Comparative and cost-effectiveness research: Competencies, opportunities, and training for nurse scientists

Cohen, Catherine C.; Pincus, Harold Alan

doi:10.1016/j.outlook.2017.04.002

Cited by 10 publications

(10 citation statements)

References 22 publications

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“…In recent years, health care improvement efforts in the United States have focused on achieving high-quality value-based care (87,88), which has been closely tied with efforts to widely establish the use of value-based payments (16). In turn, cost-effectiveness studies, which integrate information about health outcomes and health care expenditures, are tools commonly employed for assessing the value of clinical interventions (26,89) and can help inform value-based clinical decision-making (90,91).…”

Section: Discussionmentioning

confidence: 99%

The Cost-Effectiveness of Rapid Diagnostic Testing for the Diagnosis of Bloodstream Infections with or without Antimicrobial Stewardship

et al. 2018

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Bloodstream infections are associated with considerable morbidity and health care costs. Molecular rapid diagnostic tests (mRDTs) are a promising complement to conventional laboratory methods for the diagnosis of bloodstream infections and may reduce the time to effective therapy among patients with bloodstream infections. The concurrent implementation of antimicrobial stewardship programs (ASPs) may reinforce these benefits. The aim of this study was to evaluate the cost-effectivenesses of competing strategies for the diagnosis of bloodstream infection alone or combined with an ASP. To this effect, we constructed a decision-analytic model comparing 12 strategies for the diagnosis of bloodstream infection. The main arms compared the use of mRDT and conventional laboratory methods with or without an ASP. The baseline strategy used as the standard was the use of conventional laboratory methods without an ASP, and our decision-analytic model assessed the cost-effectivenesses of 5 principal strategies: mRDT (with and without an ASP), mRDT with an ASP, mRDT without an ASP, conventional laboratory methods with an ASP, and conventional laboratory methods without an ASP. Furthermore, based on the availability of data in the literature, we assessed the cost-effectivenesses of 7 mRDT subcategories, as follows: PCR with an ASP, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis with an ASP, peptide nucleic acid fluorescent hybridization (PNA-FISH) with an ASP, a blood culture nanotechnology microarray system for Gram-negative bacteria (BC-GP) with an ASP, a blood culture nanotechnology microarray system for Gram-positive bacteria (BC-GN) with an ASP, PCR without an ASP, and PNA-FISH without an ASP. Our patient population consisted of adult inpatients in U.S. hospitals with suspected bloodstream infection. The time horizon of the model was the projected life expectancy of the patients. In a base-case analysis, cost-effectiveness was determined by calculating the numbers of bloodstream infection deaths averted, the numbers of quality-adjusted life years gained, and incremental cost-effectiveness ratios (ICERs). In a probabilistic analysis, uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. In the base-case analysis, MALDI-TOF analysis with an ASP was the most cost-effective strategy, resulting in savings of $29,205 per quality-adjusted life year and preventing 1 death per 14 patients with suspected bloodstream infection tested compared to conventional laboratory methods without an ASP (ICER, -$29,205/quality-adjusted life year). BC-GN with an ASP (ICER, -$23,587/quality-adjusted life year), PCR with an ASP (ICER, -$19,833/quality-adjusted life year), and PCR without an ASP (ICER, -$21,039/quality-adjusted life year) were other cost-effective options. In the probabilistic analysis, mRDT was dominant and cost-effective in 85.1% of simulations. Importantly, mRDT with an ASP had an 80.0% chance of being cost-effective, wh...

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Section: Discussionmentioning

confidence: 99%

The Cost-Effectiveness of Rapid Diagnostic Testing for the Diagnosis of Bloodstream Infections with or without Antimicrobial Stewardship

et al. 2018

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“…MSSA bacteremia is associated with high health care costs [ 4 ]. Cost-effectiveness analysis integrates information about health outcomes and health care expenditures [ 43 ] and can help inform value-based decision-making [ 17 , 18 ]. Our study suggests that the use of cefazolin is a cost-effective strategy for the treatment of MSSA bacteremia compared with treatment with ASPs, as it prevented 1 death per 10 patients treated and resulted in savings of $97 156.8 per death averted (ICER, −$97 156.8 per death averted).…”

Section: Discussionmentioning

confidence: 99%

“…More specifically, cefazolin is associated with lower rates of nephrotoxicity and hepatotoxicity, with lower probability of discontinuation [ 15 ] and with more convenient dosing [ 16 ]. Given the current need for value-based decision-making [ 17 , 18 ] that accounts for both health outcomes and health care expenditures, the aim of this study was to perform a cost-effectiveness analysis that compares the use of cefazolin with ASPs for the treatment of MSSA bacteremia.…”

