599 research outputs found
A BUNDLED PAYMENT PROFILE FOR HEAD & NECK CANCER: DESCRIPTIVE STATISTICS, RISK ASSESSMENT, AND PRICING RECOMMENDATIONS FOR 1 YEAR TREATMENT BUNDLES USING A LARGE NATIONAL CLAIMS DATABASE
Bundled payments have the opportunity to promote care standardization and coordination while incentivizing efficiency and value-based healthcare delivery. However, bundled payments have been scrutinized due to challenges with defining the bundled lengths (also known as the episode of care period), limited inclusion/exclusion criteria, the absence of IT systems to support new payment models, and the lack of federal support. The objective of this study was to develop a profile for head and neck cancer, including descriptive statistics, risk assessment and bundled payment pricing recommendations using a large national claims database. The ability to assess pricing risks associated with head and neck cancer bundled payments across the US from a large claims database can provide evidence to either support or discredit the feasibility of bundled payment reform. The results of the study highlighted the total episode costs for head and neck cancer from start of treatment and a transparent bundled payment methodology. The results are as follows: 1) head and neck episode cancer costs on average 106,500, and median episode costs of $143,806; 2) bundled payments were developed using a complete-linked hierarchical clustering analysis of 2 possible bundling approaches of either 3 bundled payment groups or 4 bundled payment groups; 3) a monte carlo simulation resulted in recommendations that pricing negotiations not start at the 50th percentile of the bundled payment group cost as suggested by previous studies but rather at the 75th percentile; 4) study aims were summarized and displayed in a visual framework to provide a practical ‘how-to guide’ for organizations looking to start modeling bundled payments. This analysis proves bundled payment grouping is feasible and viability, albeit dependent on an organization’s ability to control healthcare spending costs and negotiate bundled payment prices above costs. The results of this work demonstrate the use of statistical and financial models to support price models and sensitivity analyses. Healthcare leaders can use these models to better understand their expected costs/ profits and leverage their negotiations; however, it should be noted that this research does not suggest all bundled payment methodologies are profitable
Cost Distribution Analysis of Remote Monitoring System Use in the Treatment of Chronic Diseases
The cost of the treatment of chronic diseases is very high and this has a huge impact on the health-care system. Several factors contribute to this high cost. Some of these include the direct costs of treatment and the costs of several potential complications that arise as a result of the presence of other diseases. The goal of this study is to evaluate a cost-effective way of managing some of the common chronic diseases by analyzing the potential cost savings of utilizing remote monitoring systems (RMS) as opposed to the use of the traditional bundle (which includes regular visits to clinics for various procedures and treatments)
Untangling hotel industry’s inefficiency: An SFA approach applied to a renowned Portuguese hotel chain
The present paper explores the technical efficiency of four hotels from Teixeira Duarte Group - a renowned Portuguese hotel chain. An efficiency ranking is established from these four hotel units located in Portugal using Stochastic Frontier Analysis. This methodology allows to discriminate between measurement error and systematic inefficiencies in the estimation process enabling to investigate the main inefficiency causes. Several suggestions concerning efficiency improvement are undertaken for each hotel studied.info:eu-repo/semantics/publishedVersio
Dosimétrie clinique en radiothérapie moléculaire
La radiothérapie moléculaire (RTM) est une radiothérapie systémique, où le produit radiopharmaceutique se lie spécifiquement sur les tumeurs pour détruire sélectivement les cibles cancéreuses tout en préservant les organes sains. Lutathera® (177Lu-DOTATATE) est un radiopharmaceutique récemment approuvé par la FDA/EMA pour le traitement des tumeurs neuroendocrines gastro-entéro-pancréatiques (GEP-NETs). Dans la pratique clinique, les patients reçoivent une activité fixe de Lutathera®, 4 cycles de 7,4 GBq, en supposant que la pharmacocinétique du radiopharmaceutique est même entre les patients. La dosimétrie spécifique au patient permet un changement de paradigme majeur dans l'administration de la RTM, passant d'une approche "taille unique" à une véritable médecine personnalisée où l'activité administrée est évaluée spécifiquement sur la base de l'irradiation délivrée à chaque patient. Pour ce faire, il faut généralement déterminer la distribution spatiale du radiopharmaceutique dans les organes par imagerie à différents moments (imagerie quantitative), estimer le nombre total de désintégrations radioactives en intégrant l'activité dans le temps (évaluation pharmacocinétique) et calculer la dose absorbée à partir des caractéristiques physiques du radionucléide et du transport de l'énergie dans les tissus du patient. Actuellement, il n'existe pas de procédures normalisées pour effectuer la dosimétrie clinique. En outre, l'évaluation des incertitudes associées à la procédure de dosimétrie n'est pas triviale. Le projet DosiTest a été lancé pour évaluer les incertitudes associées à chacune des étapes du flux de travail de la dosimétrie clinique, via une inter-comparaison multicentrique basée sur la modélisation de Monte Carlo (MC). La première phase de la thèse a consisté à comparer les analyses dosimétriques effectuées par différents centres utilisant le même logiciel et le même protocole sur le même ensemble de données de patients dans le cadre du projet IAEA-CRP E23005 afin d'évaluer la précision de la dosimétrie clinique. À notre connaissance, c'est la première fois qu'une comparaison dosimétrique multicentrique d'un seul ensemble de données cliniques sur un patient a été entreprise en utilisant le même protocole et le même logiciel par de nombreux centres dans le monde entier. Elle a mis en évidence le besoin crucial d'établir des points de contrôle et d'effectuer des vérifications de bon sens pour éliminer les disparités significatives entre les résultats et distinguer les pratiques erronées de la variabilité inter-opérateurs acceptable. Un résultat important de ce travail a été le manque d'assurance qualité