Barrett’s esophagus (BE) is an abnormality arising from gastroesophageal reflux disease that can progressively evolve into a sequence of dysplasia and adenocarcinoma. Progression of Barrett’s esophagus into dysplasia is monitored with endoscopic surveillance. The current surveillance standard requests random biopsies plus targeted biopsies of suspicious lesions under white-light endoscopy, known as the Seattle protocol. Recently, published evidence has shown that narrow-band imaging (NBI) can guide targeted biopsies to identify dysplasia and reduce the need for random biopsies. We aimed to assess the health economic implications of adopting NBI-guided targeted biopsy vs. the Seattle protocol from a National Health Service England perspective. A decision tree model was developed to undertake a cost-consequence analysis. The model estimated total costs (i.e. staff and overheads; histopathology; adverse events; capital equipment) and clinical implications of monitoring a cohort of patients with known/suspected BE, on an annual basis. In the simulation, BE patients (N = 161,657 at Year 1; estimated annual increase: +20%) entered the model every year and underwent esophageal endoscopy. After 7 years, the adoption of NBI with targeted biopsies resulted in cost reduction of £458.0 mln vs. HD-WLE with random biopsies (overall costs: £1,966.2 mln and £2,424.2 mln, respectively). The incremental investment on capital equipment to upgrade hospitals with NBI (+£68.3 mln) was offset by savings due to the reduction of histological examinations (-£505.2 mln). Reduction of biopsies also determined savings for avoided adverse events (-£21.1 mln). In the base-case analysis, the two techniques had the same accuracy (number of correctly identified cases: 1.934 mln), but NBI was safer than HD-WLE. Budget impact analysis and cost-effectiveness analyses confirmed the findings of the cost-consequence analysis. In conclusion, NBI-guided targeted biopsies was a cost-saving strategy for NHS England, compared to current practice for detection of dysplasia in patients with BE, whilst maintaining at least comparable health outcomes for patients.

Exchange (TPE) in Guillain-Barr e Syndrome (GBS) and Myasthenia Gravis (MG) applies different cost drivers, making it difficult to compare studies. Simultaneously medical professionals as well as hospital administrators are e given the recent shortages of IVIG e considering comparing these 2 treatment options from a clinical benefit as well as from a cost point of view. This study intends to map the different cost drivers for both treatment options and to suggest how these could be incorporated in a single cost model. METHODS: A systematic literature review was performed on the drivers of cost for TPE and IVIG treatments in GBS and MG. Searches were performed on PubMed as well as through the ISPOR Scientific Presentations Database. 25 peer-reviewed publications were identified between 2000 and 2018. For each of those publication the main drivers of cost per treatment type were identified. RESULTS: The most frequently applied drivers of cost for a hospital treating GBS or MG patients by means of IVIG or TPE are: patient volume, total length of stay, treatment choice, time per treatment procedure, type of staff involved, cost of staff, patient days at the neurology ward, patient days at the intensive care unit, need for mechanical ventilation, adverse events of treatment, weight of the patient, drug price, central versus peripheral access line, diagnostic tests, capital equipment cost, disposable cost and severity of disease. CONCLUSIONS: A comprehensive cost model in GBS or MG to compare IVIG and TPE treatment, should consider costs that starts from the moment the patient is brought to the hospital (e.g. diagnostic test) until the patient leaves the hospital (e.g.ed cost) and that maps costs from multiple divisions within the hospital (e.g. pharmacy costs, staff costs, hospital department costs).

Key digested messageThis paper challenges us as practitioners to reconsider the importance of taking a systems approach to development at work and provides a recent case study to illustrate the value and importance of incorporating both individual and team development to support learning and change at work.

No abstract

Organ transplant accounts for the majority of hospital health care costs in cirrhosis patients in the Brazilian public health care system. Considering patients with HCV treatment and cirrhosis, the average cost per patient was around 78% higher than the general cirrhosis patient.