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[PMID]:25186499
[Au] Autor:Rudmik L; Soler ZM; Mace JC; Schlosser RJ; Smith TL
[Ad] Endereço:Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
[Ti] Título:Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis.
[So] Source:Laryngoscope;125(1):25-32, 2015 Jan.
[Is] ISSN:1531-4995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES/HYPOTHESIS: To evaluate the long-term cost-effectiveness of endoscopic sinus surgery (ESS) compared to continued medical therapy for patients with refractory chronic rhinosinusitis (CRS). STUDY DESIGN: Cohort-style Markov decision-tree economic evaluation. METHODS: The economic perspective was the U.S. third-party payer with a 30-year time horizon. The two comparative treatment strategies were: 1) ESS, followed by appropriate postoperative medical therapy; and 2) continued medical therapy alone. Primary outcome was the incremental cost per quality-adjusted life year (QALY). Costs were discounted at a rate of 3.5% in the reference case. Multiple sensitivity analyses were performed, including differing time-horizons, discounting scenarios, and a probabilistic sensitivity analysis (PSA). RESULTS: The reference case demonstrated that the ESS strategy cost a total of $48,838.38 and produced a total of 20.50 QALYs. The medical therapy alone strategy cost a total of $28,948.98 and produced a total of 17.13 QALYs. The incremental cost effectiveness ratio for ESS versus medical therapy alone is $5,901.90 per QALY. The cost-effectiveness acceptability curve from the PSA demonstrated that there is a 74% certainty that the ESS strategy is the most cost-effective decision for any willingness to pay a threshold greater than $25,000. The time-horizon analysis suggests that ESS becomes the cost-effective intervention within the third year after surgery. CONCLUSION: Results from this study suggest that employing an ESS treatment strategy is the most cost-effective intervention compared to continued medical therapy alone for the long-term management of patients with refractory CRS.
[Mh] Termos MeSH primário: Corticosteroides/economia
Corticosteroides/uso terapêutico
Antibacterianos/economia
Antibacterianos/uso terapêutico
Endoscopia/economia
Rinite/economia
Rinite/cirurgia
Sinusite/economia
Sinusite/cirurgia
[Mh] Termos MeSH secundário: Doença Crônica
Estudos de Coortes
Análise Custo-Benefício/estatística & dados numéricos
Árvores de Decisões
Custos de Medicamentos/estatística & dados numéricos
Seres Humanos
Seguro Cirúrgico/economia
Cadeias de Markov
Modelos Econômicos
Complicações Pós-Operatórias/economia
Complicações Pós-Operatórias/etiologia
Anos de Vida Ajustados por Qualidade de Vida
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1502
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140905
[St] Status:MEDLINE
[do] DOI:10.1002/lary.24916


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[PMID]:24946515
[Au] Autor:Seto Y
[Ti] Título:[Insured medical care committee-role and future-].
[So] Source:Nihon Geka Gakkai Zasshi;115(3):118, 2014 May.
[Is] ISSN:0301-4894
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Mh] Termos MeSH primário: Cirurgia Geral/economia
Seguro Cirúrgico
Programas Nacionais de Saúde/economia
[Mh] Termos MeSH secundário: Comitês Consultivos
Japão
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1408
[Cu] Atualização por classe:140620
[Lr] Data última revisão:
140620
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140621
[St] Status:MEDLINE


