Societal Economic Benefits Research Articles

Recognizing the Broader Value of Meningococcal Vaccination: A Matter of Evidence, Ability, or Willingness?

ObjectivesIt is widely argued that the value of meningococcal vaccination extends beyond the narrow value elements traditionally considered in health technology assessment. Nevertheless, measuring broader value presents challenges, whereas assessment methods and outcomes vary widely. This article investigates the extent to which the broader value of meningococcal vaccination is recognized, considering the available evidence and decision maker’s methodological ability and willingness. MethodsA targeted literature review informed the classification of broader value elements according to their relevance to meningococcal vaccination and the quality of existing evidence. Focusing on relevant value elements with good evidentiary standards, decision makers’ perspectives and methodological ability to consider them were assessed through case studies of health technology assessment of meningococcal B vaccination in England and The Netherlands. ResultsValue elements of high relevance to meningococcal vaccination with good quality evidence include caregivers’ health gains, patients’ lifetime productivity gains, and disease severity. The willingness and methodological ability to incorporate them into value assessments have been mixed. This is attributable to the scope of the value assessment perspective and the use of evaluation methods that do not fully capture broader value. For other broader value elements, evidence gaps are another potential barrier to value demonstration and recognition. ConclusionsThe current evidence base confirms that the value of meningococcal vaccination spans beyond healthcare sector effects to health-related externalities, allocative value, and societal economic benefits. To ensure that the most efficient resource allocation outcomes are achieved, countries should consider how to improve their perspective and methodological ability to assess broader value elements accurately.

Cost-effectiveness analysis of a large-scale cr\xe8che intervention to prevent child drowning in rural Bangladesh

BackgroundDrowning is the leading cause of death among children 12–59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale crèche (daycare) intervention in preventing child drowning.MethodsThe cost of the crèches intervention was evaluated using an ingredients-based approach and monthly expenditure data collected prospectively throughout the study period from two agencies implementing the intervention in different study areas. The estimate of the effectiveness of the crèches intervention was based on a previous study. The study evaluated the cost-effectiveness from both a program and societal perspective.ResultsFrom the program perspective the annual operating cost of a crèche was $416.35 (95% CI: $221 to $576), the annual cost per child was $16 (95% CI: $8 to $23), and the incremental-cost-effectiveness ratio (ICER) per life saved with the crèches was $17,008 (95% CI: $8817 to $24,619). From the societal perspective (including parents time valued) the ICER per life saved was − $166,833 (95% CI: − $197,421 to − $141,341)—meaning crèches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $1978, the crèche intervention was cost-effective even when the societal economic benefits were ignored.ConclusionsBased on the evidence, the crèche intervention has great potential for generating net societal economic gains by reducing child drowning at a program cost that is reasonable.

Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.

BackgroundModelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.Methods and findingsWe adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare management to the economic productivity gains from reduced HCV-attributable absenteeism, presenteeism, and premature deaths. We also calculate the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for HCV elimination versus maintaining current levels of HCV treatment. This is compared to an opportunity cost-based willingness-to-pay threshold for Pakistan (US$148 to US$198/DALY).Compared to existing levels of treatment, scaling up screening and treatment to achieve HCV elimination in Pakistan averts 5.57 (95% uncertainty interval (UI) 3.80 to 8.22) million DALYs and 333,000 (219,000 to 509,000) HCV-related deaths over 2018 to 2030. If HCV testing is partially integrated, this scale-up requires an investment of US$1.45 (1.32 to 1.60) billion but will result in US$1.30 (0.94 to 1.72) billion in improved economic productivity over 2018 to 2030. This elimination strategy is highly cost-effective (ICER = US$29 per DALY averted) by 2030, with it becoming cost-saving by 2031 and having a net economic benefit of US$9.10 (95% UI 6.54 to 11.99) billion by 2050. Limitations include uncertainty around what level of integration is possible within existing primary healthcare services as well as a lack of Pakistan-specific data on disease-related healthcare management costs or productivity losses due to HCV.ConclusionsInvestment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan.

