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Ward T, Medina-Lara A, Mujica-Mota RE, Spencer AE. Accounting for Heterogeneity in Resource Allocation Decisions: Methods and Practice in UK Cancer Technology Appraisals. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:995-1008. [PMID: 34243843 DOI: 10.1016/j.jval.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/05/2020] [Accepted: 12/15/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The availability of novel, more efficacious and expensive cancer therapies is increasing, resulting in significant treatment effect heterogeneity and complicated treatment and disease pathways. The aim of this study is to review the extent to which UK cancer technology appraisals (TAs) consider the impact of patient and treatment effect heterogeneity. METHODS A systematic search of National Institute for Health and Care Excellence TAs of colorectal, lung and ovarian cancer was undertaken for the period up to April 2020. For each TA, the pivotal clinical studies and economic evaluations were reviewed for considerations of patient and treatment effect heterogeneity. The study critically reviews the use of subgroup analysis and real-world translation in economic evaluations, alongside specific attributes of the economic modeling framework. RESULTS The search identified 49 TAs including 49 economic models. In total, 804 subgroup analyses were reported across 69 clinical studies. The most common stratification factors were age, gender, and Eastern Cooperative Oncology Group performance score, with 15% (119 of 804) of analyses demonstrating significantly different clinical outcomes to the main population; economic subgroup analyses were undertaken in only 17 TAs. All economic models were cohort-level with the majority described as partitioned survival models (39) or Markov/semi-Markov models. The impact of real-world heterogeneity on disease progression estimates was only explored in 2 models. CONCLUSION The ability of current modeling approaches to capture patient and treatment effect heterogeneity is constrained by their limited flexibility and simplistic nature. This study highlights a need for the use of more sophisticated modeling methods that enable greater consideration of real-world heterogeneity.
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Affiliation(s)
- Thomas Ward
- Health Economics Group, College of Medicine and Health, University of Exeter.
| | | | - Ruben E Mujica-Mota
- Health Economics Group, College of Medicine and Health, University of Exeter; Academic Unit of Health Economics, School of Medicine, University of Leeds
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Palacios A, Rojas-Roque C, González L, Bardach A, Ciapponi A, Peckaitis C, Pichon-Riviere A, Augustovski F. Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review. PHARMACOECONOMICS 2021; 39:485-502. [PMID: 33782865 DOI: 10.1007/s40273-021-01014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Our objective was to conduct a systematic review of the literature to identify, categorise, assess, and synthesise the healthcare costs of patients with breast cancer (BC) and their relatives in Latin America and the Caribbean (LAC). METHODS In December 2020, we searched for published data in PubMed, LILACS, EMBASE, and other sources, including the grey literature. Studies were eligible if they were conducted in LAC and reported the direct medical costs, productivity loss costs, out-of-pocket expenditure, and other costs to patients with BC and their relatives. No restrictions were imposed on the type of BC population (metastatic BC or human epidermal growth factor receptor 2-positive/negative BC, among others). We summarised the characteristics and methodological approach of each study and the healthcare costs by cancer stage. We also developed and applied an original ad hoc instrument to assess the quality of the cost estimation studies. RESULTS We identified 2725 references and 63 included studies. In total, 79.3% of the studies solely reported direct medical costs and five solely reported costs to patients and their relatives. Only 14.3% of the studies were classified as of high quality. The pooled weighted average direct medical cost per patient-year (year 2020 international dollars [I$]) by BC stage was I$13,179 for stage I, I$15,556 for stage II, I$23,444 for stage III, and I$28,910 for stage IV. CONCLUSION This review provides the first synthesis of BC costs in LAC. Our findings show few high-quality costing studies in BC and a gap in the literature measuring costs to patients and their relatives. The high costs associated with the advanced stages of BC call into question the affordability of treatments and their accessibility for patients. Registered in PROSPERO (CRD42018106835).
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Affiliation(s)
- Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
- Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Lucas González
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Claudia Peckaitis
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Federico Augustovski
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
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Dal Maso L, Panato C, Tavilla A, Guzzinati S, Serraino D, Mallone S, Botta L, Boussari O, Capocaccia R, Colonna M, Crocetti E, Dumas A, Dyba T, Franceschi S, Gatta G, Gigli A, Giusti F, Jooste V, Minicozzi P, Neamtiu L, Romain G, Zorzi M, De Angelis R, Francisci S. Cancer cure for 32 cancer types: results from the EUROCARE-5 study. Int J Epidemiol 2021; 49:1517-1525. [PMID: 32984907 DOI: 10.1093/ije/dyaa128] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. METHODS 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15-74 years in 1990-2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. RESULTS LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65-74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% for thyroid cancer in women and 70% in men, 86% for skin melanoma in women and 76% in men, 66% for breast, 63% for prostate and <10% for liver, lung and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri and melanoma patients of all ages. For breast and prostate cancers, a small excess (CRS < 95%) remained for at least 15 years. CONCLUSIONS Estimates from this analysis should help to reduce unneeded medicalization and costs. They represent an opportunity to improve patients' quality of life.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Andrea Tavilla
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Sandra Mallone
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olayidé Boussari
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | | | | | - Emanuele Crocetti
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, ItalyAzienda Usl della Romagna, Forlì, Italy
| | - Agnes Dumas
- National Institute for Health and Medical Research (INSERM), Paris, France
| | - Tadek Dyba
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Silvia Franceschi
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | | | - Valerie Jooste
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Gaëlle Romain
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Silvia Francisci
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
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Realising the broader value of vaccines in the UK. Vaccine X 2021; 8:100096. [PMID: 33997762 PMCID: PMC8099625 DOI: 10.1016/j.jvacx.2021.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 02/04/2023] Open
Abstract
Many health technology assessment (HTA) agencies limit their assessments of vaccines to the health benefits for the vaccinated individual, the costs associated with vaccine administration and the disease avoided. However, because the value of vaccines tends to accrue to a large extent beyond the vaccinated individual, they are systematically undervalued in many current HTA processes. This is also the case in the UK, where the Joint Committee on Vaccination and Immunisation (JCVI) is in charge of assessing preventative vaccines, while therapeutic vaccines fall in the realm of the National Institute for Clinical Excellence (NICE). To contribute to a forward-looking perspective, we designed a framework to capture the broader value of vaccination. We reviewed the current state of the global vaccines pipeline and selected seven preventative and three therapeutic vaccines that are likely to enter the UK market within five years. We assessed on which value elements the selected vaccines would potentially generate value, and compared those against the novel broader value framework. A review of the current value elements considered by the JCVI and NICE allowed identifying the critical gaps between potential value generation and value recognition. To our knowledge, this is the first time that the broader value of vaccination has been pro-actively assessed for pipeline vaccinations. Our findings show that the existing narrow evaluation frameworks are likely to systematically undervalue the value of potential future vaccines coming to the UK market. This is particularly relevant, where their impact on AMR and other health interventions, and on the productivity of the workforce is of concern. Recommendations to overcome this include an explicit and more consistent inclusion of, and data collection on, the impact of vaccines on AMR and other health interventions by JCVI and NICE; the consideration of a societal perspective and the fiscal impact of vaccines to societies.
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de Oliveira C, Cheng J, Chan K, Earle CC, Krahn M, Mittmann N. High-Cost Patients and Preventable Spending: A Population-Based Study. J Natl Compr Canc Netw 2021; 18:23-31. [PMID: 31910386 DOI: 10.6004/jnccn.2019.7342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/26/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although high-cost (HC) patients make up a small proportion of patients, they account for most health system costs. However, little is known about HC patients with cancer or whether some of their care could potentially be prevented. This analysis sought to characterize HC patients with cancer and quantify the costs of preventable acute care (emergency department visits and inpatient hospitalizations). METHODS This analysis examined a population-based sample of all HC patients in Ontario in 2013. HC patients were defined as those above the 90th percentile of the cost distribution; all other patients were defined as non-high-cost (NHC). Patients with cancer were identified through the Ontario Cancer Registry. Sociodemographic and clinical characteristics were examined and the costs of preventable acute care for both groups by category of visit/condition were estimated using validated algorithms. RESULTS Compared with NHC patients with cancer (n=369,422), HC patients with cancer (n=187,770) were older (mean age 70 vs 65 years), more likely to live in low-income neighborhoods (19% vs 16%), sicker, and more likely to live in long-term care homes (8% vs 0%). Although most patients from both cohorts tended to be diagnosed with breast, prostate, or colorectal cancer, those with multiple myeloma or pancreatic or liver cancers were overrepresented among the HC group. Moreover, HC patients were more likely to have advanced cancer at diagnosis and be in the initial or terminal phase of treatment compared with NHC patients. Among HC patients with cancer, 9% of spending stemmed from potentially preventable/avoidable acute care, whereas for NHC patients, this spending was approximately 30%. CONCLUSIONS HC patients with cancer are a unique subpopulation. Given the type of care they receive, there seems to be limited scope to prevent acute care spending among this patient group. To reduce costs, other strategies, such as making hospital care more efficient and generating less costly encounters involving chemotherapy, should be explored.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto.,Institute for Clinical Evaluative Sciences, Toronto
| | - Joyce Cheng
- Institute for Clinical Evaluative Sciences, Toronto
| | - Kelvin Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto
| | | | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto; and
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Ramagopalan SV, Sammon C. Parking Costs-A Family Affair. JAMA Oncol 2021; 7:306-307. [PMID: 33270096 DOI: 10.1001/jamaoncol.2020.6365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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The Economic Impact of Rectal Cancer: A Population-Based Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020474. [PMID: 33430156 PMCID: PMC7827442 DOI: 10.3390/ijerph18020474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/24/2022]
Abstract
Costs of cancer care are increasing worldwide, and sustainability of cancer burden is critical. In this study, the economic impact of rectal cancer on the Italian healthcare system, measured as public healthcare expenditure related to investigation and treatment of rectal cancer patients is estimated. A cross-sectional cohort of 9358 rectal cancer patients is linked, on an individual basis, to claims associated to rectal cancer diagnosis and treatments. Costs refer mainly to years 2010–2011 and are estimated by phase of care, as healthcare needs vary along the care pathway: diagnostic procedures are mainly provided in the first year, surveillance procedures are addressed to chronically ill patients, and end-of-life procedures are given in the terminal status. Clinical approaches and corresponding costs are specific by cancer type and vary by phase of care, stage at diagnosis, and age. Surgery is undertaken by the great majority of patients. Thus, hospitalization is the main cost driver. The evidence produced can be used to improve planning and allocation of healthcare resources. In particular, early diagnosis of rectal cancer is a gain in healthcare budget. Policies raising spreading of and adherence to screening plans, above all when addressed to people living in Southern Italy, should be strongly encouraged.
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Koo MM, Unger-Saldaña K, Mwaka AD, Corbex M, Ginsburg O, Walter FM, Calanzani N, Moodley J, Rubin GP, Lyratzopoulos G. Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control. JCO Glob Oncol 2021; 7:35-45. [PMID: 33405957 PMCID: PMC8081530 DOI: 10.1200/go.20.00310] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/06/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022] Open
Abstract
Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site-specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology to inform prioritization within an intervention; third, the identification of factors influencing prompt help-seeking at individual and system level to support the design and evaluation of interventions; and finally, the evaluation of factors influencing the health systems' capacity to promptly assess patients. This conceptual framework can be used by public health researchers and policy makers to identify the greatest evidence gaps and guide the design and evaluation of local early diagnosis programs as part of broader cancer control strategies.
