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PubMedDate not supplied

[Disposable versus reusable biopsy forceps. A prospective cost analysis in the gastrointestinal endoscopy unit of the Dijon University Hospital].

AIMS: The goal of this study was to compare the cost of a biopsy session performed with a disposable and a reusable endoscopic biopsy forceps. MATERIAL AND METHODS: Over a 10-month period, 15 new reusable forceps (10 gastric and 5 colonic) were prospectively tracked. A biopsy session performed with a reusable forceps included its current purchase price, the sterilization cost and the number of uses. A biopsy session performed with a disposable forceps was calculated with its current purchase price and its incineration cost. RESULTS: At the end of the study, only one reusable forceps had broken and the number of uses was 65. The cost of a biopsy session performed with a gastric reusable forceps was euro 7.52 (including euro 1.92 of sterilization cost) and euro 8.67 for a reusable colonic forceps (with the same sterilization cost). The cost of a biopsy session performed with a gastric or a colonic disposable forceps was euro 11.98. From 44 uses for a colonic forceps and 37 uses for a gastric one, a biopsy session performed with a reusable forceps was already cheaper. CONCLUSION: In this study, a biopsy session performed with a reusable forceps was less expensive than with a disposable one. However, the extra cost generated by the disposable forceps may be offset by an easier inventory control and the reduction of the cross contamination risk.

Biopsy↗
PubMed2004

Cost of illness of chronic angina.

BACKGROUND: Angina pectoris is one of the principal manifestations of coronary artery disease (CAD). Chronic angina is a debilitating condition that affects millions of people in the United States. OBJECTIVE: The objective of the study is to estimate, from a societal perspective, the direct costs of chronic angina in the year 2000. METHODS: Data on medical utilization related to chronic angina were extracted from National Center for Health Statistics public-use databases and from IMS databases on medications (nitrates, beta-blockers, and calcium channel blockers). National average Medicare reimbursement rates were used to estimate costs. We identified medical utilization related to chronic angina based on International Classification of Diseases, Ninth Revision (ICD-9) codes. When ICD-9 codes that do not explicitly identify angina are used in medical databases, people with chronic angina may be coded as having CAD only. To address this, we developed upper- and lower-boundary estimates of the costs of chronic angina. The lower-boundary estimate is based on diagnoses that narrowly define the presence of chronic angina, and is termed "narrowly defined chronic angina." The upper-boundary estimate is based on diagnoses of CAD. RESULTS: The lower boundary on the cost of chronic angina is the estimated direct medical cost of narrowly defined chronic angina ($1.9 billion when it is the first-listed diagnosis and $8.9 billion when it is listed in any position). The upper boundary on the cost of chronic angina is the estimated total direct medical cost of CAD, which is $33 billion when it is the first-listed diagnosis and $75 billion when it is listed in any position. CONCLUSION: These analyses capture the range of direct costs that might be attributed to the care of chronic angina in the United States for the year 2000. Some components of care were not available, and estimated costs will be significantly higher if private payer reimbursement rates are used.

Angina Pectoris↗
PubMed1981

A cost-benefit analysis of immunization for pneumococcal pneumonia.

To determine whether immunization against pneumococcal pneumonia could be justified on the basis of a favorable benefit to cost ratio, we evaluated the projected impact of a program of pneumococcal vaccination on the population of a health maintenance organization. Retrospective data on average provider and patient costs associated with episodes of pneumococcal pneumonia were coupled with forecasts of the likely effectiveness of currently available vaccine and its impact on anticipated incidence of pneumonia. We found that when provider-centered and patient-centered costs and benefits were added, a program of immunizing those traditionally considered to be at high risk of contracting pneumococcal pneumonia (50 years of age and older; patients with chronic diseases of the heart, liver, lungs, or kidneys; and those with diabetes mellitus) was justified on a cost-benefit basis.

Adolescent↗
PubMed1994

Opportunities for cost reduction in diabetic retinopathy treatment: case study from Mexico.

