Standardized Cost Data Research Articles

Evolving Cost-Quality Relationship in Pediatric Heart Surgery

BackgroundFor the more than 40,000 children in the United States undergoing congenital heart surgery annually, the relationship between hospital quality and costs remains unclear. Prior studies report conflicting results and clinical outcomes have continued to improve over time. We examined a large contemporary cohort, aiming to better inform ongoing initiatives seeking to optimize health care value in this population. MethodsClinical information (The Society of Thoracic Surgeons Congenital Database) was merged with standardized cost data (Pediatric Health Information Systems) for children undergoing heart surgery from 2010 to 2015. In-hospital cost variability was analyzed using Bayesian hierarchical models adjusted for case-mix. Quality metrics examined included in-hospital mortality, postoperative complications, postoperative length of stay (PLOS), and a composite. ResultsOverall, 32 hospitals (n = 45,315 patients) were included. Median adjusted cost per case varied across hospitals from $67,700 to $51,200 in the high vs low cost tertile (ratio 1.32; 95% credible interval, 1.29 to 1.35), and all quality metrics also varied across hospitals. Across cost tertiles, there were no significant differences in the quality metrics examined, with the exception of PLOS. The PLOS findings were driven by high-risk The Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery categories 4 and 5 cases (adjusted median length of stay 16.8 vs 14.9 days in high vs low cost tertile [ratio 1.13, 1.05 to 1.24]), and intensive care unit PLOS. ConclusionsContemporary congenital heart surgery costs vary across hospitals but were not associated with most quality metrics examined, highlighting that performance in one area does not necessarily convey to others. Cost variability was associated with PLOS, particularly related to intensive care unit PLOS and high-risk cases. Care processes influencing PLOS may provide targets for value-based initiatives in this population.

The Demise of the Overhead Myth: Administrative Capacity and Financial Sustainability in Nonprofit Nursing Homes

AbstractIn the study and practice of public administration, it is often assumed that higher levels of budgetary support for non‐program expenses, such as administrator salaries, accounting, grant writing, and marketing, are evidence of inefficiency and wasteful spending. As such, grant makers and researchers often use the ratio of organizations’ administrative to total costs to measure the efficiency of public services. While this perspective has some validity, it also significantly minimizes the effect of administrative functions on sustainability, an important aspect of long‐term performance in public service organizations. We use standardized cost data from a 14‐year panel of approximately 3,000 nonprofit nursing homes and find an inverted U‐shaped relationship between administrative cost ratios and financial sustainability, which suggests a “sweet spot” in the level of administrative support that tends to promote organizational sustainability. This sweet spot occurs when administrative costs are about 40 percent of total organizational costs.

Cost Savings of Three Fraction Accelerated Partial Breast Versus Standard of Care Adjuvant Radiotherapy: Cost Analysis of a Prospective Phase II Study