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Affiliation(s)
- Minjoung Monica Koo
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Karla Unger-Saldaña
- CONACYT (National Council of Science and Technology)–National Cancer Institute, Mexico City, Mexico
| | - Amos D. Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ophira Ginsburg
- Perlmutter Cancer Center and the Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Natalia Calanzani
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Greg P. Rubin
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
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Crapnell RD, Dempsey-Hibbert NC, Peeters M, Tridente A, Banks CE. Molecularly imprinted polymer based electrochemical biosensors: Overcoming the challenges of detecting vital biomarkers and speeding up diagnosis. TALANTA OPEN 2020. [DOI: 10.1016/j.talo.2020.100018] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Cost Analysis of Cancer in Brazil: A Population-Based Study of Patients Treated by Public Health System From 2001-2015. Value Health Reg Issues 2020; 23:137-147. [PMID: 33227545 DOI: 10.1016/j.vhri.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the federal government expenditures with oncological care, for the most incident cancer types among the Brazilian population, using registries of all patients treated by the Brazilian National Health Service (SUS) between 2001 and 2015. We adopted the formal healthcare sector perspective in this study, with the costs per patient estimated by the reimbursement price paid by the Ministry of Health to service providers. METHODS The costs were adjusted by the follow-up time for each patient. We performed multivariate regression analysis using ordinary least squares. We analyzed 952 960 patients aged ≥19 years who underwent cancer treatment, between 2001 and 2015, for breast, prostate, colorectal, cervix, lung, and stomach cancers. RESULTS The annual mean costs per patient (in USD purchasing power parity) was $9572.30, varying from $5782.10 for breast cancer to $16 656 for cervical cancer. Several variables predicted higher costs of cancer treatment, namely: to be male (+14%), with younger age ranges at treatment initiation, resident in the Northeast region (+26%), treated for colorectal cancer (+482%), with treatment initiation from 2010 to 2014, tumor stages III and IV (III: +182%; IV: +165%), hospitalization for other reasons besides the cancer treatment, and suffering from some a comorbidity. CONCLUSIONS Given the forthcoming Brazilian demographic changes, which strongly suggest that the economic burden of cancer is about to increase in the near future, our estimates provide relevant information to produce useful projections about future cancer-related costs.
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Francisci S, Guzzinati S, Capodaglio G, Pierannunzio D, Mallone S, Tavilla A, Lopez T, Busco S, Mazzucco W, Angiolini C, Zorzi M, Serraino D, Barchielli A, Fusco M, Stracci F, Bianconi F, Rugge M, Iacovacci S, Russo AG, Cusimano R, Gigli A. Patterns of care and cost profiles of women with breast cancer in Italy: EPICOST study based on real world data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1003-1013. [PMID: 32399781 DOI: 10.1007/s10198-020-01190-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To estimate total direct health care costs associated to diagnosis and treatment of women with breast cancer in Italy, and to investigate their distribution by service type according to the disease pathway and patient characteristics. METHODS Data on patients provided by population-based Cancer Registries are linked at individual level with data on health-care services and corresponding claims from administrative databases. A combination of cross-sectional approach and a threephase of care decomposition model with initial, continuing and final phases-of-care defined according to time occurred since diagnosis and disease outcome is adopted. Direct estimation of cancer-related costs is obtained. RESULTS Study cohort included 49,272 patients, 15.2% were in the initial phase absorbing 42% of resources, 79.7% in the continuing phase absorbing 44% of resources and 5.1% in the final phase absorbing 14% of resources. Hospitalization was the most important cost driver, accounting for over 55% of the total costs. CONCLUSIONS This paper represents the first attempt in Italy to estimate the economic burden of cancer at population level taking into account the entire disease pathway and using multiple current health care databases. The evidence produced by the study can be used to better plan resources allocation. The model proposed is replicable to countries with individual health care information on services and claims.
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Affiliation(s)
- Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | | | | | - Daniela Pierannunzio
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Sandra Mallone
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Andrea Tavilla
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Tania Lopez
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Susanna Busco
- UOC Programmazione e Controllo di Gestione, ASL Latina, Latina, Italy
| | - Walter Mazzucco
- Sciences for Health Promotion and Mother and Child (PROSAMI) Department, University of Palermo, Palermo, Italy
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Catia Angiolini
- Breast Oncology, Careggi University Hospital, Florence, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Diego Serraino
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | | | - Mario Fusco
- Registro Tumori ASL Napoli 3 sud, Naples, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Section, Department Experimental Medicine, University of Perugia, Perugia, Italy
| | - Fortunato Bianconi
- Umbria Cancer Registry, Public Health Section, Department Experimental Medicine, University of Perugia, Perugia, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology Unit, University of Padua, Padua, Italy
| | | | | | | | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
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Goldsbury DE, Weber MF, Yap S, Rankin NM, Ngo P, Veerman L, Banks E, Canfell K, O’Connell DL. Health services costs for lung cancer care in Australia: Estimates from the 45 and Up Study. PLoS One 2020; 15:e0238018. [PMID: 32866213 PMCID: PMC7458299 DOI: 10.1371/journal.pone.0238018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Of all cancer types, healthcare for lung cancer is the third most costly in Australia, but there is little detailed information about these costs. Our aim was to provide detailed population-based estimates of health system costs for lung cancer care, as a benchmark prior to wider availability of targeted therapies/immunotherapy and to inform cost-effectiveness analyses of lung cancer screening and other interventions in Australia. Methods Health system costs were estimated for incident lung cancers in the Australian 45 and Up Study cohort, diagnosed between recruitment (2006–2009) and 2013. Costs to June 2016 included services reimbursed via the Medicare Benefits Schedule, medicines reimbursed via the Pharmaceutical Benefits Scheme, inpatient hospitalisations, and emergency department presentations. Costs for cases and matched, cancer-free controls were compared to derive excess costs of care. Costs were disaggregated by patient and tumour characteristics. Data for more recent cases identified in hospital records provided preliminary information on targeted therapy/immunotherapy. Results 994 eligible cases were diagnosed with lung cancer 2006–2013; 51% and 74% died within one and three years respectively. Excess costs from one-year pre-diagnosis to three years post-diagnosis averaged ~$51,900 per case. Observed costs were higher for cases diagnosed at age 45–59 ($67,700) or 60–69 ($63,500), and lower for cases aged ≥80 ($29,500) and those with unspecified histology ($31,700) or unknown stage ($36,500). Factors associated with lower costs generally related to shorter survival: older age (p<0.0001), smoking (p<0.0001) and unknown stage (p = 0.002). There was no evidence of differences by year of diagnosis or sex (both p>0.50). For 465 cases diagnosed 2014–2015, 29% had subsidised molecular testing for targeted therapy/immunotherapy and 4% had subsidised targeted therapies. Conclusions Lung cancer healthcare costs are strongly associated with survival-related factors. Costs appeared stable over the period 2006–2013. This study provides a framework for evaluating the health/economic impact of introducing lung cancer screening and other interventions in Australia.
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Affiliation(s)
- David E. Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- * E-mail:
| | - Marianne F. Weber
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Preston Ngo
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Prince of Wales Clinical School, UNSW Medicine, Sydney, NSW, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Buja A, Rivera M, De Polo A, Zorzi M, Baracco M, Italiano I, Vecchiato A, Del Fiore P, Guzzinati S, Saia M, Baldo V, Rugge M, Rossi CR. Differences in direct costs of patients with stage I cutaneous melanoma: A real-world data analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:976-981. [PMID: 32146052 DOI: 10.1016/j.ejso.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/21/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical factors, such as tumor thickness, ulceration and growth phase have a role as prognostic factors for stage I melanoma. However, it is still under debate whether these variables influence the related direct costs. We aimed to investigate which clinical factors represent direct health care "cost drivers" for stage I melanoma. MATERIALS AND METHOD Analyses were conducted on a cohort of patients diagnosed with stage I melanoma. Differences in the costs incurred by different groups of patients were examined using Mann-Whitney or Kruskal-Wallis non-parametric tests. Log linear multivariate analysis was used to identify the clinical drivers of the total direct costs one and two years after diagnosis. The study was conducted from the perspective of Italy's National Health care System. RESULTS One year after diagnosis, patients whose melanomas had a Breslow thickness ≥0.8 mmin (compared with those with lower thickness) and a vertical growth phase (compared with those with radial growth) incurred higher costs for hospitalization, as well as higher overall costs. One year after their diagnosis, treatment of patients with stage I melanoma in the vertical growth phase costs 50% more (95% CI: 22-85%) than their counterparts with a radial growth pattern, resulting in an estimated absolute increase of € 256.23. Having a tumor thicker than 0.8 mm prompted an increase of 91% (95% CI: 43-155%) in the costs (€955.24 in absolute terms). CONCLUSION Our data indicate a heterogeneity in the direct costs of stage I melanoma patients during the first year after diagnosis, which can be partly explained by clinical prognostic factors, like tumor thickness and growth pattern.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy.
| | - Anna De Polo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy
| | | | - Mario Saia
- Veneto Regional Authority, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
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Epidemiological and Economic Evaluation of a Pilot Prostate Cancer Screening Program. Prostate Cancer 2020; 2020:6140623. [PMID: 32411478 PMCID: PMC7204116 DOI: 10.1155/2020/6140623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/04/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background. Prostate cancer (PCa) is the second most commonly diagnosed cancer, and the sixth most common killer among men worldwide (Aubry et al., 2013). This research was motivated by the fact that PCa screening continues to be a controversial topic in the Kazakh medical community. This study aimed at description of how newly diagnosed PCa patients are managed in Pavlodar region of the Kazakhstan Republic and at presentation of a budget impact analysis (BIA) for PCa screening program. Also, we aimed to provide a comparative analysis of pricing system on medical services applied in both private and public healthcare sectors of the Kazakhstan Republic. Methods. New cases of PCa have been retrospectively analyzed for the period from January 2013 to December 2017 based on the information obtained from information system “Policlinic” maintained by the Pavlodar regional branch of the Republican Center for Electronic Health and from Cancer Registry of Pavlodar Regional Oncology Center. All data were analyzed with the help of SPSS 20.0 software. Results. The mean age of PCa patients was 68.34 years (SD = 8.559). The government of Kazakhstan invested 20,437,000 KZT (Kazakhstani tenge) in 2017 equivalently 61,188 USD—to fund a pilot study for examination of 9638 men. From 2013 to 2017, out of 49,334 men residing in Pavlodar region of Kazakhstan 1,248 men were diagnosed with prostate diseases, including 130 PCa cases. The PCa detection rate was equal to two cases per month. Only 22.8% of all PCa cases identified in the region within specified time period were revealed as a result of the government-funded PCa screening program. The average prostate cancer detection rate among the target group of Pavlodar region within the period of 5 years was equal to 0.23%. Conclusion. Based on the fact that the PCa screening program failed to enable adequate detection of new PCa cases, we would not recommend to continue this type of screening unless it is undergone careful revision and replanning.
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66
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Sussell JA, Sheinson D, Wu N, Shah-Manek B, Seetasith A. HER2-Positive Metastatic Breast Cancer: A Retrospective Cohort Study of Healthcare Costs in the Targeted-Therapy Age. Adv Ther 2020; 37:1632-1645. [PMID: 32172510 DOI: 10.1007/s12325-020-01283-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Claims data (IBM MarketScan Commercial and MarketScan Medicare Supplemental databases) from June 30, 2011 to September 30, 2017 were used to evaluate the cost impact of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) in this retrospective cohort study. METHODS The primary analysis compared short-term costs for patients diagnosed with HER2+ MBC at least 180 days after the end of first HER2-targeted treatment (MBC+ cohort) versus a propensity score matched cohort of patients with breast cancer who did not develop MBC (MBC- cohort). A pseudo-post period for patients in the HER2+ MBC- cohort was defined by indexing to the HER2+ treatment completion-MBC diagnosis time interval of the matched pair in the HER2+ MBC+ cohort; we then compared average monthly cost differences between these groups for the year preceding and following MBC diagnosis. In secondary analyses, we estimated medium-term aggregate and categorical healthcare costs for patients with HER2+ MBC up to 3 years post-diagnosis. RESULTS In the short-term primary analysis, costs for the HER2+ MBC+ and HER2+ MBC- cohorts were largely comparable in the year preceding MBC diagnosis. Monthly direct costs were significantly higher for the HER2+ MBC+ cohort in the months immediately preceding MBC diagnosis, with differences in the range of $500-5000. Following diagnosis, total monthly costs were $13,000-34,000 higher for patients in the HER2+ MBC+ cohort vs. the HER2+ MBC- cohort. In the medium-term secondary analysis, mean per patient total costs were $218,171 [standard error (SE) $5450] in the first year following MBC diagnosis and $412,903 (SE $13,034) cumulatively over 3 years following diagnosis (among patients with complete follow-up). Primary cost contributors were outpatient visits ($195,162; SE $8043) and HER2-targeted therapy drug costs ($177,489; SE $8120). CONCLUSIONS HER2+ MBC is associated with high short-term and medium-term direct healthcare costs. These could be alleviated with early diagnosis and optimal standard-of-care treatment for early breast cancer, which can significantly reduce the risk of recurrence.
