Economic analysis of chronic diseases is required for proper allocation of resources and understanding costeffectiveness studies of new therapies. Studies on health care cost of ulcerative colitis （UC） and Crohn＇s ...Economic analysis of chronic diseases is required for proper allocation of resources and understanding costeffectiveness studies of new therapies. Studies on health care cost of ulcerative colitis （UC） and Crohn＇s disease （CD） are reviewed here. These studies were carried out in various countries with disparate health care systems. In the United States, data were often modeled or retrieved from large insurance schemes. Surgery and in-patient hospitalization accounted for over half the outlay on UC and CD. Fistulous disease in CD and parenteral nutrition were very costly. In Canada, overall charges were lower than in the United States, but there too, surgical costs were relatively high. In European studies, economic data were abstracted directly from patients＇ files. One pan-European study examined the outlay on UC and CD in a community-based prospective inception cohort followed for 10 years. Overall costs in Europe were lower than in the United States. Surgery, hospitalization, year of follow-up, disease phenotype in CD and ASCA-positivity impacted significantly on costs. In all studies, the cost data were right skewed, aminosalicylates were expensive drugs, and biological agents the most expensive; moreover indirect costs were not calculated. Infliximab raised costs considerably in CD, but there were no long-term followup studies, so that the cost-benefit of biological agents remains unknown. In conclusion, costs of managing UC and CD vary by country, surgery, genotype and several other factors. The most important question for further research is whether the biological therapies are cost-effective in the long-term.展开更多
EndoSheath bronchoscopy（Vision Sciences,Inc.） uses a sterile,disposable microbial barrier that may meet the growing needs for safe,efficient,and cost effective flexible bronchoscopy.The purpose of this open-label co...EndoSheath bronchoscopy（Vision Sciences,Inc.） uses a sterile,disposable microbial barrier that may meet the growing needs for safe,efficient,and cost effective flexible bronchoscopy.The purpose of this open-label comparative study was to compare and calculate the costs-per-airway-procedure of the reusable fiberscope when used with and without EndoSheath Technology;and to record the turnover time from the completion of the use of each scope until its readiness again for the next use.Seventy-five new patients’ airways requiring airway maneuvers and manipulations with Vision Sciences,Inc.,reusable fiberscope with EndoSheath Technology were evaluated for the costs comparisons with reassessed historical costs data for Olympus scope assisted tracheal intubations.As compared to costs of an intubation（$158.50） with Olympus scope at our institute,the intubation costs with Vision Sciences,Inc.,reusable fiberscope with EndoSheath technology was $81.50（P 〈 0.001）.The mean turnover time was 5.44 min with EndoSheath technology as compared to previously reported 30 min with Olympus fiberscope（P 〈 0.001）.Based on our institutional experience,Vision Sciences,Inc.,reusable fiberscope with EndoSheath technology is significantly cost effective as compared to the Olympus scope with significantly improved turnover times.展开更多
We proposed a retrospective cost analysis of patients hospitalized in the intensive care unit of San Leonardo Hospital （Southern-Italy）, stratified for diagnostic groups at hospital admission in 2010, from National ...We proposed a retrospective cost analysis of patients hospitalized in the intensive care unit of San Leonardo Hospital （Southern-Italy）, stratified for diagnostic groups at hospital admission in 2010, from National Health Service perspective. The cost analysis was performed on patients with a length of stay longer than 24 hours. Direct medical costs were estimated： hospitalization costs and surgical procedures were calculated by tariff system DRG （diagnosis related group） while device-related costs were provided by the management of the hospital pharmacy. In order to evaluate the burden of the diagnostic groups, we used two indicators proposed by Rossi C. et al.： cost per surviving patient and money loss per patient. The most frequent admission diagnoses were edema （16.4%） and left heart failure （13.9%）. There was a wide variation in the mean costs per patient （from 62,777 for stroke to 67,227 for nephro-urological disease）. Intracranial bleeding had the highest cost for dead and survived patients, whereas neurological diseases and COPD （chronic obstructive pulmonary disease） had the lowest costs, indicating a better efficiency. Our findings are a starting point for further investigations aimed at the exploitation of resources that are currently being absorbed by ICU （intensive care unit）, in order to provide patients with the best possible healthcare.展开更多
Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society.In this paper we modelled and simulated a test-trace-andquarantine strategy to control the COVID-19 outbr...Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society.In this paper we modelled and simulated a test-trace-andquarantine strategy to control the COVID-19 outbreak in the State of São Paulo,Brasil.The State of São Paulo failed to adopt an effective social distancing strategy,reaching at most 59%in late March and started to relax the measures in late June,dropping to 41%in 08 August.Therefore,São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic.Two alternative strategies combined with economic evaluations were simulated.One strategy included indiscriminately testing the entire population of the State,reaching more than 40 million people at a maximum cost of 2.25 billion USD,that would reduce the total number of cases by the end of 2020 by 90%.The second strategy investigated testing only symptomatic cases and their immediate contacts e this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%.The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st,it would have been possible to reduce the total number of cases by 90%at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts.展开更多
