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Our study explores the efficacy and economic benefits of neurosurgical teleconsultations in managing intracerebral hemorrhage (ICH), focusing on reducing unnecessary patient transfers and associated costs. We conducted a cost-savings analysis at our institution of a previously published pilot study involving a cohort of patients with ICH who were potential candidates for airlift to our tertiary care center but instead received neurosurgical consultation via teleconsultation to avoid the transfer. Data on patient demographics, distances, and costs were collected and analyzed to assess the economic impact of teleconsultations. The cohort comprised 14 patients; we noted significant cost savings from avoiding interhospital transfers, ranging from $84,346.52 to $120,495.03 per patient. Teleconsultations facilitated immediate, collaborative decision-making between healthcare providers at community hospitals and a tertiary care center, reducing the need for expensive air transportation and unnecessary hospital transfers. Neurosurgical teleconsultations offer a cost-effective alternative to traditional patient transfer methods for ICH management, providing substantial economic benefits while maintaining high physician and patient-family satisfaction levels. This study underscores the potential of our teleneurosurgery program to significantly reduce costs by reducing unnecessary financial burdens on patients' families and healthcare systems. [ABSTRACT FROM AUTHOR]

Abstract To compare two screening strategies for diabetic retinopathy (DR), and to determine the health-economic impact of including optical coherence tomography (OCT) in a regular DR screening. This cross-sectional study included a cohort of patients (≥ 18 years) with type 1 or 2 diabetes mellitus (T1D or T2D) from a pilot DR screening program at Oslo University Hospital, Norway. A combined screening strategy where OCT was performed in addition to fundus photography for all patients, was conducted on this cohort and compared to our existing sequential screening strategy. In the sequential screening strategy, OCT was performed on a separate day only if fundus photography indicated diabetic macular edema (DME). The presence of diabetic maculopathy on fundus photography and DME on OCT was determined by two medical retina specialists. Based on the prevalence rate of diabetic maculopathy and DME from the pilot, we determined the health-economic impact of the two screening strategies. The study included 180 eyes of 90 patients. Twenty-seven eyes of 18 patients had diabetic maculopathy, and of these, 7 eyes of 6 patients revealed DME on OCT. When diabetic maculopathy was absent on fundus photographs, OCT could not reveal DME. Accordingly, 18 patients (20%) with diabetic maculopathy would have needed an additional examination with OCT in the sequential screening strategy, 6 (33%) of whom would have had DME on OCT. In an extended healthcare perspective analysis, the cost of the sequential screening strategy was higher than the cost of the combined screening strategy. There was a weak association between diabetic maculopathy on fundus photography and DME on OCT. The health economic analysis suggests that including OCT as a standard test in DR screening could potentially be cost-saving.

Objective: The objective of this study is to analyze a high‐signal approach for otolaryngology‐head and neck surgery (OHNS) residency applicants and calculate cost savings for programs and applicants. Methods: Data from both the 2022–2024 Electronic Residency Application Service (ERAS) and a data model were used to demonstrate cost savings with a high‐signal approach. Modeled data assumed that the number of applications per applicant would be equal to the number of signals allowed. Predicted and real‐world cost savings across the five other specialties participating in a high‐signal approach were calculated. Results: ERAS data cost savings for the entire OHNS applicant pool amounted to $365,950. In the modeled data, cost savings amounted to $825,921. When extrapolated to include all five high‐signal specialties, total cost savings amounted to $2,570,464 (ERAS data) and $6,359,478 (modeled data). Otolaryngology programs were predicted to experience significant time savings, resulting in cost savings of $437,883 and $1,113,342 for ERAS data and modeled data, respectively. Conclusions: The study highlights the advantages of a high‐signal approach, including financial advantages or increased time for programs to engage in holistic review and diversify the pool of interview candidates. Cost savings in this study were shown to be significant when extrapolated across all specialties using a high‐signal approach. Further research is needed to optimize the signaling system and confirm the favorable interview distribution and equity data from the low‐signal OHNS experience with a high‐signal approach. Level of Evidence: N/A Laryngoscope, 134:2684–2688, 2024 [ABSTRACT FROM AUTHOR]

Abdulmajeed Alshowair,1 Saleh Altamimi,1 Faisal A Alruhaimi,1 Saad Alshahrani,2 Fatima Alsuwailem,3 Mona Alkhaldi,4 Haiam Abdalla,5 Fahad Hamad Alkhuraiji,6 Montaser Saad Alaqeel,6 Salman Sulaiman Almureef,7 Salman Alhawasy,8 Amro Abdel-Azeem3,9 1Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 2Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 3Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 4Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 5Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 6Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 7Cost Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 8Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 9Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, EgyptCorrespondence: Amro Abdel-Azeem, Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia, Tel +966547135224, Email dr_amro_osh@hotmail.comPurpose: This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM).Methods: This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP).Results: Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient.Conclusion: MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.Keywords: cost-savings, multi-disciplinary team, complications, type 2 diabetes, predictive model

Background: Cytomegalovirus (CMV) infections among hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients impose a significant health care resource utilization (HCRU)‐related economic burden. Maribavir (MBV), a novel anti‐viral therapy (AVT), approved by the United States Food and Drug Administration for post‐transplant CMV infections refractory (with/without resistance) to conventional AVTs has demonstrated lower hospital length of stay (LOS) versus investigator‐assigned therapy (IAT; valgancilovir, ganciclovir, foscarnet, or cidofovir) in a phase 3 trial (SOLSTICE). This study estimated the HCRU costs of MBV versus IAT. Methods: An economic model was developed to estimate HCRU costs for patients treated with MBV or IAT. Mean per‐patient‐per‐year (PPPY) HCRU costs were calculated using (i) annualized mean hospital LOS in SOLSTICE, and (ii) CMV‐related direct costs from published literature. Probabilistic sensitivity analysis with Monte‐Carlo simulations assessed model robustness. Results: Of 352 randomized patients receiving MBV (n = 235) or IAT (n = 117) for 8 weeks in SOLSTICE, 40% had HSCT and 60% had SOT. Mean overall PPPY HCRU costs of overall hospital‐LOS were $67,205 (95% confidence interval [CI]: $33,767, $231,275) versus $145,501 (95% CI: $62,064, $589,505) for MBV and IAT groups, respectively. Mean PPPY ICU and non‐ICU stay costs were: $32,231 (95% CI: $5,248, $184,524) versus $45,307 (95% CI: $3,957, $481,740) for MBV and IAT groups, and $82,237 (95% CI: $40,397, $156,945) MBV versus $228,329 (95% CI: $94,442, $517,476) for MBV and IAT groups, respectively. MBV demonstrated cost savings in over 99.99% of simulations. Conclusions: This analysis suggests that Mean PPPY HCRU costs were 29%–64% lower with MBV versus other‐AVTs. [ABSTRACT FROM AUTHOR]

