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PubMed2006

Documentation of chemotherapy infusion preparation costs in academic- and community-based oncology practices.

Significant changes in Medicare reimbursement for outpatient oncology services were proposed as part of the Medicare Modernization Act of 2003. The purpose of this study was to identify the "true cost" associated with drug-related handling for the preparation and delivery of chemotherapy doses to estimate the impact of changing reimbursement schema by Medicare. Two academic medical outpatient infusion centers and 2 community cancer centers provided data used to estimate all costs (excluding drug cost) associated with the preparation of chemotherapy doses. The data included both fixed costs (drug storage, space, equipment, and information resources) and variable costs (insurance management, inventory, waste management, pharmacy staff payroll, supplies, and shipping). The average cost for the preparation of chemotherapy doses across all sites was dollar 34.27 (range, dollar 32.08-dollar 41.23). A time-and-motion study was also performed to determine what tasks were conducted by pharmacy staff and how much time was spent in the preparation of the top 15 chemotherapeutic drugs and regimens used in the 4 sites. Data from the 4 centers was projected to show that if 3,990,495 million chemotherapy infusions were administered to a national Medicare population in 2003, when multiplied by the average cost of preparation for infusions determined by the current study (dollar 34.27), the estimated total annual cost to Medicare for chemotherapy preparation by pharmacists is dollar 136,754,263.65. The pharmacists spent most of their days (90% or more) performing tasks directly related to the preparation of these agents. These data provide scientific support for the consideration of appropriate reimbursement for chemotherapy services provided by pharmacists to Medicare beneficiaries.

Academic Medical Centers↗
PubMed2000

Direct costs associated with a nosocomial outbreak of Salmonella infection: an ounce of prevention is worth a pound of cure.

BACKGROUND: Nosocomial outbreaks of Salmonella infections in Australia are an infrequent but significant source of morbidity and mortality. Such an outbreak results in direct, measurable expenses for acute care management, as well as numerous indirect (and less quantifiable) costs to those affected, the hospital, and the wider community. This article describes the significant direct costs incurred as a result of a nosocomial outbreak of Salmonella infection involving patients and staff. METHOD: Information on costs incurred by the hospital was gathered from a number of sources. The data were grouped into 4 sections (medical costs, investigative costs, lost productivity costs, and miscellaneous) with use of an existing tool for calculating the economic impact of foodborne illness. RESULTS: The outbreak cost the hospital more than AU $120, 000. (US $95,000). This amount is independent of more substantial indirect costs. CONCLUSION: Salmonella infections are preventable. Measures to aid the prevention of costly outbreaks of nosocomial salmonellosis, although available, require an investment of both time and money. We suggest that dedication of limited resources toward such preventive strategies as education is a practical and cost-effective option for health care facilities.

Cross Infection↗
PubMed2002

Cost of identifying patients for carotid endarterectomy.

BACKGROUND AND PURPOSE: The cost of carotid endarterectomy (CEA) usually considers only the cost of the preoperative investigations and the procedure for the individual patient but ignores the cost incurred in selecting a patient from a referred "pool" of potential candidates or the "total direct program cost." The aim of this study was to estimate the total direct program cost (workup and procedure) of CEA in a large major teaching hospital in Edinburgh, Scotland using a retrospective study design. METHODS: Participants were patients with transient ischemic attacks and mild strokes referred to the neurovascular clinics for assessment, investigation, and possible CEA. The "workup" was defined as the clinical consultation, carotid duplex, 1 follow-up visit, and a catheter angiogram where indicated. We used data routinely collected from the neurovascular clinics during a 1-year period to estimate the workup cost of patients who might be suitable for CEA. The CEA procedure cost was estimated prospectively in a concurrent study. Estimated costs were applied to the proportions assessed at the different levels of investigation to determine the total direct program cost of CEA. RESULTS: A total of 790 new patients with symptoms suggestive of transient ischemic attacks and mild strokes were identified. Four hundred one (51%) patients were referred for carotid duplex. Duplex identified 78 (10%) with carotid stenosis of > or =70%. Of the total of 790 patients, 26 (3.3%) had catheter angiogram and 18 (2.3%) had CEA. The total direct program cost to investigate this cohort was about 207 000 pounds sterling, with 68% (140 000 pounds sterling) of the cost incurred before any surgery was performed. CONCLUSION: The cost of identifying suitable patients for carotid surgery is quite high, with more than 30% of the cost attributed to the initial consultation at the neurovascular clinics. The cost of preventing 1 stroke by CEA is in the region of 100 000 pounds sterling at 1997/1998 prices if all the costs incurred in the workup of a cohort for potential CEA are included.

