Health Economics Commons^™

Costs, Demographics, And Causative Agents In Patients Hospitalized For Drug Induced Liver Injury: Trends In A Large Academic Healthcare System, Megan Kozar, Yunisse Gonzalez, Dina Halegoua-De Marzio

Department of Medicine Faculty Papers

PURPOSE: Drug-induced liver injury (DILI) is an uncommon but potentially life-threatening condition. To date, the burden of DILI on a single, large healthcare system has not been investigated, preventing adequate resource allocation. This study aims to quantify DILI-related healthcare utilization within the Jefferson Health System (JHS) and identify case-related factors associated with high resource requirements; such information is crucial to focus efforts toward resource reduction.

PATIENTS AND METHODS: This study characterizes trends of 48 DILI cases within JHS, including demographics, payer status, causative agent, and DILI pattern. These variables were correlated with length of stay (LOS) and cost relating to …

Cost-Effectiveness Of Blood-Based Fibrosis Screening In High-Risk Metabolic Liver Diseases With Emerging Therapies, Wanyi Chen, Stephanie T. Chang, Ramsey C. Cheung, Donald B. Chalfin, Kinpritma Sangha, Szu-Yu Zoe Kao, Artem T. Boltyenkov

College of Population Health Faculty Papers

BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) remains a global public health threat. With emerging effective pharmacologic therapies, early identification of significant fibrosis in primary care is critical. We evaluated the cost-effectiveness of blood-based noninvasive tests incorporating real-world diagnostic performance in the contemporary MASLD treatment era.

METHODS: We developed a decision-analytic model for MASLD natural history and treatment to compare 6 noninvasive test strategies using Fibrosis-4 (FIB-4) and/or enhanced liver fibrosis (ELF) tests at varying cutoffs. Patients identified with significant fibrosis were referred for hepatology staging (biopsy and/or imaging-based), and eligible individuals were considered for Resmetirom ($47,400/y; mean …

Validation Of The Jefferson Health-Related Social Needs Screener, Sara Beachy, Kristin L. Rising, Richard W. Hass, Terry Hyslop, Isabella Muti, Mackenzie Kemp, Rhea E. Powell, Cara Martino, Baligh R. Yehia, Joseph G. Cacchione, Patricia C. Henwood

Jefferson Hospital Staff Papers and Presentations

INTRODUCTION: Screening for health-related social needs (HRSN) is a growing national health priority. While multiple HRSN screening tools currently exist, none to our knowledge have been evaluated using robust statistical analyses. The goal of this work is to provide results from a validation study of the Jefferson HRSN screener conducted across inpatient and outpatient settings.

METHODS: This retrospective cross-sectional psychometric study included HRSN assessments conducted across inpatient and outpatient settings with adult patients from March 2023 to May 2024. The study was conducted across a 17-hospital academic health system serving a diverse community in a 9-county area crossing two states …

Experience Matters: An Application Of The Operative Value Index For Lumbar Fusions, Danyal Quraishi, Advith Sarikonda, D. Mitchell Self, Steven R. Glener, Arbaz A. Momin, Emily L. Isch, Ashmal K. Sami, Matthews Lan, Nicholas Clark, Ashwini Sharan, Srinivas Prasad, Jack Jallo, Joshua Pelta-Heller, Alex R. Vaccaro, James Harrop, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: As healthcare systems transition to value-based care models, it is critical to understand factors influencing costs and outcomes in neurosurgery. This study utilizes Time-Driven Activity-Based Costing (TDABC) to assess the impact of surgeon experience and case volume on costs, clinical outcomes, and operative value in lumbar fusions. While TDABC has been applied in various surgical specialties, its use in neurosurgery, particularly in analyzing surgeon-specific factors, remains limited.

