Molly T. Beinfeld

Reorganizing the System of Care Surrounding Laparoscopic Surgery: A Cost-Effectiveness Analysis Using Discrete-Event Simulation

Purpose. To determine the cost-effectiveness of a proposed reorganization of surgical and anesthesia care to balance patient volume and safety.Methods.Discrete-event simulation methods were used to compare current surgical practice with a newmodular system in which patient care is handed off between 2 anesthesiologists. Ahealth care system’s perspective, using hospital and professional costs, was chosen for the cost-effectiveness analysis. Outcomes were patient throughput, flow time, wait time, and resource use. Sensitivity analyses were performed on staffing levels, mortality rates, process times, and scheduled patient volume.Results.The new strategy was more effective (average 4.41 patients/d [median = 5] v. 4.29 [median = 4]) and had similar costs (average cost/ patient/d =

Cost-effectiveness of hepatic metastasectomy in patients with metastatic colorectal carcinoma: A state-transition Monte Carlo decision analysis

5327 v.

Potential Influence of Acute CT on Inpatient Costs in Patients with Ischemic Stroke

5289) to the current strategywith an incremental cost-effectiveness of

Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors

318/additional patient treated/d. Surgical mortality rate must be >4% or hand-off delay >15min before the new strategy is no longermore effective.Conclusion.The proposed system is more cost-effective relative to current practice over a wide range of mortality rates, hand-off times, and scheduled patient volumes.

Cost-effectiveness of Whole-Body CT Screening

ObjectiveTo evaluate the cost-effectiveness of hepatic resection (“metastasectomy”) in patients with metachronous liver metastases from colorectal carcinoma (CRC), and to investigate the impact of operative and follow-up strategies on outcomes, cost, and cost-effectiveness. Summary Background DataThere is substantial evidence that resection of CRC liver metastases can result in long-term survival in some patients. However, several unresolved issues are difficult to address using currently available clinical data. These include the appropriate threshold for resection, whether to perform repeat resection, and the relative cost-effectiveness of the procedure(s). MethodsThe authors developed a state-transition Monte Carlo decision model to evaluate the (societal) cost-effectiveness of hepatic metastasectomy in patients with metachronous CRC liver metastases. The model tracks the presence, number, size, location, growth, detection, and removal of up to 15 individual metastases in each patient. Survival, quality of life, and cost are predicted on the basis of disease extent. Imaging and surgery affect outcomes via detection and removal of individual metastases. Several patient management strategies were developed and compared with respect to cost, effectiveness, and incremental cost-effectiveness (

Cost-Effectiveness of Using N-Terminal Pro-Brain Natriuretic Peptide to Guide the Diagnostic Assessment and Management of Dyspneic Patients in the Emergency Department

/quality-adjusted life year [QALY]). A reference strategy in which metastasectomy is not offered and imaging is not performed for the purpose of assessing resectability or operative planning (“no-surgery” strategy) was included for comparison. Extensive sensitivity analysis was performed to evaluate the impact of alternative model assumptions on results. ResultsA strategy permitting resection of up to six metastases and one repeat resection, with CT follow-up every 6 months, resulted in a gain of 2.63 QALYs relative to the no-test/no-treat strategy, at an incremental cost of

Cost-effectiveness Analysis in the Assessment of Diagnostic Imaging Technologies

18,100/QALY. When additional surgical strategies were considered, the incremental cost-effectiveness ratio (ICER; relative to the next least effective strategy) of the six metastases, one repeat, 6-month strategy was

Diagnostic Imaging Costs: Are They Driving Up the Costs of Hospital Care?

31,700/QALY. Across a range of model assumptions, more aggressive treatment strategies (i.e., resection of more metastases, resection of recurrent metastases) were superior to less aggressive strategies and had ICERs below

Hospital costs for elective endovascular and surgical repairs of infrarenal abdominal aortic aneurysms.

35,000/QALY. Findings were insensitive to changes in most model parameters but somewhat sensitive to changes in surgery and treatment costs. ConclusionsHepatic metastasectomy is a cost-effective option for selected patients with metachronous CRC metastases limited to the liver. When considering metastasectomy, more aggressive approaches are generally preferred to less aggressive approaches. Overall, surgeons should be encouraged to consider resection for all patients whose metastases can technically be removed.

Abdominal Aortic Aneurysms: Cost-effectiveness of Elective Endovascular and Open Surgical Repair

RATIONALE AND OBJECTIVES Patients presenting with ischemic brain symptoms have widely variable outcomes dependent to some degree on the pathologic basis of their stroke syndrome. The purpose of this study was to determine the cost implications of the emergency use of a computed tomographic (CT) protocol comprising unenhanced CT, head and neck CT angiography, and whole-brain CT perfusion. MATERIALS AND METHODS By using a retrospective patient database from a tertiary care facility and publicly available cost data, the authors derived the potential savings from the use of CT angiography. CT perfusion, or both at hospital arrival by means of a cost model. The cost of the CT angiography-CT perfusion protocol was determined from Medicare reimbursement rates and compared with that of traditional imaging protocols. Cost savings were estimated as a decrease in the length of stay for most stroke patients, whereas the most benign (lacunar) strokes were assumed to be managed in a non-acute setting. Misdiagnosis cost (erroneously not admitting a patient with nonlacunar stroke) was calculated as the cost of a severe complication. Sensitivity testing included varying the percentage of misdiagnosed patients and admitting patients with lacunar stroke. RESULTS The nationwide net savings that would result from the adoption of the CT angiography-CT perfusion protocol are in the