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A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis: the Canadian Ciprofloxacin Health Economic Study Group.

https://arctichealth.org/en/permalink/ahliterature206818
Source
Chest. 1998 Jan;113(1):131-41
Publication Type
Article
Date
Jan-1998
Author
R. Grossman
J. Mukherjee
D. Vaughan
C. Eastwood
R. Cook
J. LaForge
N. Lampron
Author Affiliation
Department of Respiratory Medicine, Mount Sinai Hospital, Toronto, ON.
Source
Chest. 1998 Jan;113(1):131-41
Date
Jan-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anti-Infective Agents - adverse effects - economics - therapeutic use
Bronchitis - drug therapy - economics
Canada
Chronic Disease
Ciprofloxacin - adverse effects - economics - therapeutic use
Cost-Benefit Analysis
Female
Follow-Up Studies
Health Care Costs
Hospitalization - economics
Humans
Male
Middle Aged
Predictive value of tests
Quality-Adjusted Life Years
Recurrence
Treatment Outcome
Abstract
To evaluate the costs, consequences, effectiveness, and safety of ciprofloxacin vs standard antibiotic care in patients with an initial acute exacerbation of chronic bronchitis (AECB) as well as recurrent AECBs over a 1-year period.
Randomized, multicenter, parallel-group, open-label study.
Outpatient general practice.
A total of 240 patients, 18 years or older with chronic bronchitis, with a history of frequent exacerbations (three or more in the past year) presenting with a type 1 or 2 AECB (two or more of increased dyspnea, increased sputum volume, or sputum purulence).
The assessment included AECB symptoms, antibiotics prescribed, concomitant medications, adverse events, hospitalizations, emergency department visits, outpatient resources such as diagnostic tests, procedures, and patient and caregiver out-of-pocket expenses. Patients completed the Nottingham Health Profile, St. George's Respiratory Questionnaire, and the Health Utilities Index. The parameters were recorded with each AECB and at regular quarterly intervals for 1 year. These variables were compared between the ciprofloxacin-treated group and the usual-care-treated group.
Patients receiving ciprofloxacin experienced a median of two AECBs per patient compared to a median of three AECBs per patient receiving usual care. The mean annualized total number of AECB-symptom days was 42.9+/-2.8 in the ciprofloxacin arm compared to 45.6+/-3.0 days in the usual-care arm (p=0.50). The overall duration of the average AECB was 15.2+/-0.6 days for the ciprofloxacin arm compared to 16.3+/-0.6 days for the usual-care arm. Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care (relative risk=1.20; 95% confidence interval [CI], 0.91 to 1.58; p=0.19). Treatment assignment did not affect the interexacerbation period but a history of severe bronchitis, prolonged chronic bronchitis, and an increased number of AECBs in the past year were associated with shorter exacerbations-free periods. There was a slight, but not statistically significant, improvement in all quality of life measures with ciprofloxacin over usual care. The only factors predictive of hospitalization were duration of chronic bronchitis (odds ratio=4.6; 95% CI, 1.6, 13.0) and severity of chronic bronchitis (odds ratio=4.3; 95% CI, 0.8, 24.6). The incremental cost difference of $578 Canadian in favor of usual care was not significant (95% CI, -$778, $1,932). The cost for the ciprofloxacin arm over the usual care arm was $18,588 Canadian per quality-adjusted life year gained. When the simple base case analysis was expanded to examine the effect of risk stratification, the presence of moderate or severe bronchitis and at least four AECBs in the previous year changed the economic and clinical analysis to one favorable to ciprofloxacin with the ciprofloxacin-treated group having a better clinical outcome at lower cost ("win-win" scenario).
Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care; however, the difference was not statistically significant. Further, usual care was found to be more reflective of best available care rather than usual first-line agents such as amoxicillin, tetracycline, or trimethoprim-sulfamethoxazole as originally expected. Despite the similar antimicrobial activities and broad-spectrum coverage of both ciprofloxacin and usual care, the trends in clinical outcomes and all quality of life measurements favor ciprofloxacin. In patients suffering from an AECB with a history of moderate to severe chronic bronchitis and at least four AECBs in the previous year, ciprofloxacin treatment offered substantial clinical and economic benefits. In these patients, ciprofloxacin may be the preferred first antimicrobial choice.
PubMed ID
9440580 View in PubMed
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45th ESCP-NSF international symposium on clinical pharmacy: clinical pharmacy tackling inequalities and access to health care. Oslo, Norway, 5-7 October 2016.

https://arctichealth.org/en/permalink/ahliterature283198
Source
Int J Clin Pharm. 2017 Feb;39(1):208-341
Publication Type
Conference/Meeting Material
Date
Feb-2017

The 1982 Hoechst Lecture: "Cost effectiveness--the emerging 'bottom line' for pharmacy?!".

https://arctichealth.org/en/permalink/ahliterature243460
Source
Can J Hosp Pharm. 1982 Mar-Apr;35(2):39-41
Publication Type
Article
Author
J A Marshman
Source
Can J Hosp Pharm. 1982 Mar-Apr;35(2):39-41
Language
English
Publication Type
Article
Keywords
Aged
Canada
Cost-Benefit Analysis
Efficiency
Humans
Ontario
Patient Education as Topic - economics
Pharmacy Service, Hospital - economics
Abstract
In the current climate of budgetary restraint in the health care system, cost effectiveness is a concept which surfaces with increasing frequency, especially in reference to health care services funded by government. Since significant elements of pharmacy services in Canada are thus funded (including in most provinces, hospital pharmacy services, and prescription drug plans for senior citizens), it is important that pharmacy "tune into" the concept, and recognize it as an essential criterion to be met in the maintenance of existing services and in the development of new services. Prerequisite to a consideration of cost effectiveness is, of course, consideration of effectiveness; and a statement about the effectiveness; and a statement about the effectiveness of a service implies a potential for measurement of effect or outcome. In the 1980s, as pharmacy focuses its efforts on patients rather than products, that effect must surely be defined in "people" terms. One of the important dimensions of today's patient-focussed pharmacy services is patient counselling, more broadly, patient education.
PubMed ID
10309676 View in PubMed
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Accounting for care: exploring tensions and contradictions.