Carotid Arteries↗
PubMedDate not supplied

Are health risks related to medical care charges in the short-term? Challenging traditional assumptions.

PURPOSE: This study examines the association between self-reported health risks and short-term use of medical resources. DESIGN: Cross-sectional study comparing responses from a mailed survey with medical encounter and expenditure data. Bivariate analyses and multivariate linear and logistic regressions controlling for age, gender, and health status were conducted to illustrate the relationship between selected risk factors and resource use. SETTING: A group network model health maintenance organization (HMO) in Minneapolis, Minnesota. SUBJECTS: The study population was comprised of a randomly selected sample of nonsenior adults (18 to 64 years old, n = 3825) and seniors (65 years and older, n = 1955) who were enrolled in an HMO. The response rate was 72%. MEASURES: Five independent variables: smoking, alcohol use, obesity, lack of physical activity, and unhappiness were derived from a questionnaire designed to assess health status and health risks. Outcome measures were medical care charges and use of hospital services. RESULTS: Obesity, physical inactivity, and unhappiness were related to higher charges among seniors. These relationships dissipated to some degree after controlling for age, gender, and health status. Unexpected differences were found for alcohol use among both age groups, with those considered to be "not at risk" accruing higher charges and demonstrating a higher likelihood of using inpatient hospital services than those defined to be at risk. CONCLUSIONS: Bivariate and multivariate regression results demonstrated that traditional risk factors are weak and inconsistent predictors of short-term medical charges. Charging smokers and other high risk individuals a higher annual insurance premium than is offered for those at low risk raises questions about fairness when such risk factors are not necessarily good predictors of short-term resource use. The rationale for insurance cost-shifting should be supported with reliable data connecting risks to charges.

Adult↗
PubMed2004

Early preventive dental visits: effects on subsequent utilization and costs.

OBJECTIVE: To determine the effects of early preventive dental visits on subsequent utilization and costs of dental services among preschool-aged children. DESIGN: This investigation studied North Carolina children who were enrolled continuously in Medicaid from birth for a 5-year period. Our research design was a longitudinal cohort study that relied on 4 large administrative datasets, including North Carolina composite birth records from 1992, Medicaid enrollment and claims files from 1992 to 1997, and the Area Resource File. Our outcome measures included type of use and dentally related costs. RESULTS: Of the 53591 Medicaid-enrolled children born in 1992, 9204 were continuously enrolled for 5 years and met our inclusion criteria. Twenty-three children had their first preventive dental visit before 1 year of age, 249 between 1 and 2 years, 465 between 2 and 3 years, 915 between 3 and 4 years, and 823 between 4 and 5 years. Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits. Those who had their first preventive visit at age 2 or 3 were more likely to have subsequent preventive, restorative, and emergency visits. The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care. The average dentally related costs per child according to age at the first preventive visit were as follows: before age 1, 262 dollars; age 1 to 2, 339 dollars; age 2 to 3, 449 dollars; age 3 to 4, 492 dollars; age 4 to 5, 546 dollars. CONCLUSIONS: Our results should be interpreted cautiously, because of the potential for selection bias; however, we concluded that preschool-aged, Medicaid-enrolled children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs. In addition, children from racial minority groups had significantly more difficulty in finding access to dental care, as did those in counties with fewer dentists per population.

Age Factors↗
PubMed1993

[A model for the development of a reimbursement system for home health care--based on the concept of nursing cost].

The reimbursement system for nursing services needs to be set up before beginning of the home health care system. One thing we should consider as a premise in developing a reimbursement system for home health care is that the fee-schedule of home health care should be based on the cost of unit service, since the medical reimbursement system in Korea basically depends upon the concept of 'fees for service'. A model for the development of the fee schedule was designed to make some contribution to the reimbursement system for home health care, which should be prepared before the enhancement of a new system. The model is composed of three processes as follows: cost finding of the home health care department, cost computation by service of health care, development of the fee-schedule. 1. Cost finding of the home health care department The home health care department can be defined as a major cost center producing revenues. The costs of home health care department consist of the individual costs produced in more than two departments at the same time and, therefore, should be distributed to the home health care department by certain distribution rate, and the costs which are distributed from the auxiliary departments. 2. Cost computation by service of health care The services where the costs are finally aggregated to should be defined. The direct costs which can be found by service are rendered directly to the corresponding services and the indirect costs which cannot be recognized by service should be distributed to by the distribution rate. Lastly, the costs which were passed over from the auxiliary are added to. 3. Development of the fee-schedule The costs per unit service should be transformed into the relative values. The price of the unit value is produced by dividing required revenues needed to perform the home health care activities with what aggregated relative values. The formula to produce the fees of home health care is as follows: Fi = RVi x P P = NR/sigma RVi x ni Fi: the fee of service i RVi: relative values of service i P: unit price of RV i NR: required revenues Ni: expected number of cases of service i in a year.

