Economic benefit of a 1-day reduction in hospital stay for community-acquired pneumonia (CAP).

OBJECTIVE: As a component of healthcare reform, payers, hospital administrators, and physicians are looking for ways to reduce hospital expenditures and improve efficiency. The economic benefit of a reduced hospital stay must be weighed against the cost of the treatment or process necessary to achieve the reduced length of stay (LOS). The objective of this paper was to estimate the potential economic benefit of a reduction in inpatient hospital LOS for a common type of admission, community acquired pneumonia (CAP). RESEARCH DESIGN AND METHODS: Data for this study were from the CAP hospital admissions selected from the 2006 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). Potential savings associated with a 1 day reduction in CAP LOS were estimated using three methods: (1) average cost, (2) weighted-average incremental cost of an additional day, and (3) weighted-average predicted mean costs from regression models which were used to estimate incremental cost adjusting for hospitalization characteristics. MAIN OUTCOME MEASURES: Cost per day of CAP hospitalization. RESULTS: A total of 1,471,295 CAP admissions qualified for the analysis. The cost for each day of reduction in LOS in 2009 US dollars was $2273, $2373, and $2319 for the three methods: simple average, incremental, and regression, respectively. Subgroup analysis and regression analysis indicated higher costs were identified: in patients who died in the hospital, had hospital stays in the Northeast or West, and in large hospitals. Longer CAP hospitalizations had a higher cost per additional day. Limitations include those typically associated with the use of administrative claims (e.g., lack of clinical detail, issues related to diagnosis coding). CONCLUSIONS: Eliminating a day during the course of a CAP admission is potentially worth $2273-2373 in economic benefits (2009 dollars). As we strive for greater efficiency in healthcare delivery, changes in processes and/or improved diagnostics or treatments may potentially achieve a reduction in the length of stay. The cost of such changes or improvements must be weighed against the economic benefit of a shorter hospitalization.

Effect of amifostine on patient assessed clinical benefit in irradiated head and neck cancer.

PURPOSE: To determine if head and neck (H/N) cancer patients receiving daily amifostine during radiation therapy (RT) experienced clinical benefit (improvement in their ability to carry out normal functions with reduced discomfort) compared to nonamifostine treated patients. METHODS AND MATERIALS: This was an open-label, multi-institutional randomized trial in 303 H/N cancer patients treated with RT +amifostine. Clinical benefit was measured using an 8-item validated Patient Benefit Questionnaire (PBQ) during and up to 11 months after RT. RESULTS: 301 patients completed one or more PBQ assessments. Amifostine patients had significantly better PBQ scores (p < 0.05) than controls. The improvement in PBQ scores was most significant during chronic xerostomia. CONCLUSIONS: Amifostine use results in improved Patient Benefit Questionnaire (PBQ) scores, which is indicative of improved oral toxicity related outcomes and improved clinical benefit. Less oral toxicity should lead to preservation of late dental and oral health, and improvements in activities such as diet, nutrition, and sleep.

Optimizing quality of care and cost effectiveness in treating allergic rhinitis in a managed care setting.

Allergic rhinitis is a common condition in managed care populations. The direct medical cost of rhinitis exceeded $3 billion in 1996, and an additional cost of $4 billion resulted from the exacerbation of other concomitant conditions, such as asthma or otitis media. Costs continued to increase in 1999; sales of prescription antihistamines and nasal steroids exceeded $3 billion and $1 billion, respectively. The indirect costs of allergic rhinitis include lost work productivity, reduced performance and learning, and increased workplace and traffic accidents. Rhinitis treatments include allergen avoidance, over-the-counter (OTC) sedating antihistamines, nonsedating antihistamines, nasal steroids, and immunotherapy. Allergen avoidance strategies for patients with asthma and rhinitis are ineffective or are of very limited benefit. Allergists criticize the use of OTC sedating antihistamines, which are associated with reduced learning and performance even when sedation does not occur. Evidence-based literature reviews of clinical trials have shown that nasal steroids are more effective than nonsedating antihistamines in the treatment of rhinitis. The most commonly prescribed nasal steroid, fluticasone, has been shown to be effective in treating rhinitis and in improving patients' quality of life. It is also more cost effective than the most commonly prescribed antihistamine, loratadine. Clinical trials have indicated that immunotherapy is expensive and of limited benefit. As these evidence-based findings are used to develop managed care treatment guidelines, nasal steroids are likely to be recommended as the first-line treatment for rhinitis, which should result in lower treatment costs and improved outcomes for patients with rhinitis.

