4.89; I 2 =0%; 2 studies), complications (RR=0.37; 95%CI: 0.21, 0.65; I 2 = 0%; 2 studies), blood loss (mean difference= -1634.9ml; 95% CI: -2242.2ml, -1027.5ml; I 2 = 0%; 3 studies), and visual analogue scale (mean difference= -0.78; 95% CI: -1.50, -0.03; I 2 = 0%; 3 studies). Infection risk (RR=0.40; 95%CI: 0.09, 1.69; I 2 =0%; 2 studies), favorable change in cobb angle (mean difference= -0.38; 95% CI: -3.19, 2.43; I 2 =90.6%; 3 studies), and Oswestry Disability Index (mean difference= -3.45; 95% CI: -8.35, 1.45; I 2 =0%; 3 studies) were not significantly different between surgery types. Conclusions: Following a comprehensive pooling of the literature, this meta-analysis demonstrated that MIS was associated with better health and safety outcomes in adult patients with adult degenerative scoliosis compared to OS. Further studies are needed to allow for subgroup analyses and identification of specific patient populations who may benefit the most from MIS vs OS.
intraoperative or postoperative PPHFx (index) between 2010 and 2016 were identified. Patients had concurrent diagnosis for hip osteoarthritis and procedural code for THA with concurrent PPHFx (intraoperative cohort) or PPHFx identified between day 1 to 90 post-discharge. The proportion of patients admitted at least once to a skilled nursing facility (SNF), an inpatient rehabilitation facility (IRF), another inpatient site or an outpatient hospital during from 0-90 or 0-365 days post-PPHFx, and the total all-cause payments during those periods were analyzed. The results were separately reported for patients with intraoperative vs postoperative PPHFx. RESULTS: A total of 2,976 patients with intraoperative PPHFx (average age (standard deviation SD): 76.3 (6.7) -75.9% female) and 1,473 patients with postoperative PPHFx (average age (SD): 75.1(6.5) e 77.3% female), were identified. For intraoperative PPHFx, during 90-and 365-day post-index PPHFx, 44.2% and 44.8% patients were admitted to SNF, 18.4% and 19.5% to IRF, 18.6% and 34.8% to other inpatient admission and, 73.1% and 91.6% to outpatient hospital respectively. For postoperative PPHFx, during 90-day and one-year post-index PPHFx, 57.8% and 59.8% patients were admitted to SNF, 15.8% and 17.3% to IRF, 27.2% and 41.3% to other inpatient admission and, 72.5% and 92.0% to outpatient hospital respectively. The mean(SD) total all-cause payments at 0-90 and 0-365-days post-PPHFX averaged $31,533($21,626) and $39,645($31,925) for intraoperative PPHFx and $37,459($22,633) and $47,199($32,621) for postoperative PPHFx. CONCLUSIONS: This real-world study found increased healthcare burden on patients who had a total hip arthroplasty followed by an intraoperative or postoperative PPHFx.
Resource utilisation was based on number of days in hospital and administration of high cost drugs for GvHD and related complications. Relevance was determined by expert review. Costs were identified using the local pharmacy database and the unit reference costs database. RESULTS: This audit included 9 patients in the study arm and 7 patients in the comparison arm. The mean reduction in hospitalisation days per patient was 21.3% (74.7-58.7) and spend on high cost drugs per patient was reduced by 48.3% (£28,420-£14,688). The mean net reduction in costs per patient, adjusted for photopheresis treatment costs, was £28,040. Furthermore, all patients died in the comparator arm during the audit period, compared to 10% in the study group. CONCLUSIONS: The additional costs of treating non responders and treatment complications should be considered alongside direct therapy costs. The results of this audit may support the feasibility of economic studies to evaluate the cost effectiveness of treatments for rare life threatening diseases.
Objectives: Obesity affects one third of the adult population in Chile. Bariatric Surgery (BS) has the potential of improving health status and saving future medical costs through reduced medical care for conditions associated with Obesity. We conducted a Cost-Benefit analysis of BS from the perspective of public (FONASA) and private (ISAPRES) health insurers in Chile. Methods: We compared the cost of Bariatric Surgery and Related Costs (BSRC) including surgical complications, reoperations and future abdominoplasties with expected cost savings on BS patients resulting from a reduction in the incidence and prevalence of Diabetes, Hypertension, Cardiovascular events, and female cancers calculated for a cohort of patients over a 10-year time horizon with characteristics similar to those in the Swedish Obese Subjects Study. Data on annual treatment costs of comorbidities where extracted from a national claims database for ISAPRES and from a national costing study for FONASA. Private insurers billing databases with a 5-year follow-up where used to estimate BS costs and incidence and costs of surgical complications, BS reoperations and abdominoplasties in that time frame, with the assumption of equivalent incidence in private and public insurers. Results: 5.1% of cases had surgical complications requiring rehospitalization, 6.6% of patients had a new BS procedure and 5.5% had abdominoplasties. BSRC for ISAPRES and FONASA was US$ 6,218 and US$ 5,889 respectively. The present value of expected savings from improved future health status in patients undergoing BS was estimated to be US$ 1,360 for FONASA and US$ 1,883 for ISAPRES over 10 years. These estimates imply that the expected savings from avoiding obesity complications represent 23% of the cost of BSRC in FONASA and 30% in ISAPRES. Conclusions: Cost savings related to comorbidities in obese patients resulting from BS account for about one-fourth of the cost of BS in FONASA and about one-third in ISAPRES.
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