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[PMID]:24863403
[Au] Autor:Alluri RK; Kupperman AI; Montgomery SR; Wang JC; Hame SL
[Ad] Endereço:Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
[Ti] Título:Demographic analysis of open and arthroscopic distal clavicle excision in a private insurance database.
[So] Source:Arthroscopy;30(9):1068-74, 2014 Sep.
[Is] ISSN:1526-3231
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The purpose of this study was to evaluate and quantify the demographic characteristics of patients undergoing open and arthroscopic distal clavicle excision (DCE) in the United States while also describing changes in practice patterns over time. METHODS: Patients who underwent DCE from 2004 to 2009 were identified by Current Procedural Terminology (CPT) codes in a national database of orthopaedic insurance records. The year of procedure, age, sex, geographic region, and concomitant rotator cuff repair or subacromial decompression (SAD) were recorded for each patient. Results were reported as the incidence of procedures identified per 10,000 patients searched in the database. RESULTS: Between 2004 and 2009, 73,231 DCEs were performed; 74% were arthroscopic and 26% were open. The incidence of arthroscopic DCE increased from 37.8 in 2004 to 58.5 in 2009 (P < .001), whereas the incidence of open DCE decreased from 21.1 in 2004 to 14.1 in 2009 (P < .001). Sixty-one percent of DCEs were performed in men (P < .001). Women were more likely to undergo an arthroscopic procedure (P < .001). Arthroscopic DCE was most common in patients aged 50 to 59 years (P < .001). Open DCE was most common in patients aged 60 to 69 years (P < .001). Open rotator cuff repair and SAD were concomitantly performed in 38% and 23% of open DCEs, respectively. Arthroscopic rotator cuff repair and SAD were concomitantly performed in 33% and 95% arthroscopic DCEs, respectively. CONCLUSIONS: This analysis of DCE using a private insurance database shows that arthroscopic DCEs progressively increased, whereas open DCEs concomitantly decreased between 2004 and 2009. The majority of DCEs were performed in men between the ages of 50 and 59 years. Both arthroscopic and open DCEs are frequently performed in conjunction with rotator cuff repair or SAD. LEVEL OF EVIDENCE: Level IV, cross-sectional study.
[Mh] Termos MeSH primário: Artroscopia/estatística & dados numéricos
Clavícula/cirurgia
Seguro Cirúrgico/estatística & dados numéricos
Procedimentos Ortopédicos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Acrômio/cirurgia
Adulto
Distribuição por Idade
Idoso
Estudos Transversais
Bases de Dados Factuais/estatística & dados numéricos
Descompressão Cirúrgica
Demografia
Feminino
Seres Humanos
Incidência
Masculino
Meia-Idade
Ortopedia/estatística & dados numéricos
Padrões de Prática Médica/tendências
Setor Privado
Manguito Rotador/cirurgia
Distribuição por Sexo
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1504
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140528
[St] Status:MEDLINE


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[PMID]:22413583
[Au] Autor:Millar C
[Ad] Endereço:FDA Services, USA. insurance@fdaservices.com
[Ti] Título:Controlling your healthcare costs: low-cost group plans.
[So] Source:Todays FDA;23(7):36-7, 39, 2011 Nov-Dec.
[Is] ISSN:1048-5317
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Planos de Assistência de Saúde para Empregados/economia
Administração da Prática Odontológica/economia
[Mh] Termos MeSH secundário: Planos de Seguro Blue Cross Blue Shield/economia
Controle de Custos
Dedutíveis e Cosseguros/economia
Sistemas Pré-Pagos de Saúde/economia
Seres Humanos
Seguro de Hospitalização/economia
Seguro Cirúrgico/economia
Administração da Prática Odontológica/organização & administração
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1205
[Cu] Atualização por classe:120314
[Lr] Data última revisão:
120314
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:120315
[St] Status:MEDLINE