https://arctichealth.org/en/permalink/ahliterature129810
Source
ANS Adv Nurs Sci. 2011 Oct-Dec;34(4):330-44
Publication Type
Article
Author
Jacqueline A Choiniere
Author Affiliation
School of Nursing, York University, Toronto, Ontario, Canada. jacchoin@yorku.ca
Source
ANS Adv Nurs Sci. 2011 Oct-Dec;34(4):330-44
Language
English
Publication Type
Article
Keywords
Canada
Humans
Nurses
Nursing Care - psychology - standards
Nursing Staff, Hospital - economics
Philosophy, Nursing
Abstract
Within the context of neoliberal restructuring, accountability is primarily linked to efficiency, determined through standardized, numerically based technologies and focused on lengths of stay, utilization indicators, and the like. Disappearing from view in this approach is what is actually happening at the point of care for registered nurses. Grounded in semistructured interviews, this article casts a critical light on the tensions and contradictions experienced by nurses, arguing that instead of a more accountable, effective, or efficient system, this path is jeopardizing nurses' ability to provide needed care within healthy, supportive work environments, setting into motion a fundamental transformation of nursing practice.
PubMed ID
22067232 View in PubMed
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[A closed emergency unit. Consequences for referral patterns and economics].

https://arctichealth.org/en/permalink/ahliterature217504
Source
Ugeskr Laeger. 1994 Aug 29;156(35):4971-5
Publication Type
Article
Date
Aug-29-1994
Author
N. Wedderkopp
B L Rosenblad
H. Münster
S. Henriksen
Author Affiliation
Faaborg Sygehus, kirurgisk afdeling.
Source
Ugeskr Laeger. 1994 Aug 29;156(35):4971-5
Date
Aug-29-1994
Language
Danish
Publication Type
Article
Keywords
Denmark
Emergency Service, Hospital - economics - organization & administration
Family Practice - economics - statistics & numerical data
Humans
Prospective Studies
Referral and Consultation
Abstract
During the mid 1980's the emergency-room at Faaborg Hospital changed status from being open to semi-closed. From then on the patients had to contact a general practitioner before going to the emergency-room. The general practices in the area were then supposed to have a referring function. We decided to evaluate the consequences of this decision in 1991. From 25 August to 1 December 1991 we registered all patients who contacted the emergency-room. The conclusions were that no changes in the types of patients had occurred, and that it was at a greater cost to the National Health Service.
PubMed ID
7992430 View in PubMed
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Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources.

https://arctichealth.org/en/permalink/ahliterature271603
Source
Scand J Urol. 2015 Feb;49(1):43-50
Publication Type
Article
Date
Feb-2015
Author
Frederik B Thomsen
Kasper D Berg
M Andreas Røder
Peter Iversen
Klaus Brasso
Source
Scand J Urol. 2015 Feb;49(1):43-50
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - economics - utilization
Biopsy, Large-Core Needle - adverse effects - economics - statistics & numerical data
Cohort Studies
Denmark
Disease Management
Disease Progression
Health Resources - economics - utilization
Hospitalization - economics - statistics & numerical data
Humans
Kallikreins - blood
Male
Middle Aged
Prospective Studies
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - pathology - therapy
Transurethral Resection of Prostate
Watchful Waiting - economics - statistics & numerical data
Abstract
Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa.
In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost.
The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction).
AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.
PubMed ID
25363612 View in PubMed
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Activity-based costing in radiology. Application in a pediatric radiological unit.

https://arctichealth.org/en/permalink/ahliterature32870
Source
Acta Radiol. 2000 Mar;41(2):189-95
Publication Type
Article
Date
Mar-2000
Author
J. Laurila
I. Suramo
M. Brommels
E M Tolppanen
P. Koivukangas
P. Lanning
G. Standertskjöld-Nordenstam
Author Affiliation
Department of Radiology, Oulu University Hospital, Finland.
Source
Acta Radiol. 2000 Mar;41(2):189-95
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Child
Cost Savings
Costs and Cost Analysis
Health Care Rationing - economics
Hospital Costs - statistics & numerical data
Humans
Pediatrics - economics
Radiology Department, Hospital - economics
Time and Motion Studies
Abstract
PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.
PubMed ID
10741796 View in PubMed
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Source
CMAJ. 2004 Nov 23;171(11):1322; author reply 1322-3
Publication Type
Article
Date
Nov-23-2004
Author
Steve Goodacre
Source
CMAJ. 2004 Nov 23;171(11):1322; author reply 1322-3
Date
Nov-23-2004
Language
English
Publication Type
Article
Keywords
Canada
Chest Pain - economics - etiology - therapy
Cost-Benefit Analysis
Emergency Service, Hospital - economics
Great Britain
Hospital Departments - economics
Hospitalization
Humans
Myocardial Infarction - diagnosis
United States
Notes
Cites: BMJ. 2004 Jan 31;328(7434):25414724129
Cites: CMAJ. 2004 Jun 8;170(12):1803-715184334
Comment On: CMAJ. 2004 Jun 8;170(12):1803-715184334
PubMed ID
15557568 View in PubMed
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746 records – page 1 of 75.