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confidence: 99%

The Cost-effectiveness of Cefazolin Compared With Antistaphylococcal Penicillins for the Treatment of Methicillin-SensitiveStaphylococcus aureusBacteremia

Pliakos

Ziakas

Mylonakis

2021

Open Forum Infectious Diseases

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Background Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is associated with significant morbidity, mortality, and hospitalization costs. Cefazolin and anti-staphylococcal penicillins (ASPs), such as nafcillin, are the preferred treatments for MSSA bacteremia. The aim of this study was to compare the cost-effectiveness of each approach. Methods We constructed a decision-analytic model comparing the use of cefazolin to ASPs, for the treatment of MSSA bacteremia. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. Results In the base-case analysis, the cost associated with the cefazolin strategy was $38,863.1 and the associated probability of survival was 0.91. For the ASP strategy the cost was $48,578.8, and the probability of survival was 0.81. The incremental difference in cost between the two strategies was $9,715.7, with hospital length of stay being the main driver of cost, and the incremental difference in effectiveness was 0.10. Overall, cefazolin results in savings of $97,156.8 per death averted (ICER:$- 97,156.8/death averted). In the probabilistic analysis, at a willingness-to-pay of $50,000, cefazolin had a 68% chance of being cost-effective compared to ASPs. In cost-effectiveness acceptability curves, the cefazolin strategy was cost-effective in 73.5%-81.8% of simulations compared to ASP for a willingness-to-pay ranging up to $50,000. Conclusions The use of cefazolin is a cost-effective strategy for the treatment of MSSA bacteremia and, when clinically appropriate, this strategy results in considerable health care cost-savings.

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“…El financiamiento en capacitaciones en profesionales de la salud se da principalmente en intervenciones relacionadas a desnutrición/anemia en promedio de 4,3 millones de soles (1,3 millones de dólares), así como intervenciones en relación a salud maternoneonatal (planificación familiar, control prenatal y atención del parto) que estimó un promedio de 2,1 millones de soles (654 mil dólares). De acuerdo a los estudios desarrollados por Garcés et al 14 , identifican similares resultados; sin embargo, es muy reducido el financiamiento capacitación en intervenciones de prevención y control del cáncer, enfermedades no transmisibles, TBC-VIH/Sida, Salud Mental siendo intervenciones también relevantes [15][16][17][18] .…”

Section: Discussionunclassified

Financiamiento en La Capacitación De Los Profesionales en Salud Bajo La Perspectiva Del Sector Público, 2016-2018

Escobedo-Palza

Donayre

Aguado

2019

RFMH

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Objetivo: Estimar el financiamiento y costo unitario en la capacitación a largo plazo de los profesionales de salud en el Perú. Métodos: Se realizó una evaluación económica parcial (análisis de costos) desde la perspectiva del financiador público. Para el financiamiento se muestra reportes por categorías presupuestales y programas presupuestales del sector salud, los datos se obtuvieron a través del Sistema Integrado de Administración Financiera del Ministerio de Economía y finanzas (SIAF-MEF) entre los años 2016-2018. En relación al análisis de costo se estimó con la metodología de costeo por absorción. Los datos se obtuvieron del Sistema Integrado de gestión Administrativa (SIGA)-modulo logístico para obtener los precios de los insumosy del aplicativo Informático de Recursos Humanos de Servidores Públicos (AIRHSP) para los sueldos de los recursos humanos. Resultados: Financiamiento que hace el país en relación a capacitación se estima en 27 millones de soles para el año 2016, y se reduce a 20 millones de soles para el año 2018. El costo per cápita para diplomados fue de S/.12 661 (USD 3 836) y para la especialización fue de S/. 23 356 (USD 7 077). Conclusión: el financiamiento en la formación del recurso humano en salud es vital para el logro de los objetivos sanitarios en el Perú. Sin embargo existe una disminución del presupuesto destinado a actividades de capacitación en los últimos 3 años.

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Comparative and cost-effectiveness research: Competencies, opportunities, and training for nurse scientists

Cited by 10 publications

References 22 publications

The Cost-Effectiveness of Rapid Diagnostic Testing for the Diagnosis of Bloodstream Infections with or without Antimicrobial Stewardship

The Cost-Effectiveness of Rapid Diagnostic Testing for the Diagnosis of Bloodstream Infections with or without Antimicrobial Stewardship

The Cost-effectiveness of Cefazolin Compared With Antistaphylococcal Penicillins for the Treatment of Methicillin-SensitiveStaphylococcus aureusBacteremia

Financiamiento en La Capacitación De Los Profesionales en Salud Bajo La Perspectiva Del Sector Público, 2016-2018

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