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INTRODUCTION: Iodine-125 (I-125) seeds, commonly used in low-dose rate brachytherapy for ocular malignancies, are often discarded after a single use. This study examines the potential cost savings at an institution with high ocular melanoma referrals, by re-using I-125 seeds for eye-plaque brachytherapy. METHODS: In this single-institutional retrospective analysis, data was collected from I-125 seed orders from 8/2019 through 10/2022. Information including number of seeds ordered per lot, number of plaques built per lot, and number of seeds used per lot were collected. Cost per lot of seed was assumed to be the current cost from the most recent lot of 35 seeds. RESULTS: During the study, 72 I-125 seed lots were ordered bi-weekly, with a median of 35 seeds per lot (Range: 15-35). Each seed was used on average 2.26 times prior to being discarded. The average duration of each seed lot used was 62.2 days (Range: 21-126). Each seed lot contributed to the construction of an average of 8.4 eye plaques (Range: 2-20). With seed recycling, 2,475 seeds were used to construct 608 eye-plaques. Without re-using practice this would require 5,694 seeds. This resulted in a percentage cost savings of 56.5%, with a total seed cost reduction of $344,884, or $559 per eye-plaque on average. CONCLUSION: This is the first study to evaluate cost savings relative to re-using I-125 seeds for eye plaques. The data demonstrates how an institution can decrease costs associated with I-125 radiation seeds used for eye-plaque brachytherapy by re-using them.
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Braquiterapia , Redução de Custos , Neoplasias Oculares , Radioisótopos do Iodo , Melanoma , Braquiterapia/economia , Radioisótopos do Iodo/uso terapêutico , Humanos , Estudos Retrospectivos , Melanoma/radioterapia , Melanoma/economia , Neoplasias Oculares/radioterapia , Neoplasias Oculares/economiaRESUMO
Introduction: Data addressing the economic aspects of telehealth initiatives are incipient. This study aimed to evaluate the labor costs for running a COVID-19 telehealth system and its potential incremental access to health care service. Methods: From July 2020 to July 2021, data from a Brazilian teleconsultation service were analyzed. Labor costs were estimated by time-driven activity-based costing. A Generalized Reduced Gradient solving method was coded to maximize the mean incremental access rate and two scenarios were considered to compare the teleconsultation with the in-person consultation: (1) only the length of time that patients spent with a clinician in an in-person consultation was accounted and (2) in addition to the medical consultation, nursing screening was accounted. The mean incremental access rate of the teleconsultation service was defined as a maximization objective in the model. Results: Mean labor costs per medical and nursing teleconsultations are Int$ 24 and Int$ 10, based on data analyses from 25,258 patients. Telemonitoring a patient with a daily call for 7 days costs, on average, Int$ 14. COVID-19 teleconsultation service represents, on average, an incremental access to medical consultation rate of 35% to 52% (min 23% max 63%) for the scenarios (1) and (2), respectively, and considering the current consumed budget for this service. Discussion: A COVID-19 telehealth service contributes to increasing access to the health care system without increasing costs. These services can be included in the bundle of care strategies offered in a national public health care system that looks for more sustainable strategies to provide care.
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COVID-19 , Consulta Remota , Telemedicina , Humanos , COVID-19/epidemiologia , Atenção à Saúde , Telemedicina/métodos , Brasil/epidemiologiaRESUMO
BACKGROUND: Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. METHODS: A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. RESULTS: The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. CONCLUSIONS: Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.
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Antibioticoprofilaxia/normas , Cesárea , Revisão de Uso de Medicamentos , Fidelidade a Diretrizes/estatística & dados numéricos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Antibacterianos/uso terapêutico , Equador , Feminino , Humanos , Unidade Hospitalar de Ginecologia e Obstetrícia , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
WHAT IS KNOWN AND OBJECTIVE: A framework to evaluate the impact of clinical pharmacists in intensive care units (ICUs) in Chile has not yet been established. This study evaluates the cost avoidance and cost-benefit ratios of clinical pharmacist interventions in terms of treatment optimization in an adult ICU in southern Chile. METHODS: Clinical pharmacist interventions in a multidisciplinary adult ICU were assessed between January and December 2019. Only interventions suggested by pharmacists and accepted by the healthcare team were included in the analysis. Interventions were classified into six categories, and cost avoidance (in US dollars) was calculated for each category using a systematic validated approach. A cost-benefit ratio for clinical pharmacy services in the adult ICU was also calculated. RESULTS AND DISCUSSION: Over the 12-month period, 505 interventions were performed in 169 patients, of whom 62% were male. Interventions were classified into the following six categories: adverse drug event prevention (18%), which led to $87 882 in savings; resource utilization (ie change in medication route) (10%), which led to $50 525 in savings; individualization of patient care (ie dose adjustment) (36%), which led to $57 089 in savings; prophylaxis (ie initiation of stress ulcer prophylaxis) (<1%), which led to $167 in savings; hands-on care (ie bedside monitoring) (23%), which led to $57 846 in savings; and administrative and supportive tasks (ie patient own medication evaluation) (13%), which led to $9988 in savings. The total cost savings over the year-long period were $263 500, resulting in a cost-benefit ratio of 1:24.2. WHAT IS NEW AND CONCLUSION: The participation of a clinical pharmacist in a multidisciplinary ICU team reduces healthcare expenditures through treatment optimization translated into cost avoidance. This study has corroborated prior evidence that clinical pharmacist involvement in ICUs provides economic value and quality assurance in healthcare settings.