HCV elimination in Pakistan would yield "substantial societal health and economic benefits"

HCV elimination in Pakistan would yield "substantial societal health and economic benefits"

An economic case study of the control of dog-mediated rabies by an animal welfare organisation in Jaipur, India

A global strategic plan for the elimination of dog-mediated human rabies deaths by 2030 was announced in 2018. The cost-effectiveness of annual mass dog vaccination programmes, as a control and elimination method, has been advocated on many occasions. Complementary methods, such as animal birth control (ABC) activities, have received less attention. This paper provides a case-study of a programme operated by Help in Suffering (HIS) in Jaipur, India from 1994/95 until 2016/17 comprising both ABC and additional vaccination-only activities. The availability of cost data alongside information on dog numbers, dog bites and human rabies cases provided an exceptionally detailed and unique retrospective dataset recording actual events and expenditures. Updated to 2016/17 prices, the total cost of the programme was 658,744 USD. Since 2007/2008, activity costs have been separated and returned costs of 10.78 USD per dog, both sterilised and vaccinated, and 1.86 USD per dog, vaccinated only. Over the course of the programme, the number of disability-adjusted life years (DALYs) due to premature death and the distress associated with dog bites was estimated to be 36,246 fewer than would have been expected if HIS had not been operating, based on a counterfactual scenario using pre-intervention values. Linking the DALY figure to the cost of the activities undertaken by HIS yields a cost of 26 USD per DALY averted. Discounted at 3%, the DALYs averted equate to 16,587 at a cost of 40 USD per DALY averted. Both cases make it a very cost-effective intervention, in relation to the threshold of investing one year’s gross domestic product (GDP) per DALY averted (1981 USD in 2016/17). The monetary benefit from fewer dog bites and clinical human rabies cases requiring treatment amounted to 5.62 million USD after discounting, which, if attributed to Help in Suffering, yields a monetary benefit-cost ratio of 8.5. Thus, the potential monetary benefits greatly outweigh the programme costs, even without considering the DALYs averted. If a modest notional monetary value of one year’s GDP is assigned to represent the human capital or production value of DALYs averted, the discounted societal economic benefit reaches 38.48 million USD and implies a benefit-cost ratio of 58.4. These economic analyses demonstrate that ABC activities in combination with additional vaccination efforts can be a cost-effective control measure for dog-mediated human rabies.

Knowledge and Awareness among Mothers Regarding Exclusive Breastfeeding in Holy Karbala City / Iraq

Background: World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) “Exclusive breastfeeding (EBF)” is explained as “the infant receives only breast milk, no other liquids or solids. Its recommended for the first 6 months of life, and then complementary feeding should be started. EBF helps to reduce child morbidity and mortality from several diseases such as diarrhea, respiratory and / or ear infections and other infectious diseases, shielding lactation women from breast and ovarian cancer. In addition to offers societal economic and environmental benefits, The objective of this study was to assess the knowledge and awareness of exclusive breast feeding among mothers with a child < 2 years of age. Method: A descriptive cross-sectional study was carried out in Health Directorate of Holy Karbala city. The study consist of (487) mothers how attendant to six Primary Health Care center (PHC). The collected data was done by direct interview with mothers and using a questionnaire form that designed based on the study objectives according to WHO criteria. Data were analyzed by SPSS “ Statistical Package for the Social Sciences”, the descriptive statistics included numbers (N) and percentage (%), and the inferential statistical test was done by using Chi-Square test (?2), P-value (Probability of chance ) was equal or less than 0.05 considered as statistically significant to find for any association between the results variables. Result: A total of 487 participants were included in the study and the rate of response was 92.7%. The highest percentage (66.3%) of study sample were full in the age group (21-30) years, and more than three quarters were lived in urban area. Nearly half of the study sample 47% had primary education and 60% those housewives, and the main source of information being family and friends (84.4%). As an overall assessment, 61.8% of the study sample had good knowledge and awareness about exclusive breastfeeding, with highly significant differences to education level ,occupation residence of the mother. Conclusion: Over half of the subjects had good knowledge and awareness of exclusive Breastfeeding. And, on the other hand, there was a very significant difference between education level, occupation and mother’s residence with a level of knowledge.

Health and Economic Impact of Routine Pediatric Pneumococcal Immunization Programs in Canada: A Retrospective Analysis.

