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Italy, each year, 30 million working hours are lost due to back sickness. Over the past two decades, several treatments have been developed to manage the various stages of the disease: acute, sub-acute and chronic. The aim of this study is to evaluate the cost-consequences of the Human Body Posturizer (HBP), according to the stage of the disease, both in terms of direct and indirect costs. Methods: A decision tree model was developed, to compare the traditional pathway without HBP (P1) vs the new one with HBP (P2). To estimate drugs costs, the generic prices, reimbursed by the Italian National Health System (INHS), were used. Outpatient and inpatient costs were quantified with the National tariffs while productivity loss was costed using the Italian daily Gross Domestic Product per-capita. The price of HBP was € 4,550.74. The time horizon was one-year, therefore no discounts were applied. Results: For acute low back pain, the use of HBP increased direct costs from € 64.04 (P1) to € 332.02 (P2) without affecting indirect ones. In the sub-acute setting HBP was cost saving with direct costs from € 552.48 (P1) to € 347.18 (P2) and indirect ones from € 900.20 (P1) to € 128.60 (P2). Finally, considering the chronic stage, direct costs decreased from € 1526.98 (P1) to € 340.18 (P2), while indirect ones from € 1,929.00 (P1) to € 192.90 (P2). ConClusions: The introduction of HBP could be a cost saving strategy in patients with sub-acute and chronic low back pain, considering both the INHS and Society perspective.

OBJECTIVES: Surgical site infections (SSIs) associated with total knee arthroplasty (TKA) have a significant negative impact on outcomes and hospital reimbursement. Our study uniquely looks at the impact of patients having SSI in their initial admission with downstream outcomes of readmission to assess the complete consequences of TKA related SSI, beyond a single episode of care. METHODS: Thomson Medstat Marketscan® Database was used to identify patients having a TKA (ICD9-CM procedure code 81.54) between January 2007 and December 2009. Patients experiencing infections were defined by ICD-9-CM codes 998.5x, 998.66 and 998.67 as their secondary diagnosis in their index admission and as their primary or secondary diagnoses during their 90-day readmissions. Total SSI burden was assessed by evaluating differences in length of stay (LOS) and costs relative to those with no SSI in the 3 groups: 1) during the initial admission in patients developing SSI; 2) during the 90-day post surgery for patients who had developed SSI in their initial admission; and 3) in patients experiencing SSI in their postoperative period. Generalized linear models adjusting for age, gender, region and p/a diabetes were used to compute mean differences and 95% confidence intervals. RESULTS: Patients in group 1 developing SSI as a complication of TKA incur an additional LOS of 2.4 days (95%CI:2.2-2.6 days) and an extra $6360 costs (95%CI:$4610-$8100). Group 2 patients are at risk of 0.75 more downstream readmissions, and incur an average of 0.51 days additional LOS (95%CI:0.17-0.85) and $1,160 additional payments (95%CI: $130-$2180). Group 3 patients are at risk of 1.3 additional readmissions, and incur an average additional LOS of 8.2 days (95%CI:8.0-8.4) and $21,830 (95%CI:$21,160-$22,510) in additional payments. CONCLUSIONS: SSI associated with TKA increases current and downstream burden by a factor of 1.3-8.0 times in terms of readmission rates and additional LOS and provider payments. OBJECTIVES:Solid organ transplants (SOT) are expensive, and much of the cost is incurred in the first 3 months of care to cover pre-transplant, procurement and procedural costs, which can reach Ͼ$200,000 per transplant, and higher with complications. Delayed graft function (DGF) is a complication affecting 20-40% of kidney transplants and is believed to result from ischemic reperfusion injury (IRI). The objective of this analysis is to quantify the additional charges and length of stay (LOS) associated with complications such as DGF. METHODS: Using 2008 Health Care Utilization Project (HCUP) data, individuals with a recorded transplant procedure (ICD-9 CM: 07.94 (thymus); 33.50-33.52 (lung); 336 (heart-lung); 41.94 (spleen); 46.97 (intestine); 50.51 and 50.59 (liver); 52.80-52.83 (pancreas); 65.92 (ovary) were identified. The mean hospital charges for individuals with and without a recorded complication diagnosis (ICD-9 CM 996.80-996.89 and additionally for kidney patients a recorded dialysis procedure 39.95) were compared using student's t-test. RESULTS: The ...

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