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Sewell B, Jones M, Gray H, Wilkes H, Lloyd-Bennett C, Beddow K, Bevan M, Fitzsimmons D. Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study. Br J Gen Pract 2020; 70:e186-e192. [PMID: 31932296 PMCID: PMC6960004 DOI: 10.3399/bjgp20x708077] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/22/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A pilot rapid diagnosis centre (RDC) allows GPs within targeted clusters to refer adults with vague and/or non-specific symptoms suspicious of cancer, who do not meet criteria for referral under an urgent suspected cancer (USC) pathway, to a multidisciplinary RDC clinic where they are seen within 1 week. AIM To explore the cost-effectiveness of the RDC compared with standard clinical practice. DESIGN AND SETTING Cost-effectiveness modelling using routine data from Neath Port Talbot Hospital, Wales. METHOD Discrete-event simulation modelled a cohort of 1000 patients from referral to radiological diagnosis based on routine RDC and hospital data. Control patients were those referred to a USC pathway but then downgraded. Published sources provided estimates of patient quality of life (QoL) and pre-diagnosis anxiety. The model calculates time to diagnosis, costs, and quality-adjusted life years (QALYs), and estimates the probability of the RDC being a cost-effective strategy. RESULTS The RDC reduces mean time to diagnosis from 84.2 days in usual care to 5.9 days if a diagnosis is made at clinic, or 40.8 days if further investigations are booked during RDC. RDC provision is the superior strategy (that is, less costly and more effective) compared with standard clinical practice when run near or at full capacity. However, it is not cost-effective if capacity utilisation drops below 80%. CONCLUSION An RDC for patients presenting with vague or non-specific symptoms suspicious of cancer in primary care reduces time to diagnosis and provides excellent value for money if run at ≥80% capacity.
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Affiliation(s)
- Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales
| | - Mari Jones
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales
| | | | - Heather Wilkes
- Dr Wilkes & Partners, Briton Ferry Health Centre, Swansea Bay University Health Board, Neath, Wales
| | | | - Kim Beddow
- Neath Port Talbot Hospital, Swansea Bay University Health Board, Neath, Port Talbot, Wales
| | - Martin Bevan
- Neath Port Talbot Hospital, Swansea Bay University Health Board, Neath, Port Talbot, Wales
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Campioni M, Agirrezabal I, Hajek R, Minarik J, Pour L, Spicka I, Gonzalez-McQuire S, Jandova P, Maisnar V. Methodology and results of real-world cost-effectiveness of carfilzomib in combination with lenalidomide and dexamethasone in relapsed multiple myeloma using registry data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:219-233. [PMID: 31673898 PMCID: PMC7072050 DOI: 10.1007/s10198-019-01122-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/08/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To predict the real-world (RW) cost-effectiveness of carfilzomib in combination with lenalidomide and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) in relapsed multiple myeloma (MM) patients after one to three prior therapies. METHODS A partitioned survival model that included three health states (progression-free, progressed disease and death) was built. Progression-free survival (PFS), overall survival (OS) and time to discontinuation (TTD) data for the Rd arm were derived using the Registry of Monoclonal Gammopathies in the Czech Republic; the relative treatment effects of KRd versus Rd were estimated from the phase 3, randomised, ASPIRE trial, and were used to predict PFS, OS and TTD for KRd. The model was developed from the payer perspective and included drug costs, administration costs, monitoring costs, palliative care costs and adverse-event related costs collected from Czech sources. RESULTS The base case incremental cost effectiveness ratio for KRd compared with Rd was €73,156 per quality-adjusted life year (QALY) gained. Patients on KRd incurred costs of €117,534 over their lifetime compared with €53,165 for patients on Rd. The QALYs gained were 2.63 and 1.75 for patients on KRd and Rd, respectively. CONCLUSIONS Combining the strengths of randomised controlled trials and observational databases in cost-effectiveness models can generate policy-relevant results to allow well-informed decision-making. The current model showed that KRd is likely to be cost-effective versus Rd in the RW and, therefore, the reimbursement of KRd represents an efficient allocation of resources within the healthcare system.
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Affiliation(s)
- M Campioni
- Economic Modeling Center of Excellence, Global Health Economics, Amgen (Europe) GmbH, Zug, Switzerland.
| | - I Agirrezabal
- Economic Modeling Center of Excellence, Global Health Economics, Amgen (Europe) GmbH, Zug, Switzerland
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic
| | - J Minarik
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 185/6, 779 00, Olomouc, Czech Republic
| | - L Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine Masaryk Universit, Jihlavská 340/20, 625 00, Brno, Czech Republic
| | - I Spicka
- Department of Internal Medicine, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Katerinska 32, 121 08, Prague, Czech Republic
| | | | | | - V Maisnar
- Department of Internal Medicine, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Katerinska 32, 121 08, Prague, Czech Republic
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Vekic B, Dragojevic-Simic V, Jakovljevic M, Kalezic M, Zagorac Z, Dragovic S, Zivic R, Pilipovic F, Simic R, Jovanovic D, Milovanovic J, Rancic N. A Correlation Study of the Colorectal Cancer Statistics and Economic Indicators in Selected Balkan Countries. Front Public Health 2020; 8:29. [PMID: 32133335 PMCID: PMC7040482 DOI: 10.3389/fpubh.2020.00029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most commonly diagnosed malignant neoplasms. The aim of the study was to evaluate and correlate most important epidemiological and economic indicators of CRC in 11 selected Balkan countries. The number of new CRC cases was 56,960, and the highest 5-year CRC prevalence was in Slovenia, Croatia, and Greece. Age-standardized CRC incidence rates were highest in Slovenia, Serbia, and Croatia, and age-standardized mortality rates were highest in Croatia, Serbia, and Bulgaria. Current Health Expenditure as % of Gross Domestic Product was the highest in Bosnia and Herzegovina and Serbia. The GDP per capita levels have shown positive correlation with the CRC incidence rate and prevalence. Absolute numbers of new and death-related CRC cases and 5-year prevalence in absolute numbers have shown strong positive correlation with GDP in million current US$. It has been shown that various economic indicators can be linked to the rate of incidence and prevalence of the CRC patients in the selected Balkan countries. Therefore, economic factors can influence the epidemiology of CRC, and heavy CRC burden in the Balkan region may be one of the indexes of the economic development.
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Affiliation(s)
- Berislav Vekic
- Department of Surgery, Clinical Centre Dr. Dragisa Misovic, Belgrade, Serbia.,Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Viktorija Dragojevic-Simic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia.,Medical Faculty of Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Institute of Comparative Economics, Hosei University, Tokyo, Japan.,N.A. Semashko Department of Public Health and Healthcare, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Marko Kalezic
- Department of Surgery, Clinical Centre Dr. Dragisa Misovic, Belgrade, Serbia
| | - Zagor Zagorac
- Department of Surgery, Clinical Centre Dr. Dragisa Misovic, Belgrade, Serbia
| | - Sasa Dragovic
- Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
| | - Rastko Zivic
- Department of Surgery, Clinical Centre Dr. Dragisa Misovic, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Filip Pilipovic
- Institute for Orthopedic and Surgical Diseases "Banjica", Belgrade, Serbia
| | - Radoje Simic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department for Plastic Surgery, Institute for Mother and Child Health Care of Serbia Dr. Vukan Cupic, Belgrade, Serbia
| | - Dejan Jovanovic
- Institute of Radiology, Military Medical Academy, Belgrade, Serbia
| | | | - Nemanja Rancic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia.,Medical Faculty of Military Medical Academy, University of Defence, Belgrade, Serbia.,Institute of Radiology, Military Medical Academy, Belgrade, Serbia
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Bjørnelv GMW, Edwin B, Fretland ÅA, Deb P, Aas E. Till death do us part: the effect of marital status on health care utilization and costs at end-of-life. A register study on all colorectal cancer decedents in Norway between 2009 and 2013. BMC Health Serv Res 2020; 20:115. [PMID: 32054492 PMCID: PMC7020544 DOI: 10.1186/s12913-019-4794-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/29/2019] [Indexed: 01/11/2023] Open
Abstract
Background Economic analyses of end-of-life care often focus on single aspects of care in selected cohorts leading to limited knowledge on the total level of care required to patients at their end-of-life. We aim at describing the living situation and full range of health care provided to patients at their end-of-life, including how informal care affects formal health care provision, using the case of colorectal cancer. Methods All colorectal cancer decedents between 2009 and 2013 in Norway (n = 7695) were linked to six national registers. The registers included information on decedents’ living situation (days at home, in short- or long-term institution or in the hospital), their total health care utilization and costs in the secondary, primary and home- and community-based care setting. The effect of informal care was assessed through marital status (never married, currently married, or previously married) using regression analyses (negative binominal, two-part models and generalized linear models), controlling for age, gender, comorbidities, education, income, time since diagnosis and year of death. Results The average patient spent four months at home, while he or she spent 27 days in long-term institutions, 16 days in short-term institutions, and 21 days in the hospital. Of the total costs (~NOK 400,000), 58, 3 and 39% were from secondary carers (hospitals), primary carers (general practitioners and emergency rooms) and home- and community-based carers (home care and nursing homes), respectively. Compared to the never married, married patients spent 30 more days at home and utilized less home- and community-based care, but more health care services at the secondary and primary health care level. Their total healthcare costs were significantly lower (−NOK 65,621) than the never married. We found similar, but weaker, patterns for those who had been married previously. Conclusion End-of-life care is primarily provided in the secondary and home-and community-based care level, and informal caregivers have a substantial influence on formal end-of-life care provision. Excluding aspects of care such as home and community-based care or informal care in economic analyses of end-of-life care provides a biased picture of the total resources required, and might lead to inefficient resource allocations.
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Affiliation(s)
- Gudrun Maria Waaler Bjørnelv
- The Intervention Centre, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.,Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.,Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Partha Deb
- Department of Economics, Hunter College, CUNY and NBER, New York, USA
| | - Eline Aas
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway
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Lidington E, McGrath SE, Noble J, Stanway S, Lucas A, Mohammed K, van der Graaf W, Husson O. Evaluating a digital tool for supporting breast cancer patients: a randomized controlled trial protocol (ADAPT). Trials 2020; 21:86. [PMID: 31941539 PMCID: PMC6961395 DOI: 10.1186/s13063-019-3971-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/06/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There are a growing number of mHealth tools for breast cancer patients but a lack of scientific evidence for their effects. Recent studies have shown a mix of positive and negative impacts on users. Here we will assess the impact of OWise Breast Cancer, a mobile application for self-monitoring symptoms and managing care, on the process of self-management. METHODS This randomized controlled trial with early stage breast cancer patients will assess the effect of OWise use on patient activation at 3 months from diagnosis measured by the PAM-13 questionnaire. We will also assess differences in changes in health-related quality of life, psychological distress, health status, and National Health Service (NHS) health resource utilization over the first year from diagnosis. Participants will be randomly allocated (1:1) to standard care or standard care plus OWise. Participants will complete questionnaires before starting anti-cancer treatment and at 3, 6, and 12 months from diagnosis. Clinical and patient-reported outcome data will be linked to health resource utilization data from Discover, an integrated care record of primary, secondary, and social care in North West London. We will measure contamination in the control group and adjust the sample size to mitigate the dilution of effect estimates. A per-protocol analysis will be conducted as a sensitivity analysis to assess robustness of the primary results. DISCUSSION This study aims to generate evidence for the effectiveness of OWise at improving patient activation for women with early-stage breast cancer. The results will show the impact of using the tool at the patient level and the NHS health system level. The outcomes of the study will have implications for the application of OWise across the NHS for breast cancer patients and expansion into other tumor types. Assessing publicly available mHealth tools poses a challenge to trialists due to the risk of contamination. Here we apply various methods to measure, mitigate, and assess the effects of contamination. TRIAL REGISTRATION The study was registered at clincaltrials.gov (NCT03866655) on 7 March 2019.