ObjectiveA model was developed to estimate the historical impact (including total societal health and economic benefit) of pneumococcal conjugate vaccine (PCV) programs in the overall Canadian population between 2005 and 2015, inclusively.MethodsHistorical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) were obtained from epidemiologic databases supplemented with published and unpublished data. Two scenarios were considered: (1) the observed historical incidence from 2005 to 2015 in the setting of PCV use; (2) a hypothetical scenario in which we estimated the number of disease cases assuming no PCV use. Disease cases averted as a result of PCV programs were calculated by subtracting the number of observed historical cases from the number of estimated cases expected in the absence of PCV use.ResultsPCV programs were estimated to have saved 6631 lives and averted 14,990 IPD cases, 735,700 pneumonia episodes, and 3,697,993 AOM episodes. Positive clinical outcomes resulted in total cost savings of CAD $1.76 billion over 11 years. Vaccination costs were offset by the direct medical cost savings from fewer cases of IPD, pneumonia, and AOM.ConclusionsCanadian PCV programs have provided significant health benefits and resulted in a substantial value for money. Net savings achieved over the reviewed period would have provided funding for $1.76 billion in other health care costs or public health initiatives. These findings highlight the importance of considering the total value of a vaccination program, rather than vaccine acquisition costs only, when assessing the value of immunization programs.Electronic supplementary materialThe online version of this article (10.1007/s40121-020-00294-6) contains supplementary material, which is available to authorized users.

A case study applying a novel approach to estimate the social impact of a medical innovation - the use of secukinumab for psoriatic arthritis in Germany

ABSTRACT Objectives Psoriatic arthritis (PsA) is associated with serious productivity impairment. Secukinumab, a fully human IL-17A inhibitor, provides sustained relief from PsA symptoms. This study estimates the societal economic benefits of using secukinumab instead of conventional disease-modifying anti-rheumatic drugs (DMARDs) for treating patients with active PsA in Germany from 2016 to 2030. Methods A Markov and a population model simulated the functional impairment of German PsA patients. The relationship between functional impairment and work productivity was used to determine the productivity difference in the populations treated with secukinumab and csDMARDs. The corresponding gains in productive time were allocated to paid and unpaid activities and valued according to gross value added (GVA). Since increased productivity has the potential to stimulate greater macroeconomic effects, indirect and induced GVA effects were calculated as well. Results The use of secukinumab reduces the productivity impairment in the target population on average by 13 percentage points. This difference could generate 32 million active and productive hours until the year 2030, which translates to GVA equivalents of €1.3 billion. Including indirect and induced effects yield an economic estimate of €2.7 billion GVA equivalent. Conclusions The improvements in PsA-related functional impairment could lead to sizable productivity effects within the economy.

Challenges of Governing Off-Grid “Productive” Sanitation in Peri-Urban Areas: Comparison of Case Studies in Bolivia and South Africa

Globally, peri-urban areas are experiencing rapid urbanization. Conventional infrastructure development is generally slow to catch up and the lack of basic sanitation in peri-urban areas is a constantly growing—and often overlooked—problem. There are examples where these challenges have been addressed by off-grid “productive” sanitation systems that provide opportunities for recovery and reuse of valuable waste stream resources. However, governing such systems and ensuring effective municipal policies can be challenging since the socio-economic contexts in many peri-urban areas are transforming rapidly. A comparison of two initiatives in Bolivia and South Africa offers valuable insights for introducing functional off-grid “productive” sanitation systems relying on urine-diverting dry toilets (UDDTs) in peri-urban settlements. Findings suggest that acceptance of the UDDTs by households largely rely on consistent awareness raising and capacity building, in addition to adaptation to the local needs and creating a sense of ownership over the toilet system. Changing perceptions of what constitutes an aspirational toilet, and developing services for waste management collection, seem to be crucial components for ensuring long-term use and functionality of the UDDTs. Investments and further innovations for upscaling of resource recovery systems are needed to make these systems cost-effective and logistically viable. To attract these additional investments, it will be crucial to assess the societal economic benefits of off-grid “productive” sanitation compared to centralized wastewater systems. The comparison also highlights that off-grid sanitation requires a clear division and coordination of roles and responsibilities among different authorities, in order to transcend political difficulties that emerge where these boundaries overlap. Thus, integrating clear boundaries into urban planning policies, and including informal processes in communities, play an important role in improving governance of basic services in peri-urban areas.