en dosimétrie de médecine nucléaire clinique et la nécessité de développer des procédures de contrôle qualité. Alors que la dosimétrie gagne en popularité en médecine nucléaire, les meilleures pratiques doivent être adoptées pour garantir la fiabilité, la traçabilité et la reproductibilité des résultats. Cela met également en avant la nécessité de dispenser une formation suffisante après l'acquisition des progiciels relativement nouveaux, au-delà de quelques jours. Ceci est clairement insuffisant dans le contexte d'un domaine émergent où l'expérience professionnelle fait souvent défaut. Ensuite, l'étude de l'exactitude de la dosimétrie clinique nécessite de générer des ensembles de données de test, afin de définir la vérité de base par rapport à laquelle les procédures de dosimétrie clinique peuvent être comparées. La deuxième section de la thèse traite de la simulation de l'imagerie TEMP scintigraphique tridimensionnelle en implémentant le mouvement du détecteur d'auto-contournement dans la boîte à outils Monte Carlo GATE. Après la validation des projections TEMP/TDM sur des modèles anthropomorphes, une série d'images réalistes de patients cliniques a été générée. La dernière partie de la thèse a établi la preuve de concept du projet DosiTest, en utilisant un ensemble de données TEMP/TDM virtuelles (simulées) à différents moments, avec différentes gamma-caméras, permettant de comparer différentes techniques dosimétriques et d'évaluer la faisabilité clinique du projet dans certains départements de médecine nucléaire.Molecular radiotherapy (MRT) is a systemic radiotherapy where the radiopharmaceutical binds specifically to tumours to selectively destroy cancer targets while sparing healthy organs. Lutathera® (177Lu-DOTATATE) is a radiopharmaceutical that was recently FDA/EMA approved for the treatment of the GastroEnteroPancreatic NeuroEndocrine Tumours (GEP-NETs). In clinical practice, patients are administered with a fixed activity of Lutathera®, assuming that radiopharmaceutical distribution is the same for all patients. Patient-specific dosimetry allows for a major paradigm shift in the administration of MRT from "one-size-fits-all" approach, to real personalised medicine where administered activity is assessed specifically on the base of the irradiation delivered to each patient. This usually requires determining the spatial distribution of the radiopharmaceutical in various organs via imaging at different times (quantitative imaging), estimating the total number of radioactive decays by integrating activity over time (pharmacokinetic assessment) and calculating the absorbed dose using the physical characteristics of the radionuclide and implementing radiation transport in patient's tissues. Currently, there are no standardised procedures to perform clinical dosimetry. In addition, the assessment of the uncertainties associated with the dosimetry procedure is not trivial. The DosiTest project (http://www.dositest.org/) was initiated to evaluate uncertainties associated with each of the steps of the clinical dosimetry workflow, via a multicentric inter-comparison based on Monte Carlo (MC) modelling. The first phase of the thesis compared dosimetry analysis performed by various centres using the same software and protocol on the same patient dataset as a part of IAEA-CRP E23005 project in order to appraise the precision of clinical dosimetry. To our knowledge, this is the first time that a multi-centric dosimetry comparison of a single clinical patient dataset has been undertaken using the same protocol and software by many centres worldwide. It highlighted the critical need to establish checkpoints and conduct sanity checks to eliminate significant disparities among results, and distinguish erroneous practice with acceptable inter-operator variability. A significant outcome of this work was the lack of quality assurance in clinical nuclear medicine dosimetry and the need for the development of quality control procedures. While dosimetry is gaining popularity in nuclear medicine, best practices should be adopted to ensure that results are reliable, traceable, and reproducible. It also brings forward the need to deliver sufficient training after the acquisition of the relatively new software packages beyond a couple of days. This is clearly insufficient in a context of an emerging field where the professional experience is quite often lacking. Next, the study of clinical dosimetry accuracy requires generating test datasets, to define the ground truth against which clinical dosimetry procedures can be benchmarked. The second section of the thesis addressed the simulation of three-dimensional scintigraphic SPECT imaging by implementing auto-contouring detector motion in the GATE Monte Carlo toolkit. Following the validation of SPECT/CT projections on anthropomorphic models, a series of realistic clinical patient images were generated. The last part of the thesis established the proof of concept of the DosiTest project, using a virtual (simulated) SPECT/CT dataset at various time points, with various gamma cameras, enabling comparison of various dosimetric techniques and to assess the clinical feasibility of the project in selected nuclear medicine departments
CLADAG 2021 BOOK OF ABSTRACTS AND SHORT PAPERS
The book collects the short papers presented at the 13th Scientific Meeting of the Classification and Data Analysis Group (CLADAG) of the Italian Statistical Society (SIS). The meeting has been organized by the Department of Statistics, Computer Science and Applications of the University of Florence, under the auspices of the Italian Statistical Society and the International Federation of Classification Societies (IFCS). CLADAG is a member of the IFCS, a federation of national, regional, and linguistically-based classification societies. It is a non-profit, non-political scientific organization, whose aims are to further classification research
Modelling the prevalence, healthcare costs and number of deaths in chronic obstructive pulmonary disease in England and Scotland
Introduction
Chronic obstructive pulmonary disease (COPD) has emerged as a major policy focus for
health systems throughout Western Europe. This reflects the increased prevalence,
associated healthcare utilisation and costs of COPD, and the potential to substantially
improve outcomes through achieving reductions in smoking. The aim of this PhD was to
develop projections for the prevalence, healthcare costs and number of deaths in people with
COPD in England and Scotland over a 20-year horizon (i.e. from 2011 to 2030).
