BackgroundUS FDA draft guidance includes pathogen reduction (PR) or secondary rapid bacterial testing (RT) in its recommendations for mitigating risk of platelet component (PC) bacterial contamination. An interactive budget impact model was created for hospitals to use when considering these technologies.MethodsA Microsoft Excel model was built and populated with base-case costs and probabilities identified through literature search and a survey of US hospital transfusion service directors. Annual costs of PC acquisition, testing, wastage, dispensing/transfusion, sepsis, shelf life, and reimbursement for a mid-sized hospital that purchases all of its PCs were compared for four scenarios: 100% conventional PCs (C-PC), 100% RT-PC, 100% PR-PC, and 50% RT-PC/50% PR-PC.ResultsAnnual total costs were US$3.64, US$3.67, and US$3.96 million when all platelets were C-PC, RT-PC, or PR-PC, respectively, or US$3.81 million in the 50% RT-PC/50% PR-PC scenario. The annual net cost of PR-PC, obtained by subtracting annual reimbursements from annual total costs, is 6.18% above that of RT-PC. Maximum usable shelf lives for C-PC, RT-PC, and PR-PC are 3.0, 5.0, and 3.6 days, respectively; hospitals obtain PR-PC components earliest at 1.37 days.ConclusionThe model predicts minimal cost increase for PR-PC versus RT-PC, including cost offsets such as elimination of bacterial detection and irradiation, and reimbursement. Additional safety provided by PR, including risk mitigation of transfusion-transmission of a broad spectrum of viruses, parasites, and emerging pathogens, may justify this increase. Effective PC shelf life may increase with RT, but platelets can be available sooner with PR due to elimination of bacterial detection, depending on blood center logistics.

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PPPP significantly improved PD and PV knowledge. It could be delivered more efficiently by holding larger events on fewer dates, staffing with volunteers where appropriate, and utilizing a local pharmacy to manage the vaccine supply.

Objectives To test the cost-effectiveness of a home-based depression program, Beat the Blues (BTB). Design We conducted a cost-effectiveness analysis as part of a previously reported randomized controlled trial that tested BTB versus a wait-list control group. Setting Community-dwelling older African American adults. Participants African Americans who were ≥55 years of age, English speaking, cognitively intact (MMSE ≥24), and had depressive symptoms (PHQ-9 score ≥5) (N=129). Intervention Participants randomly assigned to BTB received up to 10 home visits over a period of 4 months by licensed social workers who provided care management, referral/linkage, stress reduction, depression education, and behavioral activation to help participants achieve self-identified goals. Measurements Incremental cost effectiveness ratios (ICERs) of BTB versus wait-list controls during the 4-month study period. The primary ICER was defined as cost/quality-adjusted life year using the EQ-5D and secondarily using the HUI-3. Additional ICERs were calculated using clinical measures (cost per depression improvement, cost per depression remission). Costs included BTB intervention, depression-related healthcare visits and medications, caregiver time, and social services. Results BTB cost per participant per month was $146. Base case ICERs were $64,896 per QALY (EQ-5D) and $36,875 per QALY (HUI-3). Incremental cost per depression improvement was $2,906 and per remission was $3,507. Univariate and probabilistic sensitivity analyses yielded cost/QALY range of $20,500-$76,500. Conclusion Based on the range of cost effectiveness values resulting from this study, BTB is a cost-effective treatment for managing depressive symptoms in older African Americans that compares favorably with the cost effectiveness of previously tested approaches.

The follow-up rate among children with vision problems in the authors' outreach programs has been <5%. The authors therefore developed a social worker (SW) intervention, the Children's Eye Care Adherence Program (CECAP), for Philadelphia school children. The objective of this study was to measure CECAP's effectiveness and cost, as well as to identify barriers to care through a conceptual framework and geomapping software. A SW reviewed records to identify children needing follow-up and phoned families to identify and resolve barriers to eye care and scheduled appointments. Effectiveness was defined as the percent completing ≥ 1 follow-up visit within the physician-recommended time frame. Cost was measured for SW time (SW wage rates+benefits) and additional materials (forms, postage, phone charges). Barriers were organized into a conceptual framework depicting predisposing factors, system factors, and financial factors. Geomapping software was used to illustrate follow-up rates. In all, 120 patients required additional pediatric ophthalmic care; 71 patients were contacted and returned for care (59.2%); 49 patients were contacted but did not return (40.8%). SW time was 3h rs/patient for those who returned and 2 hrs/patient for those who did not return. Based on the CECAP program total cost ($14,249) and the reimbursement payment ($6265.66), the net cost of the CECAP program was $7983.59. Predisposing factors were the primary barrier theme for patients who did not follow up. CECAP significantly improved adherence to eye care but comes at an additional cost. Future efforts should focus on reducing operational efficiencies and targeting CECAP based on predictors of follow-up.

