46 results on '"COST analysis"'
Search Results
2. Analysis of Treatment Cost Variation Among Multiple Neurosurgical Procedures Using the Value-Driven Outcomes Database.
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Reese, Jared C., Twitchell, Spencer, Wilde, Herschel, Azab, Mohammed A., Guan, Jian, Karsy, Michael, and Couldwell, William T.
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PITUITARY surgery , *DISCECTOMY , *COST analysis , *ACOUSTIC neuroma , *MEDICAL care costs , *SPINAL fusion , *THERAPEUTICS - Abstract
Health care costs comprise a substantial portion of total national expenditure. Although interest in cost-effectiveness analysis in neurosurgery has increased, there has been little cross-comparison of neurosurgical procedures. The aim of this study was to compare costs across elective neurosurgical procedures to understand whether drivers of cost differ. The Value Driven Outcomes database was used to evaluate treatment costs for resection of vestibular schwannoma, intracranial meningioma, gliomas, and pituitary adenoma; anterior cervical discectomy and fusion and lumbar spinal fusion; and aneurysm treatment. A total of 1997 patients (mean age 54.6 ± 14.5 years; 45.2% male) were evaluated. The mean length of stay (LOS) was 4.0 ± 4.4 days. For cases involving hardware implantation, including spine fusion or aneurysm treatment, supplies and implants (49.1%) accounted for the largest fraction of costs followed by facility costs (37.9%). For cases that did not involve hardware, including tumor cases, facility costs (63.9%) were the largest fraction, followed by supplies and implants (16.2%). Aneurysm treatment and lumbar fusion were 1.5–3 times more costly than cranial tumor resection and anterior cervical discectomy and fusion per patient. Multivariate linear regression demonstrated that LOS (β = 0.7, P = 0.0001) and patient treatment type (β = 0.2, P = 0.0001) had the greatest effect on costs. LOS correlated with cost differently depending on case type; its effect was largest for patients with meningioma and smallest for patients with vestibular schwannoma. Costs across time increased similarly for all case types. Costs for neurosurgical procedures vary widely depending on treatment type and correlated directly with LOS. Strategies to reduce cost may require different approaches depending on procedure type. [ABSTRACT FROM AUTHOR]
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- 2019
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3. Mortality and costs associated with alcoholic hepatitis: A claims analysis of a commercially insured population.
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Thompson, Julie A., Martinson, Noel, and Martinson, Melissa
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ALCOHOLIC liver diseases , *MORTALITY , *COST analysis , *LIVER transplantation , *INSURANCE claims , *THERAPEUTICS , *INSURANCE statistics , *MEDICAL care cost statistics , *COMPLICATIONS of alcoholism , *HEPATITIS , *HOSPITAL care - Abstract
Rising mortality in the United States due to alcoholic liver disease (ALD) and the dearth of effective treatments for ALD have led to increased research in this area, particularly in alcoholic hepatitis. To understand the burden of illness and potential economic value of effective treatments, we conducted a health care claims analysis of over 15,000 commercially insured adults who were hospitalized with alcoholic hepatitis (AH) between 2006 and 2013 and followed for up to 5 years. Their average age was 54 years and 68% were male. Over 5 years, about two-thirds of these adults died (44% in the first year), and fewer than 500 received liver transplants. There were nearly 40,000 re-hospitalizations, with over 50% of the survivors re-hospitalized within a year and nearly 75% through the second year. The total costs were nearly $145,000 per patient, with costs decreasing over time from over $50,000 in the first year (including the index hospitalization) to about $10,000 per year in the later years. Total costs for the cohort over 5 years were $2.2 billion. Patients who received a liver transplant averaged about $300,000 in transplant-related costs and over $1,000,000 in total health care costs over 5 years. Average costs in years following the index hospitalization were similar to diabetes. AH has a high mortality and is a high-cost condition. [ABSTRACT FROM AUTHOR]
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- 2018
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4. A standardized stepwise drug treatment algorithm for depression reduces direct treatment costs in depressed inpatients - Results from the German Algorithm Project (GAP3).
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Ricken, Roland, Wiethoff, Katja, Reinhold, Thomas, Stamm, Thomas J., Baghai, Thomas C., Fisher, Robert, Seemüller, Florian, Brieger, Peter, Cordes, Joachim, Laux, Gerd, Hauth, Iris, Möller, Hans-Jürgen, Heinz, Andreas, Bauer, Michael, and Adli, Mazda
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STEPWISE reactions (Chemistry) , *MEDICAL care standards , *MEDICAL care cost control , *MENTAL depression , *THERAPEUTICS , *HOSPITAL care , *ALGORITHMS , *ANTIDEPRESSANTS , *COST effectiveness , *MEDICAL care costs , *MEDICAL protocols , *WEIGHTS & measures , *COST analysis , *TREATMENT effectiveness , *ECONOMICS - Abstract
Background: In a previous single center study we found that a standardized drug treatment algorithm (ALGO) was more cost effective than treatment as usual (TAU) for inpatients with major depression. This report aimed to determine whether this promising initial finding could be replicated in a multicenter study.Methods: Treatment costs were calculated for two time periods: the study period (from enrolment to exit from study) and time in hospital (from enrolment to hospital discharge) based on daily hospital charges. Cost per remitted patient during the study period was considered as primary outcome.Results: 266 patients received ALGO and 84 received TAU. For the study period, ALGO costs were significantly lower than TAU (ALGO: 7 848 ± 6 065 €; TAU: 10 033 ± 7 696 €; p = 0.04). For time in hospital, costs were not different (ALGO: 14 734 ± 8 329 €; TAU: 14 244 ± 8 419 €; p = 0.617). Remission rates did not differ for the study period (ALGO: 57.9%, TAU: 50.0%; p=0.201). Remission rates were greater in ALGO (83.3%) than TAU (66.2%) for time in hospital (p = 0.002). Cost per remission was lower in ALGO (13 554 ± 10 476 €) than TAU (20 066 ± 15 391 €) for the study period (p < 0.001) and for time in hospital (ALGO: 17 582 ± 9 939 €; TAU: 21 516 ± 12 718 €; p = 0.036).Limitations: Indirect costs were not assessed. Different dropout rates in TAU and ALGO complicated interpretation.Conclusions: Treatment algorithms enhance the cost effectiveness of the care of depressed inpatients, which replicates our prior results in an independent sample. [ABSTRACT FROM AUTHOR]- Published
- 2018
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5. Two weeks of additional standing balance circuit classes during inpatient rehabilitation are cost saving and effective: an economic evaluation.
