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The concept of break-even analysis as a financial assessment tool is defined and demonstrated in evaluation of a proposed nurse-managed center. The advantages of using break-even analysis during proposal development are explored.
BACKGROUND: Large-scale utilization of drug-eluting stents (DES) presents significant economic limitations, related to the current high cost of the device and the absence of adequate reimbursement from the health care system. The aim of the study was to evaluate the cost of single-vessel and multivessel drug-eluting stenting and to compare it with the DRG funding level. METHODS: Between November 2003 and May 2004, we studied 100 consecutive patients who underwent a percutaneous coronary intervention (PCI) with DES, 50 single-vessel and 50 multivessel procedures, in order to evaluate the real procedure costs of DES. The cost fields calculated in the analysis included: costs for the materials and drugs used in each procedure, costs related to medical personnel and staff, costs for equipment depreciations, and costs for total hospitalization based on the length of stay in the coronary care unit and/or in the cardiology ward. RESULTS: With regard to the 50 patients with single-vessel disease, 63 lesions were treated with 58 DES. With regard to the 50 patients with multivessel disease, the average number of treated vessels was 2.3 and of lesions 2.8. An average of 2.7 DES per patient was implanted; glycoprotein Ilb/IIIa inhibitors were used in 70% of cases. The multivessel procedure necessitated an average of 1.62 guide catheters, 1.86 guides, 1.36 balloons, and 475 +/- 124 ml of contrast medium; the average endoscopy time was 16 +/- 8 min while the total procedural time was 106 +/- 37 min. The procedural success rate was 100% for both groups. The post-PCI hospital stay was 2.1 +/- 1.7 days for patients with single-vessel disease and 2.8 +/- 2.6 days for patients with multivessel disease; the total was 4.7 +/- 2.8 and 6 +/- 3.2 days respectively. The mean total cost of hospital stay for PCI and DES was 6390 +/- 2274 Euro for single-vessel PCI and 9828 +/- 3026 Euro for multivessel PCI, split as follows: materials 2915 +/- 963 Euro and 5294 +/- 1177 Euro, procedural costs 404 +/- 55 and 446 +/- 99 Euro, costs of hospital stay 3070 +/- 2024 Euro and 4089 +/- 2517 Euro respectively for single-vessel and multivessel PCI. CONCLUSIONS: The mean total cost of a single-vessel PCI with DES falls within the DRG 112 reimbursement level for coronary angioplasty of 7006 Euro, while that of multivessel PCI with multiple DES is about 40% above the same reimbursement level. Interestingly, the multivessel PCI cost with multiple DES does fall within the reimbursement amount related to DRG 107 for bypass surgery procedures (14,322 Euro).
Cost effectiveness analysis of Chagas' vertical transmission control program in Bolivia: Today, Bolivia is the most concerned country in America by Chagas disease: Trypanosoma cruzi infection affects 20% of whole population, around 1800000 inhabitants, and mother-to-child transmission is around 5%, from 1.6 to 9.8%. Direct and indirect costs derived from disease complications and death, from birth to adulthood, add up around US$ 21 millions per year for 2,718 infected new-borns. This cost falls on individual, family and society, when the nation is struggling in a depressed economy. On the other side, an effective control program could detect and treat all cases with an investment of US$ 123 per infected new-born, or US$ 1.2 per new-born in Bolivia. Indirect benefits, apart of suffering relieve and improving of life quality, are related with Chagas vector control program, increasing the demand thanks to increasing risk awareness and also induced demand testing all pregnant women in endemic areas. So the conclusion is that such investment is profitable.
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Planning for purchase, implementation, and use of an automated hospital information system is critical to its success. The planning process involves assessing needs, evaluating alternatives, selecting a system, and implementation support. Although an evaluation of costs and benefits of alternative systems is useful in planning for and selecting a system, the assessment can be very complex, and the assumptions used in the analysis are critical. Most benefits of automated systems are the result of improved timeliness, accuracy, and access to information, and these are difficult to value in dollars.
Medical and technological advances in the care of infants with low birth weight (less than 2,500 grams, or 5 pounds, 8 ounces) and very low birth weight (less than 1,500 grams, or 3 pounds, 5 ounces) have substantially increased the survival rate for these infants and have led to concerns about the demands their care places upon their families and society. The dollar cost of the resources used disproportionately to care for low birth weight children is one measure of the burden of low birth weight. Using analyses of national survey data for 1988 for children ages 0 to 15, this article presents estimates of the direct incremental costs of low birth weight--costs of the resources used to care for low birth weight infants above and beyond those used for infants of normal birth weight. In 1988, health care, education, and child care for the 3.5 to 4 million children ages 0 to 15 born low birth weight between $5.5 and $6 billion more than they would have if those children had been born normal birth weight. Low birth weight accounts for 10% of all health care costs for children, and the incremental direct costs of low birth cost weight are of similar magnitude to those of unintentional injuries among children and in 1988 were substantially greater than the direct costs of AIDS among Americans of all ages in that year.