文摘Economic analysis of chronic diseases is required for proper allocation of resources and understanding costeffectiveness studies of new therapies. Studies on health care cost of ulcerative colitis （UC） and Crohn＇s disease （CD） are reviewed here. These studies were carried out in various countries with disparate health care systems. In the United States, data were often modeled or retrieved from large insurance schemes. Surgery and in-patient hospitalization accounted for over half the outlay on UC and CD. Fistulous disease in CD and parenteral nutrition were very costly. In Canada, overall charges were lower than in the United States, but there too, surgical costs were relatively high. In European studies, economic data were abstracted directly from patients＇ files. One pan-European study examined the outlay on UC and CD in a community-based prospective inception cohort followed for 10 years. Overall costs in Europe were lower than in the United States. Surgery, hospitalization, year of follow-up, disease phenotype in CD and ASCA-positivity impacted significantly on costs. In all studies, the cost data were right skewed, aminosalicylates were expensive drugs, and biological agents the most expensive; moreover indirect costs were not calculated. Infliximab raised costs considerably in CD, but there were no long-term followup studies, so that the cost-benefit of biological agents remains unknown. In conclusion, costs of managing UC and CD vary by country, surgery, genotype and several other factors. The most important question for further research is whether the biological therapies are cost-effective in the long-term.
基金partially funded by Vision Sciences,Inc.,Orangeburg,New York,USA.No financial interests were reported
文摘EndoSheath bronchoscopy（Vision Sciences,Inc.） uses a sterile,disposable microbial barrier that may meet the growing needs for safe,efficient,and cost effective flexible bronchoscopy.The purpose of this open-label comparative study was to compare and calculate the costs-per-airway-procedure of the reusable fiberscope when used with and without EndoSheath Technology;and to record the turnover time from the completion of the use of each scope until its readiness again for the next use.Seventy-five new patients’ airways requiring airway maneuvers and manipulations with Vision Sciences,Inc.,reusable fiberscope with EndoSheath Technology were evaluated for the costs comparisons with reassessed historical costs data for Olympus scope assisted tracheal intubations.As compared to costs of an intubation（$158.50） with Olympus scope at our institute,the intubation costs with Vision Sciences,Inc.,reusable fiberscope with EndoSheath technology was $81.50（P 〈 0.001）.The mean turnover time was 5.44 min with EndoSheath technology as compared to previously reported 30 min with Olympus fiberscope（P 〈 0.001）.Based on our institutional experience,Vision Sciences,Inc.,reusable fiberscope with EndoSheath technology is significantly cost effective as compared to the Olympus scope with significantly improved turnover times.
文摘We proposed a retrospective cost analysis of patients hospitalized in the intensive care unit of San Leonardo Hospital （Southern-Italy）, stratified for diagnostic groups at hospital admission in 2010, from National Health Service perspective. The cost analysis was performed on patients with a length of stay longer than 24 hours. Direct medical costs were estimated： hospitalization costs and surgical procedures were calculated by tariff system DRG （diagnosis related group） while device-related costs were provided by the management of the hospital pharmacy. In order to evaluate the burden of the diagnostic groups, we used two indicators proposed by Rossi C. et al.： cost per surviving patient and money loss per patient. The most frequent admission diagnoses were edema （16.4%） and left heart failure （13.9%）. There was a wide variation in the mean costs per patient （from 62,777 for stroke to 67,227 for nephro-urological disease）. Intracranial bleeding had the highest cost for dead and survived patients, whereas neurological diseases and COPD （chronic obstructive pulmonary disease） had the lowest costs, indicating a better efficiency. Our findings are a starting point for further investigations aimed at the exploitation of resources that are currently being absorbed by ICU （intensive care unit）, in order to provide patients with the best possible healthcare.
基金This work was partially supported by the project ZikaPLAN,funded by the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No.734584LIM01-HFMUSP,CNPq and FAPESP and Fundacao Butantan.
文摘Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society.In this paper we modelled and simulated a test-trace-andquarantine strategy to control the COVID-19 outbreak in the State of São Paulo,Brasil.The State of São Paulo failed to adopt an effective social distancing strategy,reaching at most 59%in late March and started to relax the measures in late June,dropping to 41%in 08 August.Therefore,São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic.Two alternative strategies combined with economic evaluations were simulated.One strategy included indiscriminately testing the entire population of the State,reaching more than 40 million people at a maximum cost of 2.25 billion USD,that would reduce the total number of cases by the end of 2020 by 90%.The second strategy investigated testing only symptomatic cases and their immediate contacts e this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%.The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st,it would have been possible to reduce the total number of cases by 90%at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts.