A study was performed in order to explore the costs of treating diabetic retinopathy at a large eye hospital in Mexico with a view to identifying opportunities for improving efficiency. Clinical records of a random sample of 69 diabetic patients were reviewed for data on each patient's background, medical history, and treatment; and the costs of all resources utilized in each type of procedure provided were documented and priced. The resulting data on clinical costs was complemented by data on the private costs of treatment (medical fees, accommodation costs, transportation costs, and lost wages) that were gathered from patient interviews. The study found that the patients, who were generally poor, shouldered a substantial economic burden associated with treatment at the hospital; however, less than half this burden was in the form of fees. The rest involved other out-of-pocket expenditures on food, travel, and accommodation (45% of the total) and lost wages (10% of the total). Suggestions for reducing various of these costs without endangering treatment quality are presented. These include suggestions for reducing waiting time; reducing the number of patient visits required by increasing the strength of individual laser treatments, completing more procedures in a single visit, and reviewing hospital policy on fluoroangiograms; and increasing the chances for early and effective treatment by educating at-risk relatives accompanying the patients about the need for early treatment.

Aged↗
PubMed1996

[Direct costs of ambulatory treatment of diabetes mellitus. Comparison of observed costs with estimated costs of adherence to the treatment standard].

BACKGROUND: The aim of this investigation was to record the observed direct costs of the outpatient treatment and therapy control of diabetic patients based on patient-related analysis of health care expenses in a population-based sample and to compare these costs with those generated if the minimum requirements of the European IDDM and NIDDM Policy Groups are fulfilled. Up to now there are only few studies on this topic. PATIENTS AND METHOD: Medical records of a 5% random sample of all insured members of the AOK Dortmund (n = 6085) in 1990 provided the data basis. The direct diabetes-specific therapy and care costs were compiled per patient and year. RESULTS: The annual costs for antidiabetic drugs, monitoring of blood glucose and glycated hemoglobin, test strips for self-monitoring, checking serum cholesterol, triglycerides and creatinine as well as for fundoscopy amounted to a mean of DM 1218.-per each insulin-treated patient (n = 65), DM 211.-per patient on oral antidiabetic drugs (OAD, n = 177), and DM 42.-per patient treated by diet alone (n = 108). Provided that the minimal recommendations of the European IDDM and NIDDM Policy Groups were followed the calculated costs would be DM 1758.-, DM 287.- and DM 198.-, respectively. CONCLUSION: Fulfilling the minimum standards for diabetes care of the European IDDM and NIDDM Policy Groups, respectively, would cause additional costs per patient and year of DM 540.-for insulin-treated. of DM 76.-for OAD-treated and of DM 156.-for patients treated by diet alone. On the other hand adherence to the recommendations would reduce the annual costs for oral antidiabetic drugs by 40%. Improved care of diabetic patients would result in significantly higher costs, but these extra expenses would be probably compensated by a reduction or delay of late complication.

Adult↗
PubMed1997

Socioeconomic impact of diabetic nephropathy: can we improve the outcome?

BACKGROUND: The prevalence of non-insulin-dependent diabetes mellitus-associated nephropathy is increasing worldwide. Obviously, a greater commitment of time is required from health providers to care for such patients. Moreover, when these patients develop end-stage renal disease, healthcare costs increase geometrically when viewed in the total context of lost wages and increased health-care expenditures. INTERVENTIONS: Strict control of glucose as well as a low-protein and low-salt diet are important, but ultimately, aggressive blood pressure reduction is required to markedly decrease the time to dialysis. TREATMENT: Angiotensin converting enzyme (ACE) inhibitors should be part of the blood pressure-lowering therapy in all such patients. Recent data support the concept that addition of an ACE inhibitor to other blood pressure-lowering regimens delays the time to dialysis. Moreover, non-dihydropyridine calcium channel blockers should also be added for blood pressure control in these patients. STUDIES: Recent evidence from long-term studies in patients with nephropathy from non-insulin-dependent diabetes suggest that this subclass of calcium blockers is similar in efficacy to ACE inhibitors. CONCLUSIONS: The use of these strategies to reduce arterial systolic/diastolic pressure to < 130/80 mmHg will provide long-term benefit both to the patient and to society.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

[Estimation of the treatment cost of cervical cancer].

BACKGROUND: The goal of this study was to estimate direct costs induced by the first year of treatment of cervix cancers according to the stage at diagnosis. METHODS: Fifteen patients of the Gynaecology Department of the Besançon hospital (Doubs, France) were involved in a prospective study to estimate the real cost of treatment of carcinomas in situ (CIS) by conization and of microinvasive carcinomas (MIC) by simple hysterectomy. Costs of invasive cancers were obtained from a retrospective analysis of 24 hospital records in the Radiotherapy Department. RESULTS: The average real cost of treatment for the CIS was 5023 FF (1995 French Francs). Real treatment cost of the MIC was 15,867 FF. The average cost of treatment for the IB and IIA cancers stage (FIGO classification) was 61,540 FF and 145,314 FF for the IIB to IV stage cancers. CONCLUSIONS: Cost-estimation of cervix cancer treatment according to the stage of diagnosis has to be done before starting a cost-effectiveness analysis of mass screening for cervix cancers. This study will allow us to take into account changes in the stages distribution following on a screening campaign.