The objective of this study was to evaluate economically a screening programme within the Oxford Regional Health Authority for Down's syndrome, based on maternal serum alpha fetoprotein, unconjugated oestriol and human chorionic gonadotrophin as well as maternal age (the triple test) against maternal age alone. The design of the study involved cost-effectiveness analysis of the triple test relative to the maternal age screening programme, and the main outcome measure was the cost per Down's birth avoided. It was found that the triple test is more cost-effective over a wide range of assumptions concerning detection rates and procedure costs. Indirect costs are important in considering the cost-effectiveness of the screening programmes. The most efficient detection rate is around 58 per cent for which the cost per Down's birth avoided is approximately 29,600 pounds if only direct costs are evaluated, 20,100 pounds if all NHS costs are considered and -49,800 pounds if all resource consequences are analysed. It may be concluded that screening for Down's syndrome using the triple test is cost-effective over a wide range of assumptions concerning detection rate and procedure costs. If all resource costs are considered, the programme is highly cost-effective in comparison with other health care interventions.
Haemophilus influenzae type b (Hib) infection is a major cause of severe bacterial infection in young children in South Africa and world-wide. These diseases can be prevented by immunisation with conjugate Hib vaccines. In South Africa, unlike some developed countries, Hib vaccines are not part of the routine immunisation schedule. The objective of this study was to measure the expected net benefits from a hypothetical programme of vaccination of the 1992 Cape Town birth cohort (N = 46,537). Costs were calculated by summing the estimated direct medical care costs together with the indirect costs of Hib disease. The latter were calculated by valuing human life using alternative, and conservative human capital and willingness-to-pay measures. The difference between Hib disease costs (i.e. the benefits which would be gained from a successful vaccination programme) and the costs of the vaccination programme itself (HibTITER, Praxis Biologicals) defined the expected net benefits. In the absence of an immunisation programme, the estimated economic costs of Hib disease in the 1992 Cape Town cohort ranged from R10.7 million to R11.8 million. The costs of introducing the vaccine would have amounted to R8.3 million. Had the vaccine been administered to the 1992 birth cohort, benefits would have exceeded costs by between R2.4 million and R3.5 million.
The total direct cost of treating schizophrenia in the UK is 397 million pounds, or 1.6% of the total health care budget. Hospital-based and community-based residential care accounts for nearly three-quarters of these costs, while drugs account for only 5%. A conservative estimate of the indirect annual costs of lost production is in the region of 1.7 billion pounds. The heterogeneity of the disease and its outcome means that average treatment costs per person with schizophrenia should be treated with caution; 97% of direct costs are incurred by less than half the patients. Therefore, treatments which reduce the dependence and disability of those most severely affected by schizophrenia are likely to have a large effect on the total cost of the disease to society and may therefore be cost-effective, even though they appear expensive initially.
Birth defects now are the leading cause of infant mortality and a major contributor to heightened morbidity in the United States. Considerable medical and nonmedical resources are devoted to treating persons with birth defects. Yet, little is known about birth defects' economic burden to society and the profile of component direct and indirect costs over the lifespan of those born with specific birth defects. Using an incidence approach, we made the most comprehensive estimates to date of the cost of 18 of the most clinically significant birth defects in the United States. Our analysis provides the basis for assessing competing strategies for research and prevention.
OBJECTIVE: To estimate the annual direct and indirect costs of ectopic pregnancy in the United States and to examine trends in payment source. METHODS: We analyzed hospital discharge data for 1982-1989 from a San Francisco hospital and California statewide data for 1983-1987 to estimate direct medical care costs and to determine payment sources. Examination of national labor data was used to compute indirect cost. RESULTS: The total cost of ectopic pregnancy in 1990 was estimated to be nearly $1.1 billion. Direct costs of hospitalization and other medical treatment contributed 77% of the total costs, with average hospital costs estimated to be $6079, hospitalization-related physician fees $3254, and average outpatient costs $149, for a total direct cost-per-case of $9482. Of the total indirect costs ($250.5 million), 67% was attributed to the value of lost wages and the remainder to the lost value of household management. Public payment sources covered the largest portion of ectopic pregnancy-related direct costs among women aged 19 and younger (35%), but private insurance covered the largest portion among women aged 20-29 (32%) and women aged 30 and older (43%). In general, the proportion of payments made by private insurance has decreased, while the proportion of payments made by public pay sources and health maintenance organizations and preferred provider organizations has increased. CONCLUSIONS: Ectopic pregnancy results in a substantial economic burden, with an increasing share of direct costs being borne by public pay sources. Appropriate use of cost-effective management approaches can reduce costs, while preventive measures that decrease the risk of ectopic pregnancy can both save resources and, more important, spare human suffering.