Cost of heart failure to the healthcare system.

From an economic, mortality, and functional standpoint, heart failure is clearly a disease that needs to be targeted. We can develop a model for heart failure to determine the impact that specific management strategies will have on the overall cost to the system, which by itself can tell us some interesting things because we're currently spending twice as much on transplantation as on digoxin therapy. We can then use this model to assess the impact of different strategies, such as greater use of angiotensin-converting enzyme (ACE) inhibitors or digoxin therapy.

Cost benefit of sumatriptan to an employer.

Benefit and occupational health managers need information on whether new treatments, such as sumatriptan, for migraine headache improve organizational or individual performance. A work productivity outcomes assessment was conducted among sumatriptan-using employees of an Independent Practice Association-health maintenance organization population. Of the 164 sumatriptan users, 101 full-time employees were surveyed by telephone once in an open-label, before-after design. The results revealed that lost labor costs, a function of days missed from work and reduced productivity at work as a result of migraine, were decreased after sumatriptan treatment initiation. Incremental benefit of this reduction in lost productivity is valued at $435/month per employee. The sumatriptan cost associated with this benefit is $43.78/month. The benefit-to-cost ratio is 10:1. Other costs and benefits were excluded. In conclusion, the availability of sumatriptan for migraine headache treatments in this IPA-HMO resulted in improved work productivity and had a net benefit for the employer.

Point-of-service outcomes data and its effect on asthma treatment: a salmeterol pilot investigation.

Outcomes data have enabled physicians to have a much more complete overview of the patient's quality of life and health than their predecessors. One medical center has sought to develop a comprehensive point-of-service outcomes measurement tool for the assessment of patients with asthma. This information may provide a real-time overview on a desktop computer system of the patient's progress. A pilot project involving a therapeutic intervention in patients with asthma was conducted to test the utility of this outcomes tool in a practice setting.

Cost-effectiveness of sumatriptan in a managed care population.

We conducted an open-labeled study to determine whether sumatriptan is more cost-effective than other therapies used to treat migraine headache. We contacted by phone 220 sumatriptan users enrolled in QualMed, a health maintenance organization (HMO) in Spokane, Washington. Of these, 203 met the inclusion criteria and 164 (81%) completed our telephone survey. The main outcome measures were healthcare costs to the HMO and number of days free of migraine-related disability before and after sumatriptan treatment. Before sumatriptan treatment, 89% of patients reported severe migraine, compared with 63% after sumatriptan treatment. The number of monthly migraine disability days decreased from 6.5 days per month before sumatriptan to 3.9 days per month after sumatriptan. Healthcare utilization rates (ie, number of hospitalizations, emergency department visits) and costs were lower after the patients began taking sumatriptan. The number of different over-the-counter medicines and prescription medications (other than sumatriptan) taken for migraine disabilities decreased. Although total drug expenditures per month increased, the total migraine healthcare expenditure was 41% lower after sumatriptan was initiated. The cost-effectiveness ratio was 47% more favorable after patients started taking sumatriptan. Overall, patients reported fewer migraine-related disabilities, had lower migraine severity scores, and used fewer healthcare resources when taking sumatriptan. These changes resulted in a better cost-effectiveness ratio for migraine treatment.

A comparison of costs and efficacy of intranasal fluticasone propionate and terfenadine tablets for seasonal allergic rhinitis.

This paper compares cost-efficacy ratios for intranasal fluticasone propionate and terfenadine tablets within a sample of patients with seasonal allergic rhinitis symptoms due to mountain cedar allergy. Efficacy was assessed using secondary data analysis of patient ratings of symptoms and their overall assessment of response to treatment within a previously conducted clinical trial. Costs include direct costs of the drugs used for therapy. Patients with documented mountain cedar allergy who were 12 years of age or older (N = 232) had been randomized to either receive intranasal fluticasone propionate, terfenadine, or placebo. The cost-efficacy ratios for intranasal fluticasone propionate 200 micrograms once daily were more favorable than the ratios for terfenadine 60 mg twice daily. This relationship remained throughout the sensitivity analysis. Because intranasal fluticasone propionate is only available in a fixed package size, the number of efficacy-adjusted days of terfenadine therapy that could be purchased to reach break-even costs for a 30-day supply of fluticasone was calculated. Cost efficacy-adjusted days ranged from 11 to 18 days. If cost-efficacy adjustments are not conducted, the upper end of the range increases from 18 to 22 days, since 22 days of terfenadine could be purchased for the price of a 30-day supply of intranasal fluticasone propionate. Depending on which of the efficacy measures the reader believes, if patients use terfenadine for longer than 11 to 22 days, fluticasone propionate is the more cost-efficacious choice. Because most allergies are seasonal and allergy seasons typically last longer than 11 to 22 days, it is likely that fluticasone propionate will frequently be the more cost-efficacious choice in the patient population represented in this study.