Carcinoma in Situ↗
PubMed1998

[Introduction to the theory of pharmaco-economics].

This article presents an overview of the principles of pharmaco-economic evaluation. A pharmaco-economic evaluation is a comparison of the costs and effects of at least two therapeutic strategies, including at least one drug. It is mostly useful if a new treatment is more effective and more costly than a reference one. The way the effects of treatments are expressed defines several types of analyses: cost minimisation, cost-effectiveness, cost-utility and cost-benefit. The costs measured can be direct (medical and non-medical) and indirect (tangible and intangible). The principle of decision analysis is illustrated.

Cost Control↗
PubMed1998

The costs of depression: direct and indirect; treatment versus nontreatment.

Depression is one of the most costly illnesses in the United States today. While managed care often focuses on the costs of treatment, the costs of nontreatment are usually ignored. We have potent treatments that are highly successful, but depression is often undetected or undertreated where it appears most commonly-in the primary care setting. When comorbid with other medical problems, especially cardiovascular disease, depression greatly increases mortality, morbidity, and expense. Sophisticated pharmacoeconomic analyses can guide our cost/benefit studies, but the real cost savings and highest quality care will come by investing in educating primary care physicians regarding the recognition and treatment of psychiatric illness as it presents in their clinical practices.

Antidepressive Agents↗
PubMed1985

Evaluating financial viability of clinical programs under prospective pricing.

The new financial incentives created by prospective pricing for hospital inpatient services--especially by Medicare's diagnosis-related group (DRG) system--make it important for hospitals to evaluate the financial viability of individual clinical programs. For the purposes of such evaluations, however, DRGs are likely to be poor definitions of the services or products delivered by any given hospital. This article examines the implications of the concept of "product lines" in hospitals, three criteria for useful product definitions, ways in which DRGs fail to meet these criteria, the need for hospital-specific product definitions, and technical difficulties that hospitals may encounter in defining their products. A case study of the orthopedic service at a large, urban, teaching hospital, using both DRGs and the hospitals own product definitions, illustrates the process of evaluating the financial viability of clinical programs.

Chicago↗
PubMed2001

Cost of pelvic organ prolapse surgery in the United States.

OBJECTIVE: To estimate the annual direct cost to society of pelvic organ prolapse operations in the United States. METHODS: We multiplied the number of pelvic organ prolapse operations identified in the 1997 National Hospital Discharge Survey by national average Medicare reimbursement for physician services and hospitalizations. Although this reimbursement does not estimate the actual cost, it is a proxy for cost, which estimates what society pays for the procedures. RESULTS: In 1997, direct costs of pelvic organ prolapse surgery were 1012 million dollars (95% confidence interval [CI] 775 dollars, 1251 million), including 494 dollars million (49%) for vaginal hysterectomy, 279 million dollars (28%) for cystocele and rectocele repair, and 135 million dollars (13%) for abdominal hysterectomy. Physician services accounted for 29% (298 million dollars) of total costs, and hospitalization accounted for 71% (714 million dollars). Twenty-one percent of pelvic organ prolapse operations included urinary incontinence procedures (218 million dollars). If all operations were reimbursed by non-Medicare sources, the annual estimated cost would increase by 52% to 1543 million dollars. CONCLUSION: The annual direct costs of operations for pelvic organ prolapse are substantial.

Direct Service Costs↗
PubMed2002

The direct cost of care for psoriasis and psoriatic arthritis in the United States.