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Treacy, Daniel, Howard, Kirsten, Hayes, Alison, Hassett, Leanne, Schurr, Karl, and Sherrington, Catherine
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CONFIDENCE intervals ,COST effectiveness ,POSTURAL balance ,LONGITUDINAL method ,NEUROPSYCHOLOGICAL tests ,PROBABILITY theory ,REHABILITATION ,RESEARCH funding ,STATISTICAL sampling ,THERAPEUTICS ,COST analysis ,RANDOMIZED controlled trials ,BLIND experiment ,FUNCTIONAL assessment ,DESCRIPTIVE statistics - Abstract
Question Among people admitted for inpatient rehabilitation, is usual care plus standing balance circuit classes more cost-effective than usual care alone? Design Cost-effectiveness study embedded within a randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants 162 rehabilitation inpatients from a metropolitan hospital in Sydney, Australia. Intervention The experimental group received a 1-hour standing balance circuit class, delivered three times a week for 2 weeks, in addition to usual therapy. The circuit classes were supervised by one physiotherapist and one physiotherapy assistant for up to eight patients. The control group received usual therapy alone. Outcome measures Costs were estimated from routinely collected hospital use data in the 3 months after randomisation. The functional outcome measure was mobility measured at 3 months using the Short Physical Performance Battery administered by a blinded assessor. An incremental analysis was conducted and the joint probability distribution of costs and outcomes was examined using bootstrapping. Results The median cost savings for the intervention group was AUD4,741 (95% CI 137 to 9,372) per participant; 94% of bootstraps showed that the intervention was both effective and cost saving. Conclusions Two weeks of additional standing balance circuit classes delivered in addition to usual therapy resulted in decreased healthcare costs at 3 months in hospital inpatients admitted for rehabilitation. There is a high probability that this intervention is both cost saving and effective. Registration ACTRN12611000412932. [Treacy D, Howard K, Hayes A, Hassett L, Schurr K, Sherrington C (2018) Two weeks of additional standing balance circuit classes during inpatient rehabilitation are cost saving and effective: an economic evaluation. Journal of Physiotherapy 64: 41–47] [ABSTRACT FROM AUTHOR]
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- 2018
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6. Healthcare resource use and associated costs of hypoglycemia in patients with type 2 diabetes prescribed sulfonylureas.
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Alemayehu, Berhanu, Liu, Jinan, Rajpathak, Swapnil, and Engel, Samuel S.
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HYPOGLYCEMIA treatment , *MEDICAL care use , *COMBINED modality therapy , *COMBINATION drug therapy , *HYPOGLYCEMIA , *HYPOGLYCEMIC agents , *INSURANCE , *LONGITUDINAL method , *MEDICAL care costs , *TYPE 2 diabetes , *RETIREMENT , *COST analysis , *SULFONYLUREAS , *METFORMIN , *RETROSPECTIVE studies , *ECONOMICS , *THERAPEUTICS - Abstract
Aims: The objective of this study was to evaluate diabetes-related healthcare resource use and associated costs in patients with type 2 diabetes (T2DM) treated with a sulfonylurea (SU), with and without hypoglycemia.Methods: In this retrospective cohort study, patients 18years or older receiving SU monotherapy or as add-on to metformin were identified from a US healthcare claims database (MarketScan®). Of 113,743 patients (56.8% male, average age 62.6years), 61.6% were on SU/metformin dual therapy and 38.4% were on SU monotherapy, and 5% had one or more episodes of hypoglycemia during the 12-month follow-up period.Results: Adjusted for baseline characteristics, patients with hypoglycemia were three times more likely than those without to use emergency room services (OR 3.04, 95% CI: 2.82, 3.25), almost four times more likely to have inpatient admissions (OR 3.84, 95% CI: 3.58, 4.12), and had more frequent physician office visits (4.3 vs 3.0 visits, p<0.01) in the 12-month follow-up period. The adjusted annual diabetes-related medical expenditure was three times higher in patients with hypoglycemia compared with those without ($6884 vs $2392, p<0.001).Conclusions: This study demonstrated the higher healthcare utilization and costs associated with hypoglycemia in patients with T2DM treated with an SU. [ABSTRACT FROM AUTHOR]- Published
- 2017
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7. EE151 Cost Minimization Analysis Evaluating Turoctocog ALFA (NOVOEIGHT®) and Product X As Prophylaxis Treatment for Paediatric and Adult Patients with Severe Haemophilia a in China.
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Dou, L, Zhen, R, Zhang, Y, and Li, S
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COST analysis , *HEMOPHILIA , *CHILD patients , *PREVENTIVE medicine , *THERAPEUTICS - Published
- 2022
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8. Variation in Coverage for Progesterone to Prevent Preterm Birth: A Survey of Medicaid Managed Care Organizations.
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Batra, Priya, Hernandez Gray, Ashley A., and Moore, Jennifer E.
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INSURANCE , *GESTATIONAL age , *HEALTH services accessibility , *MANAGED care programs , *PREMATURE infants , *MEDICAID , *MEDICAL protocols , *PROGESTERONE , *SURVEYS , *HEALTH insurance reimbursement , *COST analysis , *CROSS-sectional method , *DESCRIPTIVE statistics , *STANDARDS , *PREVENTION , *THERAPEUTICS - Abstract
Introduction Preterm birth is the leading cause of U.S. infant morbidity and mortality; Medicaid enrollees disproportionately experience preterm deliveries. Data suggest that progesterone—an evidence-based therapy for preventing preterm birth—is not accessible to all eligible Medicaid beneficiaries. This study aimed to identify variation in progesterone coverage guidelines in a sample of state Medicaid managed care organizations (MMCOs). Material and Methods Using a cross-sectional design, participation in a web-based survey was offered to 20 MMCO members of the Medicaid Health Plans of America. The survey assessed coverage guidelines for progesterone and associated interventions to prevent preterm birth. MMCOs identified key barriers in providing progesterone. Descriptive analyses were performed. Results Analyses included data from 18 plans providing coverage in 31 of the 39 states with MMCOs (response rate, 90.0%). Responding MMCOs were diverse: 55.6% were multistate, 33.3% were nonprofit, and 31.2% covered more than 1,000,000 lives. Most respondents (87.5%) covered branded progesterone, and 81.3% covered compounded progesterone. Prior authorization was required by most plans for branded progesterone (86.7%) or compounded progesterone (75.0%). The MMCO gestational age restrictions for initiating progesterone varied from 22 to 37 weeks of gestation, even within the same state. MMCO-identified barriers to providing progesterone included cost, lack of clinician knowledge of indications and coverage, and variation in billing procedures. Discussion Marked variation in MMCO coverage policies and procedures for progesterone and related interventions to prevent preterm birth was noted. Implications for Practice and Policy Standardizing MMCO coverage policies may be one way to improve access to evidence-based interventions that prevent preterm birth. [ABSTRACT FROM AUTHOR]
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- 2017
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9. Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery.
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Yu, Jennifer, Elmore, Leisha C., Cyr, Amy E., Aft, Rebecca L., Gillanders, William E., and Margenthaler, Julie A.
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LUMPECTOMY , *MEDICAL care costs , *BREAST cancer surgery , *COST analysis , *DUCTAL carcinoma , *CANCER invasiveness , *MEDICAL protocols , *ECONOMICS , *THERAPEUTICS , *BREAST tumors , *CONFERENCES & conventions , *LONGITUDINAL method , *RESEARCH funding , *RETROSPECTIVE studies ,CANCER reoperation - Abstract
Background: The Society of Surgical Oncology and American Society of Radiation Oncology consensus statement was the first professional guideline in breast oncology to declare "no ink on tumor" as a negative margin in patients with stages I/II breast cancer undergoing breast-conservation therapy. We sought to analyze the financial impact of this guideline at our institution using a historic cohort.Study Design: We identified women undergoing re-excision after breast-conserving surgery for invasive breast cancer from 2010 through 2013 using a prospectively maintained institutional database. Clinical and billing data were extracted from the medical record and from administrative resources using CPT codes. Descriptive statistics were used in data analysis.Results: Of 254 women in the study population, 238 (93.7%) had stage I/II disease and 182 (71.7%) had invasive disease with ductal carcinoma in situ. A subcohort of 83 patients (32.7%) who underwent breast-conservation therapy for stage I/II disease without neoadjuvant chemotherapy had negative margins after the index procedure, per the Society of Surgical Oncology and American Society of Radiation Oncology guideline. The majority had invasive ductal carcinoma (n = 70 [84.3%]) and had invasive disease (n = 45 [54.2%]), and/or ductal carcinoma in situ (n = 49 [59.0%]) within 1 mm of the specimen margin. Seventy-nine patients underwent 1 re-excision and 4 patients underwent 2 re-excisions, accounting for 81 hours of operative time. Considering facility fees and primary surgeon billing alone, the overall estimated cost reduction would have been $195,919, or $2,360 per affected patient, under the guideline recommendations.Conclusions: Implementation of the Society of Surgical Oncology and American Society of Radiation Oncology consensus guideline holds great potential to optimize resource use. Application of the guideline to a retrospective cohort at our institution would have decreased the overall re-excision rate by 5.6% and reduced costs by nearly $200,000. Additional analysis of patient outcomes and margin assessment methods is needed to define the long-term impact on surgical practice. [ABSTRACT FROM AUTHOR]- Published
- 2017
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10. Carbapenemase-producing Acinetobacter baumannii: An outbreak report with special highlights on economic burden.