Estimation of central activity of hydroxyproline--the amino acid characteristic for collagen degradation products.

The central activity of hydroxyproline - the amino acid characteristic for collagen degradation products was studied. The levels of urinary and serum hydroxyproline are elevated in many disturbances, among them is a mental deficiency connected with hydroxyprolinemia. Previous studies showed that the mixture of collagen degradation products is biologically active and exerts and effect on central nervous system. In our study hydroxyproline significantly decreased the psychomotor activity of rats in Lat's test, enhanced amphetamine stereotypy in lower doses, and enhanced catalepsy in one of used doses. It prolonged the time of thiopental sleeping. The pentylenetetrazole seizures latency was not significantly prolonged and duration of seizures was shorter after injection (icv) of hydroxyproline. Our investigations show, that hydroxyproline is the active amino acid in the mixture of collagen degradation products and may be responsible for central activity of this mixture.

Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with COPD.

STUDY OBJECTIVE: To evaluate the short-form 36-item questionnaire (SF-36) as an instrument for measuring health-related quality of life (HRQL) in patients with symptomatic COPD. DESIGN: Observational data at a single point in time. SETTING: Outpatient pulmonary clinic. PATIENTS: Fifty male patients with COPD and no significant comorbidity. MEASUREMENTS AND RESULTS: HRQL was assessed with the SF-36, which consists of 36 questions that cover nine health domains. Clinical ratings of dyspnea were measured by the multidimensional baseline dyspnea index (BDI). Pulmonary function tests included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and maximal inspiratory mouth pressure (PImax). The mean (+/- SD) age of the patients was 72 +/- 8 years. The BDI focal score was 5.6 +/- 2.3, FEV1 was 1.32 +/- 0.60 L (48 +/- 22% pred), and PImax was 62 +/- 23 cm H2O. The BDI focal score was significantly correlated with seven of nine components of the SF-36 (range of r, 0.42 to 0.91; p < 0.05). The FEV1 percent of predicted and PImax were significantly correlated with five of nine health components (range of r, 0.30 to 0.65 and 0.31 to 0.61, respectively). Using linear regression model analysis with the different SF-36 components as the dependent variable and BDI, FVC, FEV1, and PImax as independent variables, the BDI score was the only significant predictor of social and physical functioning, role-physical, vitality, pain, health perceptions, and health transition (p < 0.05). CONCLUSIONS: The SF-36 is a valid instrument to measure HRQL in patients with COPD. The severity of dyspnea but not respiratory function was a significant predictor of various components of HRQL.

Central activity of peptide Gly-Pro-Hyp--the main component of collagen degradation products mixture.

The effect of tripeptide Gly-Pro-Hyp on the central nervous system was studied. The peptide Gly-Pro-Hyp is a main component of the mixture of collagen type I degradation products obtained by 6-h digestion with bacterial collagenase. The investigated peptide in the doses 1 microgram, 2 micrograms, and 5 micrograms significantly reduces the psychomotor activity of animals, intensifies haloperidol-induced catalepsy and enhances stereotypy behaviour after apomorphine administration. The central activity of Gly-Pro-Hyp is similar to the action of collagen degradation products mixture. This suggests that this peptide may be the active substance responsible for the effects of degradation products of collagen type I.

A search for new active amino acids responsible for pharmacological activity of collagen degradation products.

The pharmacological activity of glycine (Gly), proline (Pro) and hydroxyproline (Hyp)--the main amino acids in collagen degradation products--was studied in comparison to the activity of all mixture of DPTC (degradation products of trihelical collagen). The investigated amino acids decreased psychomotor activity of rats, enhanced apomorphine- and amphetamine-induced stereotypy. Pro and Hyp enhanced also catalepsy, but Gly decreased the haloperidol action. Each amino acid was given adequately to its contents in DPTC. Our results indicated that hydroxyproline revealed the action on the central nervous system (CNS) in each aspect most similar to the action of DPTC mixture.

