Ravi K. Goyal

Cost Analysis of Robot-Assisted Laparoscopic Versus Hand-Assisted Laparoscopic Partial Nephrectomy

PURPOSE To perform a cost comparison of three approaches to partial nephrectomy (PN): Open (OPN), hand-assisted laparoscopic (HALPN), and robot-assisted (RAPN). PATIENTS AND METHODS We retrospectively evaluated cost and clinical data from patients undergoing OPN, HALPN, and RAPN from 2007 to 2010 (n=89). Baseline demographic data, patient comorbidities, R.E.N.A.L. nephrometry score, and perioperative outcomes were assessed. Costs and subcosts from the operating room (OR) and hospital were evaluated using nonparametric statistical analyses. RESULTS Patient demographics and tumor characteristics were similar between HALPN and RAPN, while OPN patients had more comorbidities and more difficult-to-resect tumors. Thus, HALPN and RAPN were directly compared, while OPNs were excluded from the analysis. No difference was found in overall costs between HALPN and RAPN (

Effectiveness of FDA’s new over-the-counter acetaminophen warning label in improving consumer risk perception of liver damage

13,560 vs

Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population.

13,439, P=0.29). OR costs were higher for RAPN (

Economic burden of Pseudomonas aeruginosa infection in patients with cystic fibrosis.

7276 vs

Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT

5708, P=0.0001) because of the higher robotic capital and reusable equipment costs that outweighed higher disposable costs in the HALPN group. OR time-related costs were similar between groups. RAPN patients had a shorter length of stay (LOS), which decreased postoperative hospital costs (

Is medical home enrollment associated with receipt of guideline-concordant follow-up care among low-income breast cancer survivors?

4371 vs

Health care utilization from chemotherapy-related adverse events among low-income breast cancer patients: effect of enrollment in a medical home program.

5984, P=0.002). CONCLUSIONS No difference in overall cost was found between RAPN and HALPN. Robot allocation, OR equipment use, and LOS are important determinants of total cost. Further study regarding recovery and quality of life may reveal added benefits to minimally invasive approaches and increase use of nephron-sparing surgery.

Association between medical home enrollment and health care utilization and costs among breast cancer patients in a state Medicaid program

What is known and Objectives:  The Food and Drug Administration (FDA) issued new organ‐specific warning label requirements for over‐the‐counter (OTC) analgesic products in order to make consumers aware of the risk of liver damage when using acetaminophen. However, awareness of a health risk alone cannot ensure consumers’ engagement in safe and preventive behaviour. In this study, we attempted to: (i) measure consumer risk perception of liver damage due to the OTC acetaminophen products and (ii) analyse the effectiveness of the new organ‐specific warning label in improving consumer risk perception of liver damage and intention to perform protective behaviours while using OTC acetaminophen products.

Guideline-concordant surveillance and follow-up care among low-income patients with breast cancer: The role of primary care medical homes.

Despite its demonstrated effectiveness, colorectal cancer (CRC) testing is suboptimal, particularly in vulnerable populations such as those who are publicly insured. Prior studies provide an incomplete picture of the importance of the intersection of multilevel factors affecting CRC testing across heterogeneous geographic regions where vulnerable populations live. We examined CRC testing across regions of North Carolina by using population-based Medicare and Medicaid claims data from disabled individuals who turned 50 years of age during 2003-2008. We estimated multilevel models to examine predictors of CRC testing, including distance to the nearest endoscopy facility, county-level endoscopy procedural rates, and demographic and community contextual factors. Less than 50% of eligible individuals had evidence of CRC testing; men, African-Americans, Medicaid beneficiaries, and those living furthest away from endoscopy facilities had significantly lower odds of CRC testing, with significant regional variation. These results can help prioritize intervention strategies to improve CRC testing among publicly insured, disabled populations.

Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors

Abstract Objective: Chronic infection with Pseudomonas aeruginosa (PA) is the primary cause of pulmonary deterioration in cystic fibrosis (CF). This study describes healthcare costs and resource utilization among CF patients following PA infection in the US. Methods: This retrospective study utilized data from MarketScan claims database. CF patients with an initial PA infection were identified, and their healthcare utilization, medical and pharmacy costs were extracted for 12 months, pre- and post-PA infection. Descriptive and pair-wise non-parametric statistical analyses compared healthcare utilization and costs before and after infection. Results: Three hundred and fifty-eight CF patients met study criteria (mean age 20.1 years; 48% female). Mean annual per-patient costs following initial PA infection increased by an estimated