Browsing by Author "Rogalewicz, Vladimír"
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- ItemCost-effectiveness of extracorporeal membrane oxygenation in resuscitation of patients with refractory cardiac arrest(Technická Univerzita v Liberci, ) Burišková, Klára; Rogalewicz, Vladimír; Ošťádal, Petr; Ekonomická fakultaExtracorporeal cardiopulmonary resuscitation (ECPR) has been recently introduced as a therapeutic option for refractory cardiac arrest. Despite growing evidence demonstrating improved survival rate, a number of questions remains unanswered and data on cost-effectiveness are still insufficient. The paper is based on a retrospective observational comparative study of authentic clinical data from patient records. Incremental cost-effectiveness and cost-utility analyses were performed from health care provider's perspective. Sixteen patients undergoing ECPR were included into the analysis and their data were compared with 35 subjects with conventional CPR for refractory cardiac arrest. In the ECPR group eight out of sixteen patients were weaned from ECMO, four of them with good neurological outcomes (CPC 1-2); three patients survived one year with CPC 1-2, one patient survived one year with severe neurological dysfunction (CPC 3), and one patient with persisting coma (CPC 4). In comparison, in the non-ECPR group all patients died within 24 hours. In the ECPR group, the average annual costs per patient reached CZK 885,044 (Levitronix Centrimag), and CZK 788,432 (Cardiohelp) (the 2013 price level). CUA revealed 3,961,970 CZK/QALY with Cardiohelp, and 4,447,457 CZK/QALY with Levitronix. However, if only patients with CPC 1-2 were included into the analysis, the cost-utility ratio decreased below the unofficial Czech cost-effectiveness threshold. Our data indicate that ECPR for refractory cardiac arrest may be cost-effective despite high costs per individual patients, especially if we were able to better select patients for this intervention based on a reliable prediction of the neurological outcome.
- ItemThe costs and reimbursements for lung cancer treatment among selected health care providers in the Czech Republic(Technická Univerzita v Liberci, ) Šimrová, Jana; Barták, Miroslav; Vojtíšek, Radovan; Rogalewicz, Vladimír; Ekonomická fakultaThe objective of the article is to objectivise and assess the costs for the lung cancer therapy from the payer’s (health insurance company) and the healthcare provider’s (hospital) perspective based on information available from several large hospitals and specialised centres. No comprehensive assessment of costs related to the treatment of lung cancers at all stages has been published in the Czech Republic to-date. The results in this study are calculated based on diagnostic and therapeutic algorithms, i.e. process maps. These, in turn, are derived from the recommended therapeutic procedures issued by the Masaryk Institute of Oncology, the University Hospital in Hradec Králové and the University Hospital in Plzeň. In total, the costs and reimbursements were calculated for 32 utilized algorithms, i.e. process maps. The costs for therapeutic processes account for 22 results, while 10 results correspond to diagnostic processes. Both direct and indirect costs were included in individual calculations. The calculations imply that treatment costs significantly differ depending on the selected diagnostic and therapeutic procedure. It becomes apparent that the setting of the reimbursement system presently generates different stimuli for providers, who may reach both positive and negative balances. This fact, in turn, may have an effect on the economic result leading, in its consequence, to the preference of more suitable alternatives in terms of reimbursement regardless of the optimum procedures for the particular patient. This fact is, to a certain extent, reflected by the reimbursements calculated by means of the DRG system. The given algorithms may potentially be used by health care providers to reach working costs, which will allow accurate calculations for particular hospitals.