Economic productivity loss due to breast cancer in Norway – a case control study using the human capital approach

We estimate the productivity loss attributable to breast cancer in Norway, using a human capital approach where the value to the national economy of subjects’ labor is estimated through their income. Since the approach takes the viewpoint of the society, it includes reduced labor due to mortality as well as reduction among survivors. A case-control design was used. The Norwegian Cancer Registry identified 2,010 patients aged 45-54 years, with breast cancer as their first life-long malignancy diagnosis in 1992-1996. Statistics Norway matched these with random controls of the same age, marital status and municipality residency, and provided data on pension qualifying income until the year 2005, inflation adjusted to 2012 €. The effect of the cancer diagnosis on income throughout the follow-up period was estimated as the difference between the cases’ and controls’ income, corrected for systematic differences between cases and controls before the diagnosis. A quadratic curve approximation was used to estimate effects after the 13 years follow-up period, and a bootstrap resampling approach was applied to compute confidence intervals (CI). Regression modeling was used to estimate life-long productivity loss as a function of age at diagnosis. This was combined with the current Norwegian age distribution of breast cancer incidence, to estimate the national productivity loss due to breast cancer. For our cohort, the 13-years productivity loss attributable to the diagnosis was estimated to 102,600 € per case, with 95% CI (88,500, 116,700). The life-long estimate was 119,200 €, CI (95,400, 155,600). The annual national productivity loss was estimated to 179,900,000 €, or 58,200 € per case. For those aged < 65 at diagnosis, the estimate was 94,300 € per case. The estimated life-long productivity loss depends heavily on the age at diagnosis. The results can be used for evaluating the societal economic benefit from breast cancer prevention programs. Published: Online December 2017. In print December 2017.

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.

Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.

BackgroundUnderstanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children’s surgical care in low- and middle-income countries (LMICs).MethodsWe searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality.FindingsWe identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7.InterpretationOur findings show that many areas of children’s surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered “Essential Pediatric Surgical Procedures” as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.

Estimating tuberculosis cases and their economic costs averted in the United States over the past two decades.

Following a concerted public health response to the resurgence of tuberculosis (TB) in the United States in the late 1980s, annual TB incidence decreased substantially. However, no estimates exist of the number and cost savings of TB cases averted. TB cases averted in the United States during 1995-2014 were estimated: Scenario 1 used a static 1992 case rate; Scenario 2 applied the 1992 rate to foreign-born cases, and a pre-resurgence 5.1% annual decline to US-born cases; and a statistical model assessed human immunodeficiency virus and TB program indices. We applied the cost of illness to estimate the societal benefits (costs averted) in 2014 dollars. During 1992-2014, 368 184 incident TB cases were reported, and cases decreased by two thirds during that period. In the scenarios and statistical model, TB cases averted during 1995-2014 ranged from approximately 145 000 to 319 000. The societal benefits of averted TB cases ranged from US$3.1 to US$6.7 billion, excluding deaths, and from US$6.7 to US$14.5 billion, including deaths. Coordinated efforts in TB control and prevention in the United States yielded a remarkable number of TB cases averted and societal economic benefits. We illustrate the value of concerted action and targeted public health funding.

The Use of Economic Evaluation to Inform Newborn Screening Policy Decisions: The Washington State Experience.

Newborn screening not only saves lives but can also yield net societal economic benefit, in addition to benefits such as improved quality of life to affected individuals and families. Calculations of net economic benefit from newborn screening include the monetary equivalent of avoided deaths and reductions in costs of care for complications associated with late-diagnosed individuals minus the additional costs of screening, diagnosis, and treatment associated with prompt diagnosis. Since 2001 the Washington State Department of Health has successfully implemented an approach to conducting evidence-based economic evaluations of disorders proposed for addition to the state-mandated newborn screening panel. Economic evaluations can inform policy decisions on the expansion of newborn screening panels. This article documents the use of cost-benefit models in Washington State as part of the rule-making process that resulted in the implementation of screening for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and 4 other metabolic disorders in 2004, cystic fibrosis (CF) in 2006, 15 other metabolic disorders in 2008, and severe combined immune deficiency (SCID) in 2014. We reviewed Washington State Department of Health internal reports and spreadsheet models of expected net societal benefit of adding disorders to the state newborn screening panel. We summarize the assumptions and findings for 2 models (MCAD and CF) and discuss them in relation to findings in the peer-reviewed literature. The MCAD model projected a benefit-cost ratio of 3.4 to 1 based on assumptions of a 20.0 percentage point reduction in infant mortality and a 13.9 percentage point reduction in serious developmental disability. The CF model projected a benefit-cost ratio of 4.0-5.4 to 1 for a discount rate of 3%-4% and a plausible range of 1-2 percentage point reductions in deaths up to age 10 years. The Washington State cost-benefit models of newborn screening were broadly consistent with peer-reviewed literature, and their findings of net benefit appear to be robust to uncertainty in parameters. Public health newborn screening programs can develop their own capacity to project expected costs and benefits of expansion of newborn screening panels, although it would be most efficient if this capacity were shared among programs.

