A VBBD program that reduced the copayment for diabetes medications by 36.1% reduced the number of nonadherent patients by 30.0%.
The objective of this study was to evaluate the budget impact of a new prostate cancer risk index for detecting prostate cancer. The index is calculated as the combination of serum prostate-specific antigen (PSA), free PSA and a precursor form p2PSA. We constructed two budget impact models using PSA cutoff values of X2 ng ml À1 (model #1) and X4 ng ml À1 (model #2) for recommending a prostate biopsy in a hypothetical health plan with 100 000 male members aged 50-75 years old. The budgetary impact on the 1-year expected total costs for prostate cancer detection was calculated. Adding the index to the current PSA prostate cancer testing strategies including the total PSA and percent free PSA, the number of detected cancer cases decreased by 20 and 5, in models #1 and #2, respectively. The savings on expected 1-year cost for prostate cancer detection were $356 647 (or $0.30 per-member-per-month (PMPM)) in model #1 and $94 219 ($0.08 PMPM) in model #2. The index produced higher cost savings in the model #1 with PSA cutoff X2 ng ml À1 than the model #2 with cutoff X4 ng ml À1 with a small short-term reduction in the number of positive tests.
treatment initiation to their time of death or at age of 100 years. The model consisted of eight health states: well, hip fracture, vertebral fracture, wrist fracture, other osteoporotic fracture, post hip fracture, post vertebral fracture, and dead. All patients began in the well health state. The 5% discounted rate, two-year maximum offset time and persistence were adopted in this model. RESULTS: Total life time cost for alendronate and denosumab were USD 5,564 and USD 6,086, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus alendronate was USD 8,283/ QALY, Given the ICER threshold in Korea, the result showed that denosumab was dominant over alendronate. CONCLUSIONS: Denosumab is a cost-effective alternative over the oral anti-osteoporotic treatment, alendronate in South Korea.
The surgical approach was laparoscopic in 57.3% patients, and open in 42.7% patients. Mean cost per discharge was significantly higher in open thoracic procedures compared to laparoscopic procedures, $24,995 vs. $19,238, respectively(pϽ0.001). Patients undergoing laparoscopic thoracic procedures had a significantly lower rate of surgical site infections compared to patients who underwent open procedures (4.8% vs. 5.8%, respectively, pϽ0.001). There was a significantly higher rate of blood transfusions with patients undergoing open surgery compared to patients undergoing laparoscopic procedures (13.2% vs. 6.3%, respectively, pϽ0.001). CONCLUSIONS: Laparoscopic thoracic procedures were associated with shorter hospital lengths of stay, lower rate of surgical site infections, hemorrhage, blood transfusion and mortality rates. The mean costs for laparoscopic procedures were significantly lower than mean costs for open procedures. These observations highlight the potential cost advantages of providing thoracic procedures through laparoscopic techniques as a method to potentially save increasingly scarce healthcare funds for hospitals.OBJECTIVES: Analyze the differential in selected direct costs of a collaborative structured blood glucose testing intervention in non-insulin treated patients with type 2 diabetes mellitus (T2DM) when compared to enhanced usual care (active control group (ACG)). METHODS: Data was derived from the Structured Testing Program (STeP) -a 1 year, prospective, cluster-randomized, multicenter study that examined the utility of a collaborative intervention using structured self-monitoring of blood glucose (SMBG) in 483 poorly-controlled (HbA1c Ͼ 7.5%) T2DM subjects compared to the ACG. The structured testing group (STG) used the ACCU-CHEK® 360¢ a View 3-day profile tool that facilitates collection and interpretation of 7-point glucose profiles. From a US payer perspective, direct costs of diabetes medications, lab HbA1c tests, physician visits, and blood glucose testing strips associated with STG were compared with ACG using student t-test at a significance level of 5%. RESULTS: In the intent-to-treat population, STG showed a significantly greater HbA1c reduction over 12 months than the ACG (-1.2% vs. Ϫ0.9%; ⌬-0.3%; pϭ0.04). During the study, STG incurred ϩ$180.95 mean PPPY (Pay per Patient Year) total cost for diabetes medications, but -$173.73 mean PPPY for SMBG test strips, -$5.20 mean PPPY for lab HbA1c tests, and -$2.15 mean PPPY for physician visits compared to ACG. There was no significant difference in direct costs between STG and ACG (p ϭ0.9898). CONCLUSIONS: Use of a collaborative structured testing intervention improved HbA1c in STG without increasing direct cost. The increased STG medication cost was offset by a decreased use of blood glucose test strips. As previously reported, STG subjects performed significantly fewer tests/day than ACG subjects (mean ϭ 0.9 vs. 1.2, pϭ0.0003) over the year. Structured testing, from a 1 year US payer perspective, is an effective and overall cost-neutr...
Objective The purpose of the present study was to construct a diagnostic model to distinguish major depressive disorder (MDD) and bipolar disorder (BD) using potential commonly tested blood biomarkers. Methods Information of 721 inpatients with an ICD-10 diagnosis of major depressive disorder or bipolar disorder were collected from the electronic medical record system. Variables in the nomogram were selected by best subset selection method after a prior univariable screening, and then constructed using logistic regression with inclusion of the psychotropic medication use. The discrimination, calibration and internal validation of the nomogram were evaluated by the receiver operating characteristic curve, the calibration curve, cross validation and subset validation method. Results The nomogram consisted of five variables, including age, eosinophil count, plasma concentrations of prolactin, total cholesterol, and low-density lipoprotein cholesterol. The model could discriminate between MDD and BD with an AUC of 0.858, with a sensitivity of 0.716 and a specificity of 0.890. Conclusion The comprehensive nomogram constructed by the present study can be convenient to distinguish MDD and BD since the incorporating variables were common indicators in clinical practice. It could help avoid misdiagnoses and improve prognosis of the patients.
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