Community Health Nursing↗
PubMed2002

Oral cancer treatment costs in Greece and the effect of advanced disease.

BACKGROUND: The main purpose of the study was to quantify the direct costs of oral cancer treatment to the healthcare system of Greece. Another aim was to identify factors that affect costs and potential cost reduction items. More specifically, we examined the relationship between stage of disease, modality of treatment and total direct costs. METHODS: The medical records and clinic files of the Oral and Maxillofacial Clinic of the Athens General Hospital "Genimatas" were abstracted to investigate clinical treatment characteristics, including length of hospitalization, modes of treatment, stage of disease etc. Records of 95 patients with oral squamous cell carcinoma (OSSC), with at least six months of follow-up, were examined. The clinical data was then used to calculate actual direct costs, based on 2001 market values. RESULTS: The mean total direct costs for OSSC treatment estimated at euro 8,450 or approximately US$ 7,450. Costs depended on the stage of the disease, with significant increases in stages III and IV, as compared with stages I and II (p < 0.05). Multi-modality treatment applied mainly to patients in stages III and IV was the factor that affected the cost. Disease stage was also associated with the total duration of hospitalization (p < 0.05). CONCLUSIONS: The clinical management of advanced oral cancer is strongly associated with higher costs. Although the ideal would be to prevent cancer, the combination of high-risk screening, early diagnosis and early treatment seems the most efficient way to reduce costs, and most importantly, prolong life.

Carcinoma, Squamous Cell↗
PubMed1996

[Cost-effectiveness analysis of dental implants].

In this article the cost-effectiveness of dental implants (rootform and transmandibular) is compared with making complete dentures combined with vestibuloplasty and just a set of new dentures. The cost components of labour and technique are analysed at the individual patient level. Effectiveness was measured using a ratio scale. Several assumptions for the long run effectiveness of the treatment options are necessary due to lack of information about this in the literature. Assumptions were made regarding: survival rate, life span of dental implants and complete dentures, costs of aftercare and development of oral health in the long run. The main conclusion is that overdentures on rootform implants are superior to complete dentures combined with preprosthetic surgery or overdentures on a transmandibular implant. The choice between treatment with rootform implants or just a new set of dentures is a more difficult matter.

Cost-Benefit Analysis↗
PubMedDate not supplied

The cost of dental implants as compared to that of conventional strategies.

The effectiveness of dental implants is widely studied, especially in terms of their clinical outcomes. However, from the policymaker's point of view, variables other than safety and efficacy, such as the costs and effectiveness of dental implants as compared to other treatment alternatives, are vital in decision making. This paper compares the costs of different treatment strategies in a randomized clinical trial in patients with resorbed mandibles and persistent problems with their conventional dentures: treatment with a mandibular overdenture on permucosal dental implants, an overdenture on a transmandibular implant, new dentures after preprosthetic surgery, and new dentures only. Data were gathered on an individual patient level to gain insight into specific cost episodes. Direct costs were subdivided into labor, material, technique, and overhead. Data concerning these components were gathered during the consecutive treatment phases in the first year. Results show that the resources used to treat a patient with an overdenture supported by a transmandibular implant are seven times those of a complete new set of dentures. Comparison of the cost ratio of an implant-retained overdenture supported by permucosal implants and conventional new prostheses proves less unfavorable: 1:3. New dentures after preprosthetic surgery are almost as expensive as treatment with permucosal implants.

Analysis of Variance↗
PubMed2003

Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions.

BACKGROUND: Intestinal obstruction is the most severe consequence of adhesion formation. This study examined the annual surgical workload and costs of intestinal obstruction caused by postoperative intra-abdominal adhesions. METHODS: The study was a retrospective case-note review of patients hospitalized for intestinal obstruction caused by postoperative adhesions in a well defined geographical area. The surgical workload and direct costs of inpatient care were analysed. RESULTS: There were 138 admissions for postoperative adhesion-related intestinal obstruction during the study with a total of 1118 inpatient days. The median hospital stay was 4 (range 1-58) days among patients who had non-operative treatment and 11 (range 2-34) days for those who had surgery. Surgery was necessary in 40 patients (29.0 per cent). The mean operating time (time from skin incision to last stitch) and the mean time spent in the operating theatre were 79 and 141 min respectively. The cumulative operating time for the surgical group was 52 h 20 min and the cumulative theatre time was 93 h 44 min. The annual direct hospital cost for postoperative adhesional intestinal obstruction was pound 181 653 in the district studied and the estimated cost for the whole of Finland was pound 2 077 796. CONCLUSION: This population-based study indicates that the workload and costs associated with bowel obstruction caused by postoperative adhesions are substantial.