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Gagnaire, J., Gagneux-Brunon, A., Pouvaret, A., Grattard, F., Carricajo, A., Favier, H., Mattei, A., Pozzetto, B., Nuti, C., Lucht, F., Berthelot, P., and Botelho-Nevers, E.
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NOSOCOMIAL infections , *CARBAPENEMASE , *ACINETOBACTER baumannii , *MULTIDRUG resistance in bacteria , *COST estimates , *THERAPEUTICS - Abstract
Objective We aimed to describe the management of a carbapenemase-producing Acinetobacter baumannii (CP-AB) outbreak using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. We also aimed to evaluate the cost of the outbreak and simulate costs if a dedicated unit to manage such outbreak had been set-up. Methods We performed a prospective epidemiological study. Multiple interventions were implemented including cohorting measures and limitation of admissions. Cost estimation was performed using administrative local data. Results Five patients were colonized with CP-AB and hospitalized in the neurosurgery ward. The index case was a patient who had been previously hospitalized in Portugal. Four secondary colonized patients were further observed within the unit. The strains of A . baumannii were shown to belong to the same clone and all of them produced an OXA-23 carbapenemase. The closure of the ward associated with the discharge of the five patients in a cohorting area of the Infectious Diseases Unit with dedicated staff put a stop to the outbreak. The estimated cost of this 17-week outbreak was $474,474. If patients had been managed in a dedicated unit — including specific area for cohorting of patients and dedicated staff — at the beginning of the outbreak, the estimated cost would have been $189,046. Conclusion Controlling hospital outbreaks involving multidrug-resistant bacteria requires a rapid cohorting of patients. Using simulation, we highlighted cost gain when using a dedicated cohorting unit strategy for such an outbreak. [ABSTRACT FROM AUTHOR]
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- 2017
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11. Granting Order-Writing Privileges to Registered Dietitian Nutritionists Can Decrease Costs in Acute Care Hospitals.
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Phillips, Wendy and Doley, Jennifer
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CRITICAL care medicine , *DIET therapy , *COST control , *DIETITIANS , *HOSPITALS , *MEDICAL staff privileges (Hospitals) , *WORKING hours , *MEDICAL care costs , *MEDICAL protocols , *THERAPEUTICS , *COST analysis , *ECONOMICS - Published
- 2017
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12. Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer.
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Franken, M.D., van Rooijen, E.M., May, A.M., Koffijberg, H., van Tinteren, H., Mol, L., ten Tije, A.J., Creemers, G.J., van der Velden, A.M.T., Tanis, B.C., Uyl-de Groot, C.A., Punt, C.J.A., Koopman, M., and van Oijen, M.G.H.
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BEVACIZUMAB , *OXALIPLATIN , *THERAPEUTIC use of antimetabolites , *ANTINEOPLASTIC agents , *COLON tumors , *METASTASIS , *QUALITY of life , *QUESTIONNAIRES , *SURVIVAL , *COST analysis , *TREATMENT effectiveness , *QUALITY-adjusted life years , *THERAPEUTICS ,RECTUM tumors - Abstract
Aim Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancer patients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment. Methods Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters. Results CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated. Conclusion CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective. [ABSTRACT FROM AUTHOR]
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- 2017
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13. A model to estimate cost-savings in diabetic foot ulcer prevention efforts.
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Barshes, Neal R., Saedi, Samira, Wrobel, James, Kougias, Panos, Kundakcioglu, O. Erhun, and Armstrong, David G.
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TREATMENT of diabetic neuropathies , *DIABETIC foot prevention , *TREATMENT of diabetic foot , *AMPUTATION , *COMBINED modality therapy , *COMPARATIVE studies , *COST control , *COST effectiveness , *DIABETIC angiopathies , *LONGITUDINAL method , *DIABETIC neuropathies , *VETERANS , *RESEARCH methodology , *MEDICAL care costs , *MEDICAL cooperation , *PROBABILITY theory , *RESEARCH , *SURVIVAL analysis (Biometry) , *COST analysis , *EVALUATION research , *DIABETIC foot , *DISEASE incidence , *DISEASE prevalence , *STATISTICAL models , *ECONOMICS , *PREVENTION , *THERAPEUTICS - Abstract
Background: Sustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur.Methods: A Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence.Results: PP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year.Conclusions: Low-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential. [ABSTRACT FROM AUTHOR]- Published
- 2017
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14. Evaluation of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review.
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Griffin, Susan O., Naavaal, Shillpa, Scherrer, Christina, Patel, Mona, Chattopadhyay, Sajal, and Community Preventive Services Task Force
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PIT & fissure sealants (Dentistry) , *SCHOOL children , *DENTAL caries , *ECONOMIC models , *COST analysis , *CAVITY prevention , *COST effectiveness , *MEDICAID , *RESEARCH funding , *STATISTICAL models , *ECONOMICS , *THERAPEUTICS - Abstract
Context: A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review.Evidence Acquisition: Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies-ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); four on SSP net cost (cost minus benefit); and three on net cost to Medicaid of clinically delivered sealants. The authors imputed productivity losses and discounted costs/outcomes when this information was missing. The analysis, conducted in 2015, reported all values in 2014 U.S. dollars.Evidence Synthesis: The median one-time SSP cost per tooth sealed was $11.64. Labor accounted for two thirds of costs, and time to provide sealants was a major cost driver. The median annual economic benefit was $6.29, suggesting that over 4 years the SSP benefit ($23.37 at a 3% discount rate) would exceed costs by $11.73 per sealed tooth. In addition, two of four economic models and all three analyses of Medicaid claims data found that SSP benefit to society exceeded SSP cost.Conclusions: Recent evidence indicates the benefits of SSPs exceed their costs when SSPs target schools attended by a large number of high-risk children. [ABSTRACT FROM AUTHOR]- Published
- 2017
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15. Cobalt-60 Machines and Medical Linear Accelerators: Competing Technologies for External Beam Radiotherapy.
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Healy, B.J., van der Merwe, D., Christaki, K.E., and Meghzifene, A.
