Topic
Cost effectiveness
About: Cost effectiveness is a research topic. Over the lifetime, 69775 publications have been published within this topic receiving 1531477 citations.
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TL;DR: The IMPACT intervention is a high-value investment for older adults; it is associated with high clinical benefits at a low increment in health care costs.
Abstract: Context Depression is a leading cause of functional impairment in elderly individuals and is associated with high medical costs, but there are large gaps in quality of treatment in primary care. Objective To determine the incremental cost-effectiveness of the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. Design Randomized controlled trial with recruitment from July 1999 to August 2001. Setting Eighteen primary care clinics from 8 health care organizations in 5 states. Participants A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). Intervention Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual primary care (n = 895). Intervention patients were provided access to a depression care manager supervised by a psychiatrist and primary care physician. Depression care managers offered education, support of antidepressant medications prescribed in primary care, and problem-solving treatment in primary care (a brief psychotherapy). Main Outcome Measures Total outpatient costs, depression-free days, and quality-adjusted life-years. Results Relative to usual care, intervention patients experienced 107 (95% confidence interval [CI], 86 to 128) more depression-free days over 24 months. Total outpatient costs were $295 (95% CI, −$525 to $1115) higher during this period. The incremental outpatient cost per depression-free day was $2.76 (95% CI, −$4.95 to $10.47) and incremental outpatient costs per quality-adjusted life-year ranged from $2519 (95% CI, −$4517 to $9554) to $5037 (95% CI, −$9034 to $19 108). Results of a bootstrap analysis suggested a 25% probability that the IMPACT intervention was “dominant” (ie, lower costs and greater effectiveness). Conclusions The IMPACT intervention is a high-value investment for older adults; it is associated with high clinical benefits at a low increment in health care costs.
237 citations
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TL;DR: In this article, the authors examine the evidence for seven assumptions commonly made by those who promote the "employability" agenda, and raise questions about the security of these assumptions including the transferability of key skills to employment contexts, the cost effectiveness of developing key skills in Higher Education rather than in employment and the competitive market advantage that individual students are believed to obtain.
Abstract: This article examines the current preoccupation with enhancing the employability of graduates through the adoption of generic key skills into the undergraduate curriculum. It looks at the evidence for seven assumptions commonly made by those who promote the ‘employability’ agenda, and raises questions about the security of these assumptions including the transferability of key skills to employment contexts, the cost effectiveness of developing key skills in Higher Education rather than in employment and the competitive market advantage that individual students are believed to obtain. It concludes that in the absence of major changes to the funding regime there is unlikely to be a radical change to the curriculum and that more attention should now be paid to the post‐graduation/induction period than to the pre‐graduation stages.
237 citations
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TL;DR: In the PARTNER trial, TAVR was an economically attractive strategy compared with AVR for patients suitable for TF access and future studies are necessary to determine whether improved experience and outcomes with TA-TAVR can improve its cost-effectiveness relative to AVR.
237 citations
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TL;DR: Living donor liver transplantation (LDLT) offered substantial gains in life expectancy with acceptable cost‐effectiveness ratios when the waiting list exceeds 7 months, and LDLT was cost‐effective in all scenarios of waiting lists exceeding 7 months.
237 citations
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TL;DR: This study evaluated the cost‐effectiveness of enhanced recovery implementation and found that the implementation of these protocols requires time and financial investment.
Abstract: Background
Enhanced recovery protocols may reduce postoperative complications and length of hospital stay. However, the implementation of these protocols requires time and financial investment. This study evaluated the cost-effectiveness of enhanced recovery implementation.
Methods
The first 50 consecutive patients treated during implementation of an enhanced recovery programme were compared with 50 consecutive patients treated in the year before its introduction. The enhanced recovery protocol principally implemented preoperative counselling, reduced preoperative fasting, preoperative carbohydrate loading, avoidance of premedication, optimized fluid balance, standardized postoperative analgesia, use of a no-drain policy, as well as early nutrition and mobilization. Length of stay, readmissions and complications within 30 days were compared. A cost-minimization analysis was performed.
Results
Hospital stay was significantly shorter in the enhanced recovery group: median 7 (interquartile range 5–12) versus 10 (7–18) days (P = 0·003); two patients were readmitted in each group. The rate of severe complications was lower in the enhanced recovery group (12 versus 20 per cent), but there was no difference in overall morbidity. The mean saving per patient in the enhanced recovery group was €1651.
Conclusion
Enhanced recovery is cost-effective, with savings evident even in the initial implementation period.
237 citations