Accelerated partial breast radiotherapy (APBI) is an established option for favorable early stage breast cancer. In the current reimbursement environment, increased emphasis is being placed on high value care, and an alternative payment model has been released which will include episodic payments for breast cancer. This analysis aims to evaluate the potential cost saving of three fraction APBI as given per MC1532 versus standard of care radiotherapy (RT). MC1532 is a prospective phase II study evaluating adjuvant APBI after breast conservation surgery either given with 3 fraction brachytherapy, external beam photon or proton therapy. Eligible patients had Stage 1 invasive breast cancer or DCIS, ER+, with negative margins. Fractionation was 7 Gy x 3 for brachytherapy and 7 Gy (RBE) x 3 for photons and protons administered daily to the post-operative cavity with a 1cm CTV margin. A matched standard of care control group was retrospectively identified treated with predominantly hypofractionated whole breast radiotherapy (WBRT) or twice daily APBI brachytherapy. Standardized cost data was collected from the Mayo Clinic Cost Data Warehouse for the surgical and radiation period and categorized into RT related vs other costs. Mean costs were compared between groups via Mann-Whitney U testing and multivariate linear regression was used to identify associations with higher costs. A total of 115 patients treated with three fraction APBI per MC1532 (38 photons, 34 proton, and 43 brachytherapy) with available cost data and 580 matched patients (490 photons and 90 brachytherapy) treated from 2014-2017 with standard of care were included. Patient and disease characteristics were similar between the MC1532 and standard of care groups; the mean age was 66 vs 63 years. 82% vs 76% had invasive breast cancer. Hormone therapy was administered in 71% and 74%, and chemotherapy was rare <3%. The median number of fractions in the standard of care arm WBRT arm was 19 and brachytherapy arm was 10, versus 3 in MC1532. Mean RT cost for MC1532 was $3,980 versus $5,494 for standard of care, a 28% reduction (p<0.01). When analyzed by modality, patients treated on protocol consistently had lower RT costs: Photon ($4,763 vs $3,283, p<0.01), brachytherapy ($9,471 vs $3,879, p<0.01). Mean proton therapy cost on MC1532 was $4,889. On multivariate analysis not participating in MC1532, brachytherapy, left sided cancer, and younger age were significantly associated with increased costs. Three fraction APBI as tested on MC1532 was associated with 28% lower RT cost versus standard of care adjuvant radiation, which was more pronounced for brachytherapy (57%) than photon RT (34%).Tabled 1Abstract 2882; Table; Mean Radiotherapy CostsMC1532Median FractionsStandard of CareMedian FractionsWBRT$3,2833$4,76319Proton$4,8893----Brachytherapy$3,8793$9,47110 Open table in a new tab

Costs and Cost Drivers of Providing Option B+ Services to Mother-Baby Pairs for PMTCT of HIV in Health Centre IV Facilities in Jinja District, Uganda.

Background In 2013, the World Health Organization (WHO) revised the 2012 guidelines on use of antiretroviral drugs (ARVs) for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). The new guidelines recommended lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women irrespective of CD4 count or clinical stage (also referred to as Option B+). Uganda started implementing Option B+ in 2012 basing on the 2012 WHO guidelines. Despite the impressive benefits of the Option B+ strategy, implementation challenges, including cost burden and mother-baby pairs lost to follow-up, threatened its overall effectiveness. The researchers were unable to identify any studies conducted to assess costs and cost drivers associated with provision of Option B+ services to mother-baby pairs in HIV care in Uganda. Therefore, this study determined costs and cost drivers of providing Option B+ services to mother-baby pairs over a two-year period (2014–2015) in selected health facilities in Jinja district, Uganda. Methods The estimated costs of providing Option B+ to mother-baby pairs derived from the provider perspective were evaluated at four health centres (HC) in Jinja district. A retrospective, ingredient-based costing approach was used to collect data for 2014 as base year using a standardized cost data capture tool. All costs were valued in United States dollars (USD) using the 2014 midyear exchange rate. Costs incurred in the second year (2015) were obtained by inflating the 2014 costs by the ratio of 2015 and 2014 USA Gross Domestic Product (GDP) implicit price deflator. Results The average total cost of Option B+ services per HC was 66,512.7 (range: 32,168.2–102,831.1) USD over the 2-year period. The average unit cost of Option B+ services per mother-baby pair was USD 441.9 (range: 422.5–502.6). ART for mothers was the biggest driver of total mean costs (percent contribution: 62.6%; range: 56.0%–65.5%) followed by facility personnel (percent contribution: 8.2%; range: 7.7%–11.6%), and facility-level monitoring and quality improvement (percent contribution: 6.0%; range: 3.2%–12.3%). Conclusions and Recommendations. ART for mothers was the major cost driver. Efforts to lower the cost of ART for PMTCT would make delivery of Option B+ affordable and sustainable.

Asthma Cost-Effectiveness Analyses: Are We Using the Recommended Outcomes in Estimating Value?