BACKGROUND: To analyze safety in patients who switched from a reference drug to a biosimilar and to characterize providers’ perceptions about the prescribing of biosimilars. METHODS: This retrospective chart review was conducted at a multi-site academic health system and included patients who received bevacizumab or trastuzumab and were switched to the respective biosimilars, bevacizumab-awwb or trastuzumab-dkst, between October 2019 and February 2021. A survey was also administered to hematology/oncology providers that characterized their comfort with prescribing and their knowledge of biosimilars. RESULTS: This study included 185 patients, of whom 88 were in the bevacizumab group and 97 were in the trastuzumab group. After converting to a biosimilar, 25% and 23% of the patients who received bevacizumab and trastuzumab, respectively, had new adverse events. After the conversion, there were 2 instances of hypersensitivity in the bevacizumab group and 1 in the trastuzumab group. Only 2% and 6% of patients in the bevacizumab and trastuzumab biosimilar groups, respectively, switched back to the reference drug. Of the 41 providers surveyed, the majority felt comfortable or very comfortable prescribing a biosimilar for an FDA-approved indication (68%). The most common concerns noted were insurance coverage (30%) and the level of knowledge or comfort with biosimilars (20%). CONCLUSION: The results of this study demonstrated that conversion from a reference drug to a biosimilar is safe. Although the majority of providers felt comfortable prescribing biosimilars, insurance coverage and level of knowledge about or comfort with prescribing biosimilars were common concerns. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bevacizumab and its biosimilar bevacizumab-awwb are vascular endothelial growth factor inhibitors that are frequently combined with other oncolytic agents for the treatment of various malignancies. Data on real-world outcomes and the financial impact of biosimilar use are limited, particularly for oncologic indications. In patients with non–small cell lung cancer, bevacizumab-awwb and bevacizumab have demonstrated similar clinical efficacy and safety. Data on outcomes for bevacizumab-awwb in other cancer subtypes are lacking. OBJECTIVE: To compare the safety and financial impact outcomes associated with the use of bevacizumab versus its biosimilar bevacizumab-awwb. METHODS: This institutional review board–approved, single-center, retrospective cohort study included adults with cancer who received bevacizumab-awwb or bevacizumab between June 2019 and May 2021 at University of California, San Francisco Helen Diller Comprehensive Cancer Center. To be eligible for treatment with bevacizumab-awwb, patients must not have received previous treatment with bevacizumab. Patients who switched from bevacizumab to its biosimilar bevacizumab-awwb or who participated in clinical trials were excluded from the trial. Common Terminology Criteria for Adverse Events Version 5.0 was used for the safety outcomes assessment. The primary safety outcome was new-onset grade ≥2 hypertension. The secondary safety outcomes were grade ≥2 proteinuria, hemorrhage, and gastrointestinal (GI) perforation. Another secondary outcome was the cost-savings of treatment with a biosimilar compared with the reference drug using the average wholesale acquisition price. RESULTS: A total of 377 patients were included in this study, of whom 200 were included in the bevacizumab arm and 177 were included in the bevacizumab-awwb arm. Excluding ovarian cancer and hepatocellular carcinoma, 11 cancer types had similar baseline characteristics among both groups. Although there was no significant difference in grade ≥2 hypertension, the initiation of new antihypertensive therapy was higher in the bevacizumab arm than in the bevacizumab-awwb arm (P=.002). Grade 2 proteinuria was lower in the bevacizumab-awwb arm than in the bevacizumab arm (P=.01). There were no significant differences in other safety outcomes. In 2020, the use of bevacizumab-awwb accounted for 34% of dispensed orders versus 66% for bevacizumab, saving $166,894. If the use of bevacizumab-awwb increased to 75%, approximately $403,367 could be saved annually. CONCLUSION: In this real-world analysis, bevacizumab-awwb had a comparable safety profile to bevacizumab in grade ≥2 hypertension, proteinuria, hemorrhage, and GI perforation, regardless of the primary cancer type. Replacing bevacizumab with its biosimilar bevacizumab-awwb can lower acquisition costs. [ABSTRACT FROM AUTHOR]

Abstract Background In 2017, Liberia became one of the first countries in the African region to develop and implement a national strategy for integrated case management of Neglected Tropical Diseases (CM-NTDs), specifically Buruli ulcer, leprosy, lymphatic filariasis morbidities, and yaws. Implementing this plan moves the NTD program from many countries' fragmented (vertical) disease management. This study explores to what extent an integrated approach offers a cost-effective investment for national health systems. Methods This study is a mixed-method economic evaluation that explores the cost-effectiveness of the integrated CM-NTDs approach compared to the fragmented (vertical) disease management. Primary data were collected from two integrated intervention counties and two non-intervention counties to determine the relative cost-effectiveness of the integrated program model vs. fragmented (vertical) care. Data was sourced from the NTDs program annual budgets and financial reports for integrated CM-NTDs and Mass Drug Administration (MDA) to determine cost drivers and effectiveness. Results The total cost incurred by the integrated CM-NTD approach from 2017 to 2019 was US$ 789,856.30, with the highest percentage of costs for program staffing and motivation (41.8%), followed by operating costs (24.8%). In the two counties implementing fragmented (vertical) disease management, approximately US$ 325,000 was spent on the diagnosis of 84 persons and the treatment of twenty-four persons suffering from NTDs. While 2.5 times as much was spent in integrated counties, 9–10 times more patients were diagnosed and treated. Conclusions The cost of a patient being diagnosed under the fragmented (vertical) implementation is five times higher than integrated CM-NTDs, and providing treatment is ten times as costly. Findings indicate that the integrated CM-NTDs strategy has achieved its primary objective of improved access to NTD services. The success of implementing an integrated CM-NTDs approach in Liberia, presented in this paper, demonstrates that NTD integration is a cost-minimizing solution.

Background: In 2017, Liberia became one of the first countries in the African region to develop and implement a national strategy for integrated case management of Neglected Tropical Diseases (CM-NTDs), specifically Buruli ulcer, leprosy, lymphatic filariasis morbidities, and yaws. Implementing this plan moves the NTD program from many countries' fragmented (vertical) disease management. This study explores to what extent an integrated approach offers a cost-effective investment for national health systems. Methods: This study is a mixed-method economic evaluation that explores the cost-effectiveness of the integrated CM-NTDs approach compared to the fragmented (vertical) disease management. Primary data were collected from two integrated intervention counties and two non-intervention counties to determine the relative cost-effectiveness of the integrated program model vs. fragmented (vertical) care. Data was sourced from the NTDs program annual budgets and financial reports for integrated CM-NTDs and Mass Drug Administration (MDA) to determine cost drivers and effectiveness. Results: The total cost incurred by the integrated CM-NTD approach from 2017 to 2019 was US$ 789,856.30, with the highest percentage of costs for program staffing and motivation (41.8%), followed by operating costs (24.8%). In the two counties implementing fragmented (vertical) disease management, approximately US$ 325,000 was spent on the diagnosis of 84 persons and the treatment of twenty-four persons suffering from NTDs. While 2.5 times as much was spent in integrated counties, 9–10 times more patients were diagnosed and treated. Conclusions: The cost of a patient being diagnosed under the fragmented (vertical) implementation is five times higher than integrated CM-NTDs, and providing treatment is ten times as costly. Findings indicate that the integrated CM-NTDs strategy has achieved its primary objective of improved access to NTD services. The success of implementing an integrated CM-NTDs approach in Liberia, presented in this paper, demonstrates that NTD integration is a cost-minimizing solution. [ABSTRACT FROM AUTHOR]

Study Design Retrospective study. Purpose To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal performance of fungal and AFB cultures during spine debridement is cost effective. Overview of Literature Spine infections are associated with significant morbidity and costs. Spine fungal and AFB infections are rare, but their incidence has not been well documented. As such, guidance regarding sample procurement for AFB and fungal cultures is lacking. Methods A retrospective review of medical record data from patients undergoing spine irrigation and debridement (I&D) at the University of Missouri over a 10-year period was performed. Results For patients undergoing spine I&D, there was a 4% incidence of fungal infection and 0.49% rate of AFB infection. Steroid use was associated with a higher likelihood (odds ratio, 5.62; 95% confidence interval, 1.33–23.75) of positive fungal or AFB cultures. Although not significant, patients undergoing multiple I&D procedures had higher rates of positive fungal cultures during each subsequent I&D. Over a 10-year period, if fungal cultures are obtained for each patient, it would cost our healthcare system $12,151.58. This is compared to an average cost of $177,297.64 per missed fungal infection requiring subsequent treatment. Conclusions Spine fungal infections occur infrequently at a rate of 4%. Physicians should strongly consider obtaining samples for fungal cultures in patients undergoing spine I&D, especially those using steroids and those undergoing multiple I&Ds. Our AFB culture rates mirror the false positive rates seen in previous orthopedic literature. It is unlikely to be cost effective to send for AFB cultures in areas with low endemic rates of AFB.