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Affiliation(s)
| | | | | | | | - Amanda Lucas
- Discover at Imperial College Health Partners, London, United Kingdom
| | - Kabir Mohammed
- Discover at Imperial College Health Partners, London, United Kingdom
| | - Winette van der Graaf
- The Royal Marsden Hospital, London, United Kingdom
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Olga Husson
- Netherlands Cancer Institute, Amsterdam, Netherlands
- Institute of Cancer Research, Sutton, United Kingdom
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Current and Projected Financial Burden of Emergency General Surgery for Adults in Scotland's Single Payer Healthcare System: A Cost Analysis of Hospital Admissions. Ann Surg 2020; 274:e522-e528. [PMID: 31904598 DOI: 10.1097/sla.0000000000003769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To calculate the current and projected financial burden of EGS hospital admissions in a single-payer healthcare system. SUMMARY OF BACKGROUND DATA EGS is an important acute care service, which demands significant healthcare resources. EGS admissions and associated costs have increased over time, associated with an aging demographic. The National Health Service is the sole provider of emergency care in Scotland. METHODS Principal, high and low Scottish population projections were obtained for 2016 until 2041. EGS admission data were projected using an ordinary least squares linear regression model. An exponential function, fitted to historical length of hospital stay (LOS) data, was used to project future LOS. Historical hospital unit cost per bed day was projected using a linear regression model. EGS cost was calculated to 2041 by multiplying annual projections of population, admission rates, LOS, and cost per bed day. RESULTS The adult (age >15) Scottish population is projected to increase from 4.5 million to 4.8 million between 2016 and 2041. During this time, EGS admissions are expected to increase from 83,132 to 101,090 per year, cost per bed day from £786 to £1534, and overall EGS cost from £187.3 million to £202.5 million. CONCLUSIONS The future financial burden of EGS in Scotland is projected to increase moderately between 2016 and 2041. This is in sharp contrast to previous studies from settings such as the United States. However, if no further reductions in LOS or cost per bed day are made, especially for elderly patients, the cost of EGS will rise dramatically.
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Mittmann N, Liu N, Cheng SY, Seung SJ, Saxena FE, Look Hong NJ, Earle CC, Cheung MC, Leighl NB, Coburn NG, DeAngelis C, Evans WK. Health system costs for cancer medications and radiation treatment in Ontario for the 4 most common cancers: a retrospective cohort study. CMAJ Open 2020; 8:E191-E198. [PMID: 32184283 PMCID: PMC7082106 DOI: 10.9778/cmajo.20190114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Previous costing and resource estimates for cancer have not been complete owing to lack of comprehensive data on cancer-related medication and radiation treatment. Our objective was to calculate the mean overall costs per patient of cancer-related medications and radiation, as well as by disease subtype and stage, in the first year after diagnosis for the 4 most prevalent cancers in Ontario. METHODS We conducted a retrospective cohort study using provincial health administrative databases to identify population health system resources and costs for all patients diagnosed with breast, colorectal, lung or prostate cancer between Jan. 1, 2010, and Dec. 31, 2015 in Ontario. The primary outcome measure was the overall average cost per patient in the 365 days after diagnosis for cancer-related medications and radiation treatment, calculated with the use of 2 novel costing algorithms. We determined the cost by disease, disease subtype and stage as secondary outcomes. RESULTS There were 168 316 Ontarians diagnosed with cancer during the study period, 50 141 with breast cancer, 38 108 with colorectal cancer, 34 809 with lung cancer and 45 258 with prostate cancer. The mean per-patient cost for cancer-related medications was $8167 (95% confidence interval [CI] $8023-$8311), $6568 (95% CI $6446-$6691), $2900 (95% CI $2816-$2984) and $1211 (95% CI $1175-$1247) for breast, colorectal, lung and prostate cancer, respectively. The corresponding mean radiation treatment costs were $18 529 (95% CI $18 415-$18 643), $15 177 (95% CI $14 899-$15 456), $10 818 (95% CI $10 669-$10 966) and $16 887 (95% CI $16 648-$17 125). In general, stage III and IV cancers were the most expensive stages for both medications and radiation across all 4 disease sites. INTERPRETATION Our work updates previous costing estimates to help understand costs and resources critical to health care system planning in a single-payer system. More refined costing estimates are useful as inputs to allow for more robust health economic modelling and health care system planning.
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Affiliation(s)
- Nicole Mittmann
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont.
| | - Ning Liu
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Stephanie Y Cheng
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Soo Jin Seung
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Farah E Saxena
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Nicole J Look Hong
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Craig C Earle
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Matthew C Cheung
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Natasha B Leighl
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Natalie G Coburn
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - Carlo DeAngelis
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
| | - William K Evans
- Sunnybrook Research Institute (Mittmann, Seung) and Odette Cancer Centre (Look Hong, Earle, Cheung, Coburn, DeAngelis), Sunnybrook Health Sciences Centre; Cancer Care Ontario (Mittmann), Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (Mittmann), Ottawa, Ont.; ICES (Liu, Cheng, Saxena, Earle, Cheung, Coburn); Health Outcomes and PharmacoEconomic (HOPE) Research Centre (Seung); University Health Network (Leighl), Toronto, Ont.; McMaster University (Evans), Hamilton, Ont
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Iveson T, Boyd KA, Kerr RS, Robles-Zurita J, Saunders MP, Briggs AH, Cassidy J, Hollander NH, Tabernero J, Haydon A, Glimelius B, Harkin A, Allan K, McQueen J, Pearson S, Waterston A, Medley L, Wilson C, Ellis R, Essapen S, Dhadda AS, Harrison M, Falk S, Raouf S, Rees C, Olesen RK, Propper D, Bridgewater J, Azzabi A, Farrugia D, Webb A, Cunningham D, Hickish T, Weaver A, Gollins S, Wasan H, Paul J. 3-month versus 6-month adjuvant chemotherapy for patients with high-risk stage II and III colorectal cancer: 3-year follow-up of the SCOT non-inferiority RCT. Health Technol Assess 2019; 23:1-88. [PMID: 31852579 PMCID: PMC6936167 DOI: 10.3310/hta23640] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Oxaliplatin and fluoropyrimidine chemotherapy administered over 6 months is the standard adjuvant regimen for patients with high-risk stage II or III colorectal cancer. However, the regimen is associated with cumulative toxicity, characterised by chronic and often irreversible neuropathy. OBJECTIVES To assess the efficacy of 3-month versus 6-month adjuvant chemotherapy for colorectal cancer and to compare the toxicity, health-related quality of life and cost-effectiveness of the durations. DESIGN An international, randomised, open-label, non-inferiority, Phase III, parallel-group trial. SETTING A total of 244 oncology clinics from six countries: UK (England, Scotland, Wales and Northern Ireland), Denmark, Spain, Sweden, Australia and New Zealand. PARTICIPANTS Adults aged ≥ 18 years who had undergone curative resection for high-risk stage II or III adenocarcinoma of the colon or rectum. INTERVENTIONS The adjuvant treatment regimen was either oxaliplatin and 5-fluorouracil or oxaliplatin and capecitabine, randomised to be administered over 3 or 6 months. MAIN OUTCOME MEASURES The primary outcome was disease-free survival. Overall survival, adverse events, neuropathy and health-related quality of life were also assessed. The main cost categories were chemotherapy treatment and hospitalisation. Cost-effectiveness was assessed through incremental cost comparisons and quality-adjusted life-year gains between the options and was reported as net monetary benefit using a willingness-to-pay threshold of £30,000 per quality-adjusted life-year per patient. RESULTS Recruitment is closed. In total, 6088 patients were randomised (3044 per group) between 27 March 2008 and 29 November 2013, with 6065 included in the intention-to-treat analyses (3-month analysis, n = 3035; 6-month analysis, n = 3030). Follow-up for the primary analysis is complete. The 3-year disease-free survival rate in the 3-month treatment group was 76.7% (standard error 0.8%) and in the 6-month treatment group was 77.1% (standard error 0.8%), equating to a hazard ratio of 1.006 (95% confidence interval 0.909 to 1.114; p-value for non-inferiority = 0.012), confirming non-inferiority for 3-month adjuvant chemotherapy. Frequent adverse events (alopecia, anaemia, anorexia, diarrhoea, fatigue, hand-foot syndrome, mucositis, sensory neuropathy, neutropenia, pain, rash, altered taste, thrombocytopenia and watery eye) showed a significant increase in grade with 6-month duration; the greatest difference was for sensory neuropathy (grade ≥ 3 was 4% for 3-month vs.16% for 6-month duration), for which a higher rate of neuropathy was seen for the 6-month treatment group from month 4 to ≥ 5 years (p < 0.001). Quality-of-life scores were better in the 3-month treatment group over months 4-6. A cost-effectiveness analysis showed 3-month treatment to cost £4881 less over the 8-year analysis period, with an incremental net monetary benefit of £7246 per patient. CONCLUSIONS The study achieved its primary end point, showing that 3-month oxaliplatin-containing adjuvant chemotherapy is non-inferior to 6 months of the same regimen; 3-month treatment showed a better safety profile and cost less. For future work, further follow-up will refine long-term estimates of the duration effect on disease-free survival and overall survival. The health economic analysis will be updated to include long-term extrapolation for subgroups. We expect these analyses to be available in 2019-20. The Short Course Oncology Therapy (SCOT) study translational samples may allow the identification of patients who would benefit from longer treatment based on the molecular characteristics of their disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN59757862 and EudraCT 2007-003957-10. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 64. See the NIHR Journals Library website for further project information. This research was supported by the Medical Research Council (transferred to NIHR Evaluation, Trials and Studies Coordinating Centre - Efficacy and Mechanism Evaluation; grant reference G0601705), the Swedish Cancer Society and Cancer Research UK Core Clinical Trials Unit Funding (funding reference C6716/A9894).
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Affiliation(s)
- Timothy Iveson
- Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Kathleen A Boyd
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel S Kerr
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | - Andrew H Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jim Cassidy
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Niels Henrik Hollander
- Department of Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrew Haydon
- Australasian Gastro-Intestinal Trials Group, Camperdown, NSW, Australia
| | | | - Andrea Harkin
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Karen Allan
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - John McQueen
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Pearson
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | | | | | | | | | - Sharadah Essapen
- St Luke's Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | | | | | - Sherif Raouf
- Barking Havering and Redbridge University Hospital NHS Trust, Barking, UK
| | - Charlotte Rees
- Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Rene K Olesen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - David Propper
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Ashraf Azzabi
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Farrugia
- Gloucestershire Oncology Centre, Cheltenham General Hospital, UK
| | - Andrew Webb
- Brighton and Sussex University Hospital Trust, Brighton, UK
| | | | | | - Andrew Weaver
- Department of Oncology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | | | - Harpreet Wasan
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - James Paul
- The Christie Hospital NHS Foundation Trust, Manchester, UK
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75
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Badrick E, Cresswell K, Ellis P, Renehan AG, Crosbie EJ. Top ten research priorities for detecting cancer early. Lancet Public Health 2019; 4:e551. [PMID: 31562068 DOI: 10.1016/s2468-2667(19)30185-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/11/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Ellena Badrick
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK
| | - Katharine Cresswell
- Division on Evolution and Genomic Sciences, School of Biological, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK
| | | | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK; The Christie National Health Service Foundation Trust, Manchester, UK.
| | - Emma J Crosbie
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester M204BX, UK; Manchester University National Health Service Foundation Trust, Manchester, UK
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76
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Mittmann N, Cheng SY, Liu N, Seung SJ, Saxena FE, DeAngelis C, Hong NJL, Earle CC, Cheung MC, Leighl N, Coburn N, Evans WK. The generation of two specific cancer costing algorithms using Ontario administrative databases. ACTA ACUST UNITED AC 2019; 26:e682-e692. [PMID: 31708661 DOI: 10.3747/co.26.5279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cancer treatment and management have become increasingly economically burdensome. Consequently, to help with planning health service delivery, it is vital to understand the associated costs. Administrative databases can be used to help understand and generate real-world system-level costs. Using databases to generate costs can take one of two approaches: top-down or bottom-up. Top-down approaches disaggregate the total health care spending from a global health care budget by sector and provider. A bottom-up approach begins with individual-level health care use and its costs, which are then aggregated.