Asthma medication cost-effectiveness analyses (CEAs) lack the qualitative assessment regarding whether they capture the National Institutes for Health (NIH) 2012 recommended outcomes necessary to allow robust cross-study comparisons. We aimed to assess the current asthma outcomes used in CEAs and recommend a direction for improvement. We performed a systematic search using electronic databases including PubMed, EMBASE, Tufts CEA registry, Cochrane, and NHSEED from January 2010 through December 2015. Key words included (1) cost-effectiveness, cost-utility, economic evaluation, health economics, or cost-benefit AND (2) asthma. All CEA studies evaluating 1 or more asthma medication were included. Authors assessed each CEA study with respect to asthma-specific NIH outcome recommendations including core (hospitalizations, emergency department visits, outpatient visits, medication, interventions costs), supplemental (visit categories and work/school absence), and emerging (academic/job-related) asthma outcomes. Besides outcomes of each CEA, issues that could prevent robust cross-study comparison were identified and thematically summarized. A total of 12 pre-NIH and 14 post-NIH recommendation CEAs were included. Eleven (91.7%) and 14 (100%) of the pre-/post-NIH studies included at least 1 core outcome, respectively. Of the 26 total studies, 7 (26.9%) included asthma-specific outpatient visit categories, 6 (23.1%) included asthma school or work absences, 5 (19.2%) included respiratory health care use, and none of the studies included emerging outcomes. Other issues that hamper cross-study comparison include lack of standardized cost data, time frames, quality-of-life measures, and incorporation of adherence. Although the use of NIH-recommended asthma core outcomes has improved, there is still room for improvement in using supplemental and emerging outcomes. To allow robust cross-study comparisons, future work should focus on further standardizing of data sources and methods.

Developing a standardized healthcare cost data warehouse

BackgroundResearch addressing value in healthcare requires a measure of cost. While there are many sources and types of cost data, each has strengths and weaknesses. Many researchers appear to create study-specific cost datasets, but the explanations of their costing methodologies are not always clear, causing their results to be difficult to interpret. Our solution, described in this paper, was to use widely accepted costing methodologies to create a service-level, standardized healthcare cost data warehouse from an institutional perspective that includes all professional and hospital-billed services for our patients.MethodsThe warehouse is based on a National Institutes of Research–funded research infrastructure containing the linked health records and medical care administrative data of two healthcare providers and their affiliated hospitals. Since all patients are identified in the data warehouse, their costs can be linked to other systems and databases, such as electronic health records, tumor registries, and disease or treatment registries.ResultsWe describe the two institutions’ administrative source data; the reference files, which include Medicare fee schedules and cost reports; the process of creating standardized costs; and the warehouse structure. The costing algorithm can create inflation-adjusted standardized costs at the service line level for defined study cohorts on request.ConclusionThe resulting standardized costs contained in the data warehouse can be used to create detailed, bottom-up analyses of professional and facility costs of procedures, medical conditions, and patient care cycles without revealing business-sensitive information.After its creation, a standardized cost data warehouse is relatively easy to maintain and can be expanded to include data from other providers. Individual investigators who may not have sufficient knowledge about administrative data do not have to try to create their own standardized costs on a project-by-project basis because our data warehouse generates standardized costs for defined cohorts upon request.

Healthcare Use and Direct Cost of Giant Cell Arteritis: A Population-based Study.

To determine the healthcare use and direct medical cost of giant cell arteritis (GCA) in a population-based cohort. A well-defined, retrospective population-based cohort of Olmsted County, Minnesota, USA, residents diagnosed with GCA from 1982-2009 was compared to a matched referent cohort from the same population. Standardized cost data (inflation-adjusted to 2014 US dollars) for 1987-2014 and outpatient use data for 1995-2014 were obtained. Use and costs were compared between cohorts through signed-rank paired tests, McNemar's tests, and quantile regression models. Significant annual differences in outpatient costs were observed for patients with GCA in each of the first 4 years (median differences: $2085, $437, $382, $388, respectively). In adjusted analyses, median incremental cost attributed to GCA over a 5-year period was $4662. Compared with matched referent subjects, patients with GCA had higher use of laboratory visit-days annually for each of the first 3 years following incidence/index date, and increased outpatient physician visits for years 0-1, 1-2, and 3-4. Patients with GCA had significantly more radiology visit-days in years 0-1, 3-4, and 4-5, and more ophthalmologic procedures/surgery in years 0-1, 1-2, 2-3, and 4-5 compared to non-GCA. Emergency medicine visits, musculoskeletal, and cardiovascular procedures/surgery were similar between GCA and non-GCA groups throughout the study period. Direct medical outpatient costs were increased in the month preceding and in the first 4 years following GCA diagnosis. Higher use of outpatient physician, laboratory, and radiology visits, and ophthalmologic procedures among these patients accounts for the increased cost of care.