A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy

BackgroundThe economic value of robotic-assisted laparoscopic prostatectomy (RALP) in the United States is still not well understood because of limited view analyses. ObjectivesThe objective of this study was to examine the costs and benefits of RALP versus retropubic radical prostatectomy from an expanded view, including hospital, payer, and societal perspectives. MethodsWe performed a model-based cost comparison using clinical outcomes obtained from a systematic review of the published literature. Equipment costs were obtained from the manufacturer of the robotic system; other economic model parameters were obtained from government agencies, online resources, commercially available databases, an advisory expert panel, and the literature. Clinical point estimates and care pathways based on National Comprehensive Cancer Network guidelines were used to model costs out to 3 years. Hospital costs and costs incurred for the patients’ postdischarge complications, adjuvant and salvage radiation treatment, incontinence and potency treatment, and lost wages during recovery were considered. Robotic system costs were modeled in two ways: as hospital overhead (hospital overhead calculation: RALP-H) and as a function of robotic case volume (robotic amortization calculation: RALP-R). All costs were adjusted to year 2014 US dollars. ResultsBecause of more favorable clinical outcomes over 3 years, RALP provided hospital ($1094 savings with RALP-H, $341 deficit with RALP-R), payer ($1451), and societal ($1202) economic benefits relative to retropubic radical prostatectomy. ConclusionsMonte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work.

Potential Benefit of the Quadbar™ on All-Terrain Vehicles

An epidemic exists related to all-terrain vehicle (ATV) fatal and nonfatal injuries in the United States and in Australia as well as in other countries. More than 60% of these injuries are associated with ATV overturns. While behavior-related methods have failed to abate this epidemic, engineered interventions have been lacking. However, one technology, the Quadbar™ (QB), shows promise as a crush prevention device for reducing overturn-related injuries and their severity. The question addressed in this study is “What is the potential public health and economic benefit of the QB when used on ATVs?” At 40% effectiveness, our model estimated that 5082 injuries related to ATV overturns would be prevented per 100,000 ATVs equipped with QBs. The overall societal economic benefit was estimated at US$3,943 per ATV that greatly exceeds the QB purchase price of US$478, which represents an 8:1 return on investment.

Zero energy homes – Are they economically viable?

Whilst net zero energy homes are espoused in many policy circles, and many bespoke examples have been constructed to demonstrate their technical feasibility, there is a scarcity of evidence demonstrating such a standard would be economically rational, particularly for large scale housing development where orientation and aspect may not always be optimal. Drawing on energy monitoring evidence and construction economics associated with a nearly zero energy housing estate in Adelaide, Australia, this paper explores the economic feasibility of the net zero energy home policy in warm temperate climates. The results demonstrate that using economic tools and assumptions typically applied for building energy regulatory policy changes, net societal economic benefits significantly outweigh costs. The clear economic outcomes, combined with expected health and productivity benefits from improved levels of thermal comfort, should provide security to policy makers to progress home energy standards towards net zero energy performance.

Quantifying the Economic Impact of Provider Volume Through Adverse Events: The Case of Sports Medicine.