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Affiliation(s)
- N Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto.,Cancer Care Ontario, Toronto
| | | | | | - S J Seung
- Health Outcomes and PharmacoEconomic (hope) Research Centre, Toronto
| | | | - C DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto
| | - N J Look Hong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto
| | - C C Earle
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto.,ices, Toronto.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto
| | - M C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto
| | - N Leighl
- University Health Network, Toronto
| | - N Coburn
- ices, Toronto.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto
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77
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Tekin RN, Saygılı M. Determining Breast Cancer Treatment Costs Using the Top Down Cost Approach. Eur J Breast Health 2019; 15:242-248. [PMID: 31620683 DOI: 10.5152/ejbh.2019.4909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Abstract
Objective Breast cancer is the most common type of cancer among women in Turkey, with approximately 15.000 breast cancer diagnoses each year. In this study, our goal was to determine annual direct medical costs of all breast cancer patients in Turkey with top down cost approach. Materials and Methods Data regarding patients who have been diagnosed with breast cancer and received health services from any hospital in Turkey in 2014 were used for the purpose of the study. Data were obtained from the MEDULA System for a total of 126.664 patient. Treatment of costs of patients were calculated based on types of patient admissions (inpatient/outpatient/intensive care) and costs of drugs and medical equipment. Indirect costs and out of pocket costs were not included. Results Total medical costs of 126,664 patients was calculated as $116.792.107,9, with an average treatment cost per patient of $922,1. Based on types of patient admission, intensive care treatment had the highest average cost with $2.916.5. In metastatic breast cancer patients, average annual treatment cost per patient is $2.326,6, which is 2.8 times higher compared to non-metastatic breast cancer patients. Conclusion In order to ensure effective resource allocation at micro and macro level, healthcare administrators have to learn costs of diseases with high incidence such as breast cancer. Results obtained from studies on disease costs calculated using the top down cost approach provide data on actual health services use and therefore are seen as important tools for healthcare administrators in terms of effective resource allocation.
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Affiliation(s)
| | - Meltem Saygılı
- Healthcare Management, Kırıkkale University, Kırıkkale, Turkey
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78
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Feletto E, Grogan P, Vassallo A, Canfell K. Cancer costs and gender: a snapshot of issues, trends, and opportunities to reduce inequities using Australia as an example. Climacteric 2019; 22:538-543. [PMID: 31378097 DOI: 10.1080/13697137.2019.1642319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As the cancer burden increases, so too does the cost, to health systems, economies, and individuals. There is increasing interest in productivity and out-of-pocket costs for individuals and their carers, but these remain poorly understood. The costs of cancer in women, often carers themselves, are less understood. This summary analysis explored data on the cancer burden in Australia (and health costs in comparable countries), including expenditure reports and literature on macroeconomic outcomes and out-of-pocket costs, to highlight the cost impacts of a cancer diagnosis in women, at a societal and an individual level. Data on productivity costs were skewed toward men, as men are over-represented in paid work compared with women. Data on societal and individual costs of cancer in women were scant, yet the predominance of women in unpaid work suggests the cost is significant. Evidence for the benefits of cancer prevention and early detection suggests that improved targeting of interventions to women would reduce costs at a societal and an individual level. More research is needed on the specific impacts of cancer on women and those they care for, to better target public health and support services to need.
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Affiliation(s)
- E Feletto
- Cancer Research Division, Cancer Council New South Wales , Kings Cross , Sydney NSW , Australia
| | - P Grogan
- Cancer Research Division, Cancer Council New South Wales , Kings Cross , Sydney NSW , Australia.,Sydney School of Public Health, University of Sydney , Sydney , NSW , Australia
| | - A Vassallo
- Cancer Research Division, Cancer Council New South Wales , Kings Cross , Sydney NSW , Australia
| | - K Canfell
- Cancer Research Division, Cancer Council New South Wales , Kings Cross , Sydney NSW , Australia.,Sydney School of Public Health, University of Sydney , Sydney , NSW , Australia.,Prince of Wales Clinical School, University of New South Wales , Sydney , NSW , Australia
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79
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Dal Maso L, Panato C, Guzzinati S, Serraino D, Francisci S, Botta L, Capocaccia R, Tavilla A, Gigli A, Crocetti E, Rugge M, Tagliabue G, Filiberti RA, Carrozzi G, Michiara M, Ferretti S, Cesaraccio R, Tumino R, Falcini F, Stracci F, Torrisi A, Mazzoleni G, Fusco M, Rosso S, Tisano F, Fanetti AC, Sini GM, Buzzoni C, De Angelis R. Prognosis and cure of long-term cancer survivors: A population-based estimation. Cancer Med 2019; 8:4497-4507. [PMID: 31207165 PMCID: PMC6675712 DOI: 10.1002/cam4.2276] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 12/30/2022] Open
Abstract
Background Increasing evidence of cure for some neoplasms has emerged in recent years. The study aimed to estimate population‐based indicators of cancer cure. Methods Information on more than half a million cancer patients aged 15‐74 years collected by population‐based Italian cancer registries and mixture cure models were used to estimate the life expectancy of fatal tumors (LEFT), proportions of patients with similar death rates of the general population (cure fraction), and time to reach 5‐year conditional relative survival (CRS) >90% or 95% (time to cure). Results Between 1990 and 2000, the median LEFT increased >1 year for breast (from 8.1 to 9.4 years) and prostate cancers (from 5.2 to 7.4 years). Median LEFT in 1990 was >5 years for testicular cancers (5.8) and Hodgkin lymphoma (6.3) below 45 years of age. In both sexes, it was ≤0.5 years for pancreatic cancers and NHL in 1990 and in 2000. The cure fraction showed a 10% increase between 1990 and 2000. It was 95% for thyroid cancer in women, 94% for testis, 75% for prostate, 67% for breast cancers, and <20% for liver, lung, and pancreatic cancers. Time to 5‐year CRS >95% was <10 years for testis, thyroid, colon cancers, and melanoma. For breast and prostate cancers, the 5‐year CRS >90% was reached in <10 years but a small excess remained for >15 years. Conclusions The study findings confirmed that several cancer types are curable. Became aware of the possibility of cancer cure has relevant clinical and social impacts.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Silvia Francisci
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Capocaccia
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Andrea Tavilla
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS and Azienda Usl della Romagna, Meldola (Forlì), Italy
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padua, Italy.,Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rosa Angela Filiberti
- Liguria Cancer Registry, Clinical Epidemiology, IRCCS Policlinico San Martino, Genova, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, AUSL Modena, Modena, Italy
| | - Maria Michiara
- Parma Cancer Registry, Oncology Unit, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry - Section of Ferrara. Local Health Unit, University of Ferrara, Ferrara, Italy
| | - Rosaria Cesaraccio
- North Sardinia Cancer Registry, Azienda Regionale per la Tutela della Salute, Sassari, Italy
| | | | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS and Azienda Usl della Romagna, Meldola (Forlì), Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | | | - Mario Fusco
- Cancer Registry of ASL Napoli 3 Sud, Napoli, Italy
| | - Stefano Rosso
- Registro Tumori Piemonte, Provincia di Biella CPO, Biella, Italy
| | - Francesco Tisano
- Cancer Registry of the Province of Siracusa, Local Health Unit of Siracusa, Siracusa, Italy
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Epidemiology unit, ATS della Montagna, Sondrio, Italy
| | | | - Carlotta Buzzoni
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy.,AIRTUM Database, Florence, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
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Unplanned admissions for patients with myeloma in the UK: Low frequency but high costs. J Bone Oncol 2019; 17:100243. [PMID: 31223562 PMCID: PMC6579752 DOI: 10.1016/j.jbo.2019.100243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background Multiple myeloma (MM) is associated with high healthcare resource utilisation and increasing hospitalisation rates. The aim of this study was to characterise the hospital use by patients with MM in the English National Health Service (NHS). Methods Routinely-collected aggregate data about all NHS-funded hospital admissions of patients with MM were analysed. Data were obtained from the English Hospital Episodes Statistics on admissions between 1 April 2014 and 31 March 2018. Results A total of 754,345 admissions were reported over four years, equivalent to a mean of 188,586 admissions per year. Of the 41,845 patients admitted during this period, 42% were women and 58% men. From the total admissions, 90% were elective and 10% unplanned. Mean annual estimated costs over the period were £46 million for elective and £56 million for unplanned admissions. The number of elective admissions increased by 4.5% with costs increasing 1.5% per year; for unplanned admissions, these figures were 4.1% and 9.0%, respectively. Conclusions MM is associated with a significant number of hospital admissions and NHS costs. The majority of the hospital admissions are elective, but the highest burden in terms of costs relates to unplanned admissions, with numbers increasing over time.
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81
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Bauer A, Taggart L, Rasmussen J, Hatton C, Owen L, Knapp M. Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks. BMC Public Health 2019; 19:706. [PMID: 31174506 PMCID: PMC6556058 DOI: 10.1186/s12889-019-6912-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK.
| | - Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, N Ireland, Newtownabbey, BT37 0QB, UK
| | - Jill Rasmussen
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, England, NW1 2FB, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Lancaster University, Lancaster, England, LA1 4YG, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, England, SW1A 2BU, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK
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Lefeuvre D, Catajar N, Le Bihan Benjamin C, Ifrah N, De Bels F, Viguier J, Bousquet PJ. Breast cancer screening: Impact on care pathways. Cancer Med 2019; 8:4070-4078. [PMID: 31172693 PMCID: PMC6639186 DOI: 10.1002/cam4.2283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/01/2019] [Accepted: 05/06/2019] [Indexed: 02/03/2023] Open
Abstract
Background Controversy persists concerning screening programs (SPs), related to a potential risk of overdiagnosis or the impact on survival. One of the main questions to be addressed concerns the aggressiveness of the related treatments. Methods Using the "Cancer Cohort,” a national‐based cohort (medico‐administrative database), all women between the ages of 50 and 74 years and treated in 2014 for incident breast cancer were compared, according to whether their diagnosis was made following a mammogram performed within the framework of the SP (SP group) or outside it (NSP group). Results A total of 23 788 women were identified: 13 530 (57%) in the SP group and 10 258 (43%) in the NSP group. The women in the SP group had a higher rate of in situ or localized invasive breast cancer. They had a higher rate of breast‐conserving surgery (82% vs 70%), and a lower rate of chemotherapy (34% vs 53%). These findings were observed irrespective of the stage. They had a higher rate of pathways involving breast‐conserving surgery followed by radiotherapy. Among women with metastatic cancer, those in the SP group had a lower proportion of liver, lung, brain, and bone metastases, and a higher proportion of lymph node metastases (other than axillary), irrespective of the time to onset of the metastases. Conclusion The women in whom cancer was diagnosed following a mammogram performed in the context of the SP had less advanced cancer and less aggressive treatments. This observational study helps illustrate the benefit of the SP in France using a different approach.