METHODS: A retrospective cohort study was conducted at a single center, analyzing lumbar instrumented arthrodesis procedures from 2017 to 2019. Primary variables included surgeon experience (years) and case volume (annual procedures). Confounding …

Do Anterior-Posterior Lumbar Fusions Provide More Short-Term Value Than Posterior-Only? An Application Of The Operative Value Index, Steven R. Glener, Advith Sarikonda, D. Mitchell Self, Ashmal Sami, Danyal Quraishi, Emily Isch, Arbaz A. Momin, Cheritesh R. Amaravadi, Jack Jallo, Joshua Heller, Ashwini Sharan, Alex R. Vaccaro, Srinivas K. Prasad, James Harrop, Nicholas J. Clark, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

BACKGROUND: Lumbar fusion is a common treatment for degenerative spine changes. Although both anterior-posterior (AP) and posterior-only approaches are used, their cost-effectiveness remains uncertain. This study aims to compare the costs and short-term "value" (outcomes per dollar spent) of AP and posterior-only lumbar fusions using time-driven activity-based costing and patient-reported outcomes.

METHODS: A retrospective review of AP and posterior lumbar fusions from 2017 to 2022 was conducted. Time-driven activity-based costing was used to assign intraoperative costs based on resource utilization, and the Oswestry Disability Index (ODI) was collected preoperatively and 3 months postoperatively. The Operative Value Index (OVI) was defined …

Optimizing Costs In Plastic Surgery: A Systematic Review Of Time-Driven Activity-Based Costing Applications, Emily L. Isch, Gabrielle Kozlowski, D. Mitchell Self, Theodore E. Habarth-Morales, Sydney Somers, Ahilan Sivaganesan, David Kim, Heather A. Mcmahon, Andrew Newsman, Matthew Jenkins

Department of Surgery Faculty Papers

BACKGROUND: The rising complexity and cost of healthcare in plastic surgery, particularly in resource-intensive procedures like free flap and breast reconstruction, pose significant financial challenges. Time-driven activity-based costing (TDABC) offers a method to accurately assess these costs by mapping each step of the care cycle based on time and resources consumed. Although TDABC has been utilized in high-cost fields such as neurosurgery and spine surgery, its application in plastic surgery remains underexplored. This systematic review evaluates the literature on TDABC use in plastic surgery to identify key cost drivers and propose strategies for cost-efficiency.

METHODS: A systematic review was conducted …

Time-Driven Activity-Based Costing For Cervical Myelopathy Surgery: A Step Towards Total Episode Costs, Kavantissa M. Keppetipola, Adam Leibold, Jay Trivedi, Ashmal Sami, Advith Sarikonda, D. Mitchell Self, Emily L. Isch, Steven R. Glener, Srinivas Prasad, Jack Jallo, Joshua E. Pelta-Heller, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: Time-driven activity-based costing (TDABC) is a highly accurate method for determining the true cost of delivering a healthcare service. However, TDABC is most often applied to a singular phase of care such as an outpatient visit or a surgical event. Here we broaden the scope by using TDABC to estimate the costs of surgically treating cervical myelopathy - from the moment of surgical scheduling until post-operative hospital discharge.

METHODS: In a single-center retrospective study at a large tertiary academic institution, TDABC was employed to measure pre-operative, intra-operative, and post-operative (inpatient) costs for 63 patients undergoing elective surgery for cervical …

Protecting The Future Of Medical Innovation: Balancing Fiscal Responsibility With The Need For National Institutes Of Health And Federal Health Funding, Irina Petrache, Raed A. Dweik, Michelle Ng Gong, Jesse Roman, M. Patricia Rivera, Karen J. Collishaw

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Is Anterior Cervical Discectomy And Fusion More Expensive At Quaternary Care Centers? An Application Of Time-Driven Activity-Based Costing, Jay Trivedi, Advith Sarikonda, Adam Leibold, D. Mitchell Self, Nikolaos Mouchtouris, Steven R. Glener, Ashmal Sami, Kavantissa M. Keppetipola, Emily Isch, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

OBJECTIVE: Hospital setting is postulated to be a key driver of cost variation for neurosurgical procedures. Limitations in contemporary costing methodologies have led to the development of time-driven activity-based costing (TDABC). This study applies TDABC to anterior cervical discectomy and fusion (ACDF) to compare intraoperative costs at quaternary care centers versus satellite hospitals affiliated with the same health network.