Purpose: Venetoclax combined with a hypomethylating agent (HMA) has become the standard of care for elderly/unfit patients with newly diagnosed acute myeloid leukemia (AML). This study is aimed at characterizing the impact of an interdisciplinary team on the length of stay (LOS) of patients with newly diagnosed AML receiving venetoclax with an HMA. Methods: This retrospective observational study included patients with AML who received HMA with venetoclax as an initial treatment between December 2015 and July 2021. The primary outcome was the median LOS during induction stratified by HMA. Secondary outcomes included barriers to hospital discharge, incidence of tumor lysis syndrome (TLS), response rates, and utilization of the institution’s prescription assistance program (PAP). Results: Seventy-eight patients were included in our analysis: 51 received azacitidine/venetoclax, and 27 received decitabine/venetoclax. The median LOS from therapy initiation was eight days (range 7–38) for the azacitidine group and six days (range 5–26) for the decitabine group. The most common barriers to discharge were transfusion dependence (33 patients, 42.3%) and insurance coverage (12 patients, 15.4%). Twelve patients (15.3%) had tumor lysis syndrome during hospital admission, and 20 (25.6%) were readmitted during induction. Twenty-three patients (29.5%) required financial assistance for AML care, and a pharmacy-led PAP generated approximately $342,646 in cost savings. Conclusion: The utilization of an interdisciplinary AML team to target early hospital discharge proved to be safe and effective and led to a reduction in costs for the health system. Future research may identify select patients who may be suitable for earlier discharge or outpatient induction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rising healthcare expenditures and the increasing number of hematopoietic stem-cell transplants (HSCTs) have led hospitals to explore avenues to reduce inpatient costs associated with transplant-related admissions. A patient's own medication supply allows for the continued use of home medications during hospital admission, leading to cost-savings for the hospital, and the continued use of a patient's familiar medications. OBJECTIVE: To assess the potential hospital cost-savings of using patients' own medication supply of oral letermovir for allogeneic HSCT recipients. METHODS: This retrospective, single-center study included patients aged =18 years who underwent allogeneic HSCT and received at least 1 dose of letermovir during their hospital stay at Barnes-Jewish Hospital in St. Louis between June 1, 2018, and August 20, 2019. The use of oral letermovir during hospital admission from the patient's own medication supply was incorporated by our institution as part of the standard pretransplant care completed by the outpatient clinic team. We calculated the cost-savings for the hospital by assessing the total number of doses of oral letermovir taken from the hospital supply compared with the patient's own medication supply. Patients who were readmitted to the hospital after undergoing allogeneic HSCT and received at least 1 dose of letermovir were included in a subgroup analysis. The use of patients' own medication supply was determined by manual chart review of the electronic health records. RESULTS: A total of 142 patients were included in the study, including 94 (66.2%) patients in the allogeneic HSCT initial admission cohort and 48 (33.8%) patients in the readmission cohort. Overall, 90.4% of patients in the initial admission cohort used their own supply of letermovir versus 58.3% of patients in the readmission cohort. The median hospital stay was 27 days (interquartile range [IQR], 11.2-30.8) versus 5 days (IQR, 3.1-11) in the initial admission and readmission cohorts, respectively. During the 14.6-month study, the mean overall hospital cost-savings per admission in the initial admission cohort was $2403.78, with a total savings of $225,955.73. Additional savings of $912.33 per patient in the readmission cohort resulted in a total savings of $43,791.62 for that cohort, yielding a combined cost-savings of $269,747.35 for the entire study period. CONCLUSIONS: These findings suggest that the implementation of using patients' own medications strategy can provide significant cost-savings for hospitals. Readmitted patients post-HSCT were less likely to use their own medication supply of letermovir than patients who were admitted for the initial transplant. [ABSTRACT FROM AUTHOR]

Background: Two Nurse Consultants, as part of their usual practice of auditing wounds in a 25-bed dementia unit of an aged care facility in Sydney, Australia, reported on skin tears (STs), wounds that occur mainly on the forearms of the elderly and often during showering. Aims and Objectives: The main aims were to measure and reduce the prevalence of STs; replace showers with HiCare™ bath cloths; reduce the nurses’ workload; reduce costs for laundry and wound dressings and a new regime for showering residents introduced. Materials and Methods: Bedside training was given to care staff, and data on time taken to bed-bath, HiCare™ bath and shower, were collected, collated and costs estimated. Results: Three of 25 residents (12%) had a total of six STs. Following the introduction of the HiCare™ bath system the incidence of STs decreased by 96% in 6 weeks and cost savings were $AUD 6.76/resident. Conclusion: The number of showers performed each day by nurses was reduced allowing nurses more time to feed residents, go for a walk and sit in the garden. These practice changes benefit the residents as well as the nurses.

Two artificial neural networks (ANNs) were developed for producing an austempered ductile iron (ADI) with low-cost chemical composition and mechanical properties as per ASTMA897/897M-16-grade-1050/750/07 standard. Thus, the first ANN predicted the chemical composition range within the lowest cost and required mechanical properties. Next, in the second ANN, the resulting values from the first ANN were refined considering the target chemical composition suggested in the standard. Moreover, mechanical properties and microstructural analyses were undertaken in the ADI produced to support the ANNs’ findings. Hence, ANNs can be used to make a standard-compliant ADI and achieve cost savings.

Microvascular decompression (MVD) has grown as a first-line surgical intervention for severe facial pain from trigeminal neuralgia and/or hemifacial spasm. We sought to examine the safety and cost–benefits of discharging patients with MVD within 1 day of admission. We retrospectively reviewed patients undergoing MVD at our institution from 2008 to 2020. Patients were sorted by 1 day, 2 days, or >2 days until discharge and by year from 2008 to 2013, 2014 to 2018, or 2019 to 2020. Patient presenting characteristics, intraoperative measures, and complications were documented. Statistical differences were calculated by one-way analysis of variance and χ2 analyses. Our cohort included 976 patients undergoing MVD, with 231 (23.6%) between 2008 and 2013, 517 (52.9%) between 2014 and 2018, and 228 (23.3%) between 2019 and 2020. Over time, postoperative admission rates to the critical care unit, total inpatient hospital admission times, and Barrow Neurological Institute scores at first follow-up decreased. Postoperative complications, including cerebrospinal fluid leak, decreased significantly. In addition, patients discharged within 1 day of admission incurred a total hospital cost of $26,689, which was $3588 lower than patients discharged within more than 1 day of admission, P < 0.0001. Discharging carefully selected patients who are appropriate for discharge within 1 day of admission could translate to a potential cost-savings of $255,346 per year in our clinical practice. In our experience, MVDs are a safe, elective intervention. Our findings suggest that postoperative day 1 discharge in patients with an uncomplicated postoperative course may be safe while improving hospital resource use. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study. Purpose: To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal performance of fungal and AFB cultures during spine debridement is cost effective. Overview of Literature: Spine infections are associated with significant morbidity and costs. Spine fungal and AFB infections are rare, but their incidence has not been well documented. As such, guidance regarding sample procurement for AFB and fungal cultures is lacking. Methods: A retrospective review of medical record data from patients undergoing spine irrigation and debridement (I&D) at the University of Missouri over a 10-year period was performed. Results: For patients undergoing spine I&D, there was a 4% incidence of fungal infection and 0.49% rate of AFB infection. Steroid use was associated with a higher likelihood (odds ratio, 5.62; 95% confidence interval, 1.33–23.75) of positive fungal or AFB cultures. Although not significant, patients undergoing multiple I&D procedures had higher rates of positive fungal cultures during each subsequent I&D. Over a 10-year period, if fungal cultures are obtained for each patient, it would cost our healthcare system $12,151.58. This is compared to an average cost of $177,297.64 per missed fungal infection requiring subsequent treatment. Conclusions: Spine fungal infections occur infrequently at a rate of 4%. Physicians should strongly consider obtaining samples for fungal cultures in patients undergoing spine I&D, especially those using steroids and those undergoing multiple I&Ds. Our AFB culture rates mirror the false positive rates seen in previous orthopedic literature. It is unlikely to be cost effective to send for AFB cultures in areas with low endemic rates of AFB. [ABSTRACT FROM AUTHOR]

Objectives: To establish the patient-specific cost and time savings associated with telemedicine with the secondary environmental benefits of virtual visits within a tertiary referral center sub-specialty urology clinic., Methods: An electronic health record query was made of all urology telehealth visits that have occurred between October 4, 2020 and October 10, 2020 at a single academic center. We evaluated the cost of travel for an in-person visit based on zip code data. To adjust for productivity loss, the cost of missed work was added as either full day or half day-based distance and average compensation per day based on zip code data. Environmental impact was calculated using average CO 2 emissions per mile not traveled., Results: There were 6444 patients seen in the urology clinic via telehealth during the 6-month period. Urology patients traveled on average 69 ± 148 miles round-trip for an appointment. The average cost savings per patient including the cost of the gas and time away from work was $152.78 ± $105.90. Overall, over a 6-month period, the total cost savings was $984,534.73 for the 6444 patients seen via telemedicine. There was also a significant environmental impact of the decreased travel burden with 153.36 metric tons of CO 2 emissions eliminated., Conclusions: With the implementation of telehealth during the COVID-19 pandemic, patients have been able to save a substantial amount of time and money primarily driven by the decreasing work hours lost and cost of travel.