Background:Procedures performed by surgeons with higher provider volumes offer advantages both to the individual patient and the health system, with studies documenting fewer adverse events, shorter surgical times, and decreased reoperation rates. With workforce requirements for surgeons growing, it is increasingly necessary to establish the most efficient structure of this workforce.Hypothesis:Substantial economic savings are realized when procedures are performed by high-volume providers as compared with low-volume providers in the areas of readmission, prolonged admission, and subsequent surgery.Study Design:Economic and decision analysis; Level of evidence, 2.Methods:This study utilized decision modeling to estimate the cost savings to high-volume providers in sports medicine. Simple decision models were constructed for 3 common procedures: anterior cruciate ligament (ACL) reconstruction, rotator cuff repair, and total shoulder arthroplasty. Outcome probabilities for adverse events (readmission, prolonged admission, and subsequent surgery) and costs were taken from the literature. A Monte Carlo simulation reflecting the incidence of these procedures in the United States was performed to estimate the total nationwide cost of these procedures, and the impact of both negative and positive policies on this cost were examined using sensitivity analysis.Results:The costs per case attributable to adverse outcomes for ACL reconstruction (in 2010 US$) were $496, $781, and $868 for high-, medium-, and low-volume providers, respectively. For rotator cuff repair, these numbers were $523, $640, and $872, and for total shoulder arthroplasty, $1692, $1876, and $2021, respectively. Sensitivity analysis revealed that a 50% increase in the number of these 3 procedures performed by high-volume surgeons could save the health system $23.1 million. If all procedures were performed by high-volume surgeons, the health system could save $72 million.Conclusion:The hypothesis was accepted; higher provider volumes for surgeons do convey substantial societal economic benefits. Policies to incentivize and facilitate a greater portion of procedures being performed by high-volume surgeons may increase the efficiency of resource utilization in health care delivery.

Societal economic benefits associated with an extended-release opioid with abuse-deterrent technology in the United States.

Common chronic pain conditions affect approximately 100 million U.S. adults and result in costs of $560–635 billion annually in direct medical treatment costs and lost productivity [1]. In addition, pain is a common cause of disability in the United States [2]. The Food and Drug Administration (FDA) has noted that prescription opioids (RxOs) are an important component of modern pain management [3]. At the same time, the agency has acknowledged that RxO abuse is a serious public health problem. The National Survey on Drug Use and Health (NSDUH) reported that 1.8 million of the U.S. population ages 12 and up had prescription painkiller abuse or dependence in 2011 [4]. In 2007, RxO abuse accounted for an estimated $55.7 billion (US$ 2009) in annual societal costs in the United States [5]. These costs include health care, workplace, and criminal justice costs. Extended-release opioids (EROs) provide a longer period of drug release and can thus be taken less frequently than immediate-release opioids [6]. However, EROs can be manipulated and tampered with in an attempt to overcome their extended-release properties. Because of their higher drug dosages, EROs may be more attractive to some abusers than immediate-release formulations [7]. Manufacturers of EROs have attempted to address the problem of RxO abuse by developing formulations with abuse-deterrent properties. For example, reformulated extended-release oxycodone HCl with abuse-deterrent technology (reformulated ER oxycodone) was introduced in August 2010 and replaced the original formulation of ER oxycodone without abuse-deterrent technology. Several studies have examined the impact of reformulated ER oxycodone among abusers. A study on the attractiveness of reformulated ER oxycodone relative to other opioid formulations among recreational opioid abusers found that reformulated ER oxycodone was rated the least attractive, least valuable, least desirable, and least likely to be tampered with among …

The economic costs of routine INR monitoring in infants and children – Examining point-of-care devices used within the home setting compared to traditional anticoagulation clinic monitoring

IntroductionThe use of point-of-care (POC) devices within the home for routine INR monitoring has demonstrated reliability, safety and effectiveness in the management of infants and children requiring long-term warfarin therapy. However, a comprehensive cost-analysis of using this method of management, compared to attending anticoagulation clinics has not been reported. The aim of this study was to compare the estimated societal costs of attending anticoagulation clinics for routine INR monitoring to using a POC test in the home. Materials and methodsThis study used a comparative before-and-after design that included 60 infants and children managed via the Haematology department at a tertiary paediatric centre. Each participant was exposed to both modes of management at various times for a period of ≥3months. A questionnaire, consisting of 25 questions was sent to families to complete and return. Data collected included: the frequency of monitoring, mode of travel to and from clinics, total time consumed, and primary carer’s income level. ResultsThe home monitoring cohort saved a total of 1hour 19minutes per INR test compared to attending anticoagulation clinics and had a cost saving to society of $66.83 (AUD) per INR test compared to traditional care; incorporating health sector costs, travel expenses and lost time. ConclusionsThe traditional model of care requires a considerable investment of time per test from both child and carer. Home INR monitoring in infants and children provides greater societal economic benefits compared to traditional models.