ABSTRACT
BACKGROUND: Little is known about the therapeutic benefits of a value-based healthcare model compared to a traditional activity-based incentive model in psoriasis (PsO). OBJECTIVES: This prospective non-interventional study evaluated an outcome-based, patient-centred management model for patients with PsO. METHODS: In total, 49 patients with a Psoriasis Area and Severity Index (PASI) ≥3 who were starting or switching between treatments were included. Patients were assessed at baseline, 3 and 9 months. The patient benefit index (PBI) was calculated using predefined questionnaires. An expected PBI was calculated and adjusted for risk factors known to complicate treatment, that is overweight and smoking. The model remunerated the department on whether the observed PBI exceeded the expected PBI to incentivize over-performance. RESULTS: In total, 40 patients (80%) completed all three visits; 32.7% were smokers and 73.5% were overweight. Mean PASI at baseline was 11.5 (SD 9.1); PASI improved significantly from baseline through 3 months: mean reduction, 8.0 (SD 9.2), p < 0.001 and was maintained until 9 months: mean further reduction, 0.1 (SD 3.3), p = 0.893. The mean PBI was 2.5 (SD 1.3) and 2.8 (SD 1.1) at 3 and 9 months, respectively. A PBI ≥1 was achieved by 87.8% at 3 and 95.1% at 9 months. Overall, the department was remunerated a mean 2721.1 DKK (SD 4472.8) per patient. In subgroup analysis, the department was remunerated a mean of, respectively, 2428.6 (SD 5089.5), 2636.6 (SD 4471.3) and 3196.5 (SD 4497.1) DKK for patients with none, 1 or 2 risk factors, that is smoking or/and overweight. CONCLUSIONS: The model evaluated herein is the first value-based model to calculate remuneration from patient reported outcomes and showed to successfully predict the expected PBI and remunerate treatment based on whether the expected treatment goal was met or exceeded. This can be utilized in the patient-centred management of PsO.
ABSTRACT
INTRODUCTION: The purpose of this study was to compare a dual energy CT (DECT) protocol with 50% reduction of iodinated contrast to a single energy CT (SECT) protocol using standard contrast dose in imaging of the thoracic aorta. METHODS: DECT with a 50% reduction in iodinated contrast was compared with SECT. For DECT, monoenergetic images at 50, 55, 60, 65, 68, 70, and 74 keV were reconstructed with adaptive statistical iterative reconstruction (ASiR-V) of 50% and 80%. Objective image quality parameters included intravascular attenuation (HU), image noise (SD), contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR). Two independent radiologists subjectively assessed the image quality for the 55 and 68 keV DECT reconstructions and SECT on a five-point Likert scale. RESULTS: Across 14 patients, the intravascular attenuation at 50-55 keV was comparable to SECT (p > 0.05). The CNRs were significantly lower for DECT with ASIR-V 50% compared to SECT for all keV-values (p < 0.05 for all). For ASIR-V 80%, CNR was comparable to SECT at energies below 60 keV (p > 0.05). The subjective image quality was comparable between DECT and SECT independent of keV level. CONCLUSION: This study indicates that a 50% reduction in iodinated contrast may result in adequate image quality using DECT with monoenergetic reconstructions at lower energy levels for the imaging of the thoracic aorta. The best image quality was obtained for ASiR-V 80% image reconstructions at 55 keV. IMPLICATIONS OF PRACTICE: Dual energy CT with a reduction in iodinated contrast may result in adequate image quality in imaging of the thoracic aorta. However, increased radiation dose may limit the use to patients in which a reduction in fluid and iodinated contrast volume may outweigh this risk.