Background Prior to the introduction of intravenous (IV) drip infusion, most IV drugs were delivered in a syringe bolus push. However, intravenous drip infusions subsequently became the standard of care. Puerto Rico is the largest supplier of IV fluid bags and in the aftermath of Hurricane Maria, there was a nationwide fluid bag shortage. This shortage required stewardship measures to maintain the operation of the self-administered outpatient parenteral antimicrobial therapy (OPAT) program at Parkland Health. Methods Parkland pharmacists evaluated all self-administered antimicrobials for viability of administration as an IV syringe bolus push (IVP) instead of an IV-drip infusion. Medications deemed appropriate were transitioned to IVP. The hospital EMR was used to identify patients discharged to the OPAT clinic using all methods of parenteral drug delivery. Data was collected for patient demographics, patient satisfaction, and clinical outcomes. Finally cost of care was calculated for IVP and IV drip administration. Results One-hundred and thirteen self-administered IVP and 102 self-administered IV drip treatment courses were identified during the study period. Individuals using IVP had a statistically significant decrease in hospital length of stay. Patient satisfaction was greater with IVP and IVP saved 504 liters of normal saline resulting in a savings of $43,652 over 6 months. The 30-day readmission rate and mortality were similar. Conclusion The abrupt IV fluid shortage following a natural disaster led to implementation of a high value care model that improved efficiency, reduced costs, and did not affect safety or efficacy. [ABSTRACT FROM AUTHOR]

An economic model was developed to estimate the cost of negative pressure wound therapy with instillation and dwelling of a topical wound solution vs control therapies. Economic model inputs were means derived from the results of a recently published systematic review and meta‐analysis of 13 comparative studies of negative pressure wound therapy with instillation. Means across studies comprising complex acute and chronic wounds for negative pressure wound therapy‐instillation vs control (negative pressure wound therapy without instillation, gauze dressings, or gentamicin polymethylmethacrylate beads) groups were 1.77 vs 2.69 operating room visits (P =.008) and 9.88 vs 21.80 therapy days (P =.02), respectively. These inputs plus hospital cost data were used to model costs for the United States, Germany, and the United Kingdom. For the United States, Germany, and United Kingdom, respectively, economic model estimates of total potential per patient savings were $33 338, €8467, and £5626 for negative pressure wound therapy‐instillation group vs control, based on assumed number of OR visits during therapy, cost of therapy system, and length of therapy. Model results showed an overall potential cost‐savings with negative pressure wound therapy‐instillation vs control, based on fewer OR visits and shorter therapy duration as reported in the published systematic review and meta‐analysis. [ABSTRACT FROM AUTHOR]

BackgroundCompared with other kidney replacement therapies, preemptive kidney transplantation (KT) provides better clinical outcomes, reduces mortality, and improves the quality of life of patients with end-stage kidney disease (ESKD). However, evidence related to the cost-effectiveness of preemptive living-related KT (LRKT) is limited, especially in low- and middle-income countries, such as Thailand. This study compared the cost-effectiveness of LRKT with those of non-preemptive KT strategies.MethodsCost and clinical data were obtained from adult patients who underwent KT at Siriraj Hospital, Mahidol University, Thailand. A decision tree and Markov model were used to evaluate and compare the lifetime costs and health-related outcomes of LRKT with those of 2 KT strategies: non-preemptive LRKT and non-preemptive deceased donor KT (DDKT). The model’s input parameters were sourced from the hospital’s database and a systematic review. The primary outcome was incremental cost-effectiveness ratios (ICERs). Costs are reported in 2020 United States dollars (USD). One-way and probabilistic sensitivity analyses were performed.ResultsOf 140 enrolled KT patients, 40 were preemptive LRKT recipients, 50 were non-preemptive LRKT recipients, and the rest were DDKT recipients. There were no significant differences in the baseline demographic data, complications, or rejection rates of the three groups of patients. The average costs per life year gained were $10,647 (preemptive LRKT), $11,708 (non-preemptive LRKT), and $11,486 (DDKT). The QALY gained of the preemptive option was 0.47 compared with the non-preemptive strategies. Preemptive LRKT was the best-buy strategy. The sensitivity analyses indicated that the model was robust. Within all varied ranges of parameters, preemptive LRKT remained cost-saving. The probability of preemptive LRKT being cost-saving was 79.4%. Compared with non-preemptive DDKT, non-preemptive LRKT was not cost-effective at the current Thai willingness-to-pay threshold of $5113/QALY gained.ConclusionsPreemptive LRKT is a cost-saving strategy compared with non-preemptive KT strategies. Our findings should be considered during evidence-based policy development to promote preemptive LRKT among adults with ESKD in Thailand.

Background: Two Nurse Consultants, as part of their usual practice of auditing wounds in a 25-bed dementia unit of an aged care facility in Sydney, Australia, reported on skin tears (STs), wounds that occur mainly on the forearms of the elderly and often during showering. Aims and Objectives: The main aims were to measure and reduce the prevalence of STs; replace showers with HiCare™ bath cloths; reduce the nurses' workload; reduce costs for laundry and wound dressings and a new regime for showering residents introduced. Materials and Methods: Bedside training was given to care staff, and data on time taken to bed-bath, HiCare™ bath and shower, were collected, collated and costs estimated. Results: Three of 25 residents (12%) had a total of six STs. Following the introduction of the HiCare™ bath system the incidence of STs decreased by 96% in 6 weeks and cost savings were $AUD 6.76/resident. Conclusion: The number of showers performed each day by nurses was reduced allowing nurses more time to feed residents, go for a walk and sit in the garden. These practice changes benefit the residents as well as the nurses. [ABSTRACT FROM AUTHOR]

Failure of a public–private partnership (PPP) contract could cause heavy losses to sponsors. However, the current machine learning models neglect misclassification costs when predicting PPP contract failure. This research adopts an example-dependent cost-sensitive (ECS) method by customizing the existing algorithms in python libraries. The model treats the opportunity cost and equity loss as the potential cost of misclassifying a successful and failed project, respectively. It is simpler to implement and can identify failed contracts more easily. Profit-oriented and accuracy-oriented metrics, such as cost-savings and F1 score, are used to evaluate the model. A cost-savings of 0.452, representing $863.83 million dollars, is achieved for the test set. This study highlights that the most precise models are not necessarily the most cost-effective. The results can support sponsors in selecting the appropriate models to forecast the outcome of a PPP contract from a financial perspective, contributing to accurate decision-making. [ABSTRACT FROM AUTHOR]

Aim: End-to-end anastomosis staplers are frequently used in colorectal surgery, generating two anastomotic doughnuts. Whether pathological evaluation of the doughnut changes clinical practice remains unclear. We aim to identify any effects of pathological evaluation of anastomotic doughnuts after oncological colorectal surgery. Method: We performed a systematic literature search utilizing PubMed, Clinicaltrials.gov, Cochrane, Embase and Web of Science databases and selected studies on evaluation of the anastomotic doughnut after oncological colorectal surgery with stapled end-toend anastomosis. Outcome measures included: involved distal margin on the oncological sample, histological involvement of the doughnut, clinical change in management from a positive doughnut and study recommendations. Results: Of the 5761 studies identified, eight studies encompassing 1754 patients were evaluated. Most operations were for primary colon (37.5%) or rectal adenocarcinoma (37.5%). Incidence of distal margin involvement of the oncological sample was reported in three papers, with six positive cases (1.1%). Of the 1754 doughnut pairs evaluated, five were positive for neoplasia (0.29%), three for adenomas (0.18%) and one for metaplastic polyp (0.06%), none of which changed postoperative treatment. Four studies recommended abandoning routine histopathological evaluation of anastomotic doughnuts, while the remaining four recommended evaluation only under certain criteria, including gross distal margin <2 cm (one study), gross distal margin <3 cm (one study), tumours undetected on gross examination (one study), ‘histologically aggressive cancers’ or grossly involved distal margin (one study). Conclusion: Routine evaluation of anastomotic doughnuts should be reconsidered, as <1% are positive for neoplasia. Exceptions may include specific scenarios where histopathology is likely to be clinically useful. [ABSTRACT FROM AUTHOR]