Role of Donor Source on Clinical Outcomes and Inpatient Resource Utilization for Hematopoietic Cell Transplantation in Children with Acute Leukemia

Acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) are the two most common childhood leukemias. Novel drug therapies and allogeneic hematopoietic cell transplant (alloHCT) have improved ALL and AML treatment outcomes over the past two decades. However, alloHCT may be associated with significant morbidity and mortality that results in increased healthcare utilization. To date, no multi-center comparative effectiveness studies have been performed specifically evaluating alloHCT in children with ALL or AML. This study uses a novel methodology to investigate the hypothesis that matched sibling donor (MSD) alloHCT has significantly lower healthcare utilization compared to unrelated donor (URD) and that among URD, umbilical cord blood transplants (CBT) will have higher initial utilization but lower long-term utilization.Clinical and transplant outcomes data from the Center for International Blood and Marrow Transplant Research (CIBMTR) database were merged with inpatient resource utilization and standardized cost data from the Pediatric Health Information System (PHIS) database using a probabilistic merge methodology. This merged dataset contained U.S. patients age 1-21 years who received alloHCT for ALL or AML from 2004-2013 with comprehensive CIBMTR data at a PHIS reporting hospital. The primary outcomes of overall survival (OS), leukemia free survival (LFS), and inpatient resource utilization were evaluated using Kaplan-Meier analysis, Cox proportional hazards, and unadjusted Poisson regression analysis. Cost and resource comparisons for all donor types were made through day+100 and focused on URD only comparisons up to 2-year follow-up. Donor procurement costs were not directly included in this analysis.A total of 797 patients (54% of CIBMTR eligible patients and 89% of CIBMTR patients at PHIS centers) were successfully identified in both CIBMTR and PHIS; 433 had ALL and had 364 AML. LFS for ALL at 3 years was 68% for MSD, 53% for MUD, and 53% for CBT. The LFS in ALL was significantly impacted by donor type, age, disease status, and CMV (Table). The associated total costs were significantly higher for well-matched unrelated bone marrow (MUD) vs MSD at 100d ($246,149 vs $147,547, p<0.01), but CBT costs were not significantly higher compared to MUD at 100d ($275,673 vs $246,149, p=0.09). When median total costs per day were compared across donor source, findings were similar with well- MUD was significantly higher than MSD at 100d ($3,388/d vs $2,511/d, p=0.012), and no significant difference between CBT and MUD ($3,881/d vs $3,388/d, p=0.53). The corresponding average length of stay (ALOS) was 35 days for MUD, 34 days MSD, and 53 days CBT. Among URD alloHCT, median CBT costs per day were not significantly higher compared to MUD at 2yrs ($2,472/d vs $2,294/d, p=0.49).AlloHCT for AML had a 3-yr LFS of 56% for MSD, 46% for MUD, and 41% for CBT. LFS were significantly different by disease status and performance status (Table). The associated total costs were significantly higher for MUD at 100d than MSD ($259,293 vs $143,870, p<0.001), but CBT costs were not significantly higher compared to MUD at 100d ($301,160 vs $259,293, p=0.055). Comparisons of median total costs per day were similar, MUD vs MSD at 100d was significantly higher ($3,627/d vs $2,478/d, p<0.01), but CBT costs were not significantly higher compared to MUD at 100d ($3,891/d vs $3,627/d, p=0.95). The corresponding ALOS was 38 days for MUD, 35 days MSD, and 66 days CBT. Among URD alloHCT, median CBT costs per day were not significantly higher compared to MUD at 2yrs ($3,232/d vs $3,102/d, p=0.49).This study recapitulates previously published outcomes of alloHCT for acute leukemia AND adds key findings on the impact of alloHCT on inpatient resource utilization and costs. Specifically, MSD and MUD alloHCT provide similar survival outcomes; however, MSD alloHCT has a significant advantage in cost and resource utilization for both ALL and AML. Among URD transplants, CBT does not show any substantial survival or resource utilization advantage over MUD. Ongoing research will need to be performed to determine if the difference among URD alloHCT becomes significant with a larger sample size and/or beyond the 2 years following alloHCT. [Display omitted] DisclosuresPulsipher:Novartis: Consultancy, Other: Study Steering Committee; Jazz Pharmaceutical: Consultancy; Medac: Other: Housing support for conference; Chimerix: Consultancy. Hahn:Novartis: Equity Ownership; NIH: Research Funding.