METHODS: Nine hundred and fifty-eight ACDF cases performed at two quaternary care hospitals (n = 806) and six satellite hospitals (n = 152) were reviewed. Process maps were created to map the intraoperative episode, and TDABC methodology was used to calculate …

Protecting The Future Of Medical Innovation: Balancing Fiscal Responsibility With The Need For National Institutes Of Health And Federal Health Funding, Irina Petrache, Raed A. Dweik, Michelle N. Gong, Jesse Roman, M. Patricia Rivera, Karen J. Collishaw

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Does Body Mass Index Influence Intraoperative Costs And Operative Times For Open Transforaminal Lumbar Interbody Fusion? A Time-Driven Activity-Based Costing Analysis, Danyal A. Quraishi, Advith Sarikonda, Dwight M. Self, Emily Isch, Steven R. Glener, Arbaz A. Momin, Ashmal Sami, Nicholas Clark, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, Jack Jallo, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neuroscience Faculty Papers

BACKGROUND: The increasing prevalence of obesity has raised concerns about its impact on surgical outcomes and healthcare costs. This study evaluates the influence of Body Mass Index (BMI) on intraoperative costs and operative times during open Transforaminal Lumbar Interbody Fusion (TLIF) procedures using a Time-Driven Activity-Based Costing (TDABC) approach.

METHODS: A retrospective analysis was conducted on 279 patients who underwent TLIF between 2019 and 2022. Patients were categorized into 5 BMI cohorts: healthy weight (BMI 18.5-24.99), overweight (BMI 25.0-29.99), Class I obese (BMI 30.0-34.99), Class II obese (BMI 35.0-39.99), and Class III obese (BMI >40). Intraoperative costs were calculated using …

Medicare To Veterans Affairs Cost Shifting-A Challenging Conundrum, Kenneth W. Kizer, Said A. Ibrahim

JeffMD Academic Affairs

No abstract provided.

Clinical Implementation Of Tissue-Sparing Posterior Cervical Fusion: Addressing Market Access Challenges, Morgan Lorio, Pierce Nunley, Joshua Heller, Bruce Mccormack, Kai-Uwe Lewandrowski, Jon Block

Department of Neurosurgery Faculty Papers

Background: The traditional open midline posterior cervical spine fusion procedure has several shortcomings. It can cause soft tissue damage, muscle atrophy, compromise of the lateral masses and painful prominent posterior cervical instrumentation or spinous process if there is dehiscence of the fascia. Additionally, patients frequently experience the rapid development of adjacent segment disease, which can result in the reemergence of debilitating pain and functional impairment. Clinical relevance: Tissue-sparing posterior cervical fusion is an alternative method for treating patients with symptomatic cervical degenerative disc disease. However, widespread clinical adoption has been challenged by ambiguity, misunderstandings and misinterpretations regarding appropriate procedural reimbursement …

Expanding The Access To Kidney Transplantation: Strategies For Kidney Transplant Programs, Angie Nishio Lucar, Ankita Patel, Shikha Mehta, Anju Yadav, Mona Doshi, Megan Urbanski, Beatrice Concepcion, Neeraj Singh, M. Lee Sanders, Arpita Basu, Jessica Harding, Ana Rossi, Oluwafisayo Adebiyi, Milagros Samaniego-Picota, Kenneth Woodside, Ronald Parsons

Department of Medicine Faculty Papers

Kidney transplantation is the most successful kidney replacement therapy available, resulting in improved recipient survival and societal cost savings. Yet, nearly 70 years after the first successful kidney transplant, there are still numerous barriers and untapped opportunities that constrain the access to transplant. The literature describing these barriers is extensive, but the practices and processes to solve them are less clear. Solutions must be multidisciplinary and be the product of strong partnerships among patients, their networks, health care providers, and transplant programs. Transparency in the referral, evaluation, and listing process as well as organ selection are paramount to build such …