Abstract Background In 2014 and 2015, biosimilars for the drugs filgrastim, infliximab, and insulin glargine were approved for use in Canada. The introduction of biosimilars in Canada could provide significant cost savings for the Canadian healthcare system over originator biologic drugs, however it is known that the use of biosimilars varies widely across the world. The aim of this study was to estimate the use of biosimilars in Canada and potential cost-savings from their use. Methods We performed a retrospective analysis of Canadian drug purchases for filgrastim, infliximab, and insulin glargine from July 2016 to June 2018. This was a cross-sectional study and the time horizon was limited to the study period. As a result, no discounting of effects over time was included. Canadian drugstore and hospital purchases data, obtained from IQVIA™, were used to estimate the costs per unit and unit volume for biosimilars and originator biologic drugs within each province. Potential cost-savings were calculated as a product of the units of reference originator product purchased and the cost difference between the originator biologic and its corresponding biosimilar. Results The purchase of biosimilars varied by each province in Canada, ranging from a low of 0.1% to a high of 81.6% of purchases. In total, $1,048,663,876 Canadian dollars in savings could have been realized with 100% use of biosimilars over the originator products during this 2 year time period. The potential savings are highest in the province of Ontario ($349 million); however, even in smaller markets (PEI and Newfoundland), $28 million could have potentially been saved. Infliximab accounted for the vast majority of the potential cost-savings, whereas the purchases of the biosimilar filgrastim outpaced that of the originator drug in some provinces. In sensitivity analyses assuming only 80% of originator units would be eligible for use as a biosimilar, $838 million dollars in cost savings over this two-year time period would still have been realized. Conclusions The overall use of biosimilar drugs in Canada is low. Policy makers, healthcare providers, and patients need to be informed of potential savings by increased use of biosimilars, particularly in an increasingly costly healthcare system.

Introduction: Biosimilars are gaining popularity due to their ability to offer comparable therapeutic benefits at potentially lower costs., Areas Covered: This article analyses studies that compare the cost savings of biosimilars with biologics. It also explores market competition dynamics and the impact of policies in countries. The focus is on the advantages of biosimilars in oncology and rheumatological treatments while considering broader economic implications for the pharmaceutical industry such as market displacement, pricing strategies and their influence on innovation and healthcare sustainability., Expert Opinion: The introduction of biosimilars marks a shift in healthcare economics by offering cost reductions and long-term potential for economic balance. However, I also recognize challenges related to research methodologies and regulatory inconsistencies across countries. To fully capitalize on their potential, future research and development in the field of biosimilars must emphasize harmonized approaches and comprehensive studies that ensure both cost containment in healthcare and wider access, to high quality treatments.

Purposes: Aims to explicate the relationship between mental health and disease morbidity in Bhutan and the association between mental health and these two major public health concerns. Furthermore, we evaluated the added economic cost-savings benefit. Methodology: Univariate linear regression was initially utilized and calculated and ran a Shapiro-Wilk W test and a Lagrange multiplier test. Findings: It was indicated that for every one-unit increase in the number of admittances categorized as a mental health disorder within Bhutan, there is a significant average increase in health center admissions for asthma by 0.3601 and for nutritional disorders. It was estimated that the increase in the reduction of mental health disorders would increase the number of averted cases and the cost-saving to the Bhutanese healthcare systems to a significant level. Research limitation: We were unable to infer whether there was an increase in health center admissions due to new disease development or to higher occurrences of existing symptoms caused by these diseases. Practical implications: In order to decrease the burden of comorbidities associated with mental health disorders, proper dispersal of accessible resources in addition to investment in mental healthcare is necessary. Social implications: Findings reinforce the need to properly invest in mental health services not only for its own sake but also for the significant morbidities associated with other diseases. Originality: All data presented in this manuscript are true and valid and no data from the study has been or will be published separately. [ABSTRACT FROM AUTHOR]

Severe and persistent mental illnesses are frequently associated with homelessness and extensive use of public services. Cost savings after the provision of permanent supportive housing (PSH) have been examined in large metropolitan areas but not in medium-sized communities. Administrative and clinical data were collected to determine use of public services, such as use of emergency services, inpatient psychiatric and medical services, and correctional facilities, in the year preceding and the year subsequent to placement in PSH. Costs of the housing and the utilized services were also calculated. Ninety-one subjects were in housing first (HF) programs and 19 were in treatment first (TF) programs. Overall there was a net cost savings of over $1.2 million or $6134/consumer/year of PSH. Nearly all cost savings were in reduced service utilization which implies prevention of both medical and psychiatric morbidity. In HF the average per patient cost savings ($21,082.12) was not significantly greater than TF ($12,907.29; p = 0.33). Provision of PSH in a mid-sized city provides significant cost savings. [ABSTRACT FROM AUTHOR]

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Background and Objectives: Over 25% of United States (US) community-dwelling, older adults are at nutritional risk. Health and cost burdens of poor nutrition can be lowered by nutrition programs for hospital inpatients, but few studies have looked at the impact on outpatients. The objective of our study was to assess outcomes of a nutrition focused quality improvement program (QIP) on healthcare resource use and costs in poorly nourished outpatients. Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics. Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions, and were enrolled over a 15-month interval. For comparison, historical (n = 600) and concurrent control (n = 600) groups were used. Assessment of poor nutritional status was performed during each patient's baseline visit. Healthcare resource use (hospitalizations, emergency department visits, and outpatient clinic visits), medication use, and costs were determined for a 90-day interval. Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and overweight/obese (81.7%). The proportion of QIP outpatients presenting for healthcare services was significantly reduced compared to both historical and concurrent controls—relative risk reduction (RRR) versus historical (11.6%, P <.001) and versus concurrent (8.9%, P =.003). Of those who presented, RRR for healthcare resource use by QIP was significant in comparison with historical (12.9%, P =.022) but not concurrent controls. No significant differences were observed for medication usage. Lower resource use among QIP patients yielded total cost savings of $290 923 or per-patient savings of $485. Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare resource use and cut costs. Such findings underscore benefits of nutritional interventions for community-dwelling outpatients with poor nutritional status. [ABSTRACT FROM AUTHOR]

Abstract In recent studies, electronegative multimodal chromatography with Eshmuno HCX was demonstrated to be a highly promising recovery step for direct immunoglobulin G (IgG) capture from undiluted cell culture fluid. In this study, the binding properties of HCX to IgG at different pH/salt combinations were systematically studied, and its purification performance was significantly enhanced by lowering the washing pH and conductivity after high capacity binding of IgG under its optimal conditions. A single polishing step gave an end-product with non-histone host cell protein (nh-HCP) below 1 ppm, DNA less than 1 ppb, which aggregates less than 0.5% and an overall IgG recovery of 86.2%. The whole non-affinity chromatography based two-column-step process supports direct feed loading without buffer adjustment, thus extraordinarily boosting the overall productivity and cost-savings.

Alejandra Maciel, Ali Cullors, Andrew A Lukowiak, Jorge Garces AltheaDx, San Diego, CA, USA Abstract: The burden of depression significantly impacts the patient, the health care system, and society, at large. Medication management guided by pharmacogenetics has been shown to increase therapeutic efficacy and improve symptoms in patients diagnosed with depression, but limited data are available on the cost savings of pharmacogenetic-guided interventions outside of psychiatric clinical specialties. Our study utilizes published health care costs and clinical patient outcome data to model the economic impact of pharmacogenetic-guided treatment for depression in a variety of clinical settings. Assuming a test cost of USD$2,000 for pharmacogenetic testing, the model predicts a savings of USD$3,962 annually per patient with pharmacogenetic-guided medication management. Keywords: pharmacogenetics, depression, personalized medicine, cost savings, pharmacoeconomics, psychotropic, cytochrome P450