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Background and Objectives There is a critical need for effective interventions to support quality of life for persons living with dementia and their caregivers. Growing evidence supports non-pharmacologic programs which provide care management, disease education, skills training, and support. This cost-benefit analysis examined whether the Care of Persons with Dementia in their Environments (COPE) program achieves cost savings when incorporated into Connecticut’s home- and community-based services (HCBS), which are state and Medicaid funded. Research Design and Methods Findings are based on a pragmatic trial where persons living with dementia and their caregiver dyads were randomly assigned to COPE with HCBS, or HCBS alone. Cost measures included those relevant to HCBS decision-makers: intervention delivery, healthcare utilization, caregiver time, formal care, and social services. Data sources included care management records and caregiver report. Results Per-dyad mean cost savings at 12-months were $2,354 for those who received COPE with a mean difference in difference of - $6,667 versus HCBS alone (95% CI: $-15,473, $2,734; NSS). COPE costs would consume 5.6% to 11.3% of Connecticut’s HCBS annual spending limit, and HCBS cost sharing requirements align with participants’ willingness to pay for COPE. Discussion and Implications COPE represents a potentially cost-saving dementia care service that could be financed through existing Connecticut HCBS. HCBS programs represent an important, sustainable payment model for delivering non-pharmacological dementia interventions such as COPE.

HIV treatment guidelines recommend that HIV patients initiate first-line antiretroviral therapy (ART) with one of four "preferred" regimens: efavirenz/tenofovir/emtricitabine (EFV/TDF/FTC), ritonavir-boosted atazanavir + tenofovir/emtricitabine (ATV/r+TDF/FTC), ritonavir-boosted darunavir + tenofovir/emtricitabine (DRV/r+TDF/FTC), or raltegravir + tenofovir/emtricitabine (RAL+TDF/FTC). Adherence is critical to the success of ART in suppressing viral load and avoiding virological failure and development of drug resistance. This study compared ART adherence between preferred ART regimens in a real-world setting. METHODS: Retrospective study using U.S. Medicaid administrative health care claims from 15 states. Subjects were HIV patients aged 18-64 years who were enrolled in Medicaid and initiated, between January 1, 2007 and September 30, 2011, a first-line ART regimen "preferred" under U.S. DHHS HIV treatment guidelines published in March 2012. Patients were classified by ART regimen and were required to 4be continuously enrolled for 6 months before and ≥3 months following ART initiation. Follow up lasted from ART initiation until a ≥30 day gap in initiated ART, introduction of a new ART medication, or disenrollment. Adherence, defined as the proportion of days covered by ART medication during follow up (dichotomized at ≥80%), was evaluated using multivariable logistic regressions that adjusted for demographic and clinical factors. RESULTS: Sample included 1,979 patients initiating EFV/TDF/FTC (n=1,259), ATV/r+TDF/FTC (n=498), DRV/r+TDF/FTC (n=143), or RAL+TDF/FTC (n=79); mean age by regimen ranged from 40.1 to 42.1 years and proportion male from 44.1% to 55.4%. Compared with patients initiating EFV/TDF/FTC, odds of adherence ≥80% were significantly lower in DRV/r+TDF/FTC patients (odds ratio [OR]=0.56, p=0.045) and trended lower in RAL+TDF/FTC patients (OR=0.666, p=0.273) and ATV/r+TDF/FTC patients (OR=0.904, p=0.610). CONCLUSIONS: Among patients initiating a DHHS guideline-preferred first-line ART regimen, the odds of adherence were not the same for all regimens. Further research should explore the reasons for differences in adherence levels between "preferred" ART regimens.