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[PMID]:21954232
[Au] Autor:Panattoni L; Brown P; Windsor J
[Ad] Endereço:Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. laura@alumni.caltech.edu
[Ti] Título:Do market fees differ from relative value scale fees? Examining surgeon payments in New Zealand.
[So] Source:J Health Serv Res Policy;16(4):203-10, 2011 Oct.
[Is] ISSN:1758-1060
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Health funders face the challenge of determining the appropriate level of surgeon fees in fee-for-service schemes.  A resource-based relative value scale (RBRVS) attempts to identify the fees that would exist in a competitive market.  Private insurance providers in New Zealand do not use a RBRVS but rather rely on a market.  We explore the extent to which private surgeon fees in New Zealand are consistent with fees that would be generated by a RBRVS. METHODS: Data on 155,290 surgical procedures from 2004-06 were provided by New Zealand's largest private health insurer.  314 procedure codes were matched to the Australian Ministry of Health and Ageing's RBRVS. A random effects model determined predicted surgeon reimbursements based on the RBRVS, the location and the year. Procedure volume and specialty were explored as potential sources of deviations. RESULTS: The RBRVS, location and year explain 79% of the variation in surgeon fees. After accounting for the RBRVS, location and year, no statistical differences were found between five out of the seven specialties, but higher volume procedures were associated with lower fees. There was some evidence that the model explained less variation in lower volume procedures. CONCLUSIONS: Surgical fees were generally consistent with those predicted by the RBRVS. However, the fees for high volume procedures were relatively lower than predicted while the fees for low volume procedures appeared more variable. The findings are consistent with the hypothesis that market forces lowered prices for procedures with higher volumes. This has implications for how health funders might determine private surgical fees, especially in mixed public-private systems.
[Mh] Termos MeSH primário: Planos de Pagamento por Serviço Prestado/economia
Setor de Assistência à Saúde/economia
Setor Privado/economia
Escalas de Valor Relativo
Procedimentos Cirúrgicos Operatórios/economia
[Mh] Termos MeSH secundário: Austrália
Pesquisa sobre Serviços de Saúde
Seres Humanos
Seguro Cirúrgico/economia
Nova Zelândia
Especialidades Cirúrgicas/economia
Especialidades Cirúrgicas/estatística & dados numéricos
Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1202
[Cu] Atualização por classe:111003
[Lr] Data última revisão:
111003
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:110929
[St] Status:MEDLINE
[do] DOI:10.1258/jhsrp.2011.010028


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[PMID]:22452038
[Au] Autor:Iwanaka T
[Ti] Título:[Technology acknowledgement and scores given for health insurance coverage: a viewpoint of the Surgical Insurance Alliance].
[So] Source:Nihon Geka Gakkai Zasshi;110 Suppl 3:31-2, 2009 Aug.
[Is] ISSN:0301-4894
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Mh] Termos MeSH primário: Seguro Cirúrgico/economia
Programas Nacionais de Saúde/economia
[Mh] Termos MeSH secundário: Japão
Sociedades Médicas
Procedimentos Cirúrgicos Operatórios
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1208
[Cu] Atualização por classe:120327
[Lr] Data última revisão:
120327
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:120329
[St] Status:MEDLINE


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[PMID]:17903083
[Au] Autor:Benditte-Klepetko H; Leisser V; Paternostro-Sluga T; Rakos M; Trattnig S; Helbich T; Schemper M; Deutinger M
[Ad] Endereço:Department of Plastic and Reconstructive Surgery, Hospital Rudolfstiftung, Vienna, Austria. heike.benditte-klepetko@wienkav.at
[Ti] Título:Hypertrophy of the breast: a problem of beauty or health?
[So] Source:J Womens Health (Larchmt);16(7):1062-9, 2007 Sep.
[Is] ISSN:1540-9996
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite the complex health burden for women with breast hypertrophy, medical directors of health insurance companies are not convinced that this procedure is of medical benefit for patients. Therefore, coverage of cost by the health insurance companies is no longer guaranteed. The purpose of this study is to evaluate the influence of breast weight on the physical and psychological morbidity of women and to prove the medical necessity of reduction mammaplasty. METHODS: We performed a cohort study of 50 women with various breast sizes, a mean age of 28 years (range 20-40 years), and a body mass index (BMI) <25. Breast weight was measured, the spine was investigated by magnetic resonance imaging (MRI), and a spine score of clinical symptoms was assessed. The Beck Depression Inventory (BDI) was used to evaluate psychological impairment. Pathological findings have been correlated with breast weight, and the risk of developing a morphological or psychological disorder independence of the breast weight was calculated. RESULTS: The incidence of degenerative spine disorders and the extent of depressive symptoms are correlated with increasing breast weight. CONCLUSIONS: The data show that high breast weight has a negative influence on the physical and psychological morbidity of women. This objective evidence in support of the medical necessity of reduction mammaplasty should guide managed care organizations' methods for determining coverage for reduction mammaplasty.
[Mh] Termos MeSH primário: Doenças Mamárias
Mama/patologia
Seguro Cirúrgico
Mamoplastia
[Mh] Termos MeSH secundário: Adulto
Beleza
Índice de Massa Corporal
Doenças Mamárias/economia
Doenças Mamárias/cirurgia
Feminino
Seres Humanos
Hipertrofia/economia
Hipertrofia/cirurgia
Mamoplastia/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:0712
[Cu] Atualização por classe:071001
[Lr] Data última revisão:
071001
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:071002
[St] Status:MEDLINE