Rationale and Objective: Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications.Materials and Methods: A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs.Results: Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs.Conclusion: Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hospital-based, nutrition-focused interventions have significantly lowered the costassociated burden of poor nutrition through a reduction in healthcare resource utilization (HCRU). However, for patients at risk for poor nutrition who receive nutritional care at home, limited evidence exists on the economic impact of nutrition-focused interventions. OBJECTIVE: To estimate the 30-day cost-savings associated with an at-home nutrition-focused quality improvement program in the postacute care setting for patients at risk for poor nutrition from the perspective of a hospital system. METHODS: We compared the HCRU of 1546 patients enrolled in a quality improvement program during 1 year versus 7413 patients in a pre-program historical cohort who received care during the 1 year before the quality improvement program implementation. The analysis included the number of 30-day hospitalizations, emergency department and outpatient visits for both cohorts, and the associated costs. The main analysis included the fixed and variable costs for the program, and the costs of oral nutritional supplement and delivery. The costs for hospitalization, emergency department, and outpatient visit costs were based on the 2013 Healthcare Cost and Utilization Project and Medical Expenditure Panel Survey. RESULTS: Based on the 2013 survey, the baseline costs for hospitalization, emergency department, and outpatient visit costs were $18,296, $1312, and $535, respectively. Our health economic analysis about the 30-day overall HCRU has shown that the quality improvement program group resulted in a total cost-savings of $2,408,668 for the 1546 patients in the program and a net savings of $1558 per patient compared with the costs for the pre--quality improvement program historical cohort. CONCLUSION: The use of a nutrition-focused quality improvement program led to significant 30-day cost-savings, by reducing HCRU for adults who received nutritional-based care at home. The improvements in HCRU highlight the importance of implementing nutrition-focused quality improvement programs for hospital systems that provide care for patients who are at risk for poor nutrition across a variety of care settings. [ABSTRACT FROM AUTHOR]

Objectives: The escalating cost of low back pain (LBP) care has not improved outcomes. Our purpose: to compare costs between LBP care guided by a quality-assured mechanical assessment (MC) and usual community care (CC). Study Design: Administrative claims data analysis. Methods: Employees and dependents of a large self-insured manufacturer seeking care for LBP in 2013 chose between the company's primary care clinic (where MC was delivered) and community care. The claims of 5,036 were analyzed for one year following subjects' initial evaluation excluding only those with diagnostic codes for fractures, dislocations, or infections. MC included an advanced form of Mechanical Diagnosis & Therapy (MDT). CC varied based on each subjects' selection of providers. Primary outcome measure: one-year cost of each subject's care. Secondary: number of MRIs, spinal injections, and lumbar surgeries undertaken. The payer's proprietary risk-adjustment algorithm was utilized. Results: After risk adjustment, the average cost per MC subject was 51.48% lower than the CC average cost (p <.0279). The utilization of MRIs, injections, and surgeries was lower with MC by 49.75%, 39.44%, 78.38% with relative risks of 1.99, 1.64, and 4.73, respectively. Conclusions: This 51.5% cost-savings reflects the substantial reduction in downstream care-seeking with MC, including lower utilization of MRIs, injections, surgeries, and downstream care after six months from the initial visit. It is well documented that the MDT clinical examination typically elicit patterns of pain response that in turn identify how most can rapidly recover with self-care with no need for other intervention. Level of Evidence: 1b. [ABSTRACT FROM AUTHOR]

Background: In 2014 and 2015, biosimilars for the drugs filgrastim, infliximab, and insulin glargine were approved for use in Canada. The introduction of biosimilars in Canada could provide significant cost savings for the Canadian healthcare system over originator biologic drugs, however it is known that the use of biosimilars varies widely across the world. The aim of this study was to estimate the use of biosimilars in Canada and potential cost-savings from their use.Methods: We performed a retrospective analysis of Canadian drug purchases for filgrastim, infliximab, and insulin glargine from July 2016 to June 2018. This was a cross-sectional study and the time horizon was limited to the study period. As a result, no discounting of effects over time was included. Canadian drugstore and hospital purchases data, obtained from IQVIA™, were used to estimate the costs per unit and unit volume for biosimilars and originator biologic drugs within each province. Potential cost-savings were calculated as a product of the units of reference originator product purchased and the cost difference between the originator biologic and its corresponding biosimilar.Results: The purchase of biosimilars varied by each province in Canada, ranging from a low of 0.1% to a high of 81.6% of purchases. In total, $1,048,663,876 Canadian dollars in savings could have been realized with 100% use of biosimilars over the originator products during this 2 year time period. The potential savings are highest in the province of Ontario ($349 million); however, even in smaller markets (PEI and Newfoundland), $28 million could have potentially been saved. Infliximab accounted for the vast majority of the potential cost-savings, whereas the purchases of the biosimilar filgrastim outpaced that of the originator drug in some provinces. In sensitivity analyses assuming only 80% of originator units would be eligible for use as a biosimilar, $838 million dollars in cost savings over this two-year time period would still have been realized.Conclusions: The overall use of biosimilar drugs in Canada is low. Policy makers, healthcare providers, and patients need to be informed of potential savings by increased use of biosimilars, particularly in an increasingly costly healthcare system. [ABSTRACT FROM AUTHOR]

BACKGROUND: Imatinib, a first-generation tyrosine kinase inhibitor (TKI), and the newer second-generation TKIs have dramatically improved outcomes for patients with chronic myelogenous leukemia (CML). A previous model estimated the potential cost-savings over the next 2 years after the loss of patent exclusivity for imatinib in the United States in 2016 and its availability in a generic form. Payers have indeed realized meaningful savings, but it took 2 years for the prices of generic imatinib to decline substantially. OBJECTIVE: To quantify the cost-savings for a US health plan from the passive substitution of generic imatinib and the impact of step-edit therapy with the use of generic imatinib before coverage of a second-generation TKI. METHODS: We updated the previously published model utilizing hypothetical 1-million-member commercial and Medicare plans to include current TKI use and pricing combined with recent epidemiologic data. Regression models were used to project utilization to 5 years after the loss of imatinib's patent exclusivity. We compared generic imatinib costs with a scenario in which generic imatinib was not available. The impact of a step-edit therapy restriction was explored for patients with incident CML. The analyses were repeated for the entire US population based on national census data. RESULTS: The 1-million-member commercial plan saved $0.5 million (3%) from pharmacy spending on TKIs in year 1 and $3.9 million (19%) in year 2 after the loss of patent exclusivity. The projected savings significantly increased to $7.8 million (37%), $8.3 million (39%), and $8.6 million (40%) in years 3, 4, and 5, respectively. Step-edits strategies were projected to result in small incremental savings of $0.3 million (1.5%) annually in years 3 to 5. The 1-million-member Medicare plan saved $1.7 million (3%) in year 1 and $14.1 million (19%) in year 2. The projected savings were $27.8 million (37%), $29.5 million (39%), and $30.8 million (40%), with step-edit estimated to add only $0.9 million (1.2%) annually in years 3 to 5. Generic imatinib saved US payers $2.5 billion (13% of the total spending on TKIs) in years 1 and 2. In years 3 to 5, the cumulative projected savings totaled $12.2 billion, and the savings were expected to grow to 39% as a result of passive generic imatinib substitution, with only 1.7% additional savings from step-edit restriction. CONCLUSIONS: As a result of a lower price for generic imatinib relative to the brand-name version of the drug, substantial cost-savings to US payers over the next 3 years are expected without step-edit formulary management restrictions. Cost-saving strategies, including formulary management restrictions, should adhere to evidence-based guidelines to ensure the appropriate use of generic imatinib and all available TKIs, with the objective to maintain positive outcomes and, in turn, increase the value of patient care. [ABSTRACT FROM AUTHOR]

Purpose: Research relating to Total Hip Arthroplasty (THA) has found the anterior-based muscle-sparing (ABMS) approach improves both intraoperative and postoperative outcomes when compared to other THA approaches. This study compares the costs and outcomes of the ABMS approach and standard of care (SOC) to determine the relative cost-effectiveness., Methods: A decision-analytic model was utilized to estimate intraoperative outcomes (i.e. length of procedure, length of stay (LOS), and transfusion rates) and 90-day postoperative complications (deep infection, periprosthetic fracture, and dislocation). Data relating to postoperative complications, intraoperative outcomes, and costs (adjusted to 2023 USD) were obtained from the literature. Model results were presented as incremental costs and complications avoided using a willingness-to-pay threshold of $100,000. We conducted both one-way sensitivity analysis (OWSA), varying each parameter individually within a specific range, and probabilistic sensitivity analysis (PSA) where parameters were varied simultaneously. In scenario analysis, ABMS was also compared to the posterior approach (PA) and direct anterior approach (DAA) individually., Results: ABMS THA was found to have superior results compared to SOC THA over a 90-day time horizon since it decreased major complications by 0.00186 per patient and cost by $3,851 per patient. The PSA found the ABMS approach dominates SOC and is cost-effective in approximately 98.29% and 100% of 10,000 iterations, respectively. Comparing ABMS with only PA procedures increased cost savings per patient to $4,766 while it decreased to $3,242 when comparing ABMS to only DAA procedures. Length of procedure, LOS, and discharge disposition were the main cost drivers., Conclusions: This analysis demonstrates the ABMS approach for THA is a cost-effective technique when compared to PA and DAA, which may provide an opportunity for cost savings to the healthcare system.

