AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo per...AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.展开更多
Objective: The study was conducted to assess the implementation of a psychiatric consultation-liaison service (C-L) from the perspective of cost-savings, staff satisfaction, patient satisfaction and to assess the gene...Objective: The study was conducted to assess the implementation of a psychiatric consultation-liaison service (C-L) from the perspective of cost-savings, staff satisfaction, patient satisfaction and to assess the general features of patients referred to the C-L service. Methodology: Cost-savings were evaluated using a large cohort of referrals to the hospital were identified using data derived from the Institute of Clinical Evaluative Sciences (N = 2246);these data were divided into pre and post periods with respect to imitation of the C-L service. To evaluate staff satisfaction, 170 nurses and physicians completed an online survey. Patient satisfaction was assessed through a survey assessing various aspects of their experiences with the C-L service that was completed by each patient (N = 40). Finally referrals to the C-L service (N = 445) were analyzed to discern indicators of the C-L service’s efficacy (i.e. reasons for referral, time to accommodate referral). Results: The data indicated: 1) a reduction in the number of re-admissions and length of stay after the initiation of the C-L service translating into significant cost-savings for the hospital, 2) that increased staff satisfaction was associated with providing confidence, support, and improved communication, and 3) that the C-L service accommodated approximately 90% of patients within 1 day. Conclusion: The results of this study support stakeholders’ decisions to implement C-L services and also indicate areas of improvement that may improve the quality of C-L services within other institutions.展开更多
Objective: To conduct a cost analysis of pedestrian injuries at zebra crossings (marked lines only) in Stockholm city during 2008, and propose an intervention for reducing these incidents. Cost savings for the interve...Objective: To conduct a cost analysis of pedestrian injuries at zebra crossings (marked lines only) in Stockholm city during 2008, and propose an intervention for reducing these incidents. Cost savings for the intervention are calculated and presented. Method: A Cost of Illness (COI) method was used to calculate the cost for pedestrian injuries at zebra crossings. Cost of Illness included direct and indirect costs and excluded intangible costs due to lack of data. Data and statistics from STRADA, PAR and calculations from MSB were used to perform the COI. Results: During 2008, 73 pedestrians were injured at zebra crossings in Stockholm city, amounting an estimated social cost of 10.8 million Swedish Krona (SEK) (severe injuries 9.2 million SEK, minor injuries 1.6 million SEK). The costs for reducing pedestrian injuries and related social burden via the proposed intervention (zebra crossings constructed alongside asphalt speed bumps with adjacent lights on both sides of the crossing) were estimated to be 250,000 SEK at roads without intersections, and 1.6 million SEK at roads with an intersection. Conclusion: Pedestrian injuries place a large financial burden on society each year. It is recommended to add speed bumps and adjacent lights to zebra crossings where most pedestrian injuries occur. The intervention would reduce pedestrian injuries and also decrease the cost for the society due to these injuries. Cost savings for the intervention depend on the kind of injury avoided and what kind of road the intervention is built on.展开更多
Background: Tuberculosis (TB) diagnostics, such as Xpert MTB/RIF, is still limited by cost. Testing of pooled samples from presumptive TB patients has been thought as a cost-saving strategy to diagnose TB. We assessed...Background: Tuberculosis (TB) diagnostics, such as Xpert MTB/RIF, is still limited by cost. Testing of pooled samples from presumptive TB patients has been thought as a cost-saving strategy to diagnose TB. We assessed the utility and cost-saving of pooled Xpert MTB/RIF testing strategy for the diagnosis of TB in Mwanza, Tanzania. Methods: Sputum samples from Presumptive TB patients were submitted to TB laboratory for routine diagnosis of TB using Xpert MTB/RIF. The TB results from the individual sputum samples were used as the reference standard and were concealed to the investigating laboratory technicians. The remainder of samples were collected serially and were pooled (5 samples per pool) for testing. The agreement of the results between individual sample testing against pooled sample testing and cost-savings was assessed. Results: A total of 250 sputum samples from presumptive TB patients were analyzed and 50 pools were made with each pool containing 5 samples. Of the 50 sputum pools made, Mycobacterium tuberculosis (MTB) was detected in 17 (34.0%) pools. Results from the individual sputum samples MTB/RIF testing were retrieved for all 250 samples and there were 28 (11.2%) samples in which MTB was detected whereas 222 (88.8%) samples had no MTB detected. Following re-analysis of positive pools, all 28 (100%) individual positive MTB samples were detected within the 17 positive pools, with 1 to 3 individual MTB positive samples per pool. The individual sputum samples were correctly identified by pooled sputum on Xpert MTB/RIF testing, with the sensitivity of 100% and specificity of 100%. Using pooling of sputum samples strategy, we saved 46.0% (115/250) of the cartridges. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0% and has the potential to increase the affordability of Xpert MTB/RIF testing in countries with limited resources, such as Tanzania.展开更多
文摘AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.
