Cost-Benefit Analysis of Robotic vs. Laparoscopic Hepatectomy: A Propensity-Matched Retrospective Cohort Study of American College of Surgeons National Surgical Quality Improvement Program Database

2021 ◽  
pp. 000313482110111
Author(s):  
Henry P. Miller ◽  
Abraham Hakim ◽  
Alec Kellish ◽  
Marisa Wozniak ◽  
John Gaughan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Blood Transfusions ◽  
Benefit Analysis ◽  
Improvement Program ◽  
Surgical Quality ◽  
Liver Resections ◽  
American College Of Surgeons ◽  
The Cost

Background Robotic and laparoscopic hepatectomies having increased utilization as minimally invasive techniques are explored for hepatobiliary malignancies. Although the data on outcomes from these 2 approaches are emerging, the cost-benefit analysis of these approaches remains sparse. This study compares the costs associated with robotic vs. laparoscopic liver resections, taking into account 30-day complications. Methods Using the American College of Surgeons National Surgical Quality Improvement Program database, a propensity-matched cohort of patients with laparoscopic or robotic liver resections between 2014 and 2017 was identified. Costs were assigned to perioperative variables, including operating room (OR) time, length of stay, blood transfusions, and 30-day complications. Cost estimates were obtained from the Centers for Medicare and Medicaid Services billing data (2017), American Hospital Association data (2017), relevant literature, and local institutional cost data. Results In our matched cohort of 454 patients (227 per group), total costs associated with laparoscopic liver resections were estimated at $5.5 M ($24 K per patient) vs. $6.8 M ($29.8 K per patient) for robotic liver resections (21.3% difference, P < .001). The higher cost associated with robotic hepatectomies was related to blood transfusions ($22.0 K vs. $12.1 K, P = .02), length of stay ($2.05 M vs. $1.76 M, P = .046), and OR time ($4.01 M vs. $3.24 M, P < .0001). Discussion Robotic hepatectomies were associated with higher costs compared to laparoscopic hepatectomies. The 2 major contributors to the cost disparity were increased OR time and increased length of stay. Future studies are warranted to analyze high-volume Minimally Invasive Surgery surgeons’ impact in specialty centers on potentially mitigating this current cost disparity.

scholarly journals PREVENTION OF Β THALASSEMIA IN NORTHERN ISRAEL - A COST-BENEFIT ANALYSIS.

2014 ◽  
Vol 6 (1) ◽  
pp. e2014012 ◽  
Author(s):  
Ariel Koren ◽  
Lora Profeta ◽  
Luci Zalman ◽  
Haya Palmor ◽  
Carina Levin ◽  
...  
Keyword(s):  
Prevention Program ◽  
Cost Benefit Analysis ◽  
Iron Chelation ◽  
Cost Benefit ◽  
Thalassemia Major ◽  
World Population ◽  
Blood Transfusions ◽  
Benefit Analysis ◽  
The World ◽  
The Cost

Background:β Thalassemia major is characterized by hemolytic anemia, ineffectiveerythropoiesis and hemosiderosis. About 4 % of the world population carries a Thalassemiagene. Management includes blood transfusions and iron chelation, this treatmentis costly and population screening may be significantly more cost benefit. Purpose: Thepurpose of the current study is to analyze the cost of running a preventionprogram for β Thalassemia in Israel and compare it to the actual expensesincurred by treating Thalassemia patients. Methods: Threecost parameters were analyzed and compared: The prevention program, routinetreatment of patients and treatment of complications. An estimation of theexpenses needed to treat patients that present with complications werecalculated based on our ongoing experience in treatment of deterioratingpatients. Results andConclusions: The cost of preventing one affected newborn was $63,660 comparedto $1,971,380 for treatment of a patient during 50 years (mean annual cost:  $39,427). Thus, the prevention of 45 affectednewborns over a ten years period represents a net saving of $88.5 million tothe health budget. Even after deducting the cost of the prevention program ($413.795/yr.), the program still represents abenefit of $ 76 million over ten years. Each prevented case could pay thescreening and prevention program for 4.6 ys.

scholarly journals Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial

BMJ ◽  
2019 ◽  
pp. l121 ◽  
Author(s):  
Katherine Walker ◽  
Michael Ben-Meir ◽  
William Dunlop ◽  
Rachel Rosler ◽  
Adam West ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Cost Benefit Analysis ◽  
Randomised Trial ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Emergency Physicians ◽  
Patient Throughput ◽  
For Profit ◽  
The Cost

Abstract Objectives To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. Design Randomised, multicentre clinical trial. Setting Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. Participants 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site. Interventions Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. Main outcome measures Physicians’ productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians’ productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. Results Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians’ productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. Conclusions Scribes improved emergency physicians’ productivity, particularly during primary consultations, and decreased patients’ length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia’s. Trial registration ACTRN12615000607572 (pilot site); ACTRN12616000618459.

Hostile Takeovers and Anti-takeover Defenses in the Russian Corporate Market

2007 ◽  
pp. 70-84 ◽  
Author(s):  
E. Demidova
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Costs And Benefits ◽  
Hostile Takeovers ◽  
Russian Market ◽  
Takeover Defenses ◽  
The Cost ◽  
European Markets

This article analyzes definitions and the role of hostile takeovers at the Russian and European markets for corporate control. It develops the methodology of assessing the efficiency of anti-takeover defenses adapted to the conditions of the Russian market. The paper uses the cost-benefit analysis, where the costs and benefits of the pre-bid and post-bid defenses are compared.