Annual cost of antiretroviral therapy among three service delivery models in Uganda.

IntroductionIn response to the increasing burden of HIV, the Ugandan government has employed different service delivery models since 2004 that aim to reduce costs and remove barriers to accessing HIV care. These models include community-based approaches to delivering antiretroviral therapy (ART) and delegating tasks to lower-level health workers. This study aimed to provide data on annual ART cost per client among three different service delivery models in Uganda.MethodsCosting data for the entire year 2012 were retrospectively collected as part of a larger task-shifting study conducted in three organizations in Uganda: Kitovu Mobile (KM), the AIDS Support Organisation (TASO) and Uganda Cares (UC). A standard cost data capture tool was developed and used to retrospectively collect cost information regarding antiretroviral (ARV) drugs and non-ARV drugs, ART-related lab tests, personnel and administrative costs. A random sample of four TASO centres (out of 11), four UC clinics (out of 29) and all KM outreach units were selected for the study.ResultsCost varied across sites within each organization as well as across the three organizations. In addition, the number of annual ART visits was more frequent in rural areas and through KM (the community distribution model), which played a major part in the overall annual ART cost. The annual cost per client (in USD) was $404 for KM, $332 for TASO and $257 for UC. These estimates were lower than previous analyses in Uganda or the region compared to data from 2001 to 2009, but comparable with recent estimates using data from 2010 to 2013. ARVs accounted for the majority of the total cost, followed by personnel and operational costs.ConclusionsThe study provides updated data on annual cost per ART visit for three service delivery models in Uganda. These data will be vital for in-country budgetary efforts to ensure that universal access to ART, as called for in the 2015 World Health Organization (WHO) guidelines, is achievable. The lower annual ART cost found in this study indicates that we may be able to treat all people with HIV as laid out in the 2015 WHO guidelines. The variation of costs across sites and the three models indicates the potential for efficiency gains.