Adult↗
PubMed2005

Cost and enrollment implications of targeting different source population for an HIV treatment program.

BACKGROUND: Rapid scale-up of antiretroviral therapy (ART) is a worldwide priority, and ambitious targets for numbers on ART have been set. Antenatal clinics (ANCs) and tuberculosis (TB) clinics have been targeted as entry points into HIV care. METHODS: We developed a conditional probability model to evaluate the effects of ANC and TB clinic populations on ART program enrollment. RESULTS: To start 1 individual on ART, 3 TB patients have to be screened at a crude program cost of 36 US dollars per patient initiated on therapy. By contrast, 48 ANC patients have to be screened at a cost of US 214 US dollars per patient on therapy. In an incremental analysis in which ANC HIV testing was borne by a program to prevent mother-to-child transmission, recruitment efficiency increased (8 screened per patient starting ART) and cost decreased (114 US dollars per patient on therapy). Absolute numbers starting ART, however, remained fixed. If all 60,000 ANC patients seen yearly in the Lusaka District were screened, 1247 would start ART. Approaching the district's 35,000 annual TB patients would generate 11,947 patients on ART. CONCLUSION: In areas with high HIV prevalence, targeting chronically ill populations for HIV treatment may have significant short-term benefits in cost savings and recruitment efficiency.

Anti-HIV Agents↗
PubMed1988

Cost and efficacy of intravenous streptokinase plus PTCA for acute myocardial infarction when therapy is initiated in community hospitals.

The costs and clinical results of a thrombolytic therapy protocol using intravenous (IV) streptokinase in small community hospitals prior to emergency transfer for cardiac catheterization for possible percutaneous transluminal coronary angioplasty (PTCA) were prospectively studied in 56 patients with an acute myocardial infarction [Tulsa Heart Center-Myocardial Infarction Study Team (THC-MIST) protocol]. Findings were compared to those for 53 similar patients receiving "conventional therapy" during the same study period. The reperfusion rate for IV streptokinase was 63%. Additional emergency PTCA yielded a total reperfusion rate of 95%. Despite emergency cardiac catheterization for all THC-MIST patients, average hospital charges were not significantly different between the two groups ($20,495 vs. $20,722; THC-MIST vs. conventional therapy, respectively). Total charges (hospital plus physician fees) were also not significantly different ($22,986 vs. $22,400; THC-MIST vs. conventional therapy, respectively). Intensive care unit (ICU) days and total hospital stays were significantly less for THC-MIST patients (3.1 vs. 5.8 ICU days, p less than 0.05 and 8.8 vs. 12.4 hospital days, p less than 0.05; THC-MIST vs. conventional therapy, respectively). Thus initiation of IV streptokinase in community hospitals for acute myocardial infarction with subsequent transfer for possible PTCA can yield high reperfusion rates without significantly increasing health care costs.

Adult↗
PubMed2002

Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use.

OBJECTIVE: To determine the direct costs of severe sepsis patients in German intensive care units (ICUs). DESIGN: Retrospective electronic data analysis. SETTING: Three adult intensive care units (surgical/medical) in three university hospitals in Germany. PATIENTS: 385 patients identified by standard definitions as suffering from severe sepsis. MEASUREMENTS AND RESULTS: A bottom-up approach was used to determine the direct ICU cost on actual resource use (medication, laboratory tests, microbiological analysis, disposables, and clinical procedures) for patients with severe sepsis. To determine the total direct costs, center-specific personnel and basic bed ("hotel") costs were added to total resources consumed. Average hospital mortality of severely septic patients was 42.6%. Mean ICU length of stay (LOS) was 16.6 days. Survivors stayed on average 4 days longer than nonsurvivors. The mean direct ICU costs of care were 23,297+/-18,631 euros per patient and 1,318 euros per day. In comparison, average daily charges being paid for an ICU patient by the health care system in Germany are 851 euros (based on official statistics). Nonsurvivors were more expensive than survivors in total direct costs (25,446 vs. 21,984 euros) and in per day direct cost (1,649 vs. 1,162 euros). Medication makes up the largest part of the direct costs, followed by expenses for personnel. CONCLUSIONS. Patients with severe sepsis have a high ICU mortality rate and long ICU LOS and are substantially expensive to treat. Nonsurviving septic patients are more costly than survivors despite shorter ICU LOS. This is due to higher medication costs indicating increased efforts to keep patients alive.

