Background And Aim: While daily witnessed opioid agonist treatment (OAT) ingestion is common in British Columbia (BC), Canada, and elsewhere, sparse evidence supports this resource-intensive practice. Many settings across North America relaxed restrictions for take-home dosing during the COVID-19 pandemic and have reported consistent or improved patient outcomes. This study measured excess expenditures attributed to daily witnessed pharmacy dispensing compared with weekly or biweekly dispensation schedules.
Design, Setting And Participants: This study was a population-level retrospective analysis. We included all methadone, buprenorphine/naloxone and slow-release oral morphine dispensations in BC from 1 January 2014 to 30 December 2020. A total of 24 357 107 OAT dispensations among 51 195 unique individuals with 122 793 person-years of follow-up were included during the study period.
Measurements: Total expenditures for each person-week of OAT with an estimated expenditure under two scenarios are as follows: (1) a weekly dispensation scenario and (2) a biweekly dispensation scenario.
Findings: We estimated excess expenditures attributable to current dispensing practices of between $38 million (2014) and $47.4 million (2018) compared with a hypothetical weekly dispensing schedule, and $43.9 million (2014) to $54.9 million (2018) compared with biweekly dispensing. The majority of these expenditures (58-64%) were attributed to pharmacy dispensing fees ($23 million in 2014 to $30 million in 2018 compared with weekly dispensing; $26.6 million in 2014 to $34.7 million in 2018 compared with biweekly dispensing).
Conclusion: Daily witnessed opioid agonist treatment ingestion results in more than $30 million in excess expenditures annually in the province of British Columbia, Canada compared with the costs of weekly or biweekly dispensation schedules.
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http://dx.doi.org/10.1111/add.16160 | DOI Listing |
Front Oncol
December 2024
Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Objective: To evaluate the efficacy of a machine learning model for predicting prostate-specific antigen (PSA) persistence after radical prostatectomy (RP).
Methods: Data from 470 patients who underwent RP at the Affiliated Hospital of Qingdao University from January 2018 to June 2021 were retrospectively analyzed. Ten risk factors, including age, body mass index (BMI), preoperative PSA, biopsy Gleason score, total prostate specific antigen density (PSAD), clinical tumor stage, clinical lymph node status, seminal vesicle invasion, capsular invasion and positive surgical margin, were included in the analysis.
Front Pediatr
December 2024
Laboratory of Translational Research, Children's Hospital of Brasília, Brasília, Brazil.
Introduction: There is consistent evidence that may be a driver gene in B-ALL and that selected cases may benefit from the use of FLT3 inhibitors. Our study was conducted to evaluate the frequency and types of FLT3 mutations in pediatric patients with B-ALL, the relative expression of this gene, and their influence on clinical evolution.
Methods: We evaluated 156 children with B-ALL treated between July 2018 and September 2023.
GMS J Med Educ
November 2024
University Medical Center Hamburg-Eppendorf, III Medical Clinic, Hamburg, Germany.
Background: The structures of postgraduate medical education are regulated by the (guideline) regulations on specialty training ((M-)WBO). This formal structure is the result of medical discourse between medical associations, specialist societies and other associations. Various developments can be seen in the WBO.
View Article and Find Full Text PDFAnn Surg Open
December 2024
Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
Objective: To evaluate opioid consumption for 21 procedures over 4 years from the Michigan Surgical Quality Collaborative (MSQC) registry and update post-discharge prescribing guidelines.
Background: Opioids remain a common treatment for postoperative pain of moderate-to-severe intensity not adequately addressed by nonopioid analgesics, but excessive prescribing correlates with increased usage. This analysis provides updates and compares patient-reported consumption in response to new guidelines.
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