BACKGROUND: Relatively little information is available in the literature concerning the cost of psoriasis in the United States, and much of that information is out of date. OBJECTIVE: The present analyses estimate the direct cost of medical care for psoriasis (including psoriatic arthritis) from a societal perspective among adults in the United States. METHOD AND DATA: The costs of hospitalizations, outpatient and physician office visits, prescription and over-the-counter (OTC) medications, and medical procedures were estimated from the literature, analysis of publicly available health databases (Health and Nutrition Examination Survey, National Hospital Discharge Survey, Medicare Public Use Files, National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey), and analysis of privately available health databases (United Health Care/Diversified Pharmaceutical Services, the Medstat Group diagnosis-related group guide, and the National Disease and Therapeutic Index). Costs were expressed as of 1997 by using Medicare and health maintenance organization reimbursement rates and wholesale drug costs. Costs of OTC medications were derived by adjusting a previous estimate in the literature for inflation in over-the-counter drugs and population increases. RESULTS: The cost of illness for the approximately 1.4 million individuals with clinically significant disease is substantial-approximately $30.5 million for hospitalizations, $86.6 million for outpatient physician visits, $27.4 million for photochemotherapy, $147.9 million for dermatologic prescription drugs, and $357.2 million for OTC drugs, for a total direct cost of $649.6 million. CONCLUSION: Cost estimates from this study are substantially less than those found in previous studies ($1.09 billion and $4.32 billion after adjustment of estimates in the literature for medical inflation and population increases). This appears to be principally a result of decreases in hospitalization rates since 1979 and the valuation methodology per unit of medical services (with prior studies using "list" prices and the current study using reimbursement rates).

Adolescent↗
PubMed1996

The clinical need for an acute rheumatology referral service.

Should rheumatologists provide an acute referral service for general practitioners (GPs) and other clinical units? Is it cost effective? We prospectively studied acute referrals to one unit over 10 months, recording their source, diagnosis, management and outcome. Current rheumatology patients and cases only needing telephone advice were excluded. There were 253 referrals: 82 from GPs, nine from Accident and Emergency, and 162 from other hospital units. Their diagnoses comprised connective tissue diseases (22), back pain (46), inflammatory arthritis (59), osteoarthritis (22), paediatric cases (11), soft tissue problems (41) and 52 other disorders. Thirty-two needed active treatment within 24 h (classified as emergencies); examples included cerebral lupus, vasculitic pulmonary haemorrhage, retroperitoneal lymphoma with sacral plexus compression, temporal arteritis with reduced visual acuity and acute monoarthritis. All needed immediate therapy; only one died. Most (176 cases) were less urgent and needed advice in 48 h. Examples included osteoporotic vertebral collapse and acute rheumatoid disease. Forty-five could have been seen routinely; examples included lateral epicondylitis and adhesive capsulitis. The service required 1 day per week of medical staff time at an average cost of 45 pounds per case. We concluded that an acute rheumatology service is needed; it can be provided within the working day and is cost effective.

Direct Service Costs↗
PubMed1997

[Cost of illness in Parkinson disease. A retrospective 3-month analysis of direct costs].

Parkinson's disease (PD) causes significant expense for the national health care system due to its chronic progressive course, the duration of the disease, the high prevalence and the devastating prognosis. In Germany more than DM 320 million are spent for drugs to alleviate parkinsonian symptoms. The aim of this study was to calculate the economic burden of PD by assessing direct medical costs. Forty patients suffering from idiopathic PD were interviewed at an office of neurological specialists and at an outpatient movement disorder clinic about their use of health care resources 3 months prior to the study. The total annual costs reported were DM 14,500, consisting of DM 6500 for drug therapy and DM 8000 for other medical services, including hospital inpatient care (DM 5600), outpatient care (DM 700), medical sundries (DM 1100) and physiotherapy (DM 600). The costs were positively correlated to the extent of the disease (Hoehn and Yahr stage; HY) and the occurrence of motor fluctuations/dyskinesias. We found that both drug-therapy expenses and total medical costs doubled from HYI to HYIV. The rarely employed s.c. therapy with apomorphine additionally increased the costs of drug therapy in HYV. The occurrence of fluctuations/ dyskinesias also increased medical expenses by approximately a factor of two. Indirect burden due to increased days off of work, unemployment and earlier retirement are also significant in Parkinson's disease. This study includes that a treatment which could prevent or retard disease progression as well as a treatment that delays or reduces motor complications would not only ameliorate the situation of patients suffering from PD, but would also lead to significant reductions in cost for the national health care system.

Aged↗
PubMedDate not supplied

A method for the measurement of outpatient resource utilization.

A method for measuring outpatient resource utilization in terms of the amounts of time different categories of patients spend with various providers is described. Patients are categorized based on selected attributes, but other attributes could be used. The method is based on two important and measurable variables: 1) frequencies of usage of different resources (e.g., nurse practitioners, physicians, x-ray), and 2) amounts of time used, by each provider type and by ancillary services (x-ray). Using the quantitative measures described, an algorithm is developed for measuring the direct labor costs of delivering primary care to different types of primary care patients.

Algorithms↗