A health technology assessment between two pharmacological therapies through Six Sigma: the case study of bone cancer

Abstract

<jats:sec><jats:title content-type="abstract-subheading">Purpose</jats:title><jats:p>Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Design/methodology/approach</jats:title><jats:p>The Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Findings</jats:title><jats:p>The results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Research limitations/implications</jats:title><jats:p>While the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Practical implications</jats:title><jats:p>Employing the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Originality/value</jats:title><jats:p>There is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.</jats:p></jats:sec>

Application of DMAIC Cycle and Modeling as Tools for Health Technology Assessment in a University Hospital

“…The statistical analysis was useful for the subsequent modeling phase. As mentioned in the introduction, in this phase, we also considered some surgical variables analyzed in a preceding paper [ 55 ]. For both antibiotic protocols, the multiple linear regression was implemented obtaining two predictive models whose equations are shown as follows: where y 1 represents the LOS of patients treated with cefazolin/clindamycin, y 2 the LOS of patients treated with ceftriaxone, x i the considered variables, β i and ∂ i the regression coefficients, and ε i the errors.…”

“…In this study, it was used to obtain a model capable of predicting the postoperative LOS for each patient undergoing oral cavity cancer surgery on the bone. In order to obtain the best models, we considered also the surgical variables that were studied in a previous research on the same topic [ 55 ]. Therefore, the considered variables in order to implement the model were 11: gender, age, ASA score, the quality of oral hygiene, diabetes, cardiovascular diseases, tracheotomy, lymphadenectomy, infections, dehiscence, and flap.…”

“…To this aim, in our recent study [ 55 ], SS was employed to compare the use of antibiotics in patients undergoing oral cancer surgery on bone tissue. Starting from the previous promising results, in this work, two antibiotics, ceftriaxone and the combination of cefazolin and clindamycin, are compared in order to understand which one reduces the postoperative length of hospital stay (LOS) for patients undergoing oral cavity cancer surgery on the bone tissue.…”

“…After applying DMAIC, a modeling study was conducted through a multinomial linear regression; in particular, it was applied to obtain two models capable of predicting postoperative LOS for each antibiotic. In order to do this, we included the surgical variables that were considered in the previous study [ 55 ].…”

Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty

“…Its goal is to contribute to the identification of safe, effective, patient centred health policies aimed at achieving the best value. The HTA process is based on scientific evidence from studies; indeed, this approach was applied to examine the problem of surgical infections in patients with oral cavity cancer by comparing two drugs in terms of shorter duration of LOS, 25 and maximizing health gains through efficient use of resources in Saudi Arabia. 24 Therefore, the quality of healthcare is a matter of great concern and finding ways to improve quality and reduce costs is one of the most important issues.…”