Use Of DRGs Research Articles

Clinical and economic comparison of utilization of reslizumab, mepolizumab and benralizumab in the treatment of severe eosinophilic asthma

The aim of this study was to compare the clinical and economic consequences of the use of biological agents that antagonize IL-5 in the treatment of severe eosinophilic asthma in adults. Two methods of clinical and economic research were used: assessment of the cost-effectiveness ratio and analysis of the budget impact. The effectiveness of the drugs was assessed using indirect comparison; special attention was paid to comparability of the patient groups in the studies chosen for such an assessment. Two approaches were used for calculation of the cost of therapy for severe asthma: using DRGs (applicable to most regions of Russia), and without the use of DRGs, which is relevant only for few Russian regions. Basing on the data obtained from a budget impact study without the use of DRG, it was shown that reslizumab was dominating for patients with body mass of up to 70 kg, while for the patients with body mass of 70 to 110 kg, mepolizumab was dominating, while utilization of reslizumab appeared to be somewhat more expensive. In the group of patients with body mass over 110 kg, mepolizumab also was dominating. The calculation of the cost-effectiveness ratio (CER) showed that reslizumab appeared to be dominating over two other MABs, The results of the study using the DRG demonstrated that the cost of an annual course of benralizumab in most cases in Russia would exceed the amount that can be compensated by Territorial Funds for Mandatory Medical Insurance to a healthcare institution for therapy of bronchial asthma in one adult patient with genetically engineered drugs. Therefore, further comparisons were made for reslizumab and mepolizumab only. Analysis of the impact on the budget demonstrated that treatment with reslizumab and mepolizumab would represent a similar burden for the budget. When applying cost-effectiveness analysis, reslizumab was more cost-effective than mepolizumab (regardless of patient body mass). Thus, the results of the clinical and economic study suggested that, basing on the cost-effectiveness analysis, reslizumab appeared to be the dominant IL-5 antagonist (regardless of body mass if DRG approach was used and in patients with body mass up to 110 kg, if such an approach was not used). Basing on budget impact analysis, calculations without use of DRG approach showed superiority of reslizumab over mepolizumab and benralizumab for the patients with body mass up to 70 kg and the DRG-based approach showed equal burden for the budget for reslizumab and mepolizumab for the patients with any body mass.

98 Use of Drgs with Anticholinergic Properties in People Living with Alzheimer’s Disease: Data from NILVAD

Abstract Background Prolonged exposure to anticholinergic medication, particularly in midlife, is associated with increased risk of cognitive impairment/dementia. Less well explored is the ongoing use of drugs with anticholinergic properties in patients with Alzheimer’s Disease (AD), where the potential to accelerate cognitive decline may be greatest. Methods We analysed medication data from the NILVAD trial, a clinical trial examining the efficacy of Nilvadapine in mild-moderate Alzheimer’s Disease (AD). Drgs were coded based on their Anatomical Therapeutic Chemical (ATC) classification and Anticholinergic Burden Scale (ABS) applied to each participant’s medication list. Logistic and linear regression were used to model predictors of potential anticholinergic medication use/total ABS score. Results Of 510 participants with AD (mean age 72.8 +/-8.3 years; 62% female), just over one-quarter (N = 134, 26.27%) were prescribed a drug with potential/definite anticholinergic properties. Half of these had an anticholinergic burden score of 3 or greater (N = 67, 13.4%). The most frequent definite anticholinergics prescribed included quetiapine (N=27) oxybutynin (N = 22), paroxetine (N=14) and amitriptyline (N=8). Usage did not significantly differ by country or study arm. Overall, 88.43% of patients were prescribed a cholinesterase inhibitor. On multivariate analysis of potential/definite anticholinergic usage, age (p=0.044; OR 1.03, 1.01-1.06), total number of medications (p=0.001, OR 1.3, 1.18-1.41) as well as a greater dementia severity rated using the Alzheimer’s Disease Assessment Scale (ADAS-Cog) (p=0.008; 1.04 1.01-1.07) were associated with likelihood of anticholinergic use. Conclusion Over one-quarter of community-dwelling older patients with AD are prescribed a drug with potential or definite anticholinergic properties. Use of drugs with potential/definite anticholinergic properties were associated with total medication burden in addition to greater dementia severity at baseline. This is particularly pertinent given the deleterious cognitive effects of anticholinergic medication. Further attention to reducing total anticholinergic burden in patients with dementia is warranted.

