Cost-Minimization Analysis of Midline Catheters versus Peripherally Inserted Central Catheters in Korea

Smeet Gala,심하나,Sook-Young Jeon,어윤재,이권선,권경우,배성윤 한국보건의료기술평가학회 2021 보건의료기술평가 Vol.9 No.1

Objectives: Due to the lack of an appropriate alternative vascular access device, peripherally inserted central catheter (PICCs) are used unnecessarily among patients who do not require longterm catheterization. Unnecessary use of PICCs can lead to catheter-related blood stream infections (CRBSIs) or other complications that pose a substantial clinical and economic burden on patients and healthcare systems. Introduction of midline catheters (MCs) provides a cost-saving option for patients who require mid-term catheterization. This study investigated the cost-difference of using MCs vs. PICCs following the inclusion of MCs on a reimbursement list in Korea. Methods: A costminimization analysis conducted from the healthcare system perspective compared the costs of device use, complications, and labor for MCs and PICCs in a Korean inpatient setting over a year. Clinical and cost inputs were obtained from literature searches and the Health Insurance Review and Assessment (HIRA) Service database. The base case assumed that MCs were not reimbursed and thus all patients received PICCs. The future scenario predicted total costs when MCs were reimbursed, leading to an increased use of MCs in clinical practice. Sensitivity analyses were conducted to identify key drivers of cost savings. Scenario analyses assessed cost savings when the estimated percentage of patients using MCs was altered in the model. Results: Introduction of MCs led to cost savings of KRW 9,374,456,648 over a year, attributed to lower device costs, lower rates of CRBSI, and shorter insertion time associated with MCs compared with PICCs. The mean duration of PICC insertion time, annual mean salary of healthcare professionals performing PICC insertions, and prevalence of CRBSI for PICCs were key drivers of cost savings. Cost savings were still observed when the percentage of patients receiving MCs was as low as 10% in the model. Conclusion: The availability of MCs presents a cost-saving option to patients who were receiving unnecessary PICCs for mid-term catheterization during hospitalization in Korea.

보건분야 공무원 교육수요충족을 위한 개선방안에 대한 비용최소화방안

양병국,배은영,김영택 국립보건연구원 1998 국립보건원보 Vol.35 No.-

한국통신의 비용최소화가설에 대한 검증

문춘걸 정보통신정책학회 2003 정보통신정책연구 Vol.10 No.3

1966년~1997년 기간의 한국통신 경영자료를 사용하여 "비용최소화모형"을 특수한 경우로 포함하는 "비비용최소화모형"을 주정하였다 이 추정결과에 의거하여 한국통신의 비용(생산)구조를 분석하고, 정부의 규제 하에서 생산요소의 배합선택이 비용측면에서 최적적이었는지를 검정하고, 나아가서 비용최소화를 달성하지 못한 경우 이로 인한 초과비용의 규모를 주정하였다. 실증분석 결과에 의하면, 경영구조와 규제환경의 변화 속에서 한국통신이 투입 요소의 고용 및 배합에 있어서 가격효율성을 달성하여 가변비용을 최소화하였다는 가설을 기각할 수 없었다. Using Korea Telecom's managerial data covering the period of 1966 to 1997, we study its cost (production) structure by adopting the non-cost-minimization model, which includes the standard analytical framework of the cost-minimization model as a special case. By estimating the virtual cost function, we can examine empirically whether, under various types and intensities of government regulation, Korea Telecom's choice of the production plan (combining production factors) was optimal on the cost side and estimate the excess costs implied by the non-optimal choice of production plan if Korea Telecom was found non-cost-minimizing. Our empirical results do not reject the hypothesis that Korea Telecom minimized its variable costs by achieving allocative efficiency in employing and combining variable factors of production even with constant changes in its management structure and the regulation environment in the telecom market.

Cost Aspects of Radical Nephrectomy for the Treatment of Renal Cell Carcinoma in Korea: Open, Laparoscopic, Robot-Assisted Laparoscopic, and Video-Assisted Minilaparotomy Surgeries

박재원,최경화,양승철,한웅규 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.8

Purpose: This study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS). Materials and Methods: Among patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs. Results: The total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791±240,757, 2,024,246±674,859 (p=0.998), 3,603,557±870,333 (p<0.01), and 8,021,902±330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627±231,957, 1,798,127±645,602 (p=0.634), 3,039,769 ±711,792 (p<0.01), and 899,668±323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163±24,581, 226,119±215,009, 563,788±487,798 (p<0.01), and 7,122,234±56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost. Conclusions: VAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN. Purpose: This study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS). Materials and Methods: Among patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs. Results: The total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791±240,757, 2,024,246±674,859 (p=0.998), 3,603,557±870,333 (p<0.01), and 8,021,902±330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627±231,957, 1,798,127±645,602 (p=0.634), 3,039,769 ±711,792 (p<0.01), and 899,668±323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163±24,581, 226,119±215,009, 563,788±487,798 (p<0.01), and 7,122,234±56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost. Conclusions: VAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN.

피하주사로 투여하는 생물학적 항류마티스 제제의 비용 최소화 연구

박승후,이민영,이의경 한국임상약학회 2016 한국임상약학회지 Vol.26 No.1

Background: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. Methods: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. Results: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. Conclusion: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.

