Browsing by Subject "Costs"
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Item A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses(American Urological Association, 2021) Lee, Matthew S.; Assmus, Mark; Agarwal, Deepak; Large, Tim; Krambeck, Amy; Urology, School of MedicineIntroduction: Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the treatment of benign prostatic hyperplasia. HoLEP has been shown to have excellent improvements in prostate symptom scores and maximum flow rates that have been durable for 2 decades. However, the steep learning curve associated with HoLEP has prevented its widespread adoption. New advancements in lasers, specifically the Moses™ pulse-modulation technology, have resulted in improvements in hemostasis and achieving same-day discharges and catheter removals. We aimed to perform a cost-comparison to analyze if Moses-augmented HoLEP (m-HoLEP) resulted in cost-savings. Methods: A retrospective review was performed of a single expert surgeon's experience from May 2018 to November 2020, comparing m-HoLEP with HoLEP. Perioperative and postoperative variables were abstracted from the medical record. Univariate and multivariate analyses were performed using SAS® 9.4. Two-sided significance was set at p <0.05. Results: A total of 312 men underwent HoLEP during the study period (192 in m-HoLEP group and 120 in HoLEP group). The m-HoLEP group had more same-day discharges (p <0.001) and emergency department visits (6.3% vs 1.7%, p=0.0071). m-HoLEP resulted in hospital cost savings of $840 for the initial surgical episode (p=0.0297). When factoring in emergency department visits/readmissions, the cost savings decreased to $747 per case (p=0.0574). Conclusions: m-HoLEP was associated with same-day discharge and hospital cost savings of $840 for the initial surgical episode. Further study in other institutions with surgeons of varying experience levels will need to be performed to see if these findings can be replicated.Item Associated costs with dental studies in a public Mexican university(2014) Medina-Solís, Carlo Eduardo; Medina-Solís, June Janette; Sánchez-de la Cruz, Alicia; Ascencio-Villagrán, Arturo; de la Rosa-Santillana, Ruben; Mendoza-Rodríguez, Martha; Maupomé, GerardoObjective: to calculate associated costs with dental studies (ACDS) in a public university. Methods: we performed a cross-sectional study using a costing system on a random sample of 376 dental students enrolled at any semester in a public university. To calculate ACDS (Mexican pesos of 2009-1), we used a questionnaire divided into eight sections. Sociodemographic and socioeconomic variables, housing costs, food, transportation, instruments and equipment, as well as remunerations associated with patient care along 16 weeks of classes in each semester were included. We used linear regression. Results: the average of ACDS was of 18,357.54 ± 12,746.81 Mexican pesos. The largest percentage of ACDS (30.2 %) was for clinical instruments (5,537.66 ± 6,260.50). Students also spent funds in paying to patients for their time during care delivered (2,402.11 ± 4,796.50). Associated variables (p < 0.001) with the ACDS were having completed at least one clinical course or one theoretical-practical course, living within the state or out of state (compared to students who live in the city where dental studies take place), and being enrolled in the more advanced dental studies. Conclusions: the results indicate that a signifi cant percentage of the cost to students (13.1 %) is related with clinical care delivery.Item Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy(Elmer Press, 2023) Dahiya, Dushyant Singh; Nivedita, Fnu; Perisetti, Abhilash; Goyal, Hemant; Inamdar, Sumant; Gangwani, Manesh Kumar; Aziz, Muhammad; Ali, Hassam; Cheng, Chin-I; Sanaka, Madhusudhan R.; Al-Haddad, Mohammad; Sharma, Neil R.; Medicine, School of MedicineBackground: Per-oral endoscopic myotomy (POEM) is a rapidly emerging minimally invasive procedure for management of achalasia. Same-day discharge after POEM is safe and feasible; however, some patients may need hospitalization. We aimed to identify characteristics and outcomes for achalasia patients requiring hospitalizations after POEM in the United States (US). Methods: The US National Inpatient Sample was utilized to identify all adult achalasia patients who were admitted after POEM from 2016 to 2019. Hospitalization characteristics and clinical outcomes were highlighted. Results: From 2016 to 2019, we found that 1,885 achalasia patients were admitted after POEM. There was an increase in the total number of hospitalizations after POEM from 380 in 2016 to 490 in 2019. The mean age increased from 54.2 years in 2016 to 59.3 years in 2019. Most POEM-related hospitalizations were for the 65 - 79 age group (31.8%), females (50.4%), and Whites (68.4%). A majority (56.2%) of the study population had a Charlson Comorbidity Index of 0. The Northeast hospital region had the highest number of POEM-related hospitalizations. Most of these patients (88.3%) were eventually discharged home. There was no inpatient mortality. The mean length of stay decreased from 4 days in 2016 to 3.2 days in 2019, while the mean total healthcare charge increased from $52,057 in 2016 to $65,109 in 2019. Esophageal perforation was the most common complication seen in 1.3% of patients. Conclusion: The number of achalasia patients needing hospitalization after POEM increased. There was no inpatient mortality conferring an excellent safety profile of this procedure.Item The Hidden Costs of Incarceration(2021-07-29) Huntington, Christian; Messmore, NikiPeople who have been incarcerated face many obstacles, many of which are not immediately clear to those who do not have experience with the justice system. In addition to direct consequences such as loss of housing and employment due to being in jail or prison, there are many additional repercussions which have been referred to as “collateral” or “indirect” consequences. These consequences, which may seem relatively insignificant when considered individually, have an additive effect on the incarcerated individual and their loved ones which hinders transition back into society. When considering the goals of the justice system, regardless of whether an emphasis is placed on punishment or rehabilitation, there is a vested interest for society as a whole to make reintegration as simple as possible. These hidden costs, which will be discussed in this submission, hinder this reintegration for those who have been incarcerated, which reinforces the cycle of incarceration through increasing recidivism and stigma against those who have been incarcerated. This submission aims to show the importance of lessening stigma against those who have been incarcerated and lowering institutional barriers to reentry. In this study, Interviews were conducted with residents and staff members of Dismas House of Indiana, Inc. in order to explore the barriers that they have faced through incarceration. Many hidden costs of incarceration were discussed for both the individual and their loved ones and for the state. Costs and fees associated with phone calls, visitation, laundry, hygiene products, and other goods purchased from commissary at a markup make up a significant financial burden for an inmate and their families. Even after release, loss of belongings as well as fees associated with home detention and work release programs can be significant as well. Aside from direct financial impacts, incarceration has collateral consequences on mental health, as well as impeded access to healthcare, jobs, transportation, and housing.