AIM: To identify and, where possible, measure and value the private costs related to HIV/AIDS, that is, those costs that fall on the person with HIV/AIDS and the family/household/informal caregivers. METHOD: Twenty-five people living with HIV - ranging from asymptomatic seropositive people, to people with AIDS - were followed prospectively to obtain information concerning the private costs (broadly defined) incurred. The participants resided in the Auckland, Hamilton, Wellington and Christchurch areas. RESULTS: Private direct costs rise steeply as the illness progresses, from around $100 per month for asymptomatic people to around $400 per month for people with AIDS. Both indirect costs (foregone income) and intangibles (measured by a range of indicators) were also considerable. CONCLUSION: The private costs of HIV/AIDS, defined in terms of direct, indirect and intangible costs, are significant and burdensome. Costing studies which ignore them will conceal, confuse and mislead.
The aim of this study, carried out at the Institut Paoli-Calmettes (Marseille-France), was to compare, in terms of monetary and non monetary costs, alternate procedures for hematopoietic stem cells collection i.e. peripheral blood stem cells collection (PBSCC) and bone marrow collection (BMC) used in cancer therapies. Monetary costs have been evaluated by calculating the direct costs of the two types of procedures and non monetary costs by comparing anxiety, discomfort and pain of cancer patients submitted to PBSCC or BMC. Patients, randomized (7/1993-2/1994), in view of autologous transplantation, to receive the first procedure or the second one received three self-administered questionnaires to complete before, during and after the procedure. Pain was assessed using visual analogical scale and McGill Pain questionnaire. Anxiety was evaluated by means of State-Trait Anxiety Inventory. Results showed that, under some conditions, presently realized in the current practice, direct costs of PBSCC (10,140 to 13,780 FF) were lower than BMC ones (16,509 FF) and that anxiety and pain experienced by patients submitted to PBSCC, with or without femoral catheter, were significantly less severe than in other group patients (State anxiety, before procedure : p < 0.01 ; pain related to the procedure assessed on VAS : p < 0.001 and total McGill score : p < 0.00001). These findings justify the substitution of bone marrow transplantation by peripheral blood stem cells transplantation, provided there is a demonstration of similar medical efficacy for cancer therapy.
To calculate cost effectiveness of wound care, it is incorrect to calculate the costs of just a dressing. All aspects influencing the costs of treatment should be calculated. These include costs for the actual materials, labor, and nonmedical costs to society.
Cost-benefit analyses to translate treatment costs and effects into monetary units. For a cost-benefit analyses of psychotherapy data, direct costs can be most easily and reliably estimated; but indirect costs of treatment and the effects of treatment are difficult to estimate. Among these are such considerations as lost pay, disruption of relationships, embarrassment and anxiety. There are also costs associated with not having treatment--e.g., compromise of personal and familial immunologic systems, lost productivity. But, for the sake of simplicity, we focus on the direct monetary costs of treatment. We have developed theoretical frameworks--the dosage and phase models--within which to approach a cost-benefit analysis of psychotherapy. The dosage model specifies a lawful relationship between number of sessions and therapeutic benefit. The phase model utilizes a three-component conception of psychotherapy--remoralization, remediation, and rehabilitation--and allows for differential cost-benefit analyses for specific therapeutic benefits.
OBJECTIVE: In this 3 year randomized clinical trial the cost effectiveness of a 6 week educational/cognitive intervention (ECO) is compared with an educational discussion intervention (EDI) and a waiting list condition (WLC). METHODS: A total of 131 patients with fibromyalgia were randomly allocated to the ECO, EDI, or WLC intervention. The ECO and EDI groups were followed for 12 months, whereas the WLC group was followed for 6 weeks. Direct health care and nonhealth care costs, and the indirect costs associated with lost production due to illness, were calculated. The effects were measured in terms of utilities, using rating scale and standard gamble methods. RESULTS: Treatment costs were estimated to be US $980 per patient for both ECO and EDI. The total direct health care costs of ECO treatment were US $1623 higher than those for EDI. This difference was significant. Indirect costs for the 2 groups were not significantly different. At 6 weeks there was a significant difference in rating scale utilities between the 3 groups, caused by a significantly greater improvement in the EDI group compared to the WLC group. However, no significant differences in either rating scale or standard gamble utilities were found between the ECO and EDI groups immediately after treatment, or at the 6 or 12 month followups. CONCLUSION: The economic evaluation showed that the addition of a cognitive component to the educational intervention led to significantly higher health care costs and no additional improvement in quality of life compared to the educational intervention alone. This conclusion is robust through a range of plausible values used in a sensitivity analysis.
Actual cases show that directly observed therapy (DOT) works with tuberculosis patients--and while DOT may increase the short-term cost of care, in the long term DOT can deter other costs.
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