Health Care Costs Among Patients With Hematologic Malignancies Receiving Allogeneic Transplants: A Us Payer Perspective, Richard Maziarz, Usama Gergis, Marie Louise Edwards, Yan Song, Qing Liu, Annika Anderson, James Signorovitch, Rocio Manghani, Ronit Simantov, Heayoung Shin, Smitha Sivaraman

Department of Medical Oncology Faculty Papers

Patients with hematologic malignancies undergoing allogeneic hematopoietic cell transplant (allo-HCT) require extensive care. Using the Merative MarketScan Commercial Claims and Encounters database (2016 Q1-2020 Q2), we quantified the costs of care and assessed real-world complication rates among commercially insured US patients diagnosed with a hematologic malignancy and aged between 12 and 64 years undergoing inpatient allo-HCT. Health care resource use and costs were assessed from 100 days before HCT to 100 days after HCT. Primary hospitalization was defined as the time from HCT until first discharge date. Incidence of complications was assessed using medical billing codes from HCT date to …

Guaranteed Income And Financial Treatment Trial (Gift Trial Or Giftt): A 12-Month, Randomized Controlled Trial To Compare The Effectiveness Of Monthly Unconditional Cash Transfers To Treatment As Usual In Reducing Financial Toxicity In People With Cancer Who Have Low Incomes, Meredith Doherty, Jonathan Heintz, Amy Leader, David Wittenburg, Yonatan Ben-Shalom, Jessica Jacoby, Amy Castro, Stacia West

Department of Medical Oncology Faculty Papers

Cancer-related financial hardship (i.e., financial toxicity) has been associated with anxiety and depression, greater pain and symptom burden, treatment nonadherence, and mortality. Out-of-pocket healthcare costs and lost income are primary drivers of financial toxicity, however, income loss is a pronounced risk factor for cancer patients with low incomes. There has been little progress in developing an income intervention to alleviate financial toxicity cancer patients with low incomes. Unconditional cash transfers (UCT), or guaranteed income, have produced positive health effects in experiments with general low-income populations, but have not yet been evaluated in people with cancer. The Guaranteed Income and Financial …

The Financial Dialogue In The Development Of Medical Treatment Plans, Christopher D. Busack, Ms3, Bethany Fox, Ms3

The Medicine Forum

As patients face increasingly high out-of-pocket costs and difficulties navigating the healthcare system, failing to discuss available treatment options in financial terms can lead to grave consequences for patients. Medical bills are responsible for the majority of bankruptcies in the United States. Given the severe financial implications of medical bills, it is imperative that patients become more involved in discussions of their treatment plans and become aware of the costs of their decisions up front. Counseling about costs ensures that physicians avoid placing a debilitating financial burden on patients and maintain adherence to the ethical principle of non-maleficence. Various studies …

Direct Comparison Of Apremilast And Best Supportive Care Using A Discrete Event Simulation, Zoe Clancy, Pharmd

Master of Science in Applied Health Economics and Outcomes Research Capstone Presentations

Apremilast is compared to best supportive care (BSC), and response to treatment is assessed after a trial period of 16 weeks, which corresponds to the primary efficacy endpoint in the apremilast clinical trials. DES is a technique that is event-based and models a population at the individual level in terms of utility, costs, and resource use. The DES was implemented as a series of input, calculation, and output flowcharts in Arena®. The DES reported an incremental QALY per patient of 0.16 and incremental cost per patient of $17,325. The Markov model reported an incremental QALY of 0.18 and incremental cost …

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Value-Based Purchasing Newsletter

No abstract provided.

Governance And Value-Based Purchasing: What Employers Need To Know, Valerie Pracilio

Value-Based Purchasing Newsletter

In the current economy, employers are increasingly aware of the need to employ value-based purchasing strategies. Similar strategies can also be used by health care organization governing boards.

Today, more health care providers are accepting positions at the boardroom table than in the past. These providers are well trained in the clinical aspects of health care but not the business of health care delivery. It is not surprising that providers often find themselves unprepared for a board member’s role as a decision-maker and steward. It has become clear that education is essential to prepare providers for board positions.

