Are Medical Device Characteristics Included in HTA Methods Guidelines and Reports? A Brief Review.

It is well accepted that medical devices (MDs) and procedures have several unique characteristics compared with pharmaceuticals, such as learning curve (LC), incremental innovation (II), dynamic pricing (DP), and organizational impact (OI). The objective of this study was to determine the extent to which these MD characteristics are routinely assessed by health technology assessment (HTA) agencies and incorporated in their guidelines and reports. Three approaches were taken.

The Economic Consequences of Cardiac Surgery Associated Acute Renal Dysfunction After Heart Surgery.

The Society of Thoracic Surgeons definition of acute renal failure requires a 3-fold rise in creatinine, creatinine > 4 mg/dL (with at least 0.5mg/dL rise from preoperative value), or new hemodialysis requirement. This definition does not capture the incidence, clinical impact, and economic burden of lesser degrees of acute renal dysfunction.

Intrinsic properties of medical devices: considerations for economic evaluation.

: In recent decades, medical devices (MDs) have increasingly become an integral part of patient care. However, when it comes to designing and appraising economic models, researchers typically follow pharmaceutical templates (e.g.

Fee comparisons of treatments for nonmelanoma skin cancer in a private practice academic setting.

Objective: To compare fees for biopsy, treatment procedure, repair, and 2-month follow-up for nonmelanoma skin cancer (NMSC) treatments: electrodesiccation and curettage (ED&C), excision, and Mohs micrographic surgery (MMS).

Methods: A cost comparison of 936 primary NMSCs diagnosed in 1999/2000 at a University affiliated dermatology practice. Clinical data was from medical record review.

The effect of prophylaxis on pediatric HIV costs.

The objective of this study was to determine and compare the cost to treat HIV(+) and HIV(-) pediatric patients both before and after HIV prophylaxis became the standard of care. Retrospective chart review of a pediatric HIV/AIDS specialty clinic's medical charts was conducted for clinical and healthcare utilization data on 125 children diagnosed from 1986 to 2007. Mean HIV-related costs were compared using bootstrapped t-tests for children born in the pre-prophylaxis (1979-1993) and prophylaxis eras (1994-2007).

Lifetime medical expenditures among hypertensive men and women in the United States.

Objective: Our objective was to estimate lifetime medical expenditures that can be attributed to hypertension, by gender, in the United States, given important gender differences in both survival and medical expenditures.

Methods: We estimated lifetime medical expenditures among hypertensive and nonhypertensive men and women aged 20 and older. Expenditures were estimated from the 2001 to 2004 Medical Expenditure Panel Survey and life expectancies were estimated from the 1986 to 2002 National Health Interview Survey Linked Mortality Files.

Socioeconomic status, health care use, and outcomes: persistence of disparities over time.

Purpose: To determine the persistence of disparities in health care use and outcomes in socioeconomically diverse populations of epilepsy patients.

Methods: We followed patients for a year at one clinic in Houston and two in New York City that serve predominantly low-income, minority, Medicaid-insured, or uninsured patients, and a fourth clinic in Houston that serves a more balanced racial/ethnic and higher socioeconomic status (SES) population. We interviewed the patients several times regarding health care use, seizures, side effects, and outcomes, and examined differences between the patients at the three low-SES clinics and the patients at the high-SES clinic.

Pediatric HIV costs across three treatment eras from 1986 to 2007.

Objective: Life has changed dramatically for infants exposed perinatally to HIV to HIV primarily because of a successful translational research program that has also affected treatment costs. We compared treatment costs among HIV+ patients in an HIV/AIDS specialty clinic across 3 treatment eras: monotherapy (pre-1990), combination therapy (1990-1996), and highly active antiretroviral therapy (HAART) (1997-2007). We also estimated cumulative health care costs among pediatric HIV/AIDS patients born in each era.

Gender disparities in medical expenditures attributable to hypertension in the United States.

Objective: We sought to examine and attempt to explain gender disparities in hypertension-attributable expenditure among noninstitutionalized individuals in the United States.

Methods: Using the 2001-2004 Medical Expenditure Panel Survey and the Aday and Andersen health care use model, we estimated hypertension-attributable health care expenditures for inpatient stay, outpatient visits, prescription drugs, office visits, and emergency room (ER) visits among men and women by applying the method of recycled prediction. Hypertensive individuals were identified using International Classification of Diseases, 9th edition, codes or self-report of a diagnosis of hypertension.

Concordance of survey and billing data in a study of outpatient healthcare cost and utilization among epilepsy patients.

We assessed the concordance between healthcare utilization and cost measured with patient survey and billing data among 226 epilepsy patients in a large multi-specialty group practice. Does survey information on utilization combined with prices, provide a cost of care that is approximately equal to the cost of care derived from billing data, utilizing the same price structure? Do measures of cost from survey and billing data yield the same correlates of cost among epilepsy patients? If so, survey data may be utilized to estimate correlates and cost of epilepsy care in cases where complete billing information is not available. For five of eight outpatient services, the concordance coefficients exceeded the practical cut-off value for clinical studies, suggesting substantial agreement between the billing and survey data.

Sociodemographic disparities in epilepsy care: Results from the Houston/New York City health care use and outcomes study.

Purpose: The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care.

Methods: Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients.

Cost to achieve an undetectable viral load using recommended antiretroviral regimens.

Purpose: The April 2005 Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents recommended 9 regimens to be combined with 2 nucleoside reverse transcriptase inhibitors (NRTIs). These regimens are effective in lowering viral load but are expensive. This study aimed to determine the cost for each regimen to achieve an undetectable viral load.