Objective Non-invasive prenatal testing (NIPT) based on cell-free fetal DNA (cffDNA) is highly accurate in the detection of common fetal autosomal trisomies. Aim of this project was to investigate short-term costs and clinical outcomes of the contingent use of cffDNA for prenatal screening of trisomies 21, 18, 13 within a national health service (NHS). Methods An economic analysis was developed from the perspective of the Italian NHS to compare two possible scenarios for managing pregnant women: women managed according to the Standard of Care screening (SoC) vs a cffDNA scenario, where Harmony Prenatal Test was introduced as a second line screening choice for women with an “at risk” result from SoC screening. Results The introduction of cffDNA as a second line screening test, conditional to a risk ≥ 1:1,000 from SoC screening, showed a 3% increase in the detection of trisomies, with a 71% decrease in the number of invasive tests performed. Total short-term costs (pregnancy management until childbirth) decreased by € 19 million (from € 84.5 to 65.5 million). Conclusion The adoption of the Harmony Prenatal Test in women resulting at risk from SoC screening, implied a greater number of trisomies detection, together with a reduction of the healthcare costs.
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Objectives: On-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system has been shown to be a safe and clinically promising therapy for the treatment of chronic cluster headache. Our objective was to estimate changes in cluster headache medication cost observed in patients treated with the ATI PULSANTE Neurostimulation System, using baseline and 12-month utilization data from the recent Pathway registry and United Kingdom drug costs for reference. MethOds: Detailed patient-level data of n= 71 chronic cluster headache patients followed through 12 months in Pathway R1 (NCT01677026) were analyzed to assess weekly utilization of acute cluster headache medications at baseline and 12 months. Cost estimates for all drug/dosage combinations were developed based on current 2017 pharmaceutical prices published in the British National Formulary (BNF 73, 2017), and used the lowest priced product and largest available package size in each instance to determine cost. Results: In the patients receiving SPG stimulation treatment, overall weekly medication costs per patient were reduced by 54.8% from £197.60 to £89.42 (-£108.20) from baseline to 12 months. Under a steady-state assumption, the observed drug cost reductions resulted in annualized acute drug cost savings to the U.K. National Health Service (NHS) of £5,626 (reduction from £10,276 to £4,650 per year). cOnclusiOns: Our analysis suggests that SPG stimulation for the treatment of chronic cluster headache is associated with pronounced reductions in acute cluster headache medication usage, leading to sizable annual savings in medication costs for the United Kingdom's NHS. On the basis of prior clinical studies investigating SPG therapy, these reductions stem from both effective treatment of attacks with stimulation, and also a reduction in attack frequency observed in stimulation-treated patients.
OBJECTIVES: Electrocardiograph (ECG) systems used during and after coronary artery bypass graft (CABG) surgery can be reusable (rECG) or single-patient-use (spECG). Standard of care rECG has been shown to be contaminated in 33-77% of cases, increasing the surgical site infection (SSI) risk. SSIs are an NHS England care quality indicator. Avoidable SSIs within 30 days of CABG are not reimbursed. As spECG can significantly reduce SSI post-CABG, how would full transition to spECG impact NHS budgets? METHODS: A 1-year Markov model was informed by published literature and patient data from Hospital Episode Statistics 2016-2017: mean characteristics of age 67.5 years, 19% female, and 28% obese. Health states included CABG, mechanical ventilation, intensive care unit (ICU), general ward, SSI, deepsternal wound infection (DSWI), outpatient, and deceased. In-hospital, ECG monitoring was used for 4 days. By day 11 post-CABG, 2.15% of rECG and 1.60% of spECG patients would develop an SSI. SSI and DSWI increased length of stay (LOS) by 11 and 23 days, respectively. Outpatient SSI resulted in readmission or outpatient care. Costs and payments (2017 GBP) from NHS tariffs and published literature. RESULTS: The mean annual cost of care was £7,352 per patient with rECG and reduced by £73 (1%) with use of spECG. Cost reduction was driven by reduced SSI resulting in shorter LOS. With a reduction of 3.7 ICU days and 1.5 readmissions per 100 CABG patients. Fewer readmissions reduced hospital revenue by mean £35 per patient, but overall spECG increased hospital profits: +£38 per patient. Following 2,000 simulations, results showed significance at p<0.05. The median saving was $16,514 (95% credible interval $5,200 to $48,326). CONCLUSIONS: Driven by lower SSI incidence, use of spECG systems in the NHS are expected to result in reduced revenue and costs and increased profit for hospitals PMD33 BUDGET IMPACT ANALYSIS OF A DUAL-LAYER STENT RETRIEVER OBJECTIVES: The National Institute for Health and Care Excellence (NICE) recommends mechanical clot retrieval (MCR) for the treatment of acute ischemic stroke (AIS). Recently, a large clinical trial in AIS patients treated with a dual-layer stent retriever (DLSR) reported excellent functional independence outcomes, an important goal of stroke therapy that impacts patient quality of life. While the clinical benefits of MCR have been demonstrated, studies assessing the economic implications of technology selection are limited. Thus, this study estimated the budget impact of adopting a DLSR for patients with AIS from a 12-month National Health Service (NHS) perspective. METHODS: The analysis compared a cost scenario considering a DLSR to a scenario with single-layer stent retrievers only, assuming a 25% adoption rate of DSLR. Acute (90-day) healthcare costs based on patient functional independence measured using the modified Rankin Scale (mRS) were included. Index procedure costs were limited to the acquisition cost of MCR technology, as evidence indicates other procedural resources to be similar...
with NBI or WLI cystoscopy. Based on diagnostic accuracy, patients are classified as: true positive (TP), true negative (TN), false positive (FP), or false negative (FN). Patients with a NMIBC diagnosis undergo transurethral resection of bladder tumor (TURBT), while patients diagnosed as cancer-free receive standard monitoring. After one year of observation, patients are stratified into three states: i) cancer-free; ii) recurrence; iii) non-diagnosed NMIBC. Patients with recurrence or non-diagnosed NMIBC can progress from non-invasive to invasive bladder cancer. The model considers hospital costs related to equipment, reprocessing, maintenance, consumables / medication, staff, TURBT, recurrence management and disease progression. A micro-costing approach was adopted to calculate cystoscopy costs. RESULTS: NBI reduced the recurrence rate vs. WLI (16.9% vs. 37.4%, respectively), and resulted in cost-savings of £9,046 (overall costs: £170,577 vs. £179,623, respectively). More NIMBC cases were detected with NBI vs. WLI (81 vs. 69 TP cases, respectively), resulting in increased TURBT costs (£19,309; £127,614 vs. £108,305, respectively). However, increased TURBT costs were offset by the reduction of recurrences, which determined cost-savings of £28,355 (£23,282 with NBI; £51,637 with WLI). CONCLUSIONS: This analysis suggests that NBI is dominant vs. WLI for detection and support during the treatment of NMIBC in UK hospitals.
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