The Patient Centered Medical Home-What Employers Need To Know, Richard Jacoby Md

Value-Based Purchasing Newsletter

In their capacity as payers for their employees’ medical services, employers need to be aware of trends that impact the provision and payment of healthcare services. One such trend in primary care healthcare services – specifically, the Patient Centered Medical Home (PCMH) - meets both of these criteria by providing financial incentives to physicians for meeting certain quality criteria. In the following paragraphs, I’ll elaborate on the concepts underlying the PCMH, its potential to impact quality and cost of patient care, and some of the barriers to its implementation.

Consumer Health Websites Accelerate Consumer-Driven Healthcare, Richard Toner

Value-Based Purchasing Newsletter

Consumer health websites (sites) have been around for more than a decade now. WebMD, RevolutionHealth, MyOptumHealth, HealthCentral, Everydayhealth, QualityHealth… the list of sites goes on and on. Employers, employees, health plans, providers, and general healthcare consumers have had varying reactions to these sites and buy-in remains largely a personal preference.

Editor's Updates From The College, Neil I. Goldfarb

Value-Based Purchasing Newsletter

CAMHB Gets a New Name. The College for Advanced Management of Health Benefits has been renamed The College for Value-Based Purchasing of Health Benefits (CVBP). When the College was founded in 2004 the term “value-based purchasing” was relatively unknown outside of the limited circle of employers and coalitions that were already engaged in VBP activity. Since that time, the VBP movement has gathered steam, due in no small part to DHHS’ stated commitment to becoming a value-based purchaser of health services. The College curriculum has always been focused on value-based purchasing, and will continue to have this focus, so, in …

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Value-Based Purchasing Newsletter

No abstract provided.

Spouse Accountability In Wellness Program Requirements

Value-Based Purchasing Newsletter

No abstract provided.

Benefits College Program Schedule For 2008, Neil I. Goldfarb

Value-Based Purchasing Newsletter

No abstract provided.

Challenges And Benefits In Using Productivity Data From Clinical Trials For Vbp Decisions, Thomas J. Bunz, Pharm.D., Laura T. Pizzi

Value-Based Purchasing Newsletter

Making value based purchasing decisions in healthcare requires balancing data from several sources. Information on effectiveness of interventions often comes from clinical trials, with less reliance on observational studies. Historically, the opposite has been true of information on the cost of interventions. More recently, providers of healthcare interventions such as drugs, devices, and disease management programs have begun to understand and appreciate the importance of costs in healthcare decision making. Because of this, the clinical trials used to demonstrate effectiveness have begun to gather data on costs. This article describes some benefits and detriments of collecting cost data as a …

The Emerging Role Of Electronic Medical Records - What Do They Mean To Quality And Value?, Richard Jacoby

Value-Based Purchasing Newsletter

President Bush identified electronic medical records (EMRs), also known as electronic health records (EHRs), as one of the 4 cornerstones in his value driven health care initiative. EMRs represent a “disruptive technology” insofar as they change the way we capture, store, retrieve, share, and use health information. Because they have the ability to transform and enhance virtually all communications, transactions, and analyses involving healthcare information, implementation of EMRs will have a profound effect on patients, providers, and payers. The transformation likely will parallel the one which occurred as information technology enhanced knowledge and productivity in the non-healthcare segments of the …

The Centers For Medicare And Medicaid Services’ Approach To Value-Based Purchasing, Bettina Berman

Value-Based Purchasing Newsletter

Although evidence suggests that both the quality and the affordability of health care can be improved¹, it is likely that such improvements will come at great cost. Healthcare expenditures in the United States (U.S.) are expected to rise precipitously - from $1.5 trillion in 2005 to over $4 trillion in 2016.² Medicare, the nation’s single largest health care purchaser, spent an estimated $425 billion on health services in 2007. With the projected growth in Medicare beneficiaries, the amount may surpass $800 billion by 2017, placing the government under significant pressure to control health care costs.³

This …

Uncle Sam's Debut On The Value-Based Purchasing Stage, Neil I. Goldfarb

Value-Based Purchasing Newsletter

No abstract provided.