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Affiliation(s)
- Delphine Lefeuvre
- Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Nathalie Catajar
- Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Christine Le Bihan Benjamin
- Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Norbert Ifrah
- Presidency, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Frédéric De Bels
- Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Jérôme Viguier
- Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.,Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
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83
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Leng A, Jing J, Nicholas S, Wang J. Catastrophic health expenditure of cancer patients at the end-of-life: a retrospective observational study in China. BMC Palliat Care 2019; 18:43. [PMID: 31122235 PMCID: PMC6533646 DOI: 10.1186/s12904-019-0426-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cancer is the second leading cause of death globally, causing a substantial economic burden on cancer suffers and their families. The aim of this study is to explore the prevalence, determinants and consequences of catastrophic health expenditure (CHE) among urban and rural end-of-life (EOF) cancer patients in China. Methods Using respondent-driven sampling and face-to-face interviews, field research was conducted with a specialist questionnaire. Data were collected on 792 cancer patients who died between June 2013 and June 2016 in China. The determinants of household catastrophic expenditure were identified by multivariate logistic regression. Findings It is found that more than 80% of cancer patients received life-extending treatment. Extremely high rates of CHE were identified among EOL cancer patients, at 94.3% for urban families and 96.1% for rural families. After spending for health, 84.1% of urban and 91.1% rural EOL cancer patient households were impoverished, falling below the poverty line. For both urban and rural households, income was the most significant factor associated with catastrophic health expenditure (CHE). Health insurance did not adequately compensate for CHE. Rural families experienced higher CHE, lower levels of health care utilization, a different mix of health care access and higher rates of borrowing for out-of-pocket (OOP) health care expenditures than urban families. Both urban and rural households suffered long-term economic disadvantage due to CHE and borrowing for OOP medical care expenses. Conclusions EOL cancer patients experienced severe CHE, with families forced into poverty. With only about 1% of EOL cancer patients receiving palliative care, developing palliative care services and expanding the acceptance of palliative care in China is both urgent and essential. To help address impoverishment due to CHE, China should also develop targeted programs to reduce income inequality, especially rural-urban inequalities; increase access to health care; and accelerate health reform. Increasing the retirement age would provide households with more savings and wealth to withstand CHE.
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Affiliation(s)
- Anli Leng
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan, China. No. 44 Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Jun Jing
- Jun Jing Research Center for Public Health, Medical School, Tsinghua University, Room B408, Beijing, 100084, China
| | - Stephen Nicholas
- School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, Tianjin, 300074, China. .,TOP Education Institute 1 Central Avenue Australian Technology Park, Eveleigh, Sydney, NSW, 2015, Australia. .,Research Institute of International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, Guangzhou, 510420, People's Republic of China. .,Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW, Australia.
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, 54 Dongsi Lishi Hutong, Beijing, 100010, China.
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Yin X, Xu Y, Man X, Liu L, Jiang Y, Zhao L, Cheng W. Direct costs of both inpatient and outpatient care for all type cancers: The evidence from Beijing, China. Cancer Med 2019; 8:3250-3260. [PMID: 31062522 PMCID: PMC6558587 DOI: 10.1002/cam4.2184] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background Cancer is a major public health issue worldwide. The cost of cancer care imposes a substantial economic burden on society and patient, but it has not been thoroughly studied in China. This study aimed to describe direct cost and cost elements of all cancer types by different beneficial characteristics. Methods The research was a retrospective observational study based on inpatient and outpatient records with a primary diagnosis of cancer from 31 hospitals in 2016. Total cost and cost per time were analyzed by cancer type, sources (prescription medicines, consumables fee for diagnosis and surgery, and other health services), and beneficial characteristics (gender and age). Results A total of 30 224 eligible inpatient admissions and 485 391 outpatient visits were identified during the study period. Inpatient care costs account for 58.6% cancer treatment costs. Nearly 70% of the total expenditure is spent on patients aged 50‐79 years. Lung cancer had the highest economic cost (15% of overall cancer costs), followed by breast cancer (12%), and colorectal cancer (10%). Anticancer drug cost accounted a large proportion in both inpatient (37.7%) and outpatient care (64.6%). The average cost per inpatient admission was estimated to be $4590.1 (5621.9), ranging from $1157.7 (1349.8) for testis cancer to $7975 (7343.9) for stomach cancer. The regression analyses revealed that length of hospital stay, cancer type, age, payment type, and hospital level were highly correlated with the expenditure per admission (P < 0.001). Conclusions The cancer care cost is substantial and varies with cancer type. Our findings provide important information for health service planning, allowing more efficient allocation of health resources for the care of people with cancer.
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Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Xu
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowei Man
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Liming Liu
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Jiang
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Liying Zhao
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Cheng
- College of Administration, Beijing University of Chinese Medicine, Beijing, China
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Healthcare utilization of breast cancer patients following telephone-based consultations of oncology nurse navigator via telemedical care. PLoS One 2019; 14:e0216365. [PMID: 31048852 PMCID: PMC6497384 DOI: 10.1371/journal.pone.0216365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/18/2019] [Indexed: 01/31/2023] Open
Abstract
Objectives To characterize breast cancer patients who received telephone-based consultations of oncology nurse navigator via telemedical care (TMC patients) and analyze their healthcare utilization (HCU) one year before and after receiving this service. Methods A retrospective study among Maccabi Healthcare Services enrollees that were newly diagnosed during 2016 (n = 1035). HCU, demographic characteristics and comorbidities were obtained from computerized database. Multivariable ordered logit model was specified for the determinants of HCU by quarters. Independent variables included: annual number of telephone-based consultations, gap between diagnosis and first consultation, age, socio-economic status, eligibility for disability and income security benefits, and comorbidities. Results Twenty-two percent of our cohort were TMC patients. Compared to others, these patients were younger and had a lower prevalence of hypertension. A higher proportion of these patients received disability benefits, and a lower proportion received income security benefits. The total average annual HCU of TMC patients (n = 107) before first consultation was $8857 and increased to $44130 in the first year following it (p<0.001), predominantly due to a significant increase in outpatient visits ($20380 vs. $3502, p<0.001) and medication costs ($19339 vs. $1758, p<0.001). The multivariable model revealed that each additional telephone-based consultation decreased the likelihood to be in the lowest quarter of the HCU distribution by 1.1 percentage points (p = 0.015), and increased the likelihood to be in the upper quarter of the HCU distribution by 1.1 percentage points (p = 0.016). Conclusions There was a significant increase in outpatient care and medications usage following first consultation. Moreover, a more intense use of this service was associated with elevated HCU. This result may stem from the proactive nature of the telemedical care.
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86
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Waterhouse DJ, Fitzpatrick CRM, Pogue BW, O'Connor JPB, Bohndiek SE. A roadmap for the clinical implementation of optical-imaging biomarkers. Nat Biomed Eng 2019; 3:339-353. [PMID: 31036890 DOI: 10.1038/s41551-019-0392-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/17/2019] [Indexed: 02/07/2023]
Abstract
Clinical workflows for the non-invasive detection and characterization of disease states could benefit from optical-imaging biomarkers. In this Perspective, we discuss opportunities and challenges towards the clinical implementation of optical-imaging biomarkers for the early detection of cancer by analysing two case studies: the assessment of skin lesions in primary care, and the surveillance of patients with Barrett's oesophagus in specialist care. We stress the importance of technical and biological validations and clinical-utility assessments, and the need to address implementation bottlenecks. In addition, we define a translational roadmap for the widespread clinical implementation of optical-imaging technologies.
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Affiliation(s)
- Dale J Waterhouse
- Department of Physics, University of Cambridge, Cambridge, UK
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Catherine R M Fitzpatrick
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Engineering, University of Cambridge, Cambridge, UK
| | | | | | - Sarah E Bohndiek
- Department of Physics, University of Cambridge, Cambridge, UK.
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, UK.
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Geographical disparities in treatment and health care costs for end-of-life cancer patients in China: a retrospective study. BMC Cancer 2019; 19:39. [PMID: 30621633 PMCID: PMC6325809 DOI: 10.1186/s12885-018-5237-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 12/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Cancer imposes substantial burdens on cancer suffers, their families and the health system, especially in the end of life (EOL) of care patients. There are few developing country studies of EOL health care costs and no specialist studies of the disparities in cancer treatment and care costs by geographical location in China. We sought to examine geographical disparities in the types of cancer treatments and care costs during the last 3 months of life for Chinese cancer patients. Methods Using snowball sampling and face-to-face interviews, field research was conducted with a specialist questionnaire. Data were collected on 792 cancer patients who died between July 2013 and June 2016 in China. Total EOL health care costs were modeled using generalized linear models (GLMs) with log link and gamma distribution. Results Total health care costs were highest for urban (US$12,501) and western region (US$9808) patients and lowest for rural (US$5996) and central region (US$5814) patients. Our study revealed about 40% of the health care expenses occur in the last three months of life, and was mainly driven by hospital costs that accounted for about 70% of EOL expenditures. Patients faced out-of-pocket expenses for health care, with the ability to borrow from family and friends also impacting the type of treatment and health facility. Life-extending treatments per cancer patient was about two times that of patients receiving conservative treatments.Urban patients were more likely to receive life-extending treatments, financed by higher incomes and a greater capacity to borrow from family and friends to bridge the gap between health insurance reimbursements and out-of-pocket expenditures. Cancer patients in western region and urban area were significantly more likely to access hospice care. Conclusions We found significant urban-rural and regional disparities in EOL types of cancer treatment, utilization of medical care and the health care expenditures. The EOL cancer care costs imposed heavy economic burdens in China.We recommend better clinical guidelines, improved EOL conversations and fuller information on treatment regimes among patients, family caregivers and doctors. Policies and information should pay more attention to palliative care options and the socio-cultural context of cancer care decision-making by family. Electronic supplementary material The online version of this article (10.1186/s12885-018-5237-1) contains supplementary material, which is available to authorized users.
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Broder MS, Cai B, Chang E, Yan T, Benson Iii AB. Treatment adherence, healthcare resource utilization, and costs in patients with lung neuroendocrine tumors (lung NETs) in the USA. Curr Med Res Opin 2018; 34:2151-2156. [PMID: 30047289 DOI: 10.1080/03007995.2018.1505277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess first-line treatment adherence, healthcare resource utilization, and costs in lung NET patients initiating pharmacologic treatments. METHODS In two US claims databases, patients aged ≥18 years with ≥1 inpatient or ≥2 outpatient lung NET claims within 12 months were identified. The first claim for pharmacologic treatments (e.g. somatostatin analogs [SSAs], cytotoxic chemotherapy [CC], targeted therapy [TT]) following diagnosis, between July 1, 2009-December 31, 2014, was defined as the index date. A 6-month pre-index period without any NET treatment, and ≥1-year post-index enrollment were required. Proportion of days covered (PDC) was calculated during follow-up. Descriptive statistics, including means, standard deviations, and frequencies/percentages for continuous and categorical data, respectively, were reported. RESULTS Of 354 patients with 1-year of follow-up, 252 initiated CC, 89 SSA, 3 TT, and 10 various combinations. Due to sample sizes, the remaining results focus only on CC and SSAs. Mean PDC (SD) was 0.320 (0.176) for CC and 0.673 (0.322) for SSAs; CC users had a mean (SD) of 33.3 (23.8) office visits and 0.79 (1.39) hospitalizations; SSA users had 23.1 (12.4) visits and 0.48 (1.07) hospitalizations. Mean total (SD) annual cost for CC users was $124,383 (135,836) and $98,713 (81,495) for SSA users. Among 163 patients with 2 years of follow-up, the annual mean cost in the second-year was $43,026 lower and $8110 higher than the first-year for CC and SSAs, respectively. CONCLUSIONS The majority of patients with lung NETs initiated CC; only about one quarter initiated SSA in the first-line. This descriptive study updates the utilization and costs of pharmacologically-treated lung NETs.
