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The latter cohorts did not significantly differ in individual cost effectiveness (median MCER 110 € versus 108 € per gained% WOMAC increase, Wilcoxon p = 0.936).
The confirmatory cohort comparison was based on the MCER, where individual cost effectiveness of a patients' care process was defined by means of a (sub) process cost/patient benefit relation ≤ 100 €/% WOMAC increase.
In accordance to these heuristic median estimates, an individual MCER estimate ≤ 100 €/% was defined as an indication for "individual cost effectiveness" for the respective patient's health care (sub) process.
As a consequence from both an ethical and clinical point of view, the clinical project investigators were - with respect to patient safety - unwilling and unable to implement a further shortening in LOS, and thereby the individual cost effectiveness ratios turned out merely unchanged for the cohort, who refused the offered patient information/education.
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To obtain a global cost-effectiveness analysis, a weighted average of individual cost-effectiveness ratios was used.
A sensitivity analysis will also be performed on the individual cost-effectiveness ratios by means of bootstrapping.
In summary, the proposed critical pathway for TKA could be shown to be significantly cost efficient, but not cost effective concerning functional outcome, when the above individual marginal cost effectiveness criterion was concentrated on.
The primary health economic target parameter of the investigation was then the individual marginal cost effectiveness ratio (MCER) relating a patient's process cost sum to his/her individual gain in algo-function as assessed by means of the WOMAC index.
The health economic evaluation was based on margiual cost-effectveness ratios (MCERs); an individual marginal cost effectiveness relation ≤ 100 € per % WOMAC index increase was considered as primary endpoint of the confirmatory cohort comparison.
An individual marginal cost effectiveness relation ≤ 100 €/% WOMAC index increase was found in 38% of the patients in the pre pathway implementation cohort versus in 30% of the post pathway implementation cohort (Fisher p = 0.278).
6 Although the detection rate is important for individuals, the cost effectiveness ratio and similar end points of screening strategies are needed for the development of optimal public health strategies.
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