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COBALT , *WORKING hours , *PARTICLE accelerators , *RADIATION protection , *RADIATION dosimetry , *RADIOTHERAPY , *COST analysis , *EQUIPMENT maintenance & repair , *RADIOLOGIC technology , *THERAPEUTICS - Abstract
Medical linear accelerators (linacs) and cobalt-60 machines are both mature technologies for external beam radiotherapy. A comparison is made between these two technologies in terms of infrastructure and maintenance, dosimetry, shielding requirements, staffing, costs, security, patient throughput and clinical use. Infrastructure and maintenance are more demanding for linacs due to the complex electric componentry. In dosimetry, a higher beam energy, modulated dose rate and smaller focal spot size mean that it is easier to create an optimised treatment with a linac for conformal dose coverage of the tumour while sparing healthy organs at risk. In shielding, the requirements for a concrete bunker are similar for cobalt-60 machines and linacs but extra shielding and protection from neutrons are required for linacs. Staffing levels can be higher for linacs and more staff training is required for linacs. Life cycle costs are higher for linacs, especially multi-energy linacs. Security is more complex for cobalt-60 machines because of the high activity radioactive source. Patient throughput can be affected by source decay for cobalt-60 machines but poor maintenance and breakdowns can severely affect patient throughput for linacs. In clinical use, more complex treatment techniques are easier to achieve with linacs, and the availability of electron beams on high-energy linacs can be useful for certain treatments. In summary, there is no simple answer to the question of the choice of either cobalt-60 machines or linacs for radiotherapy in low- and middle-income countries. In fact a radiotherapy department with a combination of technologies, including orthovoltage X-ray units, may be an option. Local needs, conditions and resources will have to be factored into any decision on technology taking into account the characteristics of both forms of teletherapy, with the primary goal being the sustainability of the radiotherapy service over the useful lifetime of the equipment. [ABSTRACT FROM AUTHOR]
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- 2017
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16. Effects of foot complications in patients with Type 2 diabetes mellitus on public healthcare: An analysis based on the Korea National Diabetes Program Cohort.
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Park, So Young, Rhee, Sang Youl, Chon, Suk, Ahn, Kyu Jeung, Kim, Sung-Hoon, Baik, Sei Hyun, Park, Yongsoo, Nam, Moon Suk, Lee, Kwan Woo, Woo, Jeong-taek, Chun, Ki Hong, Kim, Young Seol, and KNDP study investigators
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TREATMENT of diabetic foot , *TYPE 2 diabetes complications , *COMPARATIVE studies , *ECONOMIC aspects of diseases , *FOOT injuries , *LENGTH of stay in hospitals , *HOSPITAL costs , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *NATIONAL health services , *PUBLIC hospitals , *RESEARCH , *COST analysis , *EVALUATION research , *DIABETIC foot , *DISEASE incidence , *ECONOMICS , *THERAPEUTICS - Abstract
Aim: Diabetes mellitus (DM) patients are susceptible to foot injury or foot diseases such as diabetic foot and peripheral arterial disease. Although these conditions are considered important, few studies have investigated them in detail. Therefore, we investigated the epidemiology of diabetic foot complications (DFC) with respect to the effects on the public healthcare system.Methods: We evaluated the incidence, clinical characteristics, health service utilization frequency and medical expenses of DFC in type 2 DM patients in the Korea National Diabetes Program (KNDP), the largest multi-center, prospective cohort in Korea (n=4405). To determine precise outcomes, we used national representative databases, including claims data from the Health Insurance Review & Assessment Service of Korea.Results: During a median follow-up period of 3.30years, 528 patients (12.0%) were newly diagnosed with DFC at an incidence rate of 43.02 cases per 1000 person-years. The patients with DFC were significantly older than patients without DFC, but other clinical characteristics were similar between the two groups. The patients with DFC had more hospital visits (p<0.001), longer duration of hospitalization (p<0.001), and increased expenses (p<0.001) compared to patients without DFC. After multiple adjustments, the differences in number of hospital visits and medical expenses were consistent. In a before and after comparison within the DFC group, all three variables increased significantly after the onset of DFC (p<0.001).Conclusions: DFC were significantly associated with poor clinical outcomes and caused a substantial burden to the national healthcare system in Korea. Therefore, intervention to prevent DFC is important. [ABSTRACT FROM AUTHOR]- Published
- 2017
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17. EE669 Use of Dalbavancin in the Treatment of Acute Bacterial Skin and Skin Structure Infections in the Spanish Hospital Setting: A Comparative Cost Analysis.
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Hernández, I, Carcedo, D, Sabaniego, J, Rossellò, I, and Jiménez, A
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SKIN infections , *COST analysis , *COMPARATIVE studies , *THERAPEUTICS - Published
- 2022
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18. An Outcome and Cost Analysis Comparing Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Intraoperative Fluoroscopy versus Computed Tomography–Guided Navigation.
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Khanna, Ryan, McDevitt, Joseph L., Abecassis, Zachary A., Smith, Zachary A., Koski, Tyler R., Fessler, Richard G., and Dahdaleh, Nader S.
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COST analysis , *FLUOROSCOPY , *COMPUTED tomography , *SPONDYLOSIS , *INTRAOPERATIVE radiotherapy , *THERAPEUTICS - Abstract
Background Minimally invasive transforaminal lumbar interbody fusion (TLIF) has undergone significant evolution since its conception as a fusion technique to treat lumbar spondylosis. Minimally invasive TLIF is commonly performed using intraoperative two-dimensional fluoroscopic x-rays. However, intraoperative computed tomography (CT)–based navigation during minimally invasive TLIF is gaining popularity for improvements in visualizing anatomy and reducing intraoperative radiation to surgeons and operating room staff. This is the first study to compare clinical outcomes and cost between these 2 imaging techniques during minimally invasive TILF. Methods For comparison, 28 patients who underwent single-level minimally invasive TLIF using fluoroscopy were matched to 28 patients undergoing single-level minimally invasive TLIF using CT navigation based on race, sex, age, smoking status, payer type, and medical comorbidities (Charlson Comorbidity Index). The minimum follow-up time was 6 months. The 2 groups were compared in regard to clinical outcomes and hospital reimbursement from the payer perspective. Results Average surgery time, anesthesia time, and hospital length of stay were similar for both groups, but average estimated blood loss was lower in the fluoroscopy group compared with the CT navigation group (154 mL vs. 262 mL; P = 0.016). Oswestry Disability Index, back visual analog scale, and leg visual analog scale scores similarly improved in both groups ( P > 0.05) at 6-month follow-up. Cost analysis showed that average hospital payments were similar in the fluoroscopy versus the CT navigation groups ($32,347 vs. $32,656; P = 0.925) as well as payments for the operating room ( P = 0.868). Conclusions Single minimally invasive TLIF performed with fluoroscopy versus CT navigation showed similar clinical outcomes and cost at 6 months. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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19. Cost-Utility Analysis of Long-Acting Beta Agonists versus Leukotriene Receptor Antagonists in Older Adults with Persistent Asthma Receiving Concomitant Inhaled Corticosteroid Therapy.
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Altawalbeh, Shoroq M., Thorpe, Joshua M., Thorpe, Carolyn T., and Smith, Kenneth J.
