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Cost analysis of autologous peripheral blood stem cell transplantation for multiple myeloma.

https://arctichealth.org/en/permalink/ahliterature18424
Source
Clin Lab Haematol. 2003 Jun;25(3):179-84
Publication Type
Article
Date
Jun-2003
Author
V. Mishra
S. Vaaler
L. Brinch
Author Affiliation
Health Professional Support Department, The Rikshospitalet University Hospital, Oslo, Norway. vinod.mishra@rikshospitalet.no
Source
Clin Lab Haematol. 2003 Jun;25(3):179-84
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Antineoplastic Combined Chemotherapy Protocols - economics
Costs and Cost Analysis
Cryopreservation - economics
Female
Hematopoietic Stem Cell Mobilization - economics
Humans
Length of Stay
Male
Middle Aged
Multiple Myeloma - economics - therapy
Nursing Care
Peripheral Blood Stem Cell Transplantation - economics
Prospective Studies
Transplantation, Autologous
Abstract
High-dose chemotherapy (HDC) with autologous peripheral blood stem cell (PBSC) support is a common but expensive treatment for various hematological malignancies. A prospective cost analysis of evaluation/mobilization and the HDC + PBSC phase for patients with multiple myeloma was performed. Eleven consecutive patients at the National University Hospital Oslo, taking part in a Nordic treatment protocol, were included in the analysis during the period from May 1999 to December 2000. Clinical and resource use data were obtained prospectively on a daily basis registration and from patient records.The total cost for the evaluation/mobilization and the HDC + PBSC phase varied from 22,999 US dollars to 61,722 US dollars (mean 38,186 US dollars; median 30,569 US dollars). The mean length of hospital stay for the evaluation/mobilization phase was 8 days (range 4-17 days) and for the HDC + PBSC phase 19 days (range 14-29 days). A statistically significant correlation was found between the length of hospital stay and hospital costs for both phases (P
PubMed ID
12755795 View in PubMed
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Cost of autologous peripheral blood stem cell transplantation: the Norwegian experience from a multicenter cost study.

https://arctichealth.org/en/permalink/ahliterature174911
Source
Bone Marrow Transplant. 2005 Jun;35(12):1149-53
Publication Type
Article
Date
Jun-2005
Author
V. Mishra
S. Andresen
L. Brinch
S. Kvaløy
P. Ernst
M K Lønset
J M Tangen
J. Wikelund
C. Flatum
E. Baggerød
B. Helle
S. Vaaler
T P Hagen
Author Affiliation
Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway. vinod.mishra@rikshospitalet.no
Source
Bone Marrow Transplant. 2005 Jun;35(12):1149-53
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents - economics
Costs and Cost Analysis
Cryopreservation - economics
Cytapheresis - economics
Financing, Government
Hematopoietic Stem Cell Mobilization - economics
Hospitalization - economics
Humans
Norway
Peripheral Blood Stem Cell Transplantation - economics
Prospective Studies
Transplantation, Autologous
Abstract
High-dose therapy with autologous blood progenitor cell support is now routinely used for patients with certain malignant lymphomas and multiple myeloma. We performed a prospective cost analysis of the mobilization, harvesting and cryopreservation phases and the high-dose therapy with stem cell reinfusion and hospitalization phases. In total, 40 consecutive patients were studied at four different university hospitals between 1999 and 2001. Data on direct costs were obtained on a daily basis. Data on indirect costs were allocated to the specific patient based on estimates of relevant department costs (ie the service department's costs), and by means of predefined allocation keys. All cost data were calculated at 2001 prices. The mean total costs for the two phases were US$ 32,160 (range US$ 19,092-50,550). The mean total length of hospital stay for two phases was 31 days (range 27-37). A large part of the actual cost in the harvest phase was attributed to stem cell mobilization, including growth factors, harvesting and cryopreservation. In the high-dose chemotherapy phase, the most significant part of the costs was nursing staff. Average total costs were considerably higher than actual DRG-based reimbursement from the government, indicating that the treatment of these patients was heavily subsidized by the basic hospital grants.
PubMed ID
15880133 View in PubMed
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Orthopaedic surgery in severe bleeding disorders: a low-volume, high-cost procedure.

