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      A transition from using multi‐step procedures to a fully integrated system for performing extracorporeal photopheresis: A comparison of costs and efficiencies

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          Abstract

          Introduction

          The Pitié Salpêtrière Hospital Hemobiotherapy Department, Paris, France, has been providing extracorporeal photopheresis (ECP) since November 2011, and started using the Therakos ® CELLEX ® fully integrated system in 2012. This report summarizes our single‐center experience of transitioning from the use of multi‐step ECP procedures to the fully integrated ECP system, considering the capacity and cost implications.

          Materials and Methods

          The total number of ECP procedures performed 2011–2015 was derived from department records. The time taken to complete a single ECP treatment using a multi‐step technique and the fully integrated system at our department was assessed. Resource costs (2014€) were obtained for materials and calculated for personnel time required. Time‐driven activity‐based costing methods were applied to provide a cost comparison.

          Results

          The number of ECP treatments per year increased from 225 (2012) to 727 (2015). The single multi‐step procedure took 270 min compared to 120 min for the fully integrated system. The total calculated per‐session cost of performing ECP using the multi‐step procedure was greater than with the CELLEX ® system (€1,429.37 and €1,264.70 per treatment, respectively).

          Conclusions

          For hospitals considering a transition from multi‐step procedures to fully integrated methods for ECP where cost may be a barrier, time‐driven activity‐based costing should be utilized to gain a more comprehensive understanding the full benefit that such a transition offers. The example from our department confirmed that there were not just cost and time savings, but that the time efficiencies gained with CELLEX ® allow for more patient treatments per year.

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          Most cited references15

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          Using time-driven activity-based costing to identify value improvement opportunities in healthcare.

          As healthcare providers cope with pricing pressures and increased accountability for performance, they should be rededicating themselves to improving the value they deliver to their patients: better outcomes and lower costs. Time-driven activity-based costing offers the potential for clinicians to redesign their care processes toward that end. This costing approach, however, is new to healthcare and has not yet been systematically implemented and evaluated. This article describes early time-driven activity-based costing work at several leading healthcare organizations in the United States and Europe. It identifies the opportunities they found to improve value for patients and demonstrates how this costing method can serve as the foundation for new bundled payment reimbursement approaches.
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            Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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              Mechanistic insights into extracorporeal photochemotherapy: efficient induction of monocyte-to-dendritic cell maturation.

              Extracorporeal photochemotherapy (ECP) is a widely used immunotherapy for cutaneous T cell lymphoma, as well as immunomodulation of graft-versus-host disease (GVHD) and transplanted organ rejection. ECP's mechanism encompasses large-scale physiologic platelet induction of dendritic cells (DCs). The normal bidirectional immunologic talents of DCs likely contribute heavily to ECP's capacity to immunize against tumor antigens, while also suppressing transplant immunopathology. Our understanding of how ECP physiologically induces monocyte-to-DC maturation can enhance the treatment's potency, potentially broaden its use to other cancers and autoimmune disorders and tailor its application to individual patients' diseases. ECP's next decade is filled with promise.

                Author and article information

                Contributors
                nabih.azar@aphp.fr
                Journal
                J Clin Apher
                J Clin Apher
                10.1002/(ISSN)1098-1101
                JCA
                Journal of Clinical Apheresis
                John Wiley and Sons Inc. (Hoboken )
                0733-2459
                1098-1101
                17 April 2017
                December 2017
                : 32
                : 6 ( doiID: 10.1002/jca.v32.6 )
                : 474-478
                Affiliations
                [ 1 ] Groupe Hospitalier, Pitié Salpêtrière Paris France
                [ 2 ] ProcEx Solutions Ltd. Wales United Kingdom
                Author notes
                [*] [* ] Correspondence Nabih Azar, Groupe Hospitalier, Pitié Salpêtrière, 47‐83 Boulevard de l'Hôpital, 75013 Paris. Email: nabih.azar@ 123456aphp.fr
                Article
                JCA21542
                10.1002/jca.21542
                5724655
                28419561
                a6830c8a-d275-4c6c-88ac-4f715039be42
                © 2017 The Authors Journal of Clinical Apheresis Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 15 December 2016
                : 23 February 2017
                : 24 March 2017
                Page count
                Figures: 1, Tables: 1, Pages: 5, Words: 3123
                Funding
                Funded by: Mallinckrodt Pharmaceuticals
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                jca21542
                December 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.8 mode:remove_FC converted:11.12.2017

                cost comparison,photopheresis,time‐driven activity‐based costing

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