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Affiliation(s)
- Michael S Broder
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Beilei Cai
- b Novartis Pharmaceuticals , East Hanover , NJ , USA
| | - Eunice Chang
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Tingjian Yan
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
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SCOT: a comparison of cost-effectiveness from a large randomised phase III trial of two durations of adjuvant Oxaliplatin combination chemotherapy for colorectal cancer. Br J Cancer 2018; 119:1332-1338. [PMID: 30420616 PMCID: PMC6265336 DOI: 10.1038/s41416-018-0319-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Short Course Oncology Therapy (SCOT) study is an international, multicentre, non-inferiority randomised controlled trial assessing the efficacy, toxicity, and cost-effectiveness of 3 months (3 M) versus the usually given 6 months (6 M) of adjuvant chemotherapy in colorectal cancer. METHODS In total, 6088 patients with fully resected high-risk stage II or stage III colorectal cancer were randomised and followed up for 3–8 years. The within-trial cost-effectiveness analysis from a UK health-care perspective is presented using the resource use data, quality of life (EQ-5D-3L), time on treatment (ToT), disease-free survival after treatment (DFS) and overall survival (OS) data. Quality-adjusted partitioned survival analysis and Kaplan–Meier Sample Average Estimator estimated QALYs and costs. Probabilistic sensitivity and subgroup analysis was undertaken. RESULTS The 3 M arm is less costly (-£4881; 95% CI: -£6269; -£3492) and entails (non-significant) QALY gains (0.08; 95% CI: −0.086; 0.230) due to a better significant quality of life. The net monetary benefit was significantly higher in 3 M under a wide range of monetary values of a QALY. The subgroup analysis found similar results for patients in the CAPOX regimen. However, for the FOLFOX regimen, 3 M had lower QALYs than 6 M (not statistically significant). CONCLUSIONS Overall, 3 M dominates 6 M with no significant detrimental impact on QALYs. The results provide the economic case that a 3 M treatment strategy should be considered a new standard of care.
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Bates N, Callander E, Lindsay D, Watt K. CancerCostMod: a model of the healthcare expenditure, patient resource use, and patient co-payment costs for Australian cancer patients. HEALTH ECONOMICS REVIEW 2018; 8:28. [PMID: 30382489 PMCID: PMC6742917 DOI: 10.1186/s13561-018-0212-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/16/2018] [Indexed: 06/08/2023]
Abstract
Although cancer survival in general has improved in Australia over the past 30 years, Indigenous Australians, socioeconomically disadvantaged persons, and people living in remote areas still experience poorer health outcomes. This paper aims to describe the development of CancerCostMod, and to present the healthcare expenditure and patient co-payments for the first 12-months post-diagnosis. The base population is a census of all cancer diagnoses (excluding non-melanoma skin cancer) in Queensland, Australia between 1 July 2011 and 30 June 2012 (N = 25,553). Each individual record was linked to their Queensland Health Admitted Patient Data Collection, Emergency Department Information System, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records from 1 July 2011 to 30 June 2015. Indigenous status was recorded for 87% of participants in our base population. Multiple imputation was used to assign Indigenous status to records where Indigenous status was missing. This base population was then weighted, using a programmed SAS macro (GREGWT) to be representative of the Australian population. We adopted a national healthcare perspective to estimate the cost of cancer for hospital episodes, ED presentations, primary healthcare, and prescription pharmaceuticals. We also adopted an individual perspective, to estimate the primary healthcare and prescription pharmaceutical patient co-payments. Once weighted, our sample represents approximately 123,900 Australians (1.7% Indigenous Australians). The total healthcare system cost of all cancers during the first 12-months post diagnosis was $4.8 billion, [corrected] and patient co-payments costs were $127 million. After adjusting for sex, age at diagnosis, Indigenous status, rurality, socioeconomic status, and broad cancer type, significant differences in costs were observed for population groups of interest within the first year post-diagnosis. This paper provides a more recent national estimate of the cost of cancer, and addresses current research gaps by highlighting the distribution of healthcare and individual costs by Indigenous status, rurality, and socioeconomic status.
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Affiliation(s)
- Nicole Bates
- College of Public Health, Medical and Veterinary Sciences (CPHMVS), James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, QLD Australia
| | - Emily Callander
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, QLD Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences (CPHMVS), James Cook University, Townsville, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences (CPHMVS), James Cook University, Townsville, Australia
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91
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Health Care Resource Utilization and Costs among Adult Patients with Advanced Soft Tissue Sarcoma: A Retrospective Medical Record Review in the United Kingdom, Spain, Germany, and France. Sarcoma 2018; 2018:2020591. [PMID: 30297977 PMCID: PMC6157208 DOI: 10.1155/2018/2020591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To describe health care resource utilization and costs for patients with advanced soft tissue sarcoma (STS) in the United Kingdom (UK), Spain, Germany, and France. Methods Physicians abstracted data for adult patients with a diagnosis of advanced STS (other than Kaposi's sarcoma or gastrointestinal stromal tumor) who received ≥1 lines of systemic therapy. Health care resource utilization related to advanced STS treatment was recorded; associated costs were estimated by applying unit costs. Results A total of 130 physicians provided data for 807 patients (UK: 199; Spain: 203; Germany: 204; and France: 201). The site of care during active treatment varied based on differences in the health care systems of these four countries. Total mean per-patient health care cost in the UK was £19,457; in Spain, €26,814; in Germany, €20,468; and in France, €24,368. Advanced STS-related systemic treatment costs were driven primarily by drug acquisition and administration costs. Treatment-related costs increased during later lines of therapy for all countries except France, where they decreased after first-line therapy. Pain control and antiemetics were the most common supportive care medications. Conclusions This study provides real-world data on resource utilization and estimated costs in advanced STS and could inform policymakers about treatment burden.
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Muller P, Walters S, Coleman MP, Woods L. Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival? Cancer Epidemiol 2018; 56:161-170. [PMID: 30056051 PMCID: PMC6189520 DOI: 10.1016/j.canep.2018.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/20/2018] [Accepted: 07/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND A key component of recent English cancer policy is the monitoring of trends in early diagnosis of cancer. Early diagnosis can be defined by the disease stage at diagnosis or by other indicators derived from electronic health records. We evaluate the association between different early diagnosis indicators and survival, and discuss the implementation of the indicators in surveillance of early diagnosis. METHODS We searched the PubMed database and grey literature to identify early diagnosis indicators and evaluate their association with survival. We analysed cancer registrations for 355,502 cancer patients diagnosed in England during the period 2009-2013, and quantified the association between each early diagnosis indicator and 30-day mortality and five-year net survival. RESULTS Each incremental difference in stage (I-IV) predicts lower 5-year survival, so prognostic information is lost in comparisons which use binary stage indicators. Patients without a recorded stage have high risk of death shortly following diagnosis and lower 5-year survival. Emergency presentation is independently associated with lower five-year survival. Shorter intervals between first symptoms and diagnosis are not consistently associated with improved survival, potentially due to confounding from tumour characteristics. INTERPRETATION Contrary to current practice, we recommend that all the stage information should be used in surveillance. Patients missing stage should also be included to minimise bias. Combined data on stage and emergency presentation could be used to create summary prognostic measures. More work is needed to create statistics based on the diagnostic interval that will be useful for surveillance.
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Affiliation(s)
- Patrick Muller
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Sarah Walters
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Laura Woods
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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93
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Broder MS, Cai B, Chang E, Yan T, Benson AB. First-line systemic treatment adherence, healthcare resource utilization, and costs in patients with gastrointestinal neuroendocrine tumors (GI NETs) in the USA. J Med Econ 2018; 21:821-826. [PMID: 29741466 DOI: 10.1080/13696998.2018.1474748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To assess treatment adherence, healthcare resource utilization, and costs in gastrointestinal neuroendocrine tumor (GI NET) patients initiating pharmacologic treatments in the US. METHODS In two US commercial claims databases, patients ≥18 years with ≥1 inpatient or ≥2 outpatient GI NET claims within 12 months were identified. The first claim for pharmacologic treatments (e.g. somatostatin analogs [SSAs], cytotoxic chemotherapy [CC], targeted therapy [TT]) following diagnosis, between July 1, 2009 - December 31, 2014, was defined as the index date. A 6-month pre-index NET treatment-free period, and ≥1-year post-index enrollment were required. Proportion of days covered (PDC) was calculated during the follow-up period. Outcomes were reported separately for patients with 1- and 2-years post-index enrollment. Descriptive statistics, including means, standard deviations, and frequencies and percentages for continuous and categorical data, respectively, were reported. RESULTS Of 1,322 patients with 1-year follow-up, 847 initiated SSA, 397 CC, 35 TT, two interferon, and 41 various combinations. Mean (SD) PDC was 0.669 (0.331) for SSA, 0.466 (0.236) for CC, and 0.505 (0.328) for TT. Mean (SD) office visits and hospitalizations, respectively, were 20.5 (13.5) and 0.59 (1.03) for SSA, 30.5 (19.8) and 0.89 (1.45) for CC, and 17.7 (12.5) and 1.23 (1.93) for TT. Total annual cost for patients during year 1 was $99,691 (82,423) for SSA, $134,912 (116,078) for CC, and $158,397 (82,878) for TT. Among 685 patients with 2-years follow-up, annual mean costs in year 2 were $8,071, $58,944, and $36,248 lower than year 1 for SSA, CC, and TT, respectively. LIMITATIONS Findings may not be generalizable to the US population. Claims are designed for reimbursement, not research. The study may under-estimate costs not covered by insurance. CONCLUSION This study reports utilization and costs associated with different treatment therapies. Costs were higher in year 1 than year 2. This two-database study offers new information on the magnitude and trends in the cost of pharmacologically-treated GI NETs.
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Affiliation(s)
- Michael S Broder
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Beilei Cai
- b Novartis Pharmaceuticals , East Hanover , NJ , USA
| | - Eunice Chang
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Tingjian Yan
- a Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Al B Benson
- c Northwestern University , Chicago , IL , USA
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Goldsbury DE, Yap S, Weber MF, Veerman L, Rankin N, Banks E, Canfell K, O’Connell DL. Health services costs for cancer care in Australia: Estimates from the 45 and Up Study. PLoS One 2018; 13:e0201552. [PMID: 30059534 PMCID: PMC6066250 DOI: 10.1371/journal.pone.0201552] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Background Cancer care represents a substantial and rapidly rising healthcare cost in Australia. Our aim was to provide accurate population-based estimates of the health services cost of cancer care using large-scale linked patient-level data. Methods We analysed data for incident cancers diagnosed 2006–2010 and followed to 2014 among 266,793 eligible participants in the 45 and Up Study. Health system costs included Medicare and pharmaceutical claims, inpatient hospital episodes and emergency department presentations. Costs for cancer cases and matched cancer-free controls were compared, to estimate monthly/annual excess costs of cancer care by cancer type, before and after diagnosis and by phase of care (initial, continuing, terminal). Total costs incurred in 2013 were also estimated for all people diagnosed in Australia 2009–2013. Results 7624 participants diagnosed with cancer were matched with up to three controls. The mean excess cost of care per case was AUD$1,622 for the year before diagnosis, $33,944 for the first year post-diagnosis and $8,796 for the second year post-diagnosis, with considerable variation by cancer type. Mean annual cost after the initial treatment phase was $4,474/case and the mean cost for the last year of life was $49,733/case. In 2013 the cost for cancers among people in Australia diagnosed during 2009–2013 was ~$6.3billion (0.4% of Gross Domestic Product; $272 per capita), with the largest costs for colorectal cancer ($1.1billion), breast cancer ($0.8billion), lung cancer ($0.6billion) and prostate cancer ($0.5billion). Conclusions The cost of cancer care is substantial and varies by cancer type and time since diagnosis. These findings emphasise the economic importance of effective primary and secondary cancer prevention strategies.