Objectives: Biosimilars improve patient access by providing cost-effective treatment options. This study assessed the potential for savings and expanded patient access with increased use of two biosimilar disease modifying anti-rheumatic drugs (DMARDs): (a) approved adalimumab biosimilars and (b) the first tocilizumab biosimilar, representing an established biosimilar field and a recent biosimilar entrant in France, Germany, Italy, Spain, and the United Kingdom (UK)., Methods: Separate ex-ante analyses were conducted for each country, parameterized using country-specific list prices, unit volumes annually, and market shares for each therapy. Discounting scenarios of 10%, 20%, and 30% were tested for tocilizumab. Outputs included direct cost-savings associated with drug acquisition or the incremental number of patients that could be treated if savings were redirected. Two biosimilar conversion scenarios were tested., Results: Savings associated with a 100% conversion to adalimumab biosimilar ranged from €10.5 to €187 million (UK and Germany, respectively), or an additional 1,096 to 19,454 patients that could be treated using the cost-savings. Introduction of a tocilizumab biosimilar provided savings up to €29.3 million in the most conservative scenario. Exclusive use of tocilizumab biosimilars (at a 30% discount) could increase savings to €28.8 to €113 million or expand access to an additional 43% of existing tocilizumab users across countries., Conclusion: This study demonstrates the benefits that can be realized through increased biosimilar adoption, not only in an untapped tocilizumab market, but also through incremental increases in well-established markets such as adalimumab. As healthcare budgets continue to face downwards pressure globally, strategies to increase biosimilar market share could prove useful to help manage financial constraints.

BACKGROUND: Biologic drugs are used in the management of many disease states and make up approximately 25% of the global pharmaceutical market. The use of biologic drugs among patients with cancer has led to significant advances in cancer treatments and supportive care. Biosimilar drugs (or biosimilars) are highly similar, but not identical, to a reference biologic drug. The US Food and Drug Administration (FDA) has approved several biosimilars for the treatment of cancer and supportive care management, and the number is expected to continue to increase. OBJECTIVES: To review the FDA’s biosimilar approval process; the common issues that often arise with the prescribing, administration, and dispensing of biosimilars; and the benefits and concerns associated with their use. DISCUSSION: In addition to biosimilars already approved by the FDA for cancer, several new biosimilars are being evaluated by the FDA for oncologic indications, and more are anticipated to be approved with the patent expirations of several biologic drugs in the coming years. The main advantage to the addition of biosimilars to the US market is the potential decreased cost of such agents compared with their reference biologic drugs, which can lead to an increase in patient access to medications. With the development of oncology biosimilars, several concerns have arisen regarding their use in patients with cancer. CONCLUSION: The use of biosimilars is intriguing in cancer care, because of their potential for cost-savings. As more biosimilars are approved by the FDA and marketed, knowledge of their use and their potential risks and benefits is imperative to implement them properly and safely into treatment and supportive care of patients with cancer in the United States. [ABSTRACT FROM AUTHOR]

We designed and implemented a novel automated negative non‐invasive prenatal test (NIPT) result disclosure process using a proprietary, HIPAA‐compliant web‐based portal. High‐risk pregnant patients who opted for NIPT from 04/2017 to 12/2018 were given the option to receive their negative result through the automated process. Patients were required to watch a brief educational video and answer evaluative questions before downloading their result. After completing the process, patients completed a survey regarding their opinion of the efficiency and convenience of the process and their satisfaction. A total of 10,170 women registered online during the study period, and 8,965 completed the automated process (88%). Out of 8,965 women, 2,121 women responded to the survey (24%). Most (2,030 of 2,101) strongly agreed/agreed that they could easily navigate the patient portal (97%); 1,852 of 1,966 strongly agreed/agreed that disclosure was efficient and convenient (94%); 1,852 of 1,960 strongly agreed/agreed that they felt informed after watching a short educational video (94%); and 1,903 of 1,967 strongly agreed/agreed that they preferred downloading results rather than waiting for their next doctor's appointment (97%). This study demonstrates high patient satisfaction with this automated and scalable solution in a high‐volume health system. As the utilization of genetic testing increases, we predict greater need for innovative healthcare delivery models. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR process and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR involving ongoing, periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, and medically unnecessary care, and implement corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure the prescription drug cost-savings generated from its DUR programs annually, but it provides no methodology for doing so. An earlier article compared the methodologies used by states to measure cost-savings in their retrospective DUR program in fiscal years 2014 and 2015. OBJECTIVE: To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid prospective DUR program in federal fiscal years 2015 and 2016. METHODS: For each state, we downloaded from Medicaid's website the cost-savings methodologies included in the Medicaid DUR 2015 and 2016 reports. We then reviewed and synthesized the reports. Methods described by the states were classified into a unique group based on the methodology used, except for Arkansas and Connecticut, which were classified in more than 1 category for the same period. RESULTS: Currently, 3 different methodologies are being used by states. in 2015 and 2016, the most common methodology used (by 18 states) was the calculation of total claim rejections and subtracting claim resubmissions at the amount actually paid. The comparisons of DUR program cost-savings among states are unreliable, because the states lack a common methodology in the way they measure their performance. CONCLUSIONS: Considering the lack of methodologic consistency among states in measuring the savings in the Medicaid DUR program shown in this analysis, the federal government must lead an effort to define a unique methodology to measure cost-savings in its entire DUR program. This will help to improve the measure of savings among states and understand how this program is performing in that matter. [ABSTRACT FROM AUTHOR]

The purpose of this analysis was to measure the impact of palliative care services on hospital charges in the 5 days prior to death—the most expensive time of a patient's life—and identify hospital service categories and patient financial classes yielding the highest savings from palliative care. The analysis population included UT Southwestern patients admitted to the hospital between October 1, 2013, and September 30, 2016. Palliative care patients were defined as any patient who received at least one completed palliative care order. In order to create an accurate comparison group, a propensity score match was generated to identify patients most likely to have qualified for a palliative care consult. Covariates included in the model were age, sex, race, financial class, and number of comorbidities. Comorbidities were identified using the Elixhauser Comorbidity Index, and all charges were pulled for the 5 days prior to death. Total hospital charges were also reported by hospital service and financial class. Statistical significance was then derived using a gamma distributed log-linked generalized linear model. The final population included in the analysis, post the propensity score match, was composed of mostly white, non-Hispanic males. The majority of the patients had five or fewer comorbidities, and the primary preexisting conditions seen among patients were cardiovascular diseases (36.0%) and cancer (23.4%). The hospital service categories yielding the highest mean savings were pharmacy (mean $2,765; P <.0001) and labs (mean $1,063; P <.0001). Financial classes with the greatest savings were Medicaid and charity/self-pay. Overall, there was a significant difference in charges between those that received a palliative care consult and those that did not. The fact that the highest savings were in pharmacy and laboratory services suggests that unnecessary labs and medications are discontinued in an effort to improve patient care and quality of life while reducing costs during end-of-life care. Palliative care services ease the cost burden of end-of-life services for low-income populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Omadacycline is an oral and intravenous (IV) once-daily aminomethylcycline antibiotic that was recently approved by the US Food and Drug Administration for the treatment of patients with acute bacterial skin and skin structure infections (ABSSSI). In 2 phase 3 clinical trials, IV-to-oral switch and oral-only administration of omadacycline achieved the primary end points of noninferiority compared with linezolid in treating patients with ABSSSI. OBJECTIVE: To estimate the potential cost-savings with bioequivalent IV-to-oral antibiotics, such as omadacycline, compared with the standard of care with IV vancomycin by avoiding hospitalizations and reducing hospital stays in patients presenting from the emergency department for ABSSSI treatment. METHODS: We used hospital avoidance models to examine the potential cost-savings of managing patients with ABSSSI and no or limited comorbidities and without life-threatening conditions by using omadacycline in the outpatient setting compared with the current standard of care. Early hospital discharge models were used to evaluate the hospital stay reduction that would be required to be achieved with omadacycline treatment relative to IV vancomycin to confer cost-savings compared with standard of care among patients with ABSSSI and ≥2 comorbidities but no life-threatening conditions. RESULTS: In the hospital stay avoidance models, cost-savings may be realized by using therapeutically bioequivalent IV-to-oral antibiotics, such as omadacycline, compared with inpatient treatment with IV vancomycin. Based on a sensitivity analysis, further savings could be possible with outpatient administration of omadacycline, even if 20% of omadacycline outpatients were subsequently admitted and incurred the full inpatient cost, with no reimbursement penalties. Of more than 300 patients, only 1 was admitted to the hospital after a full course of omadacycline in the oral-only clinical trial. In the early hospital discharge models, the maximum cost-minimizing daily expense of omadacycline varied from $173 to $936, depending on the presence of active comorbidities or systemic symptoms, hospital stay reduction, and model perspective. CONCLUSION: These results suggest that the targeted use of antibiotics with bioequivalent IV-to-oral formulations, such as omadacycline, for select patients with ABSSSI may lead to cost-savings compared with inpatient IV vancomycin treatment by shifting care to the outpatient setting or by facilitating earlier hospital discharge among hospitalized patients. [ABSTRACT FROM AUTHOR]