신한옥 건설 특성을 반영한 표준품셈 개발

최근 한옥의 수요 증가에 따라 전통한옥을 보급화 하기 위한 방안으로 신한옥이 개발되었다. 신한옥이란 전통한옥 보급의 저해 요인으로 작용하였던 높은 평단가 및 건축물 성능 보완하여 개발한 한옥의 한 형태이다. 신한옥이 개발되어 짐에 따라 보급화, 표준화, 생산성 향상 등을 위한 다양한 연구들이 진행되고 있다. 그 중, 신한옥을 건설하기 위하여 필수적 요소로 논의되는 예가 산정의 한 측면으로 품셈에 대한 요구가 지속된다. 이에, 본 연구에서는 신한옥 건설 특성을 반영한 표준품셈을 제안한다. 연구의 방법으로는 기존의 품셈 및 Cost Data 체계를 분석하여 신한옥과 부합하는 품셈구조를 제시하고, 실제 구축사례를 통한 세부항목의 선정과 1차적 검증을 실시하였다. 해당 신한옥 표준품셈은 신한옥 표준정보분류체계와 연계되어 있어 다방면에서 효율적인 활용이 가능하다. 또한, 추가 신한옥 구축을 통하여 데이터가 업데이트되면 보다 신뢰할 수 있는 표준품셈이 될 것으로 기대한다. As the demands for traditional Korean housing has been increased in recent years, modernized Korean traditional housing (Hanok) was developed as a way of providing Hanok for the public. Modernized Hanok attempts to remedy the shortcomings of the traditional hanok (i.e., high unit cost of building and low energy performance). In the previous researches, standardization and productivity improvement for modernized Hanok dissemination have been intensely developed. Above all, cost estimating for modernized Hanok is also an important factor. In an effort to provide effective system for Hanok construction, this paper developed 'standard cost data' for modernized Hanok. Distinct characteristic of modernized Hanok construction were analyzed first. Then, basic structure was identified, and major items were selected for Hanok standard cost data. However, this set of cost data was developed based on two mock-up Hanok projects actually constructed. Accordingly, this standard cost data will be further updated and modified by continuously accumulating real-world Hanok projects

Waste Costing as a Catalyst in Pollution Prevention Investment Decisions

Summary This article presents a case study in a Nigerian firm of how waste costing can be applied to pollution prevention (P2) investment decisions. This case is informed by the priority accorded to P2 as a preferred alternative to end-of-pipe pollution control. It demonstrates that even in the absence of effective regulations in a developing country, cost accounting can spur P2 decisions by management through the system of waste cost allocation. The case used standard cost data from the Wonder Beauty Care Company and applied the activity-based costing (ABC) system to waste cost allocation using waste cost drivers, which yielded another genre of waste costs—waste-induced overhead. Subsequently, the waste-induced overhead was applied to P2 investment analysis. This analysis indicated that the P2 investment alternative that incorporates the waste-induced overhead produced a preferred alternative choice. The case further revealed that managers’ knowledge of waste costs in a Nigerian firm may influence their P2 decisions. The case illustrates practically a possible dual advantage of an improved costing system for Nigerian firms—cost reduction and cleaner production.

Proposal for the Development of a Standardized Protocol for Assessing the Economic Costs of HIV Prevention Interventions

Maximizing our economic investment in HIV prevention requires balancing the costs of candidate interventions against their effects and selecting the most cost-effective interventions for implementation. However, many HIV prevention intervention trials do not collect cost information, and those that do use a variety of cost data collection methods and analysis techniques. Standardized cost data collection procedures, instrumentation, and analysis techniques are needed to facilitate the task of assessing intervention costs and to ensure comparability across intervention trials. This article describes the basic elements of a standardized cost data collection and analysis protocol and outlines a computer-based approach to implementing this protocol. Ultimately, the development of such a protocol would require contributions and "buy-in" from a diverse range of stakeholders, including HIV prevention researchers, cost-effectiveness analysts, community collaborators, public health decision makers, and funding agencies.

The Cost of Managing Pleural Effusion Associated with Dasatinib in CML Patients Post Imatinib Failure.