文摘Objective: The study was conducted to assess the implementation of a psychiatric consultation-liaison service (C-L) from the perspective of cost-savings, staff satisfaction, patient satisfaction and to assess the general features of patients referred to the C-L service. Methodology: Cost-savings were evaluated using a large cohort of referrals to the hospital were identified using data derived from the Institute of Clinical Evaluative Sciences (N = 2246);these data were divided into pre and post periods with respect to imitation of the C-L service. To evaluate staff satisfaction, 170 nurses and physicians completed an online survey. Patient satisfaction was assessed through a survey assessing various aspects of their experiences with the C-L service that was completed by each patient (N = 40). Finally referrals to the C-L service (N = 445) were analyzed to discern indicators of the C-L service’s efficacy (i.e. reasons for referral, time to accommodate referral). Results: The data indicated: 1) a reduction in the number of re-admissions and length of stay after the initiation of the C-L service translating into significant cost-savings for the hospital, 2) that increased staff satisfaction was associated with providing confidence, support, and improved communication, and 3) that the C-L service accommodated approximately 90% of patients within 1 day. Conclusion: The results of this study support stakeholders’ decisions to implement C-L services and also indicate areas of improvement that may improve the quality of C-L services within other institutions.
文摘Objective: To conduct a cost analysis of pedestrian injuries at zebra crossings (marked lines only) in Stockholm city during 2008, and propose an intervention for reducing these incidents. Cost savings for the intervention are calculated and presented. Method: A Cost of Illness (COI) method was used to calculate the cost for pedestrian injuries at zebra crossings. Cost of Illness included direct and indirect costs and excluded intangible costs due to lack of data. Data and statistics from STRADA, PAR and calculations from MSB were used to perform the COI. Results: During 2008, 73 pedestrians were injured at zebra crossings in Stockholm city, amounting an estimated social cost of 10.8 million Swedish Krona (SEK) (severe injuries 9.2 million SEK, minor injuries 1.6 million SEK). The costs for reducing pedestrian injuries and related social burden via the proposed intervention (zebra crossings constructed alongside asphalt speed bumps with adjacent lights on both sides of the crossing) were estimated to be 250,000 SEK at roads without intersections, and 1.6 million SEK at roads with an intersection. Conclusion: Pedestrian injuries place a large financial burden on society each year. It is recommended to add speed bumps and adjacent lights to zebra crossings where most pedestrian injuries occur. The intervention would reduce pedestrian injuries and also decrease the cost for the society due to these injuries. Cost savings for the intervention depend on the kind of injury avoided and what kind of road the intervention is built on.
文摘Background: Tuberculosis (TB) diagnostics, such as Xpert MTB/RIF, is still limited by cost. Testing of pooled samples from presumptive TB patients has been thought as a cost-saving strategy to diagnose TB. We assessed the utility and cost-saving of pooled Xpert MTB/RIF testing strategy for the diagnosis of TB in Mwanza, Tanzania. Methods: Sputum samples from Presumptive TB patients were submitted to TB laboratory for routine diagnosis of TB using Xpert MTB/RIF. The TB results from the individual sputum samples were used as the reference standard and were concealed to the investigating laboratory technicians. The remainder of samples were collected serially and were pooled (5 samples per pool) for testing. The agreement of the results between individual sample testing against pooled sample testing and cost-savings was assessed. Results: A total of 250 sputum samples from presumptive TB patients were analyzed and 50 pools were made with each pool containing 5 samples. Of the 50 sputum pools made, Mycobacterium tuberculosis (MTB) was detected in 17 (34.0%) pools. Results from the individual sputum samples MTB/RIF testing were retrieved for all 250 samples and there were 28 (11.2%) samples in which MTB was detected whereas 222 (88.8%) samples had no MTB detected. Following re-analysis of positive pools, all 28 (100%) individual positive MTB samples were detected within the 17 positive pools, with 1 to 3 individual MTB positive samples per pool. The individual sputum samples were correctly identified by pooled sputum on Xpert MTB/RIF testing, with the sensitivity of 100% and specificity of 100%. Using pooling of sputum samples strategy, we saved 46.0% (115/250) of the cartridges. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0% and has the potential to increase the affordability of Xpert MTB/RIF testing in countries with limited resources, such as Tanzania.