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COST analysis , *ADRENERGIC beta agonists , *LEUKOTRIENE antagonists , *ASTHMATICS , *ASTHMA treatment , *CORTICOSTEROIDS , *DRUG therapy for asthma , *IMMUNOSUPPRESSIVE agents , *BRONCHODILATOR agents , *COST effectiveness , *PROBABILITY theory , *QUALITY-adjusted life years , *INHALATION administration , *THERAPEUTICS - Abstract
Background: Long-acting beta agonists (LABA) and leukotriene receptor antagonists (LTRA) are the major add-on treatments in older adults with persistent asthma when inhaled corticosteroids (ICS) fail to achieve adequate asthma control.Objectives: To evaluate the cost-utility of ICS + LABA treatment compared with ICS + LTRA treatment in older adults with asthma.Methods: A Markov model was used to estimate the incremental costs and quality-adjusted life expectancy associated with ICS + LABA treatment versus ICS + LTRA treatment in older adults with asthma in the United States from the health system perspective. The HCUPnet 2010 national statistics were used to extract the costs associated with asthma and cardiovascular hospitalizations, and inpatient mortality associated with these events. Event probabilities were predicted using Medicare 2009-2010 claims for older adults with asthma. Treatment costs were estimated on the basis of average wholesale drug price listings, and utility estimates were extracted from the literature. To account for uncertainty, one-way sensitivity analysis and probabilistic sensitivity analysis were performed.Results: The model predicted that, compared with ICS + LTRA treatment, ICS + LABA treatment costs $5,823 more while gaining 0.03 quality-adjusted life-years (QALYs), resulting in an incremental cost-effectiveness ratio of $209,090 per QALY. Hospitalization probabilities and posthospitalization utilities were the most influential parameters in the one-way sensitivity analysis. Probabilistic uncertainty analysis using Monte-Carlo simulations showed that the probabilities that ICS + LTRA treatment is cost-effective compared with ICS + LABA treatment are 77% and 62% at $50,000 and $100,000 per QALY gained willingness-to-pay thresholds, respectively.Conclusions: The cost-effectiveness of ICS + LABA treatment is economically unfavorable in older adults when compared with LTRA as add-on treatment. [ABSTRACT FROM AUTHOR]- Published
- 2016
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20. Induction of labor using prostaglandin vaginal gel: cost analysis comparing early amniotomy with repeat prostaglandin gel.
- Author
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Beckmann, Michael, Merollini, Katharina, Kumar, Sailesh, and Flenady, Vicki
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PROSTAGLANDINS , *VAGINAL discharge , *MEDICAL care costs , *DINOPROSTONE , *HEALTH outcome assessment , *LENGTH of stay in hospitals , *AMNION , *CERVIX uteri , *COMPARATIVE studies , *LABOR (Obstetrics) , *INDUCED labor (Obstetrics) , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *COST analysis , *VAGINAL medication , *EVALUATION research , *RANDOMIZED controlled trials , *DRUG administration , *OXYTOCICS , *DRUG dosage , *ECONOMICS , *THERAPEUTICS - Abstract
Background: In a randomized controlled trial of two policies for induction of labor (IOL) using Prostaglandin E2 (PGE2) vaginal gel, women who had an earlier amniotomy experienced a shorter IOL-to-birth time.Objective: To report the cost analysis of this trial and determine if there are differences in healthcare costs when an early amniotomy is performed as opposed to giving more PGE2 vaginal gel, for women undergoing IOL at term.Study Design: Following an evening dose of PGE2 vaginal gel, 245 women with live singleton pregnancies, ≥37+0 weeks, were randomized into an amniotomy or repeat-PGE2 group. Healthcare costs were a secondary outcome measure, sourced from hospital finance systems and included staff costs, equipment and consumables, pharmacy, pathology, hotel services and business overheads. A decision analytic model, specifically a Markov chain, was developed to further investigate costs, and a Monte Carlo simulation was performed to confirm the robustness of these findings. Mean and median costs and cost differences between the two groups are reported, from the hospital perspective.Results: The healthcare costs associated with IOL were available for all 245 trial participants. A 1000-patient cohort simulation demonstrated that performing an early amniotomy was associated with a cost-saving of $AUD289 ($AUD7094 vs $AUD7338) per woman induced, compared with administering more PGE2. Propagating the uncertainty through the model 10,000 times, early amniotomy was associated with a median cost savings of $AUD487 (IQR -$AUD573, +$AUD1498).Conclusions: After an initial dose of PGE2 vaginal gel, a policy of administering more PGE2 when the Modified Bishop's score is <7 was associated with increased healthcare costs compared with a policy of performing an amniotomy, if technically possible. Length of stay was the main driver of healthcare costs. [ABSTRACT FROM AUTHOR]- Published
- 2016
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21. Home administration of bortezomib in multiple myeloma is cost-effective and is preferred by patients compared with hospital administration: results of a prospective single-center study.
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Lassalle, A., Thomaré, P., Fronteau, C., Mahé, B., Jubé, C., Blin, N., Voldoire, M., Dubruille, V., Tessoulin, B., Touzeau, C., Chauvin, C., Loirat, M., Lok, A., Bourcier, J., Lestang, E., Mocquet, R., Barbarot, V., and Moreau, P.
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MULTIPLE myeloma , *BORTEZOMIB , *DRUG administration , *COST effectiveness , *SUBCUTANEOUS infusions , *HEMATOLOGY , *PATIENTS , *THERAPEUTICS - Abstract
Background: Subcutaneous (s.c.) administration of bortezomib is the most widely used route of administration for the treatment of patients with multiple myeloma. No study has as yet prospectively evaluated home versus hospital administration of s.c. bortezomib with respect to patient preference and cost. Patients and methods: In this prospective trial, myeloma patients received the first administration of s.c. bortezomib of each cycle in the outpatient unit of the Department of Hematology. When possible, all subsequent doses of bortezomib within each cycle were provided at home. A cost analysis was carried out to compare the average cost of an injection of bortezomib in the outpatient unit and at home. In order to compare hospital and home administration of bortezomib for preference and satisfaction, patients had to complete 2 simple questionnaires analyzing 16 criteria, such as quality of life, well-being, social life, satisfaction, safety, quality of care, the reduction in personal transportation time, and personal anxiety. Each item was analyzed using a Likert scale. Results: Fifty patients were studied. Overall, a total of 1043 s.c. injections of bortezomib were carried out, 655 (62.8%) at home, and 388 (35.2%) in the outpatient unit. The cost analysis showed that the total cost of one s.c. injection of bortezomib in the outpatient unit was ∊1510.09 versus ∊1224.57 for the home administration, which represents a reduction of ∊285.52, i.e. 20% of the cost of the hospital administration. The evaluation of patient preference and satisfaction showed that home administration improved the quality of life in 84% of the patients, increased well-being in 78%, and improved the activities of daily living in 72% of the cases. Overall, 98% of the patients noted their preference for home administration over the hospital administration of bortezomib. Conclusion: Home administration of s.c. bortezomib is cost-effective and is preferred by myeloma patients compared with hospital administration. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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22. Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome: Doubled Costs Compared with Patients with Asthma Alone.