The effect of collagen degradation products (CDP) on the central nervous system (CNS).

Rat collagen type I was digested with bacterial collagenase. The peptides obtained were submitted to gel filtration on Sephadex G-25. Two fractions differing in molecular weight (CDP I-3000 D and CDP II-1200 D) were obtained. These fractions administered to rats were found to have an inhibiting effect on the central nervous system (CNS) in Lat's test and the mobility of the animals recorded on a motimeter was found to be reduced. This effect was dependent on the peptide dose and occurred after intravenous (iv) as well as intraventricular (icv) injection.

The effect of collagen degradation products (CDP) on the central dopaminergic system.

The effect of collagen degradation products (CDP I--molecular weight circa 3000 D and CDP II--molecular weight circa 1200 D) on the central dopaminergic system was studied. Differences in the action of both these fractions in the apomorphine stereotypy test were noted; CDP I administered to rats in a dose of 5 micrograms just before application of the drug inducing the stereotypy enhanced the stereotypic behaviour of the animals whereas a dose of 40 micrograms significantly inhibited such behaviour. CDP II, on the other hand, had no effect on this type of stereotypy. Both fractions given in doses of 15 and 40 micrograms enhanced the stereotypy induced by amphetamine. CDP I and CDP II (15 and 40 micrograms) administered 30 min before observation of the animals intensified the cataleptic action of haloperidol, whereas both fractions (CDP I and CDP II) when administered 45 min before observation reduced the catalepsy.

Person-environment fit as a predictor of hospital pharmacist job performance.

The relationship between person-environment fit and job performance of hospital pharmacists was examined. Person-environment fit is the extent to which personal needs are supplied in the work environment. Pharmacists (n = 86) from 10 hospitals completed a survey that assessed their need for certain attributes in the work environment and their perception of the extent to which those attributes were supplied. Statements from the Jackson Personality Research Form A were used to assess need for achievement, autonomy, cognitive structure, endurance, order, and social recognition. Statements from the same form were used to assess the degree to which respondents perceived that the hospital pharmacy environment supplied the six attributes. Person-environment fit was calculated by subtracting the environmental supply score from the personal need score. Job performance was rated by supervisors. The respondents' highest need was for achievement and lowest need was for autonomy. The supply of five of the attributes was rated similarly; the supply of autonomy was perceived to be significantly lower. Scores for person-environment fit showed that the need for endurance was most closely matched by the work environment and the need for autonomy was most poorly matched. Overall job performance was not predicted by the person-environment fit score for any of the attributes. The supply of autonomy predicted 17% of the variance in performance scores. Job performance was significantly associated with the environmental supply of autonomy but not with person-environment fit.

[The radioprotective action of suprofen]. / Radiozashchitnoe deistvie suprofena.

Suprofen is a new non-steroidal anti-inflammatory drug administered intragastrically 90 min before roentgen irradiation in a dose of 20 mg/kg and then daily for 10 days in a dose of 10 mg/kg exerts the radioprotective effect evaluated according to a 30-day survival rate and an average life expectancy of the deceased animals as well as according to a decrease of postirradiation leukopenia incidence. A single administration of suprofen following roentgen irradiation exerts no radioprotective effect. Suprofen was found to enhance the radioprotective action of cysteamine.

[Disorders of the system of hemostasis in patients with juvenile rheumatoid arthritis and rheumatic fever]. / Zaburzenia ukladu hemostazy u chorych na mlodziencze reumatoidalne zapalenie stawów i goraczke reumatyczna.

The investigation of haemostasis has been performed in 55 children aged 2 to 18 years suffering from juvenile rheumatoid arthritis (31 girls and 13 boys) and children suffering from rheumatic fever (7 girls and 4 boys). The results were compared with the control group of 25 healthy children. The minimal abnormalities has been found in the group of children with rheumatic fever in the investigated indices of haemostasis in the beginning of the disease as well as during treatment. In the group of children with juvenile rheumatoid arthritis the following abnormalities has been found: increased platelet count, fibrinogen, fibrinogen degradation products, fibrin, elongation of lysis time of the euglobulines, decrease of the plasminogen concentration.