Background: Recent follow-up data from dasatinib at a large cancer center suggests that pleural effusion events occur in up to 35% of patients, emerging as late as 24 months into therapy, and require additional medical resource use beyond the typical routine care. This study aims to apply economic costs to the medical resource utilization involved with treating pleural effusions associated with dasatinib.Methods: The costs of managing pleural effusions were estimated by applying standard cost data to medical resource utilization reported for 48 patients with dasatinib-related pleural effusions at one large cancer center (Quintas-Cardama et al, ASH 2006). Relevant CPT codes and median fees for outpatient procedures and office visits were retrieved from the 2006 Ingenix National Fee Analyzer. Cost of inpatient management of pleural effusions with chest tubes or other procedures were obtained from the medical literature (Putnam et al, 2000). Clinical expert input was used to supplement the literature related to assumptions of frequency of office visits and chest X-rays. Based on the above, the following key assumptions were made: 100% of patients incurred two additional physician visits, two chest x-rays, and a course of diuretics; 30% received steroids; 24% had recurrent effusions; 19% required 3 thoracentesis outpatient procedures; 5% were managed as inpatients with chest tube; and 4% required Denver shunts as inpatients. All costs were inflated to 2006 US prices.Results: Fifty-eight percent of pleural effusions reported at the cancer center involved ≤25% of one lung volume and were managed medically including diuretics and steroids. Costs for this medically managed group were $619 per episode, including physician office visits, chest X-rays and medications. Forty-two percent of pleural effusions were more significant, involving 26% to >75% of one lung volume, with half of those patients requiring invasive procedures. The cost of invasive procedures for inpatient management of pleural effusions was $10,130 for a chest tube and $14,475 with a pleural catheter. The cost of invasive outpatient management of pleural effusions ranged from $680 for ultrasound thoracentesis to $4,387 for pleural catheter. The average projected cost of treating a pleural effusion adverse event (including all severity levels) ranged from $1,694 to $3,882, depending on whether outpatient thoracentesis occurred or placement of outpatient pleural catheter was utilized. Important cost drivers included management of recurrent effusions.Conclusion: This economic analysis based on actually observed treatment patterns suggests that the management of pleural effusions with dasatinib is costly and requires intensive resource utilization. Development of pleural effusions with dasatinib poses a significant challenge to physicians, as they cannot be predicted, the time of onset is variable, and management may require repeat invasive procedures and possible complications. This economic analysis is likely conservative in that it did not include the cost of platelet transfusions that may be needed to perform thoracentesis, or the potential complications of hypokalemia and QTcF prolongation with the use of diuretics. Effective tyrosine kinase inhibitors with lower rates of pleural effusions may represent a clinically and economically valuable alternative for imatinib-resistant or -intolerant CML patients.

A Pharmacoeconomic Evaluation of the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study in the United Kingdom

To determine the short-term healthcare costs associated with intensive lipid lowering with atorvastatin initiated within 24-96 hours of the occurrence of acute coronary syndrome (ACS) in patients in the UK. Patient-level clinical outcome data from the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial and standard cost data were used to compare the total expected 16-week cost per patient on atorvastatin 80 mg/day versus placebo. Clinical outcomes assessed included the following: death; cardiac arrest with resuscitation; nonfatal myocardial infarction; worsening angina pectoris with objective evidence of myocardial ischaemia requiring rehospitalisation; surgical or percutaneous coronary revascularisation; nonfatal stroke; hospitalisation for angina without objective evidence of myocardial ischaemia; and new or worsening congestive heart failure requiring rehospitalisation. All relevant direct medical costs from the perspective of the NHS were considered. The total expected cost was pound 784.05 per patient in the placebo cohort and pound 851.59 per patient in the atorvastatin cohort, resulting in an incremental cost of pound 67.54 per patient in the atorvastatin group. The cost per event avoided was pound 1762.04. A third of the cost of atorvastatin treatment was offset within 16 weeks by the cost savings resulting from the reduction in the number of events in the atorvastatin cohort compared with the placebo cohort. The clinical benefits of short-term intensive atorvastatin treatment administered after ACS is attainable through a marginal increase in 'upfront' costs.

A COMPARISON OF LEARNING CURVE ANALYSIS AND MOVING AVERAGE RATIO ANALYSIS FOR DETAILED OPERATIONAL PLANNING*

ABSTRACTThis study tests the use of learning curve analysis for production planning at the detailed component level under various conditions, represented by factors of product turnover rate, learning rate, variance levels, and planning horizon length. It also presents an alternative to learning curve analysis that considers aggregation of cost data across time. This alternative is periodic revision of standard cost data using moving average forecasts to reflect productivity trends. Results of this study indicate that in most circumstances a moving average analysis can provide better estimates of short‐term, detailed component operations costs than either a learning curve analysis or a standard analysis.