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Gerhardsson de Verdier, Maria, Andersson, Maria, Kern, David M., Zhou, Siting, and Tunceli, Ozgur
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OBSTRUCTIVE lung diseases , *ASTHMATICS , *MEDICAL care costs , *MEDICAL informatics , *DISEASE exacerbation , *DISEASE progression , *ASTHMA treatment , *ASTHMA diagnosis , *OBSTRUCTIVE lung disease treatment , *HOSPITAL care , *HOSPITAL emergency services , *ASTHMA , *BRONCHODILATOR agents , *MEDICAL care use , *PROGNOSIS , *SYNDROMES , *TIME , *COMORBIDITY , *COST analysis , *DISEASE prevalence , *RETROSPECTIVE studies , *STATISTICAL models , *DISEASE complications , *ECONOMICS , *THERAPEUTICS - Abstract
Background: Patients with asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) have more rapid disease progression and more exacerbations than do those with either condition alone. Little research has been performed, however, in these patients.Objective: The objective was to summarize the health care utilization, costs, and comorbidities of patients with uncontrolled asthma and patients with ACOS.Methods: This retrospective analysis used medical and pharmacy claims from large commercial health plans. The study included patients 6 years or older with a diagnosis of asthma and one or more asthma exacerbation (index event). Patients were classified as having asthma alone or ACOS, and the two groups were matched for age, sex, region, index year, index month, and health plan type. Outcomes included rates of comorbid disease, health care utilization, and costs during the 12 months before and after the index exacerbation.Results: Among the matched patients with asthma (6,505 ACOS; 26,060 without COPD), mean annual all-cause health care costs were twice as high as for patients with ACOS ($22,393 vs. $11,716; P < 0.0001). Asthma-related costs, representing 29% of total costs, were nearly twice as high among patients with ACOS ($6,319 vs. 3,356; P < 0.0001). Cost differences were driven by large differences in the proportions of patients with an inpatient hospitalization (34.0% vs. 14.6%; P < 0.0001) or emergency department visit (29.6% vs. 19.9%; P < 0.0001). Nearly all prespecified comorbid conditions were more prevalent in the ACOS group.Conclusions: Patients with asthma and COPD had nearly double the health care costs as did patients with asthma without COPD. The overall disease profile of patients with asthma should be considered when managing patients, rather than treating asthma as a solitary condition. [ABSTRACT FROM AUTHOR]- Published
- 2015
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23. Evaluating the Cost of Bringing People with Type 2 Diabetes Mellitus to Multiple Targets of Treatment in Canada.
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Skovgaard, Rasmus, Jon Ploug, Uffe, Hunt, Barnaby, and Valentine, William J.
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INSULIN derivatives , *PIOGLITAZONE , *EXENATIDE , *SITAGLIPTIN , *GLUCAGON-like peptide-1 agonists , *COST effectiveness , *GLYCOSYLATED hemoglobin , *HYPOGLYCEMIC agents , *MEDICAL care costs , *TYPE 2 diabetes , *WEIGHT gain , *COST analysis , *TREATMENT effectiveness , *GLYCEMIC control , *ECONOMICS , *THERAPEUTICS - Abstract
Purpose Evidence suggests that clinical outcomes for people with type 2 diabetes mellitus can be improved through multifactorial treatment. The key challenges in the successful treatment of type 2 diabetes include maintaining tight glycemic control, minimizing the risk of hypoglycemia, controlling cardiovascular risk factors, and reducing or controlling weight. The aim of the present analysis was to evaluate the cost per patient achieving a composite clinical end point (glycosylated hemoglobin <7%, with no weight gain and no hypoglycemic events) in patients with type 2 diabetes in Quebec, Quebec, Canada, receiving liraglutide 1.2 mg, liraglutide 1.8 mg, thiazolidinedione, sulfonylurea, insulin glargine, sitagliptin, or exenatide. Methods The proportion of patients achieving control was taken from a meta-analysis that was based on the Phase III trial program of liraglutide. Treatment costs, estimated from a health care payer perspective, were calculated on the basis of the trials included in the meta-analysis and captured the study drug, needles, self-monitoring of blood glucose (SMBG) test strips, SMBG lancets, and other antidiabetes medications received. Cost-effectiveness in terms of cost per patient achieving the composite end point (cost of control) was evaluated with an economic model developed in Microsoft Excel. No discounting was applied to cost or clinical outcomes because these were not projected beyond a 1-year time horizon. Sensitivity analyses were performed. Findings Liraglutide 1.8 mg was associated with the lowest number needed to treat, with 3 patients needing to be treated to bring 1 patient to the composite end point. Pioglitazone was associated with the highest number needed to treat, with 17 patients requiring treatment to bring 1 patient to the composite end point. Evaluation of only annual pharmacy costs indicated that liraglutide 1.8 mg was the most costly treatment at Can$2780 per patient per year. Pioglitazone and glimepiride were associated with the lowest direct annual costs. Combining the clinical efficacy data with the annual cost of medications produced cost of control values of Can$6070 (liraglutide 1.2 mg), Can$6949 (liraglutide 1.8 mg), Can$7237 (glimepiride), Can$7704 (exenatide), Can$8297 (insulin glargine), Can$8741 (pioglitazone), and Can$9270 (sitagliptin) per patient achieving the composite end point. Implications Liraglutide 1.2 mg and 1.8 mg were associated with the lowest cost of control values, driven by the high proportion of patients achieving the composite end point, which offset the higher medication costs. A relatively low cost of control value was achieved for glimepiride, driven by low acquisition costs, despite relatively few patients achieving the composite end point. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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24. Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom.
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Monsivais, Pablo, Scarborough, Peter, Lloyd, Tina, Mizdrak, Anja, Luben, Robert, Mulligan, Angela A., Wareham, Nicholas J., and Woodcock, James
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DASH diet ,CARDIOVASCULAR disease prevention ,HYPERTENSION ,THERAPEUTICS ,DIET & environment ,GREENHOUSE gases prevention ,PUBLIC health ,HEALTH promotion ,FOOD ,ANALYSIS of variance ,CONFIDENCE intervals ,ENVIRONMENTAL health ,EPIDEMIOLOGICAL research ,GRAIN ,GREENHOUSE effect ,LONGITUDINAL method ,MEAT ,NUTRITIONAL assessment ,PROBABILITY theory ,QUESTIONNAIRES ,REGRESSION analysis ,RESEARCH funding ,COST analysis ,CROSS-sectional method ,DATA analysis software ,DESCRIPTIVE statistics ,ECONOMICS - Abstract
Background: The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). Objective: The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. Design: In this cross-sectional study of adults aged 39-79 y from the European Prospective Investigation into Cancer and Nutrition-Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom-based supermarket comparison website. Results: Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Conclusions: Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed. [ABSTRACT FROM AUTHOR]
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- 2015
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25. EE79 A Cost of Control Analysis of Once-Weekly Subcutaneous Semaglutide Versus Dulaglutide for Bringing Patients to Treatment Targets in China.
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Zhen, R, Gu, Z, Shen, Y, and Chen, L
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COST control , *COST analysis , *SEMAGLUTIDE , *THERAPEUTICS - Published
- 2022
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26. Prevention of depression in older age.
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Almeida, Osvaldo P.
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THERAPEUTICS , *MENTAL depression , *PREVENTION of mental depression , *COST analysis , *HEALTH of older people , *HEALTH outcome assessment , *ANTIDEPRESSANTS , *DISEASE relapse - Abstract
Depression is a common disorder in later life that is associated with increased disability and costs, and negative health outcomes over time. Antidepressant treatments in the form of medications or psychotherapy are available, but a large proportion of those treated fail to respond fully, and relapse or recurrence of symptoms is frequent among those who recover. Hence, successful prevention would avoid these negative outcomes. This paper selectively reviews currently available observational and trial data on the prevention of depression. It initially reviews risk factors associated with depression, and then discusses strategies for primary (including universal, selective and indicated), secondary and tertiary prevention. Currently available evidence suggests that selective and indicated preventive interventions are feasible and initial results look promising. Existing trial data indicate that ongoing antidepressant treatments reduce the risk of relapse and recurrence of symptoms, but benefits may not extend beyond two or three years. At this point in time, no interventions have been shown to reduce the long term complications associated with depression. Mental health professionals will need to work collaboratively to develop primary, secondary and tertiary preventive interventions that are effective at targeting relevant risk factors systematically and that can be easily adopted into clinical practice. [ABSTRACT FROM AUTHOR]
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- 2014
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27. POSC77 Incorporating Possibility of Cure into Cost Utility Analysis for Nivolumab in Adjuvant Treatment of Resected Stage III/IV Melanoma in France.