Background: Oral surgery referrals from dentists are rising and putting increased pressure on finite hospital resources. It has been suggested that primary care specialist services can provide care for selected patients at reduced costs and similar levels of quality and patient satisfaction. Research questions: Can an electronic referral system with consultant- or peer-led triage effectively divert patients requiring oral surgery into primary care specialist settings safely, and at a reduced cost, without destabilising existing services? Design: A mixed-methods, interrupted time study (ITS) with adjunct diagnostic test accuracy assessment and health economic evaluation. Setting: The ITS was conducted in a geographically defined health economy with appropriate hospital services and no pre-existing referral management or primary care oral surgery service. Hospital services included a district general, a foundation trust and a dental hospital. Participants: Patients, carers, general and specialist dentists, consultants (both surgical and Dental Public Health), hospital managers, commissioners and dental educators contributed to the qualitative component of the work. Referrals from primary care dental practices for oral surgery procedures over a 3-year period were utilised for the quantitative and health economic evaluation. Interventions: A consultant- then practitioner-led triage system for oral surgery referrals embedded within an electronic referral system for oral surgery with an adjunct primary care service. Main outcome measures: Diagnostic test accuracy metrics for sensitivity and specificity were calculated. Total referrals, numbers of referrals sent to primary care and the cost per referral are reported for the main intervention. Qualitative findings in relation to patient experience and whole-system impact are described. Results: In the diagnostic test accuracy study, remote triage was found to be highly specific (mean 88.4, confidence intervals 82.6 and 92.8) but with lower values for sensitivity. The implementation of the referral system and primary care service was uneventful. During consultant triage in the active phases of the study, 45% of referrals were diverted to primary care, and when general practitioner triage was used this dropped to 43%. Only 4% of referrals were sent from specialist primary care to hospital, suggesting highly efficient triage of referrals. A significant per-referral saving of £108.23 [standard error (SE) £11.59] was seen with consultant triage, and £84.13 (SE £11.56) with practitioner triage. Cost savings varied according the differing methods of applying the national tariff. Patients reported similar levels of satisfaction for both settings, and speed of treatment was their over-riding concern. Conclusions: Implementation of electronic referral management in primary care can lead, when combined with triage, to diversions of appropriate cases to primary care. Cost savings can be realised but are dependent on tariff application by hospitals, with a risk of overestimating where hospitals are using day case tariffs extensively. Study limitations: The geographical footprint of the study was relatively small and, hence, the impact on services was minimal and could not be fully assessed across all three hospitals. Future work: The findings suggest that the intervention should be tested in other localities and disciplines, especially those, such as dermatology, that present the opportunity to use imaging to triage. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

Nowadays the LEAN tools with their proven efficiency are indispensable parts of the production management. I think there is no producing enterprise that cannot utilize a wide variety of these LEAN tools. The question now is how these tools can support companies in increasing the efficiency of their supporting IT processes. In this study I will demonstrate how these well-known LEAN tools from production management can be used in IT management to create more cost-effective, efficient and transparent solutions during the IT system development and IT operation activities. I will show respectively without attempting to be comprehensive the most important tools of the LEAN management and I will analyse how these tools can be used in the IT sector. At the end of this study I will demonstrate what the IT managers think about the practical use of these tools.

Background: Biosimilars can directly reduce the cost of treating patients for whom a reference biologic is indicated by offering a highly similar, lower priced alternative. We examine factors related to biosimilar regulatory approval, uptake, pricing, and financing and the potential impact on drug expenditures in the U.S.Methods: We developed a framework to illustrate how key factors including regulatory policies, provider and patient perception, pricing, and payer policies impact biosimilar cost-savings. Further, we developed a budget impact cost model to estimate savings from filgrastim biosimilars under various scenarios. The model uses publicly available data on disease incidence, treatment patterns, market share, and drug prices to estimate the cost-savings over a 5-year time horizon.Results: We estimate five-year cost savings of $256 million, of which 18% ($47 million) are from reduced patient out-of-pocket costs, 34% ($86 million) are savings to commercial payers, and 48% ($123 million) are savings for Medicare. Additional scenarios demonstrate the impact of uncertain factors, including price, uptake, and financing policies.Conclusions: A variety or interrelated factors influence the development, uptake, and cost-savings for Biosimilars use in the U.S. The filgrastim case is a useful example that illustrates these factors and the potential magnitude of costs savings. [ABSTRACT FROM AUTHOR]

Objectives We assess the diagnostic yield of repeat testing for C. difficile using molecular methods within 7 days of a negative test and identify specific factors associated with conversion from negative to positive test result within a 7-day period to aid in selective test utilization. Methods A retrospective chart review of 20,866 laboratory test orders for C. difficile PCR was conducted. The test result, clinicopathologic patient features, and previous test results were recorded. Univariate and multivariate analysis was conducted to compare patients with initial and repeat negative results ( n = 248) to a group of patients with conversion from negative to positive results within 7 days. Results Univariate analysis demonstrated a history of C. difficile infection, receipt of antibiotics within 14 days, and duration of hospital stay as factors significantly different between patients with repeat negative and conversion to positive C. difficile test result. Only history of C. difficile infection was significantly different upon multivariate analysis. Conclusions Identification of prior C. difficile infection as the only factor significantly correlated with conversion from negative to positive C. difficile test result within 7 days aids in selective test utilization and reduces the costs associated with unnecessary laboratory testing. [ABSTRACT FROM AUTHOR]

Artificially intelligent and predictive modelling of geomechanical properties is performed by creating supervised machine learning data models utilizing artificial neural networks (ANN) and will predict geomechanical properties from basic and commonly used conventional well logs such as gamma ray, and bulk density. The predictive models were created by following the approach on a large volume of data acquired from 112 wells containing the Bakken Formation in North Dakota. The studied wells cover a large surface area of the formation containing the five main producing counties in North Dakota: Burke, Mountrail, McKenzie, Dunn, and Williams. Thus, with a large surface area being analyzed in this research, there is confidence with a high degree of certainty that an extensive representation of the Bakken Formation is modelled, by training neural networks to work on varying properties from the different counties containing the Bakken Formation in North Dakota. Shear wave velocity of 112 wells is also analyzed by regression methods and neural networks, and a new correlation is proposed for the Bakken Formation. The final goal of the research is to achieve supervised artificial neural network models that predict geomechanical properties of future wells with an accuracy of at least 90% for the Upper and Middle Bakken Formation. Thus, obtaining these logs by generating it from statistical and artificially intelligent methods shows a potential for significant improvements in performance, efficiency, and profitability for oil and gas operators. [ABSTRACT FROM AUTHOR]