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Unidades de Terapia Intensiva/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Adulto , Idoso , Chile , Redução de Custos , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/normas , Farmacêuticos/economia , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/normas , Papel Profissional , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
Clinical pharmacists in intensive care units are involved in patient safety, technical guidance and cost saving with rational use of medicines. This study aimed to estimate the cost saving of clinical pharmacist interventions in pediatric intensive care units (PICU). This was a retrospective, observational study. Savings were measured for three months based on (1) Clinical pharmacist interventions from prescription analysis, (2) Individualized doses of four antibiotics, (3) Comparison of drugs dispensing systems before and after the decentralization of pharmacy services. The main outcome is costs saving with strategic planning of medication use based on local reality. A number of 73 clinical pharmacist interventions were made, from which 13 allowed the calculation of economic impact, saving US$ 633.38/year. Cost saving from individualized doses of four antibiotics was US$ 8,754.46/year. The decentralization of pharmacy services saved US$ 28,770.52/year. The evaluated interventions were successful. Clinical pharmacist interventions, individualized antimicrobials doses and decentralization of pharmacy services reduce costs in the hospital.
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Análise de MediaçãoRESUMO
We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus-related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus-associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs.
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Anticoncepção/economia , Análise Custo-Benefício , Surtos de Doenças , Microcefalia/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Infecção por Zika virus/prevenção & controle , Adulto , Anticoncepção/métodos , Árvores de Decisões , Feminino , Previsões , Custos de Cuidados de Saúde , Humanos , Microcefalia/economia , Microcefalia/epidemiologia , Microcefalia/virologia , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/economia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Porto Rico/epidemiologia , Zika virus/patogenicidade , Zika virus/fisiologia , Infecção por Zika virus/economia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologiaRESUMO
RACIONAL: A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. OBJETIVO: Apresentar a viabilidade de um método com menor uso de suturas mecânicas. MÉTODOS: Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81 por cento), com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. RESULTADOS: O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6 por cento), estenose (1,6 por cento) e fístula na anastomose gastrojejunal (1,6 por cento) e torção da anastomose intestinal (1,6 por cento). A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica). O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. CONCLUSÃO: Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas.
BACKGROUND: To perform laparoscopic gastric bypass in public university hospital has been difficult due to the high cost of the surgical staplers. This fact induced to look for different technical options, with low cost, maintaining the efficacy. AIM: To present the viability of a new method with the use of a low number of stapler devices. METHODS: Sixty three patients were operated in two university hospitals, 12 men and 51 women (81 percent), with mean age of 33.5y and average BMI of 43. The surgical technique used followed this sequence: loop section with electrical scalpel 50 cm of the duodenojejunal angle; termino-lateral anastomosis; retrogastric-retrocolic passage of the Roux limb; construction of the lateral wall of the pouch using 1 blue load of 45 and other of 60 mm after horizontal section with electrical scalpel; suture of the excluded stomach and gastrojejunal anastomosis. The anastomoses were hand-sewn made and a single-layer continuous absorble suture was performed. RESULTS: The average surgical time was 5.5 hours. The early complications were: fistula in the esophago-gastric angle (1.6 percent), stenosis (1.6 percent); fistula in the gastro-jejunal anastomosis (1.6 percent); obstruction of the intestinal anastomosis (1.6 percent). The stenosis was treated by endoscopic dilation. The remaining complications, with 3 re-operations (2 with laparoscopic and 1 with laparotomic approaches). The length of hospital stay was in average 4 days. CONCLUSION: This method is viable with low cost; however, it is complex and requires ability mainly in laparoscopic handsewn sutures.
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O presente estudo avaliou a assistência odontológica fornecida a cerca de 4 mil funcionários e dependentes de um hospital privado. A análise foi dividida em três momentos: (1) linha de base (controle): quando a assistência odontológica fornecida era terceirizada por uma empresa que operava com rede credenciada, (2) quando houve uma renegociação de preços com a prestadora original e (3) quando a assistência era feita por um serviço de odontologia próprio sem a intermediação de uma prestadora e com profissionais remunerados através de valores fixos. Foram coletados mensalmente dados econômicos e sobre o tipo e número de procedimentos realizados. A renegociação de preços reduziu os custos em cerca de 37 por cento em relação à linha de base, ao passo que o serviço próprio reduziu os custos em 50 por cento. A renegociação de preços provocou uma diminuição de 31 por cento no número de procedimentos realizados sem modificar o perfil da assistência, ao passo que o serviço próprio não causou diminuição na quantidade de serviços, mas modificou o padrão da assistência, pois se aumentaram os procedimentos relacionados com as causas das patologias e reduziram-se os procedimentos cirúrgico-restauradores.
The present study evaluated the dental care plan offered to 4,000 employees of a private hospital and their respective families. The analysis covered three stages: (1) baseline (control), when dental care was provided by an outsourced company with a network of dentists paid for services, (2) a renegotiation of costs with the original dental care provider, and (3) provision of dental care by the hospital itself, through directly hired dentists on regular salaries. Monthly economic and clinical data were collected for this research. The dental plan renegotiation reduced costs by 37 percent in relation to baseline, and the hospital's own dental service reduced costs by 50 percent. Renegotiation led to a 31 percent reduction in clinical procedures, without altering the dental care profile; the hospital's own dental service did not reduce the total number of clinical procedures, but modified the profile of dental care, since procedures related to the causes of diseases increased and surgical/restorative procedures decreased.