What's it Worth? Improving Surface Water Quality

1999 ◽  
Vol 40 (10) ◽  
pp. 153-159 ◽  
Author(s):  
D. H. Newsome ◽  
C. D. Stephen
Keyword(s):  
Water Quality ◽  
Surface Water ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Surface Water Quality ◽  
Control Measures ◽  
Benefit Analysis ◽  
The Cost

Many countries are investing in measures to improve surface water quality, but the investment programmes for so doing are increasingly becoming subject to cost-benefit analysis. Whilst the cost of control measures can usually be determined for individual improvement schemes, there are currently no established procedures for valuing the benefits attributable to improved surface water quality. The paper describes a methodology that has been derived that now makes this possible.

scholarly journals Economic Analysis of the Use of VCS2000 for Pork Carcass Meat Yield Grading in Korea

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1297
Author(s):  
Juntae Kim ◽  
Hyo-Dong Han ◽  
Wang Yeol Lee ◽  
Collins Wakholi ◽  
Jayoung Lee ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Net Present Value ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Feed Consumption ◽  
Cost Ratio ◽  
Benefit Analysis ◽  
Labor Costs ◽  
Meat Yield ◽  
The Cost

Currently, the pork industry is incorporating in-line automation with the aim of increasing the slaughtered pork carcass throughput while monitoring quality and safety. In Korea, 21 parameters (such as back-fat thickness and carcass weight) are used for quality grading of pork carcasses. Recently, the VCS2000 system—an automatic meat yield grading machine system—was introduced to enhance grading efficiency and therefore increase pork carcass production. The VCS2000 system is able to predict pork carcass yield based on image analysis. This study also conducted an economic analysis of the system using a cost—benefit analysis. The subsection items of the cost-benefit analysis considered were net present value (NPV), internal rate of return (IRR), and benefit/cost ratio (BC ratio), and each method was verified through sensitivity analysis. For our analysis, the benefits were grouped into three categories: the benefits of reducing labor costs, the benefits of improving meat yield production, and the benefits of reducing pig feed consumption through optimization. The cost-benefit analysis of the system resulted in an NPV of approximately 615.6 million Korean won, an IRR of 13.52%, and a B/C ratio of 1.65.

scholarly journals Beyond the Stern Review: Lessons from a risky venture at the limits of the cost–benefit analysis

2009 ◽  
Vol 68 (10) ◽  
pp. 2479-2484 ◽  
Author(s):  
Jean-Charles Hourcade ◽  
Philippe Ambrosi ◽  
Patrice Dumas
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Stern Review ◽  
The Cost

Inferring age from otolith measurements: a review and a new approach

2004 ◽  
Vol 61 (7) ◽  
pp. 1269-1284 ◽  
Author(s):  
RIC Chris Francis ◽  
Steven E Campana
Keyword(s):  
Simulation Experiment ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
New Method ◽  
Population Parameters ◽  
Benefit Analysis ◽  
Mixture Analysis ◽  
New Approach ◽  
Individual Fish ◽  
The Cost

In 1985, Boehlert (Fish. Bull. 83: 103–117) suggested that fish age could be estimated from otolith measurements. Since that time, a number of inferential techniques have been proposed and tested in a range of species. A review of these techniques shows that all are subject to at least one of four types of bias. In addition, they all focus on assigning ages to individual fish, whereas the estimation of population parameters (particularly proportions at age) is usually the goal. We propose a new flexible method of inference based on mixture analysis, which avoids these biases and makes better use of the data. We argue that the most appropriate technique for evaluating the performance of these methods is a cost–benefit analysis that compares the cost of the estimated ages with that of the traditional annulus count method. A simulation experiment is used to illustrate both the new method and the cost–benefit analysis.

Drug costs and treatment choices: a DTB symposium

1993 ◽  
Vol 31 (11) ◽  
pp. 41-44
Keyword(s):  
Cost Benefit Analysis ◽  
Health Benefit ◽  
Cost Benefit ◽  
Drug Costs ◽  
Benefit Analysis ◽  
Treatment Choices ◽  
The Subject ◽  
The Cost ◽  
The Relationship ◽  
Service Managers

The relationship between drug costs and treatment choices was the subject of the first annual Drug and Therapeutics Bulletin symposium held in March 1993.* In a time of severe financial constraints for the NHS it is important that the money available is well spent. In the case of treatment that means the benefits must be worth the cost. There is, however, no agreed way of deciding when a particular health benefit to an individual is worth the cost to the NHS. Drug prices are easier to measure and more consistent than the prices of other treatments, and may be more amenable to cost-benefit analysis. Treatment choices are made primarily by doctors but with critical input from patients, pharmacists, nurses and health service managers. In this article we give an overview of the symposium at which speakers described ways in which drug costs and treatment choices were tackled in general practice (Ann McPherson, John Howie), in hospital (Dorothy Anderson), in clinical research and audit (Iain Chalmers, Alison Frater), by consumers (Anna Bradley), by health economists (Mike Drummond) and by government (Joe Collier). We also take into account points raised in discussion by the participants.

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