Browsing by Subject "Cost-Benefit Analysis"
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Item Cost Analysis of the Anterior Vaginal Wall Suspension Procedure to the Repair of Stress Urinary Incontinence with Early Grade Anterior Compartment Prolapse(2015-01-26) Rawlings, Tanner; Zimmern, Philippe E.INTRODUCTION: To evaluate the contemporary cost of the Anterior Vaginal Wall Suspension (AVWS) procedure to correct SUI with early grade compartment prolapsed. METHODS: The cost of AVWS for women undergoing AVWS alone (with no associated procedure) was analyzed from a prospective long-term database. Costing data was obtained from a tertiary care institution for operating room expenses, medical and surgical supplies, pharmacy, anesthesia supplies, and room and bed. Professional fees for the AVWS procedure were obtained from the Medicare Fee for Service Schedule. Costs for 2012 were adjusted by 3% to match 2013 costs. Due to non-normality in the data, the non-parametric Wilcoxon Rank Sum test was used to test for differences in cost by fiscal year or payer type. The Student t-test was used to ensure this population was a representative sample by testing for differences between the patients in this sample compared to the remainder of the patients that have undergone AVWS without concomitant surgery at our institution RESULTS: For 2012 - 2013, 34 of 48 women met inclusion criteria. One charity case was excluded, and others had concomitant procedures like hysterectomy. With the 3% inflation adjustment for 2012, the mean total cost was $3681 ± $764, with a median cost of $3664. Anesthesia, operating room, and room and bed costs differed significantly from 2012 to 2013. Only pharmacy cost differed between payer mix and Medicare. The sample analyzed had a shorter mean surgery time (69.6 min) compared to the overall AVWS population (86 min).). This cost data compares favorably to the average cost reported in contemporary U.S. literature for Tension free vaginal tape (TVT)( $8082 - 9579), transobturator tape (TOT) ($9017), and BC ($9320 - $105450) CONCLUSION: The AVWS mean total cost was $3681, with an increase in cost from 2012 to 2013 related to anesthesia, operating room, and room and bed costs, a figure much lower than most reported costs for comparable anti-incontinence procedures.Item Donald W. Seldin, M.D., Research Symposium finalist presentations(2021-04-23) Arvind, Ashwini; Elias, Roy; McAdams, Meredith; Salazar, Alonso Pezo; Rao, Shreya; Sheth, RahulThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Sixth Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 23, 2021. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2021 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation also includes additional awards honoring Clinical Vignettes and an award for work in Quality and Education at Parkland Hospital.Item Home vs In-Office Phototherapy for Patients with Vitiligo: Comparison of Time, Cost, Efficacy, and Safety(2016-01-19) Powe, Jean-Claire; Ford, ChiAyrsh; Pandya, Amit G.BACKGROUND: The use of home phototherapy has been a research topic for multiple skin diseases, including vitiligo, psoriasis, and eczema. Home phototherapy requires a large upfront cost for the equipment needed at the patient's home. However, lower long- term costs and greater convenience could make it an ideal option for patients with full-time employment, inability to pay for in-office treatments or other daily responsibilities preventing travel for in-office treatments. HYPOTHESIS: Home Phototherapy will reduce the socioeconomic burden and long-term out-of-pocket costs for vitiligo patients compared to in-office phototherapy. SPECIFIC AIMSs: The objective of this study is to evaluate and compare the treatment time and treatment costs of in-office phototherapy to that of home phototherapy in the treatment of vitiligo. METHODS: 18 patients with vitiligo were identified as receiving either home phototherapy or in-office phototherapy based on chart review. Nine patients receiving phototherapy were then matched with 9 patients who were receiving in-office phototherapy. The study participants were categorized into two groups: participants receiving in-office phototherapy and participants receiving home phototherapy. Patients were matched on ethnicity, vitiligo severity, and amount of time treated with phototherapy. The patients in each group were asked to record time to complete phototherapy sessions for one week. The cost of in office phototherapy treatment, insurance reimbursement, and patient out of pocket costs were obtained from financial records. OUTCOMES: The home phototherapy unit we used for the study, the Panasol 3D, costs USD 4590. The projected mean cost over one year for home phototherapy was USD 4,590, while the mean cost for in-office phototherapy was USD 21,271. In 3 months the home phototherapy unit pays for itself compared to in office phototherapy. Regarding the time to complete phototherapy, 9 pairs of patients, matched for distance from the dermatology clinic, skin type and duration of phototherapy treatment. We found that the mean time to complete home phototherapy was 22 minutes while mean time to complete in office treatments was 86 minutes (p = .0004). The mean percent improvement for the home group was 43%, while the mean percent improvement for the in-office group was 45%, (p = 0.8073). Both groups showed significant improvement of their vitiligo Home phototherapy reduces the socioeconomic burden and long-term out-of-pocket costs for vitiligo.