Adult↗
PubMed1998

Quantifying the costs of serious adverse drug reactions to antiepileptic drugs.

PURPOSE: We assessed from an institutional perspective the direct costs of severe adverse cutaneous or hypersensitivity reactions due to antiepileptic drug (AED) therapy that led to hospitalization or prolonged hospital stay. METHODS: Patients admitted for or developing severe AED-induced cutaneous or hypersensitivity reactions while in hospital from January 1990 through June 1996 were identified by ICD-9 codes E936, E937, E693, E695.1, E995.1, and E995.2. Identified cases were analyzed retrospectively by chart review and were included in the analysis if a causal relationship was determined to be possible, probable, or definite. Clinical outcomes were abstracted and related direct costs of the adverse drug reactions (ADRs) calculated. RESULTS: A total of 384 cases were identified by ICD-9 codes, of which 13 cases (mean age +/- SD 52.9+/-21.0 years) were included for further analysis. Eight patients (62%) were admitted because of an ADR (median length of stay 9.5 days; range 4-43), five (38%) experienced an ADR during hospitalization (median duration of ADR episodes 8.5 days; range: 7-21 days). The median direct medical costs of the ADRs were Canadian (CDN) $3,128 (range 1,149-21,293) per patient. CONCLUSIONS: The management of serious cutaneous and hypersensitivity ADRs due to AEDs is associated with considerable direct medical costs. These figures should be considered along with drug acquisition costs and treatment of clinical successes and failures in the overall assessment of the economic impact of pharmacotherapy. Prospective collection of direct costs associated with ADRs in clinical trials would be of value.

Adolescent↗
PubMed1995

Emergency department patient classification system.

Very little has been reported about costing out nursing services in emergency departments. In this study, an emergency care unit (ECU) worked with consultants to adapt the hospital patient classification system to provide more accurate ECU service charges for nursing care.

Direct Service Costs↗
PubMed2005

Direct medical costs of syncope-related hospitalizations in the United States.

Little is known about the costs of syncope-related admissions in the United States. A nationally representative sample of hospital discharges and reported charges was analyzed, and costs were estimated using Medicare cost-to-charge ratios. A conservative estimate of total annual costs for syncope-related hospitalizations was $2.4 billion (95% confidence interval [CI] $2.2 to $2.6 billion), with a mean cost of $5,400 (95% CI $5,100 to $5,600) per hospitalization. Efforts to safely decrease syncope-related admissions may result in substantial costs savings.

Adolescent↗
PubMed1999

The health and economic benefits of influenza vaccination for healthy and at-risk persons aged 65 to 74 years.

OBJECTIVE: The objective of this study was to assess the health and economic benefits of influenza vaccination in both healthy and at-risk seniors aged 65 to 74 years. DESIGN AND SETTING: We used administrative claims data from 6 consecutive serial cohorts spanning the years 1990 to 1991 through 1995 to 1996. All members of a Twin-Cities managed care organisation who were > or = 65 years of age for the respective study year were included in each cohort. Other information obtained included demographic characteristics, baseline comorbidities, prior resource utilisation, and influenza vaccination status. Study outcomes included hospitalisations for pneumonia and influenza and for all respiratory conditions and death. Economic analyses assumed the societal perspective and included both direct and indirect costs. MAIN OUTCOME MEASURES AND RESULTS: During the 6 study seasons, there were 100 195 person-periods of observation for persons aged 65 to 74 years. Of these, two-thirds were healthy and one-third had at least one major baseline comorbidity. Influenza vaccination was associated with reductions in hospitalisations for pneumonia and influenza and for all respiratory conditions in both healthy and at-risk groups, although the results did not reach statistical significance among the healthy individuals. Vaccination was also associated with significant reductions in the risk of death for both groups. The economic analysis demonstrated that vaccination against influenza in the base case was associated with direct and total cost savings for both healthy and at-risk seniors aged 65 to 74 years. CONCLUSION: Influenza vaccination of healthy and at-risk seniors aged 65 to 74 years is associated with substantial health benefits and is cost saving. These findings support age-based vaccination strategies for all persons > or = 65 years of age.

Aged↗