An Economic Analysis of Potential Cost Savings from the Use of Low Voltage DC (LVDC) Distribution Network

Don Hur,Ross Baldick 대한전기학회 2014 Journal of Electrical Engineering & Technology Vol.9 No.3

The proposed technical work attempts to compare the two key technologies of power distribution, i.e. direct current (DC) and alternating current (AC) in a fiscal manner. The DC versus AC debate has been around since the earliest days of electric power. Here, at least four types of a low voltage DC (LVDC) distribution are examined as an alternative to the existing medium voltage AC (MVAC) distribution with an economic assessment technique for a project investment. Besides, the sensitivity analysis will be incorporated in the overall economic analysis model to cover uncertainties of the input data. A detailed feasibility study indicates that many of the common benefits claimed for an LVDC distribution will continue to grow more profoundly as it is foreseen to arise with the increased integration of renewable energy sources and the proliferation of energy storage associated with the enhanced utilization of uninterruptible power supply (UPS) systems.

An Economic Analysis of Potential Cost Savings from the Use of Low Voltage DC (LVDC) Distribution Network

Hur, Don,Baldick, Ross The Korean Institute of Electrical Engineers 2014 Journal of Electrical Engineering & Technology Vol.9 No.3

The proposed technical work attempts to compare the two key technologies of power distribution, i.e. direct current (DC) and alternating current (AC) in a fiscal manner. The DC versus AC debate has been around since the earliest days of electric power. Here, at least four types of a low voltage DC (LVDC) distribution are examined as an alternative to the existing medium voltage AC (MVAC) distribution with an economic assessment technique for a project investment. Besides, the sensitivity analysis will be incorporated in the overall economic analysis model to cover uncertainties of the input data. A detailed feasibility study indicates that many of the common benefits claimed for an LVDC distribution will continue to grow more profoundly as it is foreseen to arise with the increased integration of renewable energy sources and the proliferation of energy storage associated with the enhanced utilization of uninterruptible power supply (UPS) systems.

신뢰성 해석에 의한 지반의 측방유동 판정식에 관한 연구

안종필 ( Jong Pil Ahn ),박주원 ( Ju Won Park ),김규덕 ( Gyu Deok Kim ) 조선대학교 공학기술연구원 2008 공학기술논문지 Vol.1 No.1

This study conducted the decision method of lateral flow in abutment structures founded on the soft soils and the reliability analysis on the foundation pile for abutment. Reliability analysis was conducted by applying second moment method, point estimation method, and expected total cost minimization so called, optimum reliability analysis method to lateral movement index, lateral movement decision index, modified lateral movement decision index, and circular failure safety factor for the decision criteria of lateral flow. The reliability index by analysis method had a similar tendency each other. Point estimation method was found as a practical method in the aspect of convenience because it could conduct the analysis only by mean and standard deviation as well as the partial derivative on random variables was not necessary. Optimum reliability index and optimum safety according to increasing in failure factors and load ratio were analyzed and loads and resistance factors of the design criteria of optimum reliability were estimated. It presented rational design model which can consider construction level and stability and economical efficiency overall.

신뢰성 해석에 의한 교대 기초말뚝의 안정성에 관한 연구

안종필 ( Jong Pil Ahn ),박상범 ( Sang Bum Park ),김규덕 ( Gyu Deok Kim ) 조선대학교 공학기술연구원 2008 공학기술논문지 Vol.1 No.1

In the stability analysis of lateral flow in abutment structures founded on the soft soils, it is necessary to develop the methods and design criteria of stability analysis of lateral flow in order to sublate the irrationality of the current design method by decisive empiricism and consider stability and economical efficiency in probability. This study conducted the decision method of lateral flow in abutment structures founded on the soft soils and the reliability analysis on the foundation pile for abutment. On the basis of the results, this study proposed the reliability design model. RC-pile, PC-pile, Steel Pipe-pile and PHC-pile were selected for the reliability analysis on the foundation pile and the optimum reliability analysis was conducted by expected total cost minimization to estimate optimum reliability index and optimum safety by the type of each pile. By applying Fujino`s, Kanda`s, Frangopol`s, and Chou`s method for PHC pile, the optimum reliability index and optimum safety were estimated and compared. The results suggest that there was a difference between optimum reliability indexes according to the degree of considering variable by proposed method. Optimum reliability index and optimum safety according to increasing in failure factors and load ratio were analyzed and loads and resistance factors of the design criteria of optimum reliability were estimated. It presented rational design model which can consider construction level and stability and economical efficiency overall.

Mix Proportioning of Concrete Containing Brick Chips as Coarse Aggregate for Cost Minimization

밀리언 타페세,김락현,양범주,김형기 한국콘크리트학회 2020 콘크리트학회논문집 Vol.32 No.6

Mix proportioning in terms of cost minimization was conducted for concrete containing brick chips as coarse aggregate. First, the physical and chemical characteristics of the brick chips were evaluated in detail, including computed tomography scanning, direct compressive strength measurement, and X-ray diffraction analysis, to further understand their effect on the properties of concrete. Second, the strength of brick chips concrete with various mix proportions was measured, and the proportioning of mixtures for material cost minimization based on the equivalent strength design was carried out using linear regression of the results following the local market price in the project area. By using the proposed proportioning method for brick chips concrete, it was possible to obtain a cost reduction of 5~24 % for mixtures with strengths of 25~33 MPa.