Analysis was performed using multivariable linear regression. Two hundred SLE patients, contributing 357.8 person-years of observation, were included. A history of lupus nephritis was present in 42% of patients, and damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index >0) was present at study commencement in 57.3% of patients. The mean ± SD annual direct medical cost per patient was US$7,413 ± 13,133/year. In multivariable analysis, increased cost was associated with the presence of baseline organ damage (41.7% increase; P = 0.009) and corticosteroid use (>7.5-15 mg/day: 55.7% increase; P = 0.02; and >15 mg/day: 202% increase; P < 0.001). In contrast, spending ≥50% of the observation period in LLDAS was associated with a 25.9% reduction in annual direct medical cost (P = 0.04). Greater time spent in LLDAS was associated with significantly reduced direct hospital health care costs among patients with SLE.

Laparoscopic versus open hemihepatectomy: comprehensive comparison of complications and costs at 90\xa0days using a propensity method

Laparoscopic hemihepatectomy (LHH) may offer advantages over open hemihepatectomy (OHH) in blood loss, recovery, and hospital stay. The aim of this study is to evaluate our recent experience performing hemihepatectomy and compare complications and costs up to 90 days following laparoscopic versus open procedures. Retrospective evaluation of patients undergoing hemihepatectomy at our center 01/2010–12/2018 was performed. Patient, tumor, and surgical characteristics; 90-day complications; and costs were analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. A total of 141 hemihepatectomies were included: 96 OHH and 45 LHH. While operative times were longer for LHH, blood loss and transfusions were less. At 90 days, there were similar rates of liver-specific and surgical complications but fewer medical complications following LHH. Medical complications that arose with greater frequency following OHH were primarily pulmonary complications and urinary and central venous catheter infections. Complications at 90 days were lower following LHH (Clavien–Dindo grade ≥ III OHH 23%, LHH 11%, p = 0.130; Comprehensive Complication Index OHH 20.0 ± 16.1, LHH 10.9 ± 14.2, p = 0.001). While operating costs were higher, costs for hospital stay and readmissions were lower with LHH. Patients undergoing LHH experience a significant reduction in postoperative medical complications and costs, resulting in 90-day cost equity compared with OHH.

Cost of Relapse Management in Patients with Schizophrenia in Italy and Spain: Comparison Between Lurasidone and Quetiapine XR.

Background and ObjectiveSchizophrenia is a low-prevalence mental disorder with a global age-standardized prevalence of 21 million people (2016). Second-generation antipsychotics (lurasidone and quetiapine XR) are recommended as the first-line treatment for schizophrenia. It is interesting to investigate how the results of clinical studies translate into direct medical costs. The objective of this analysis was to assess the direct medical costs related to pharmaceutical treatments and the management of relapses in patients affected with schizophrenia treated with lurasidone (74 mg) vs quetiapine XR (300 mg) assuming the Italian and Spanish National Health Service perspective.MethodsA health economic model was developed based on a previously published model. The analysis considered direct medical costs related to the pharmacological therapies and inpatient or outpatient management of relapses (direct medical costs referred to 2019). The probability of relapses and related costs were derived from two systematic reviews. A deterministic sensitivity analysis was implemented to test the robustness of the results.ResultsThe use of lurasidone (74 mg) compared with quetiapine XR (300 mg) would lead to a reduction in direct medical costs in Italy and Spain, with a lower cost per patient of − 163.7 € (− 9.0%) and − 327.2 € (− 22.7%), respectively. In detail, it would lead to an increase in the cost of therapy of + 53.8% and of + 30.5% in Italy and Spain, respectively, to a decrease in the cost of relapses with hospitalization of − 135.7%, and to an increase in the cost of relapses without hospitalization of + 24.5%.ConclusionsThe use of lurasidone (74 mg) for the treatment of patients affected with schizophrenia, compared with quetiapine XR (300 mg), would be a cost-saving strategy in the two contexts investigated assuming the National Health Service point of view.Electronic supplementary materialThe online version of this article (10.1007/s40261-020-00944-0) contains supplementary material, which is available to authorized users.

Comparison of the costs and benefits of the Clean India Mission

Abstract Background The Swachh Bharat (Clean India) Mission (SBM) launched in October 2014 is the world’s largest sanitation campaign. Our aim was to estimate and compare major economic costs and benefits associated with sanitation improvement achieved during three years of SBM from households’ financial and economic perspectives and a broader societal perspective. Methods Cost-benefit model inputs were obtained from household surveys in the twelve Indian states that once contributed to over 90 percent of open defecation in India, published literature and secondary data. Monetized costs included household financial and time investments in building and maintaining toilets, and government’s investments on subsidies and campaign activities. Monetized benefits included reductions in medical costs and mortality associated with diarrheal diseases, productive time saved from fewer diarrhoea cases and accessing outside defecation options, and increase in the property value of having a toilet. Probabilistic uncertainty analysis assessed the combined effect of key modelling assumptions and sampling errors in the inputs to the cost-benefit model. Findings Investment costs average US$ 396 per latrine and average annual operational costs are US$ 37 (financial) and US$ 94 (time costs) 1 . Annual benefits of US$ 727 per household are mainly from savings associated with reduced diarrhoea incidence (55%) and from sanitation access time savings (45%). The estimated Benefit-Cost Ratios (BCRs) are 1.7 (household financial perspective), 4.5 (household economic perspective) and 4.0 (societal perspective) under Open Defecation Free (ODF, corresponding to 100% toilet coverage and usage) scenario. However, under partial-ODF scenario with 85 percent toilet use rate, the BCRs are 1.1, 3.3 and 3.0, respectively. Probabilistic uncertainty analysis shows that the financial BCRs under the partial-ODF scenario can reduce to 0.7, but societal BCR will remain above 2. Interpretation This study shows the sanitation improvements under the SBM are highly cost-beneficial, more when communities are free of open defecation with all households using private improved sanitation facilities. Future SBM investments must ensure not only sustaining the universal toilet coverage and usage, but also ensure safe faecal waste management so that households continue to enjoy full benefits of sanitation.