Care coordination in a business-to-business and a business-to-consumer model for telemonitoring patients with chronic diseases

Introduction For telemonitoring to support care coordination, a sound business model is conditional. The aim of this study is to explore the systemic and economic differences in care coordination via business-to-business and business-to-consumer models for telemonitoring patients with chronic diseases. Methods We performed a literature search in order to design the business-to-business and business-to-consumer telemonitoring models, and to assess the design elements and themes by applying the activity system theory, and describe the transaction costs in each model. The design elements are content, structure, and governance, while the design themes are novelty, lock-in, complementarities, and efficiency. In the transaction cost analysis, we looked into all the elements of a transaction in both models. Results Care coordination in the business-to-business model is designed to be organized between the places of activity, rather than the participants in the activity. The design of the business-to-business model creates a firm lock-in but for a limited time. In the business-to-consumer model, the interdependencies are to be found between the persons in the care process and not between the places of care. The differences between the models were found in both the design elements and the design themes. Discussion Care coordination in the business-to-business and business-to-consumer models for telemonitoring chronic diseases differs in principle in terms of design elements and design themes. Based on the theoretical models, the transaction costs could potentially be lower in the business-to-consumer model than in the business-to-business, which could be a promoting economic principle for the implementation of telemonitoring

Productivity Loss Related to Neglected Tropical Diseases Eligible for Preventive Chemotherapy

Neglected Tropical Diseases (NTDs) not only have impact on health and life expectancy of mostly disadvantaged populations, but can also lead to economic consequences, including reduced ability to work. Investments in health improvement of the populations affected by NTDs would also help to increase economic growth of the affected regions, since healthier populations are more economically productive. We performed a systematic literature review to better understand how much NTDs affect people’s economic welfare. Here we present the results for the NTDs that are controlled with preventive chemotherapy (PCT): lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths (ascariasis, trichuriasis, and hookworm infection) and trachoma. Our findings show that PCT NTDs clearly affect productivity, although the actual impact depends on the type and severity of the NTD as well as on the context where the disease occurs. Variation in estimated productivity loss is also caused by differences in research methods. Publications should provide enough information to enable readers to assess the quality and relevance of the study for their purposes

Cost-effectiveness of adding rituximab to fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia in Ukraine

The aim of this study was to assess the cost-effectiveness, from a health care perspective, of adding rituximab to fludarabine and cyclophosphamide scheme (FCR versus FC) for treatment-naïve and refractory/relapsed Ukrainian patients with chronic lymphocytic leukemia. A decision-analytic Markov cohort model with three health states and 1-month cycle time was developed and run within a life time horizon. Data from two multinational, prospective, open-label Phase 3 studies were used to assess patients’ survival. While utilities were generalized from UK data, local resource utilization and disease-associated treatment, hospitalization, and side effect costs were applied. The alternative scenario was performed to assess the impact of lower life expectancy of the general population in Ukraine on the incremental cost-effectiveness ratio (ICER) for treatment-naïve patients. One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the robustness of the results. The ICER (in US dollars) of treating chronic lymphocytic leukemia patients with FCR versus FC is US$8,704 per quality-adjusted life year gained for treatment-naïve patients and US$11,056 for refractory/relapsed patients. When survival data were modified to the lower life expectancy of the general population in Ukraine, the ICER for treatment-naïve patients was higher than US$13,000. This value is higher than three times the current gross domestic product per capita in Ukraine. Sensitivity analyses have shown a high impact of rituximab costs and a moderate impact of differences in utilities on the ICER. Furthermore, probabilistic sensitivity analyses have shown that for refractory/relapsed patients the probability of FCR being cost-effective is higher than for treatment-naïve patients and is close to one if the threshold is higher than US$15,000. State coverage of rituximab treatment may be considered a cost-effective treatment for the Ukrainian population u

Assessment of a Business-to-Consumer (B2C) model for Telemonitoring patients with Chronic Heart Failure (CHF)