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Affiliation(s)
- David E. Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- * E-mail:
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Marianne F. Weber
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Nicole Rankin
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney Catalyst, NHMRC Clinical Trials Centre, Chris O’Brien Lifehouse Building, Camperdown, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, UNSW Medicine, Sydney, New South Wales, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Torkki P, Leskelä RL, Linna M, Mäklin S, Mecklin JP, Bono P, Kataja V, Karjalainen S. Cancer costs and outcomes for common cancer sites in the Finnish population between 2009-2014. Acta Oncol 2018; 57:983-988. [PMID: 29451406 DOI: 10.1080/0284186x.2018.1438656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The cost of cancer and outcomes of cancer care have been discussed a lot since cancer represents 3-6% of total healthcare costs and cost estimations have indicated growing costs. There are studies considering the cost of all cancers, but studies focusing on the cost of disease and outcomes in most common cancer sites are limited. The objective of this study was to analyze the development of the costs and outcomes in Finland between 2009 and 2014 per cancer site. METHODS The National cost, episode and outcomes data were obtained from the National register databases based on International Statistical Classification of Diseases (ICD)-10 diagnosis codes. Cost data included both the direct and indirect costs. Two hospitals were used to validate the costs of care. The outcome measures included relative survival rate, mortality, sick leave days per patient and number of new disability pensions. FINDINGS The outcomes of cancer care in most common cancer sites have improved in Finland between 2009-2014. The real costs per new cancer patient decreased in seven out of ten most common cancer sites. The significance of different cost components differ significantly between the different cancer sites. The share of medication costs of the total cost of all cancers increased, but decreased for the five most common cancer sites. INTERPRETATION The changes in the cost components indicate that the length of stay has shortened in special care and treatment methods have developed towards outpatient care. This partially explains the decrease of costs. Also, at the same time outcomes improved, which indicates that decrease in costs did not come at the expense of treatment quality. As the survival rates increase, the relevance of mortality measures decreases and the relevance of other, patient-relevant outcome measures increases. In the future, the outcomes and costs of health care systems should be assessed routinely for the most common patient groups.
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Affiliation(s)
- Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Industrial Management and Engineering, Aalto-yliopisto Tuotantotalouden laitos, Aalto, Finland
| | | | - Miika Linna
- Industrial Management and Engineering, Aalto-yliopisto Tuotantotalouden laitos, Aalto, Finland
| | - Suvi Mäklin
- Cancer Society of Finland, Helsinki, Finland
| | - Jukka-Pekka Mecklin
- Surgical Department, Central Finland Central Hospital, Jyväskylä, Finland
- Department of Sport and Health Science, University of Jyväskylä, Jyväskylä, Finland
| | - Petri Bono
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Vesa Kataja
- Surgical Department, Central Finland Central Hospital, Jyväskylä, Finland
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Walsh B, Laudicella M. Disparities In Cancer Care And Costs At The End Of Life: Evidence From England's National Health Service. Health Aff (Millwood) 2018; 36:1218-1226. [PMID: 28679808 DOI: 10.1377/hlthaff.2017.0167] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In universal health care systems such as the English National Health Service, equality of access is a core principle, and health care is free at the point of delivery. However, even within a universal system, disparities in care and costs exist along a socioeconomic gradient. Little is known about socioeconomic disparities at the end of life and how they affect health care costs. This study examines disparities in end-of-life treatment costs for cancer patients in England. Analyzing data on over 250,000 colorectal, breast, prostate, and lung cancer patients from multiple national databases, we found evidence illustrating that disparities are driven largely by the greater use of emergency inpatient care among patients of lower socioeconomic status. Even within a system with free health care, differences in the use of care create disparities in cancer costs. While further studies of these barriers is required, our research suggests that disparities may be reduced through better management of needs through the use of less expensive and more effective health care settings and treatments.
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Affiliation(s)
- Brendan Walsh
- Brendan Walsh is a research officer at the Economic and Social Research Institute in Dublin, Ireland, and a research affiliate in the School of Health Sciences, City University of London, in England
| | - Mauro Laudicella
- Mauro Laudicella is a senior lecturer at City University of London
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Laudicella M, Walsh B, Burns E, Li Donni P, Smith PC. What is the impact of rerouting a cancer diagnosis from emergency presentation to GP referral on resource use and survival? Evidence from a population-based study. BMC Cancer 2018; 18:394. [PMID: 29625606 PMCID: PMC5889525 DOI: 10.1186/s12885-018-4274-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Studies on alternative routes to diagnosis stimulated successful policy interventions reducing the number of emergency diagnoses and associated mortality risk. A dearth of evidence on the costs of such interventions might prevent new policies from achieving more ambitious targets. METHODS We conducted a retrospective cohort study on the population of colorectal (88,051), breast (90,387), prostate (96,219), and lung (97,696) cancer patients diagnosed after a GP referral or an emergency presentation and reported in the Cancer Registry of England. Resource use and survival were compared 1 year before and 5 years after diagnosis (3 years for lung), including the costs of GP referrals not converted into a positive diagnosis. Risk-adjusted statistical models were used to calculate the effect of rerouting patient' diagnoses from emergency presentation to GP referral. RESULTS Rerouting a cancer diagnosis results in a relatively small additional costs to the National Health System against additional years of life saved to the patient. The cost per year of life saved is £6456 in colorectal, £1057 in breast, -£662 in prostate (savings), and £819 in lung cancer. Reducing the overall prevalence of emergency presentations to the level achieved by the 20% of Clinical Commissioning Groups with the lowest prevalence would result in £11,481,948 against 1863 years of life saved for Colorectal, £847,750 against 889 years for breast, -£943,434 (cost savings) against 1195 years for prostate, and £609,938 against 1011 years for lung cancer. CONCLUSION Redirecting diagnoses from emergency presentation to GP referral appears an achievable target that can produce large benefits to patients against modest additional costs to the National Health System.
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Affiliation(s)
- Mauro Laudicella
- School of Health Sciences, City, University of London, EC1V 0HB, London, UK.
| | - Brendan Walsh
- Social Research Division, Economic and Social Research Institute, Dublin, D02 K138, Ireland
| | - Elaine Burns
- Department of Surgery and Cancer, Imperial College London, St Mary's Campus, London, W2 1NY, UK
| | - Paolo Li Donni
- Economics Department, University of Palermo, Viale delle Scienze, 90128, Palermo, Italy
| | - Peter C Smith
- Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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Schepers J, Annemans L. The potential health and economic effects of plant-based food patterns in Belgium and the United Kingdom. Nutrition 2018; 48:24-32. [DOI: 10.1016/j.nut.2017.11.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/06/2017] [Accepted: 11/11/2017] [Indexed: 12/30/2022]
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Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis. Oncotarget 2018; 8:32171-32189. [PMID: 28418870 PMCID: PMC5458276 DOI: 10.18632/oncotarget.16291] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS). We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively. Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR.
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Guzzinati S, Virdone S, De Angelis R, Panato C, Buzzoni C, Capocaccia R, Francisci S, Gigli A, Zorzi M, Tagliabue G, Serraino D, Falcini F, Casella C, Russo AG, Stracci F, Caruso B, Michiara M, Caiazzo AL, Castaing M, Ferretti S, Mangone L, Rudisi G, Sensi F, Mazzoleni G, Pannozzo F, Tumino R, Fusco M, Ricci P, Gola G, Giacomin A, Tisano F, Candela G, Fanetti AC, Pala F, Sardo AS, Rugge M, Botta L, Dal Maso L. Characteristics of people living in Italy after a cancer diagnosis in 2010 and projections to 2020. BMC Cancer 2018; 18:169. [PMID: 29426306 PMCID: PMC5807846 DOI: 10.1186/s12885-018-4053-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Estimates of cancer prevalence are widely based on limited duration, often including patients living after a cancer diagnosis made in the previous 5 years and less frequently on complete prevalence (i.e., including all patients regardless of the time elapsed since diagnosis). This study aims to provide estimates of complete cancer prevalence in Italy by sex, age, and time since diagnosis for all cancers combined, and for selected cancer types. Projections were made up to 2020, overall and by time since diagnosis. METHODS Data were from 27 Italian population-based cancer registries, covering 32% of the Italian population, able to provide at least 7 years of registration as of December 2009 and follow-up of vital status as of December 2013. The data were used to compute the limited-duration prevalence, in order to estimate the complete prevalence by means of the COMPREV software. RESULTS In 2010, 2,637,975 persons were estimated to live in Italy after a cancer diagnosis, 1.2 million men and 1.4 million women, or 4.6% of the Italian population. A quarter of male prevalent cases had prostate cancer (n = 305,044), while 42% of prevalent women had breast cancer (n = 604,841). More than 1.5 million people (2.7% of Italians) were alive since 5 or more years after diagnosis and 20% since ≥15 years. It is projected that, in 2020 in Italy, there will be 3.6 million prevalent cancer cases (+ 37% vs 2010). The largest 10-year increases are foreseen for prostate (+ 85%) and for thyroid cancers (+ 79%), and for long-term survivors diagnosed since 20 or more years (+ 45%). Among the population aged ≥75 years, 22% will have had a previous cancer diagnosis. CONCLUSIONS The number of persons living after a cancer diagnosis is estimated to rise of approximately 3% per year in Italy. The availability of detailed estimates and projections of the complete prevalence are intended to help the implementation of guidelines aimed to enhance the long-term follow-up of cancer survivors and to contribute their rehabilitation needs.
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Affiliation(s)
- Stefano Guzzinati
- Veneto Tumor Registry, Veneto Region, Padova, Passaggio Gaudenzio 1, 35131 Padova, Italy
| | - Saverio Virdone
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
| | | | - Chiara Panato
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
| | - Carlotta Buzzoni
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy
- AIRTUM Database, Florence, Italy
| | - Riccardo Capocaccia
- Dipartimento di Ricerca Epidemiologica e Medicina Molecolare (DREaMM), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Veneto Region, Padova, Passaggio Gaudenzio 1, 35131 Padova, Italy
| | - Giovanna Tagliabue
- Lombardy Cancer Registry, Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (Forlì), Italy-Azienda Usl della Romagna, Forlì, Italy
| | - Claudia Casella
- Registro Tumori Ligure, Epidemiologia Clinica, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Antonio Giampiero Russo
- Cancer Registry of Milan, Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Bianca Caruso
- Modena Cancer Registry, Public Health Department, AUSL Modena, Modena, Italy
| | - Maria Michiara
- Parma Cancer Registry, Oncology Unit, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | | | - Marine Castaing
- Registro Tumori Integrato Catania-Messina-Siracusa-Enna, Università degli Studi di Catania, Catania, Italy
| | - Stefano Ferretti
- Ferrara Cancer Registry, Ferrara Local Health Board, University of Ferrara, USL Ferrara, Ferrara, Italy
| | - Lucia Mangone
- Reggio Emilia Cancer Registry, Epidemiology unit, AUSL ASMN-IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppa Rudisi
- Palermo and Province Cancer Registry, Clinical Epidemiology Unit, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Flavio Sensi
- North Sardinia Cancer Registry, Azienda Regionale per la Tutela della Salute, Sassari, Italy
| | | | - Fabio Pannozzo
- Cancer Registry of Latina Province, AUSL Latina, Latina, Italy
| | | | - Mario Fusco
- Cancer Registry of ASL Napoli 3 Sud, Napoli, Italy
| | - Paolo Ricci
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova, Italy
| | - Gemma Gola
- Como Cancer Registry, ATS Insubria, Varese, Italy
| | - Adriano Giacomin
- Registro Tumori Piemonte, Provincia di Biella CPO, Biella, Italy
| | - Francesco Tisano
- Cancer Registry of of the Province of Siracusa, Local Health Unit of Siracusa, Siracusa, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della Salute, Trapani, Italy
| | | | - Filomena Pala
- Nuoro Cancer Registry, RT Nuoro, ASSL Nuoro/ATS Sardegna, Nuoro, Italy
| | | | - Massimo Rugge
- Veneto Tumor Registry, Veneto Region, Padova, Passaggio Gaudenzio 1, 35131 Padova, Italy
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Laura Botta
- Dipartimento di Ricerca Epidemiologica e Medicina Molecolare (DREaMM), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
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