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Harris, G, Orsini, I, Edmonson-Jones, M, Moshyk, A, Bregman, B, Vanderpuye-Orgle, J, Chowdhury, E, Gaudin, AF, and Kurt, M
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COST analysis , *NIVOLUMAB , *MELANOMA , *POSSIBILITY , *THERAPEUTICS - Published
- 2022
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28. PRO24 Cost Analysis for the Treatment of Fabry Disease with Agalsidase ALFA and Agalsidase Beta in Colombia.
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Londono, S., Pareja, M., and Becerra, J.
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ANGIOKERATOMA corporis diffusum , *COST analysis , *THERAPEUTICS - Published
- 2020
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29. Comparative study of surgical orchidectomy and medical castration in treatment efficacy, adverse effects and cost based on a large prospective metastatic prostate cancer registry.
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Tan, Yu Guang, Poon, Randy JY, Pang, Leonard JW, Villanueva, Andre, Huang, Hong Hong, Chen, Kenneth, Ng, Tze Kiat, Tay, Kae Jack, Ho, Henry SS, and Yuen, John SP
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CASTRATION-resistant prostate cancer , *TREATMENT effectiveness , *METASTASIS , *PROSTATE cancer , *THERAPEUTICS , *ASIANS , *RESEARCH , *ANTIANDROGENS , *RESEARCH methodology , *ACQUISITION of data , *SURGICAL complications , *MEDICAL cooperation , *EVALUATION research , *COMPARATIVE studies , *CASTRATION , *COST analysis , *PROSTATE tumors , *LONGITUDINAL method - Abstract
Introduction: Androgen deprivation therapy (ADT) remains the mainstay of treatment for metastatic prostate cancer (mPCa) but is associated with significant morbidities. Comparisons of medical castration (MC) and surgical orchidectomy (SO) have yielded varied results. We aimed to evaluate the oncological outcomes, adverse effect (AE) profiles and costs of MC and SO in patients with mPCa.Methods and Materials: We reviewed 523 patients who presented with de novo mPCa from a prospectively maintained prostate cancer database over 15 years (2001-2015). All patients received ADT (either MC or SO) within 3 months of diagnosis. The data were analyzed with chi-square, binary and logistics regression models.Results: One hundred and fifty one (28.9%) patients received SO while 372 (71.1%) patients had MC. The median age of presentation was 73 [67 -79] years old. The median prostate-specific antigen (PSA) was 280ng/ml [82.4-958]. Three hundred and thirty one patients (66.3%) had high volume bone metastasis and 57 patients (10.9%) had visceral metastasis. Clinical demographics and clinicopathological were similar across both groups. Similar oncological outcomes were observed in both groups. The proportion of PSA response (PSA <1ng/ml) was 65.6% for SO and 67.2% for MC (P = 0.212). Both therapies achieve >95% of effective androgen suppression (testosterone <50ng/dL). Time to castrate-resistance was similar (18 vs 16 months, P = 0.097), with comparative overall survival (42 vs. 38.5 months, P = 0.058) and prostate cancer mortality (80.1 vs. 75.9%, P = 0.328). Similarly, no difference was observed for the 4 AE profiles between SO and MC respectively; change in Haemoglobin (-0.75 vs. -1.0g/dL, P = 0.302), newly diagnosed Diabetes mellitus (4.6 vs. 2.9%, P = 0.281), control measured by HbA1c (0.2 vs. 0.25%, P = 0.769), coronary artery disease events (9.9 vs. 12.9%, P = 0.376) and skeletal-related fractures (9.3 vs. 7.3%, P = 0.476). After adjusting for varying governmental subsidies and inflation rates, the median cost of SO was $5275, compared to MC of $9185.80.Conclusion: Both SO and MC have similar oncological outcomes and AE profiles. However, SO remains a much more cost-effective form of ADT for the long-term treatment of mPCa patients. [ABSTRACT FROM AUTHOR]- Published
- 2020
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30. PUK4 COST UTILITY ANALYSIS OF END-STAGE RENAL DISEASE TREATMENT CHOICES (ETC) MODEL FOR CHRONIC MAINTENANCE DIALYSIS IN THE UNITED STATES.
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Cha, A.S., Zimmermann, M., and Hansen, R.
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CHRONIC kidney failure , *COST analysis , *THERAPEUTICS , *QUALITY-adjusted life years - Abstract
End-stage renal disease (ESRD) remains a substantial cost burden that currently affects less than 1% of US adults, while steadily accounting for approximately 7% of overall Medicare fee-for-service spending over the past 15 years. Costs were estimated from the societal and healthcare perspective for the 2018 US Medicare population in 1-year cycles over a lifetime time horizon with a 3% discount rate for all health outcome and cost inputs. From the healthcare system perspective, the ICER was $67,528/QALY from the healthcare perspective, which was most sensitive to annual home dialysis costs and patient utility. [Extracted from the article]
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- 2020
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31. Generic drugs: are they the future for affordable medicine?
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The Lancet Oncology, null and The Lancet Oncology
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GENERIC drugs , *DRUG prices , *CISPLATIN , *MULTIPLE sclerosis , *PHARMACEUTICAL industry , *INDUSTRIES , *FORECASTING , *MEDICAL care costs , *COST analysis , *ECONOMICS , *THERAPEUTICS - Published
- 2018
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32. P96 - Outcomes and Cost-Minimization Analysis of Cement Spacers and Expandable Cages for Posterior-Only Reconstruction of Metastatic Spine Corpectomies.
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Jordan, Yusef J., Buchowski, Jacob M., Mokkarala, Mahati, and Bumpass, David B.
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SPINAL surgery , *SPINE diseases , *MEDICAL care costs , *OPERATING rooms , *COST analysis , *THERAPEUTICS - Published
- 2017
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33. PMS34 - ESTIMATED COST OF BUPIVACAINE LIPOSOMAL INJECTABLE SUSPENSION IN MEDICARE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING PREMIER CHARGEMASTER DATA.
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Dagenais, S., Kang, A., and Scranton, R.
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BUPIVACAINE , *TOTAL hip replacement , *MEDICAL care costs , *COST analysis , *QUALITY of life , *LENGTH of stay in hospitals , *THERAPEUTICS - Published
- 2016
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34. PSY9 - DYNAMIC COST-UTILITY ANALYSIS FOR HEALTH TECHNOLOGY ASSESSMENT: A SYSTEMS DYNAMIC MODELING APPLICATION TO OPTIMIZE TREATMENTS FOR CHRONIC GRAFT VERSUS HOST DISEASE.
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Zia, A., Mesa, O.A., Peters, C., and Jones, C.A.
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GRAFT versus host disease , *COST analysis , *DRUG therapy , *IMATINIB , *RITUXIMAB , *MEDICAL technology , *DYNAMIC models , *THERAPEUTICS - Published
- 2016
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35. PIN19 - COST ANALYSIS OF RALTEGRAVIR VERSUS ATAZANAVIR/R OR DARUNAVIR/R FOR TREATMENT-NAIVE ADULTS WITH HIV-1 INFECTION IN THE UNITED STATES.
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Davis, A.E., Brogan, A.J., and Goodwin, B.B.
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HIV infections , *THERAPEUTICS , *RALTEGRAVIR , *ATAZANAVIR , *DARUNAVIR , *COST analysis ,DISEASES in adults - Published
- 2016
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36. PCN63 - Cost Per Responder Analysis from the Checkmate 025 Phase III Trial of Nivolumab Versus Everolimus in Previously Treated Patients with Advanced Renal Cell Carcinoma.