Critical Evaluations of the French Health Care Accounting Indicators: The Use of Drgs

Responding to legitimate public demand for a more effective government, and pressed by EU authorities to achieve fiscal balance, and to reorient the economy toward an export model (Lux, 2015), French authorities embraced New Public Management (NPM). The aims were: to modernize the public sector; to introduce some elements of economic performance in the administration; and to enhance accountability (Bezes, 2008). The health care sector was not spared. Diagnostic-Related Groups (DRG) was one of the new accounting tools designed to effect changes in this sector. The purpose of this paper is to critically evaluate the appropriateness of the DRG system and the challenges associated with its implementation in the health system. We evaluate the impact of DRGs using the four evaluation dimensions of the World Health Organization: efficiency, quality, relevancy and equity. Our findings indicate that although DRGs contributed to improving the relevance of the system and its efficiency (the ‘reality axis’ of WHO model), it has failed to meet what the society expects of an ‘ideal’ health care system: an increase in the quality of care and the promotion of equity between public and private care providers (the ‘ideal axis’ of the WHO model).

Physiotherapy as one column of an integrative and interdisciplinary medical approach—Impact of the introduction of diagnosis related groups in Germany

To investigate the introduction of case tariff fee remuneration - as required by the current system - and its influence on patient satisfaction with the provision of physiotherapeutic treatment in an acute hospital aligned on a holistic, interdisciplinary therapeutic approach. Randomised controlled study with a total of 4598 patients were interviewed. No case tariff fee system was used during the years 2004 to 2006. The data were compared with the results of interviews that took place during 2007 and 2008 (use of DRGs). The results of this study are based on the largest survey performed to date of patient satisfaction with physiotherapeutic treatment in acute care focusing on a holistic interdisciplinary approach. In-patients being treated under DRG conditions were compared with a control group for whom the DRG system had not been applied. The target parameter of the study, which took more than five years, was the determination of patient satisfaction with the physiotherapeutic interventions. There were no significant differences between the two groups in respect of satisfaction with the physiotherapeutic treatments received. Regarding the outcome parameter encouragement to take more exercise, a significant change could be demonstrated under DRG conditions. Physiotherapeutic interventions play an important role in the provision of interdisciplinary care. In particular, the holistic perception of the patient, the interdisciplinary approach to complex diseases, and the requirements of the DRG system on the care provider can exert a positive influence on outcome quality.

Issues for comparability of DRG statistics in Europe. Results from EURODRG

DRG use has spread through most European countries thus offering an opportunity for improving hospital data bases at the European level. An EEC Concerted Action 'Use of DRGs to support Hospital Sector Management in the European Community' was approved by the Committee of Health Services Research of the EEC. A general overview of the project Is presented as well as a detailed description of the results of the work on aspects related to DRG data production. These aspects (MBDS Implementation and variables definition; coding systems and updating; mapping systems; data auditing; trimming methods; and DRG grouper versions) have been analyzed with the objective of increasing opportunities for valid international comparisons of DRG statistics between European countries.

The Use of DRGs in the Management and Planning of Hospital Services

Australian Economic ReviewVolume 24, Issue 1 p. 62-70 The Use of DRGs in the Management and Planning of Hospital Services George R. Palmer, School of Health Services Management University of New South WalesSearch for more papers by this author George R. Palmer, School of Health Services Management University of New South WalesSearch for more papers by this author First published: January 1991 https://doi.org/10.1111/j.1467-8462.1991.tb00383.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Citing Literature Volume24, Issue1January 1991Pages 62-70 RelatedInformation

Evolution of DRGs and clinical information systems

DRG definitions have evolved during the past decade and will continue to evolve as methods for evaluating severity data become available. The use of DRGs for hospital budgeting, payment and evaluation as well as the support of hospital utilization review and quality assurance activities requires that systems be available to insure data quality. A comprehensive and flexible clinical information system will be required by hospitals in order to manage under a DRG system.