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[PMID]:17020123
[Au] Autor:Kurosawa H
[Ti] Título:[The insurance system for cardiovascular surgery: a comparison with overseas].
[So] Source:Nihon Geka Gakkai Zasshi;107 Suppl 3:18-9, 2006 Aug.
[Is] ISSN:0301-4894
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardiovasculares/economia
Seguro Cirúrgico/economia
[Mh] Termos MeSH secundário: Europa (Continente)
Japão
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:0611
[Cu] Atualização por classe:110726
[Lr] Data última revisão:
110726
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:061006
[St] Status:MEDLINE


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[PMID]:16730552
[Au] Autor:Cognetti DM; Reiter D
[Ti] Título:The implications of "pay-for-performance" reimbursement for Otolaryngology-Head and Neck Surgery.
[So] Source:Otolaryngol Head Neck Surg;134(6):1036-42, 2006 Jun.
[Is] ISSN:0194-5998
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To introduce otolaryngologists to outcomes-linked reimbursement ("pay-for-performance"), identify clinical practice implications, and recommend changes for successful transition from the traditional "pay-for-effort" reimbursement model. STUDY DESIGN: Policy review. RESULTS: Payers are actively linking reimbursement to quality. Since the Institute of Medicine issued its report on medical errors in 1999, there has been much public and private concern over patient safety. In an effort to base health care payment on quality, "pay-for-performance" programs reward or penalize hospitals and physicians for their ability to maintain standards of care established by payers and regulatory groups. More than 100 such programs are operational in the United States today. This reimbursement model relies on detailed documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of determining reimbursement. Because performance criteria for reimbursement have not yet been proposed within otolaryngology-head and neck surgery, otolaryngologists must be involved to ensure the adoption of reasonable goals and development of reasonable systems for documentation. CONCLUSION: "Pay-for-performance" reimbursement is increasingly common in the current era of outcomes-based medicine. It will assume an even greater role over the next 3 years and will directly affect most otolaryngologists.
[Mh] Termos MeSH primário: Seguro Cirúrgico/tendências
Otolaringologia/economia
Procedimentos Cirúrgicos Otorrinolaringológicos/economia
Garantia da Qualidade dos Cuidados de Saúde/economia
Reembolso de Incentivo
[Mh] Termos MeSH secundário: Seres Humanos
Erros Médicos/prevenção & controle
Otolaringologia/normas
Procedimentos Cirúrgicos Otorrinolaringológicos/normas
Avaliação de Resultados (Cuidados de Saúde)/economia
Garantia da Qualidade dos Cuidados de Saúde/métodos
Gestão da Segurança/economia
Estados Unidos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:0607
[Cu] Atualização por classe:060529
[Lr] Data última revisão:
060529
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:060530
[St] Status:MEDLINE


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[PMID]:16628841
[Au] Autor:Hoberg R; Bauernfeind J; Hezel W
[Ad] Endereço:Hauptverwaltung der AOK Baden-Württemberg, Stuttgart.
[Ti] Título:[Perspectives for comprehensive emergency surgical coverage].
[Ti] Título:Perspektiven unfallchirurgischer flächendeckender Notfallversorgung..
[So] Source:Unfallchirurg;108(12):1089-92, 2005 Dec.
[Is] ISSN:0177-5537
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Grupos Diagnósticos Relacionados/economia
Serviço Hospitalar de Emergência/economia
Planejamento Hospitalar
Hospitais/normas
Cobertura do Seguro
Seguro de Acidentes
Seguro Cirúrgico
[Mh] Termos MeSH secundário: Alemanha
Seres Humanos
Traumatismo Múltiplo
Centro Cirúrgico Hospitalar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:0605
[Cu] Atualização por classe:060420
[Lr] Data última revisão:
060420
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:060422
[St] Status:MEDLINE



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