Background: The purpose of this study is to assess the Business-to-Consumer (B2C) model for telemonitoring patients with Chronic Heart Failure (CHF) by analysing the value it creates, both for organizations or ventures that provide telemonitoring services based on it, and for society. Methods: The business model assessment was based on the following categories: caveats, venture type, six-factor alignment, strategic market assessment, financial viability, valuation analysis, sustainability, societal impact, and technology assessment. The venture valuation was performed for three jurisdictions (countries) - Singapore, the Netherlands and the United States - in order to show the opportunities in a small, medium-sized, and large country (i.e. population). Results: The business model assessment revealed that B2C telemonitoring is viable and profitable in the Innovating in Healthcare Framework. Analysis of the ecosystem revealed an average-to-excellent fit with the six factors. The structure and financing fit was average, public policy and technology alignment was good, while consumer alignment and accountability fit was deemed excellent. The financial prognosis revealed that the venture is viable and profitable in Singapore and the Netherlands but not in the United States due to relatively high salary inputs. Conclusions: The B2C model in telemonitoring CHF potentially creates value for patients, shareholders of the service provider, and society. However, the validity of the results could be improved, for instance by using a peer-reviewed framework, a systematic literature search, case-based cost/efficiency inputs, and varied scenario inputs

№ 201. Ордер на обшук та арешт Харитона Гов’ядовського від 21лютого 1938 р.

Op de studiegroep Wiskunde met de Industrie in 2005 in Amsterdam was de medische wetenschap prominent aanwezig. Het woord ‘industrie’ in de naam van de workshop moet dan ook al sinds vele jaren ruim worden opgevat. De studiegroep is daarmee tevens een test hoe bruikbaar wiskunde eigenlijk is voor de samenleving. Hoe kunnen wiskundige disciplines commercieel worden ingezet, wat hebben we aan de nieuwste ontwikkelingen in de statistiek, wat is de betekenis van de steeds maar groeiende kennis van het modelleren met differentiaalvergelijkingen? Soms valt dit tegen, maar wiskundige common sense geeft de bedrijven ook dikwijls een andere blik op hun probleem. En de wiskundigen kunnen met hun neus bovenop een open-hartoperatie komen te staan

Temperature and surgical wound heat loss during orthopedic surgery: computer simulations and measurements

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Improving management of patients with acute cough by C-reactive protein point of care testing and communication training (IMPAC(3)T): study protocol of a cluster randomised controlled trial

BACKGROUND: Most antibiotic prescriptions for acute cough due to lower respiratory tract infections (LRTI) in primary care are not warranted. Diagnostic uncertainty and patient expectations and worries are major drivers of unnecessary antibiotic prescribing. A C-reactive protein (CRP) point of care test may help GPs to better guide antibiotic treatment by ruling out pneumonia in cases of low test results. Alternatively, enhanced communication skills training to help clinicians address patients' expectations and worries could lead to a decrease in antibiotic prescribing, without compromising clinical recovery, while enhancing patient enablement. The aim of this paper is to describe the design and methods of a study to assess two interventions for improving LRTI management in general practice. METHODS/DESIGN: This cluster randomised controlled, factorial trial will introduce two interventions in general practice; point of care CRP testing and enhanced communication skills training for LRTI. Twenty general practices with two participating GPs per practice will recruit 400 patients with LRTI during two winter periods. Patients will be followed up for at least 28 days. The primary outcome measure is the antibiotic prescribing rate. Secondary outcomes are clinical recovery, cost-effectiveness, use of other diagnostic tests and medical services (including reconsultation), and patient enablement. DISCUSSION: This trial is the first cluster randomised trial to evaluate the influence of point of care CRP testing in the hands of the general practitioner and enhanced communication skills, on the management of LRTI in primary care. The pragmatic nature of the study, which leaves treatment decisions up to the responsible clinicians, will enhance the applicability and generalisability of findings. The factorial design will allow conclusion to be made about the value of CRP testing on its own, communication skills training on its own, and the two combined. Evaluating a biomedical and communication based intervention ('hard' and 'soft' technologies) together in this way makes this trial unique in its field

TECH-VER: A Verification Checklist to Reduce Errors in Models and Improve Their Credibility

Background In health economic literature, checklists or best practice recommendations on model validation/credibility always declare verifcation of the programmed model as a fundamental step, such as ‘is the model implemented correctly and does the implementation accurately represent the conceptual model?’ However, to date, little operational guidance for the model verifcation process has been given. In this study, we aimed to create an operational checklist for model users or reviewers to verify the technical implementation of health economic decision analytical models and document their verifcation eforts. Methods Literature on model validation, verifcation, programming errors and credibility was reviewed systematically from scientifc databases. An initial beta version of the checklist was developed based on the checklists/tests identifed from the literature and from authors’ previous modeling/appraisa