https://arctichealth.org/en/permalink/ahliterature74945
Source
Haemophilia. 2002 Nov;8(6):809-14
Publication Type
Article
Date
Nov-2002
Author
V. Mishra
G E Tjønnfjord
A C Paus
S. Vaaler
Author Affiliation
Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway. vinod.mishra@rikshospitalet.no
Source
Haemophilia. 2002 Nov;8(6):809-14
Date
Nov-2002
Language
English
Publication Type
Article
Keywords
Adult
Diagnosis-Related Groups - economics
Factor IX - therapeutic use
Factor VIII - therapeutic use
Follow-Up Studies
Hemarthrosis - complications - economics
Hemophilia A - complications - economics
Hemophilia B - complications - economics
Hospital Costs
Humans
Joint Diseases - economics - etiology - surgery
Length of Stay
Male
Middle Aged
Norway
Orthopedic Procedures - economics
Prospective Studies
Reimbursement Mechanisms
Abstract
As more and more nations are scrutinizing their health care costs, attention has been focused on high-cost low-density disease. Assessment of actual total cost of care for haemophilia and its positive outcome becomes essential to justify support for these patients. In this study, we assessed hospital cost and diagnosis-related group (DRG) reimbursement for patients undergoing elective orthopaedic surgical procedures from May 1999 to December 1999. Hospital cost was assessed by a prospective microcost-analysis method. To identify real hospital costs, we performed registration of preoperative phase, operative phase and 1-year follow-up costs. Hospital cost included personnel costs and costs for clinical and laboratory procedures, blood products, prosthetic implants, coagulation factor concentrates and drugs. These data were compared with hospital DRG reimbursement. We included nine consecutive patients, with a mean age 38 years (19-54 years) who had had 10 major orthopaedic surgical procedures performed during the study period. Six patients had haemophilia A, two had haemophilia B and one had factor VII deficiency. Data analysis showed a mean cost of US$ 54,201 (range US$ 25,795-105,479; 1US$ = 8.5 NOK). The average actual hospital revenue (50% DRG reimbursement + income related to length of stay) was $4,730 (range $ 1,308-13,601). Our study confirms that orthopaedic surgery in patients with severe bleeding disorders puts the hospital to a considerable expense. Activity-based financing, as used in Norway, does not provide a proper reimbursement for this part of the haemophilia care.
PubMed ID
12410652 View in PubMed
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A prospective cost evaluation related to allogeneic haemopoietic stem cell transplantation including pretransplant procedures, transplantation and 1 year follow-up procedures.

https://arctichealth.org/en/permalink/ahliterature71779
Source
Bone Marrow Transplant. 2001 Dec;28(12):1111-6
Publication Type
Article
Date
Dec-2001
Author
V. Mishra
S. Vaaler
L. Brinch
Author Affiliation
Center for Epidemiology and Hospital Statistics, The National University Hospital, 0027 Oslo, Norway.
Source
Bone Marrow Transplant. 2001 Dec;28(12):1111-6
Date
Dec-2001
Language
English
Publication Type
Article
Keywords
Adult
Costs and Cost Analysis
Diagnosis-Related Groups
Female
Follow-Up Studies
Hematopoietic Stem Cell Transplantation - economics
Humans
Male
Prospective Studies
Transplantation, Homologous
Abstract
The Norwegian Ministry of Health and Social Affairs recently introduced activity-based financing for hospitals partly based on diagnosis-related groups (DRG). We soon observed that there seemed to be a considerable discrepancy between the reimbursement amount and the real cost of allogeneic haemopoietic stem cell transplantation. It was therefore decided to undertake a prospective micro-cost analysis to define a more realistic reimbursement. To identify real costs, we undertook a registration of pre-transplant procedures, transplantation and 1 year follow-up costs, including harvesting, personnel costs, clinical and laboratory procedures, together with blood products and drugs related to patients and donors. These data were compared to hospital DRG reimbursement. This information was registered for 17 consecutive patients, with a mean age 40 years (range 17-58 years). Ten patients had chronic myeloid leukaemia, three had acute lymphatic leukaemia, two had acute myeloid leukaemia and two had myelodysplastic syndrome. The data analysis showed a mean cost of US$ 106825 (NOK 901982), (range US$ 42376-362430). The average actual hospital revenue (50% DRG reimbursement + income related to length of stay + special procedure funding) was US$ 36404 (range US$ 26228-55998). Activity-based financing as applied in Norway, under-compensates hospital costs for allogeneic bone marrow transplantation. The government should make realistic estimates of real costs before introducing financial reforms in the health care system.
PubMed ID
11803351 View in PubMed
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