Time-driven activity-based costing for capturing the complexity of healthcare processes: the case of deep vein thrombosis and leg ulcers

Time-driven activity-based costing (TDABC) is suggested to assess costs within the value-based healthcare approach, but there is a paucity of applications in chronic diseases such as deep vein thrombosis (DVT) and leg ulcers. In this context, we applied TDABC in a cost-effectiveness analysis comparing venous stenting to compression ± anticoagulation (standard of care—SOC) from both hospital and societal perspectives in Italy. TDABC was applied to both treatments to assess costs that were included in a cost-effectiveness model. Clinical inputs were retrieved from the literature and integrated with real-world data. The Incremental Cost Utility Ratio (ICUR) of stenting compared to SOC was EUR 10,270/QALY and EUR 8962/QALY for hospital and societal perspectives, respectively. The mean cost per patient for venous stenting of EUR 5082 was higher than the Diagnosis-Related Group (DRG) reimbursement (EUR 4742). For SOC, an ulcer healing in 3 months costs EUR 1892, of which EUR 302 (16%) is borne by the patient versus a reimbursement of EUR 1132. TDABC showed that venous stenting may be cost-effective compared with SOC but that reimbursement rates may not completely cover the real costs, which are partially sustained by the patients. A more efficient policy for covering the real costs may be beneficial for both clinical centers and patients

Compression after vein harvesting for coronary bypass

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Clinical guidelines vs. current clinical practice for the management of Deep Vein Thrombosis: where do we stand?

Background: Deep Vein Thrombosis (DVT) is one of the major health problems worldwide with potentially serious outcomes related to mortality and morbidity. Objectives: We tried to give a current view on how DVT patients are managed in routine practice compared to recommendations of published clinical guidelines. Methods: A literature review has been conducted on studies reporting diagnostic and treatment patterns for acute DVT. Four dimensions have been evaluated to compare differences between clinical practice and clinical guidelines recommendations: diagnostic pathway, prescription of pharmacological treatment and related duration, prescription of compression therapy. For each aspect, the agreement with the corresponding guideline has been estimated as a percentage ranging from 0% (no agreement) to 100% (full agreement). Results: Sixteen studies reported clinical practices in 10 countries. Among them, Japan showed the highest agreement with guidelines, followed by UK and Switzerland. Hong Kong showed the highest agreement with diagnosis guidelines, Spain for drug treatment, UK for treatment duration and France for compression therapy. Conversely, Germany reported a complete disagreement with guidelines for diagnosis, followed by low agreement level by UK and Italy, while Switzerland reported the lower agreement level with prescription of compression therapy. Conclusions: The implementation of clinical guidelines for the management of patients with DVT varies among countries from strict adherence to no adherence at all. In this context the use of registries may be a useful tool to investigate the clinical practices and to produce findings that may be generalizable across populations

La profondoplastica: indicazioni e risultati

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Venous stenting for patients with outflow obstruction and leg ulcers: cost–effectiveness and budget impact analyses

Aim: To perform cost–effectiveness analysis (CEA) and budget impact analysis (BIA) comparing stenting to standard medical treatment (SMT) for the management of deep venous outflow obstruction and leg ulcers from the Italian Healthcare Service perspective. Materials & methods: A Markov model was developed to project costs and quality-adjusted life-years (QALYs) over 3 years, based on data from literature combined with real-world data. Moreover, a BIA was performed comparing the current scenario (100% SMT) with increasing utilization rates of stenting over SMT from 0.5 to 5%, in the next 5 years. Results: Stenting is a cost-effective (incremental cost-utility ratio €12,388/QALY) or dominant option versus SMT, according to in-patient or day-hospital settings, respectively. Increasing use of stenting over SMT, in the next 5 years, is expected to yield additional costs of 39.5 million Euros (in-patient) or savings of 5.1 million Euros (dayhospital). Conclusion: Stenting is a cost-effective option compared with SMT for patients with deep vein occlusion and ulceration in Italy

Malattia venosa cronica:protocollo strumentale a carattere applicativo.

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L'archiviazione computerizzata per dati ed immagini in flebologia.

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