Methods
I undertook a phased programme of work, which began with a systematic review of the
published and unpublished literature to identify models that were suitable for estimating
and/or projecting the prevalence and disease and economic burden from COPD. This
involved searching Medline, Embase, CAB Abstracts, World Health Organization (WHO)
Library and Information Services and WHO Regional Indexes, and Google over the time
period 1980-2013. The models were then critically appraised for their quality of reporting.
From these, I selected the Dutch Model developed by Erasmus University for generating
projections. Suitable data sources from both England and Scotland were identified, sourced
and carefully processed in order to run the modelling exercises. Rates of incidence and
prevalence were calculated using English and Scottish healthcare datasets and population
data were obtained from the Office for National Statistics (ONS) and the General Register
Office for Scotland (GROS). Relative risks for all-cause mortality among people with COPD
were calculated from the Clinical Practice Research Datalink and mortality data were
obtained from the ONS and GROS. The Model was thus adjusted to apply to England and
Scotland. I then travelled to the Netherlands to work with the developers of the Dutch Model
and ran a baseline model and an array of sensitivity analyses with modified inputs to the
Model. Finally, my Rotterdam colleagues calculated uncertainty intervals for some of the
estimates using probabilistic analysis.
Results
Using the probabilistic means and uncertainty intervals, in England, the modelled prevalence
of diagnosed COPD among males of all ages in 2011 was 1.8% (95% uncertainty interval
1.8-1.9) increasing to 2.0% (1.7-2.1) by 2030. In females, in England, the baseline estimate
was 1.8% (1.7-1.8) in 2011 increasing to 2.4% (2.0-2.6) in 2030. In Scotland, the modelled
prevalence among males was 1.9% (1.8-1.9) in 2011 and this was projected to stay the same
at 1.9% (1.7-2.2) by 2030. In females in Scotland, the estimated prevalence was 2.2% (2.1-
2.3) in 2011 and was projected to increase to 2.5% (2.1-2.7) in 2030.Using the Model I
estimated that overall in 2011 there were a total of 952,000 (941,000-966,000) people with
diagnosed COPD in England and 106,000 (103,000-110,000) in Scotland and that these
numbers would increase to 1,325,000 (1,117,000-1,408,000) in England in 2030 and 125,000
(113,000-136,000) in Scotland in 2030, respectively. The greatest increase in COPD was
projected to be in females over 65 years of age in both countries.
The total annual direct healthcare costs of COPD in England were projected to increase from
£1.60 (95% uncertainty interval 1.18-2.5) billion in 2011 to £2.35 (1.85-3.08) billion in
2030. In Scotland, costs were projected to increase from £170 (128-268) million in 2011 to
£210 (165-274) million in 2030. These costs were calculated in terms of 2011 costs without
the application of any economic trends (i.e. no annual increase applied for inflation).
The number of deaths among people with COPD in England was estimated to be 99,000
(93,000-129,000) in 2011, increasing to 129,000 (126,000-133,000) in 2030. In Scotland
there were estimated to be 10,000 (9,000-12,000) deaths in 2011, increasing to 14,000
(13,000-15,000) in 2030.
The Dutch Model demonstrated a 39% increase in the number of people with COPD in
England and a 17% increase in Scotland between 2011 and 2030. It provided an estimate of a
30% increase in deaths among people with COPD in England and of a 43% increase in
Scotland. Overall, there was a projected 46% increase in the direct healthcare costs required
to care for people with COPD in England and a 23% increase in Scotland between 2011 and
2030. The reasons for these differences are largely due to higher COPD-related excess
mortality in Scotland and to differences in the data used for populating the model in both
countries.
Conclusions
There are likely to be substantial increases in the number of people with COPD, associated
morbidity, direct healthcare costs and mortality in both England and Scotland over the next
two decades. These increases in numbers will predominantly occur in females over 65 years
of age and are likely to have substantial societal impact in terms of organising the health and
social care for this frail population
Current Topics on Risk Analysis: ICRA6 and RISK2015 Conference
Peer ReviewedPostprint (published version
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