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Liu, JS, Bell, J, and Sumati, R
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RENAL cell carcinoma , *EVEROLIMUS , *COST analysis , *NEOVASCULARIZATION , *CLINICAL drug trials , *MEDICAL care costs , *PATIENTS , *THERAPEUTICS - Published
- 2016
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37. Cost Analysis of Proton Pump Inhibitors In The Treatment of Gastroesophageal Reflux Disease In Ukraine.
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Iakovlieva, L, Gerasymova, O, Mishchenko, O, Bezditko, N, Kyrychenko, O, and Kuznetsov, I
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PROTON pump inhibitors , *COST analysis , *GASTROESOPHAGEAL reflux , *LANSOPRAZOLE , *OMEPRAZOLE , *THERAPEUTICS - Published
- 2015
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38. Cost-Utility Analysis of Primary versus Revision Surgery for Adult Spinal Deformity.
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Raman, Tina, Kebaish, Khaled M., Skolasky, Richard L., and Nayar, Suresh
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SPINE abnormalities , *SPINAL surgery , *SURGICAL complications , *COST analysis , *HEALTH outcome assessment , *QUALITY of life , *MEDICAL care costs , *RETROSPECTIVE studies , *THERAPEUTICS - Published
- 2015
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39. External fixation design evolution enhances biomechanical frame performance.
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Sellei, Richard Martin, Kobbe, Philipp, Dadgar, Azad, Pfeifer, Roman, Behrens, Markus, von Oldenburg, Geert, and Pape, Hans-Christoph
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EXTERNAL skeletal fixation (Surgery) , *INJURIES of the anatomical extremities , *PELVIS , *OVERWEIGHT persons , *BIOLOGICAL evolution , *BIOMECHANICS , *MAGNETIC resonance imaging , *THERAPEUTICS , *DISEASES , *FRACTURE fixation , *KINEMATICS , *MATERIALS testing , *ORTHOPEDIC implants , *COST analysis , *PRODUCT design , *PHYSIOLOGIC strain , *WEIGHT-bearing (Orthopedics) ,EXTERNAL fixators - Abstract
Background: External fixation has become a quick and easy application for fracture stabilisation of the extremities and/or pelvis to maintain the reduction and provide stability while sparing the soft tissues. Over the last years, enhanced construct stiffness has become an essential requirement to preserve fracture reduction, particularly in active and overweight patients. This study was performed to determine whether the advancement of design features enhances the external fixation construct stiffness. The stiffness of the recently developed Hoffmann 3 external fixation system was determined and its characteristics compared with the widely clinically accepted Hoffmann II MRI fixation system.Methods: A synthetic fracture model was used. Two carbon tubes with a fracture gap of 20 mm were appropriate to determine the stiffness of three different configurations: the basic frame configuration (group H 3, representing Hoffmann 3 with a rod diameter of 11 mm) using a double rod construction with 6 mm Apex pins, was compared with the Hoffmann II MRI fixation system using two 8.0 mm diameter rods with 6 mm (group H II-6 mm) and 5 mm (group H II-5 mm) Apex pins. Each group was tested five times under anterior-posterior bending (N/mm), medio-lateral bending (N/mm) and axial torsion loading directions (Nm/deg). The stiffness results of each construct were compared statistically.Results: The basic frame construct (group H 3) showed consistently higher stiffness properties compared with the other configurations. The anterior-posterior-bending loads resulted in a mean value of 31 N/mm, which was significantly higher compared with the other groups (p=0.008) at 16 N/mm. The medio-lateral-bending test revealed a mean stiffness of 59 N/mm in the H3 group, compared with 43 N/mm in the H II-6 group and 31 N/mm in the H II-5 group. The axial torsion measurements of the Hoffmann 3 group yielded significantly higher results (1.03 Nm/°) compared with group H II-6 (0.61 Nm/°) and group H II-5 (0.56 Nm/°).Conclusions: The Hoffmann 3 construct showed the highest stiffness properties under bending and torsion loads. The enhanced stiffness of the Hoffmann 3 device may be helpful in maintaining fracture reduction and soft tissue compromise. This investigation showed the advancement of Hoffmann design features may be effective in enhancing frame stiffness. [ABSTRACT FROM AUTHOR]- Published
- 2015
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40. PSY22 - Cost analysis of Voriconazole versus Caspofungin for Primary Therapy of invasive Aspergillosis among High-Risk Hematologic Cancer Patients in China.
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Gao, X., Xue, M., Stephens, J., Chen, Y., Haider, S., and Charbonneau, C.
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COST analysis , *VORICONAZOLE , *ASPERGILLOSIS treatment , *INTRODUCED fungi , *HEMATOLOGIC malignancies , *HEMATOLOGY , *PATIENTS , *THERAPEUTICS - Published
- 2015
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41. Cost Analysis of two Aftercare Strategies in Chronic Continuous Intrathecal Baclofen Therapy in Patients with Intractable Spasticity.
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Burgers, L.T., Goslinga-van der Gaag, S.M.E, Delhaas, E.M., and Redekop, W.K.
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PATIENT aftercare , *BACLOFEN , *SPASTICITY , *COST analysis , *CAREGIVERS , *HOME care services , *THERAPEUTICS - Published
- 2014
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42. Short-Term Cost-Effectiveness Analysis of Insulin Detemir Versus Insulin Neutral Protamine Hagedorn (Nph) In Patients With Type 2 Diabetes Mellitus in Spain.
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Ramírez, de Arellano A., Morales, C., De, Luis D., Ferrario, M.G., and Lizán, L.
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TYPE 2 diabetes treatment , *INSULIN therapy , *COST effectiveness , *COST analysis , *PROTAMINES , *THERAPEUTICS - Published
- 2014
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43. COST- MINIMIZATION ANALYSIS OF THE DIRECT COSTS OF SEVELAMER CARBONATE AND LANTHANUM CARBONATE IN THE TREATMENT OF CKD-ND PATIENTS.
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Petrov, M.K., Dimitrova, M., and Petrova, G.I.
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KIDNEY disease treatments , *LANTHANUM compounds , *DISEASE prevalence , *HEMODIALYSIS , *MEDICAL care costs , *COST analysis , *DIRECT costing , *THERAPEUTICS - Published
- 2014
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44. Cost-Utility Analysis Of Carotid Artery Stenting Versus Endarterectomy For Symptomatic Carotid Stenosis Patients.
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Oh, SH, You, J.H., Lee, J.Y., Park, J.J., Shin, S., and Oh, S H
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ENDARTERECTOMY , *COST analysis , *MEDICAL care costs , *RETROSPECTIVE studies , *PATIENTS , *THERAPEUTICS ,CAROTID artery stenosis - Published
- 2014
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45. Cost-Utility Analysis Of Fidaxomicin Compared To Vancomycin In The Management Of Severe Clostridium Difficile Infection In Poland.
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Petryszyn, P. and Well, A.
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CLOSTRIDIOIDES difficile , *BACTERIAL diseases , *VANCOMYCIN , *DRUG prices , *COST analysis , *FIDAXOMICIN , *THERAPEUTICS - Published
- 2014
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46. Cost-Utility Analysis of Varenicline Versus Existing Smoking Cessation Strategies in Korea.
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Park, D.J., Kim, Y.H., and Kim, E.J.
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COST analysis , *VARENICLINE , *SMOKING cessation , *BUPROPION , *CLINICAL trials , *THERAPEUTICS - Published
- 2014
- Full Text
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