Background: Open-group behavioral weight management programs are effective in the short term but longer term outcomes are unclear. We conducted the first randomized controlled trial to evaluate the ...5-year effectiveness and cost-effectiveness of a commercial opengroup intervention versus standard care. Methods: We randomized 1267 adults from English primary care practices with BMI>=28kg/m2 to either a brief intervention, 12-week behavioral program, or 52-week behavioral program in a 2:5:5 allocation. We followed them up 5 years later. We estimated adjusted differences in 5-year weight change between randomized groups using ANCOVA, assessed within-trial cost-effectiveness, and modeled long-term cost-effectiveness. This study is registered: ISRCTN64986150. Results: We ascertained weight for 871 (69%) participants. Mean (SD) weight change from baseline to 5 years was -0.46kg (8.31) in the brief intervention group, -1.95kg (9.55) in the 12-week program group, and -2.67kg (9.81) in the 52-week program. The adjusted difference (95%CI) was -1.76kg (-3.68, 0.17) between the 52-week program and the brief intervention; -0.96 kg (-2.90, 0.97) between the 12-week program and the brief intervention; and -0.80kg (-2.13, 0.54) between the 52-week and the 12-week program. There was no evidence of any differences between groups in fat mass, glycated hemoglobin, lipid profile and blood pressure. During the study, the 12-week program incurred the lowest cost and produced the highest Quality Adjusted Life Years (QALY). Modeling of clinical events beyond 5 years, suggested the 52-week program would deliver the highest QALYs at the lowest cost. Conclusions: Whilst 5-year differences in weight were not conclusive, they counter the common belief that all weight lost is quickly regained. Although there was no evidence within the trial that cardiovascular risk factors improved, long-term modeling suggests that commercial open-group behavioral programs are likely to reduce the incidence of weight-related disease and may be cost-saving.
Financial Management for Health-System Pharmacists, 2nd edition, serves as a guidebook to support the management of enterprise pharmacy finance across business and care continuums. The 2nd edition ...engages the reader with a mix of chapters, some new to this edition, along with a trove of new health-system pharmacy financial business cases. As leaders look to transform their organizations, the principles and practices provided give the reader the knowledge and guidance to craft a new path forward as they look to improve the provision of pharmacy and patient-care services.
Background: Interventions are regularly developed, packaged, and tested aimed at increasing the effectiveness of clinical treatment for adolescents with obesity, but the cost-effectiveness of these ...strategies are less frequently established. Few studies have reported the methods employed and challenges faced when establishing the costs these interventions. The objective of this study is to conduct an economic evaluation of two different obesity intervention programs. This study will establish the economic costs for delivering these programs and the cost basis for a cost-effectiveness analysis of these programs. Methods: Two interventions were developed aimed at increasing the effectiveness of clinical obesity treatment for adolescents. The first (ImPACT), was designed as a compliment to the Brenner Families in Training (BFIT) pediatric weight management clinic, with mHealth components designed to increase self-monitoring, goal setting, and engagement with the clinical team through provision of accessible, educational materials and behavioral self-monitoring tools. The second (Dyad Plus), is a compliment to the youth serving BFIT program and the adult serving By Design Essentials, a weight management clinic for the adult caregiver. Dyad Plus includes six additional virtual lessons for the parent/child dyad designed to build communication skills to reinforce the goals and behavior change strategies taught at each clinic. Economic costs associated with both interventions were collected, evaluated, and calculated. Results: Four types of costs were assessed for each intervention: medical vs. non-medical, and direct vs. non-direct. Costs that were considered unique to conducting the research project were excluded from the cost analysis. Challenges related to the tailored nature of the clinic services and delineation of non-direct costs were encountered. Conclusions: This economic evaluation technique can serve as an example for other investigators who plan to conduct similar economic assessments for their clinical interventions.
Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments ...related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of whether and how to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.
Despite the unprecedented therapeutic potentials of extracellular vesicles derived from mesenchymal stem cells, it is still early in their development and transition towards clinical applications. ...Integrating scalable upstream and downstream cGMP-compatible technologies is critical for developing reliable and cost-effective EV manufacturing pipelines that meet commercial and clinical demands. We have developed an EV bioprocess economic model to support the bioprocess optimization while minimizing financial and technological risks in EV manufacturing.
To develop any economic model, an actual bioprocess run is required as the base case. Therefore, we performed an end to end and scalable 2L bioprocess run for EVs derived from MSCs as the base case. In summary, the upstream included MSCs expansion, growth, and collection phases (10 days total) in a 2L bioreactor. Downstream processing consisted of a combination of clarification/filtration, tangential flow filtration, and anion exchange chromatography steps. From the experimental recovery data, %15 total EV recovery and production of 1000 EVs per cell were used as inputs for the model at different scales (2, 15, 50 and 150L). Since, a wide range of EV doses have been reported in different pre-clinical and clinical data, we performed our cost analysis based on 3 different EV doses, 2E8,1E9, and 1E10 EVs.
Downstream processing is around 10% of the total cost and the upstream processing is the main contributor (90%) with media costing 50% of that.
We also compared the cost of MSC-EV therapy with MSC therapy alone. At the highest dose ( EVs), the cost of MSC-EV therapy is 10 times higher than MSC therapy, but it becomes comparable or cheaper at the lower doses.
We studied the effect of total EV recovery on the cost. Our analysis suggested that increasing the recovery from 15% to 30% drops the cost to 50%. However, the cost reaches almost a plateau beyond 40% total EV recovery.
In conclusion, this model is a fundamental tool to guide researchers in the EV bioprocess design. Furthermore, this model will allow us to compare EV based therapeutic approaches against viral vector based and lipid nanoparticle-based drug delivery systems.
Background
Robotic surgical systems have been used at a rapidly increasing rate in general surgery. Many of these procedures have been performed laparoscopically for years. In a surgical encounter, a ...significant portion of the total costs is associated with consumable supplies. Our hospital system has invested in a software program that can track the costs of consumable surgical supplies. We sought to determine the differences in cost of consumables with elective laparoscopic and robotic procedures for our health care organization.
Methods
De-identified procedural cost and equipment utilization data were collected from the Surgical Profitability Compass Procedure Cost Manager System (The Advisory Board Company, Washington, DC) for our health care system for laparoscopic and robotic cholecystectomy, fundoplication, and inguinal hernia between the years 2013 and 2015. Outcomes were length of stay, case duration, and supply cost. Statistical analysis was performed using a
t
-test for continuous variables, and statistical significance was defined as
p
< 0.05.
Results
The total cost of consumable surgical supplies was significantly greater for all robotic procedures. Length of stay did not differ for fundoplication or cholecystectomy. Length of stay was greater for robotic inguinal hernia repair. Case duration was similar for cholecystectomy (84.3 robotic and 75.5 min laparoscopic,
p
= 0.08), but significantly longer for robotic fundoplication (197.2 robotic and 162.1 min laparoscopic,
p
= 0.01) and inguinal hernia repair (124.0 robotic and 84.4 min laparoscopic,
p
= ≪0.01).
Conclusions
We found a significantly increased cost of general surgery procedures for our health care system when cases commonly performed laparoscopically are instead performed robotically. Our analysis is limited by the fact that we only included costs associated with consumable surgical supplies. The initial acquisition cost (over $1 million for robotic surgical system), depreciation, and service contract for the robotic and laparoscopic systems were not included in this analysis.
PDF
