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Genderson MW, Thomson MD, Siminoff LA. Where you begin is not necessarily where you end: the mental and physical health trajectories of cancer caregivers over time. Support Care Cancer 2024; 32:233. [PMID: 38499880 DOI: 10.1007/s00520-024-08437-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Cancer caregiving, a critical component in the cancer-care model, has deleterious effects on the caregiver's physical and mental health. The degree to which these negative effects are uniformly experienced by caregivers is unclear; effects may be exacerbated at the end of life when caregiving is intensified. Not all caregivers have the support of an additional involved support person (secondary caregiver). The impact of the secondary caregiver's absence on the primary caregiver's well-being is understudied. METHODS Terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics and followed for six months or until patient death. Longitudinal latent growth models were used to characterize the heterogeneity of caregiver physical health and depressive symptoms; characteristics associated with these trajectories are examined. RESULTS Caregivers were majority female (74%), white (55%) and patient spouses (60%). Two physical health (moderate, stable; initially good, declining) and two depressive symptom (moderate, stable; high, increasing) trajectories were identified. Declining physical health was more likely among caregivers who were healthiest at baseline, had higher levels of education, lower subjective burden, fewer depressive symptoms, cared for patients with fewer functional limitations and reported fewer caregiving tasks rendered by a secondary caregiver. Those with increasing depressive symptoms were more likely to be white, patient's wife, have higher subjective caregiver burden, lower physical health, and care for a patient with greater functional limitations. CONCLUSIONS Decreasing physical health was evident among caregivers who were initially healthier and reported less assistance from secondary caregivers. Increasing depression was seen in white, female spouses with higher subjective burden. Sample heterogeneity revealed hidden groups unexpectedly at risk in the primary cancer caregiver role to which the oncology care team should be alert.
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Affiliation(s)
- Maureen Wilson Genderson
- College of Public Health, Social and Behavioral Sciences, Temple University, 1700 N Broad St, 4th fl Suite 417, Philadelphia, PA, 19122, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 East Main Street Richmond, Richmond, VA, 23219, USA
| | - Laura A Siminoff
- College of Public Health, Social and Behavioral Sciences, Temple University, 1700 N Broad St, 4th fl Suite 417, Philadelphia, PA, 19122, USA.
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Weth FR, Hoggarth GB, Weth AF, Paterson E, White MPJ, Tan ST, Peng L, Gray C. Unlocking hidden potential: advancements, approaches, and obstacles in repurposing drugs for cancer therapy. Br J Cancer 2024; 130:703-715. [PMID: 38012383 PMCID: PMC10912636 DOI: 10.1038/s41416-023-02502-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
High rates of failure, exorbitant costs, and the sluggish pace of new drug discovery and development have led to a growing interest in repurposing "old" drugs to treat both common and rare diseases, particularly cancer. Cancer, a complex and heterogeneous disease, often necessitates a combination of different treatment modalities to achieve optimal outcomes. The intrinsic polygenicity of cancer, intricate biological signalling networks, and feedback loops make the inhibition of a single target frequently insufficient for achieving the desired therapeutic impact. As a result, addressing these complex or "smart" malignancies demands equally sophisticated treatment strategies. Combinatory treatments that target the multifaceted oncogenic signalling network hold immense promise. Repurposed drugs offer a potential solution to this challenge, harnessing known compounds for new indications. By avoiding the prohibitive costs and long development timelines associated with novel cancer drugs, this approach holds the potential to usher in more effective, efficient, and cost-effective cancer treatments. The pursuit of combinatory therapies through drug repurposing may hold the key to achieving superior outcomes for cancer patients. However, drug repurposing faces significant commercial, technological and regulatory challenges that need to be addressed. This review explores the diverse approaches employed in drug repurposing, delves into the challenges faced by the drug repurposing community, and presents innovative solutions to overcome these obstacles. By emphasising the significance of combinatory treatments within the context of drug repurposing, we aim to unlock the full potential of this approach for enhancing cancer therapy. The positive aspects of drug repurposing in oncology are underscored here; encompassing personalized treatment, accelerated development, market opportunities for shelved drugs, cancer prevention, expanded patient reach, improved patient access, multi-partner collaborations, increased likelihood of approval, reduced costs, and enhanced combination therapy.
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Affiliation(s)
- Freya R Weth
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
- Centre for Biodiscovery and School of Biological Sciences, Victoria University of Wellington, Kelburn, Wellington, 6021, New Zealand
| | - Georgia B Hoggarth
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
| | - Anya F Weth
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
| | - Erin Paterson
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
| | | | - Swee T Tan
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
- Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Lower Hutt, 5040, New Zealand
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Lifeng Peng
- Centre for Biodiscovery and School of Biological Sciences, Victoria University of Wellington, Kelburn, Wellington, 6021, New Zealand
| | - Clint Gray
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand.
- Centre for Biodiscovery and School of Biological Sciences, Victoria University of Wellington, Kelburn, Wellington, 6021, New Zealand.
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Wilson-Genderson M, Thomson MD, Siminoff LA. Where you begin is not necessarily where you end: the mental and physical health trajectories of cancer caregivers over time. RESEARCH SQUARE 2023:rs.3.rs-3513142. [PMID: 37986993 PMCID: PMC10659542 DOI: 10.21203/rs.3.rs-3513142/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Purpose Cancer caregiving, a critical component in the cancer-care model, has deleterious effects on the caregiver's physical and mental health. The degree to which these negative effects are uniformly experienced by caregivers is unclear. The impact of the secondary caregiver's absence on the primary caregivers' well-being is understudied. Methods Terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics and followed for six months or until patient death. Longitudinal latent growth models were used to characterize the heterogeneity of caregiver physical health and depressive symptoms; characteristics associated with these trajectories are examined. Results Caregivers were majority female (74%), white (55%) and patient spouses (60%). Two physical health (moderate, stable; initially good, declining) and two depressive symptom (moderate, stable; high, increasing) trajectories were identified. Declining physical health was more likely among caregivers who were healthiest at baseline, had higher levels of education, lower subjective burden, fewer depressive symptoms, cared for patients with fewer functional limitations and reported fewer caregiving tasks rendered by a secondary caregiver. Those with increasing depressive symptoms were more likely to be white, patient's wife, have higher subjective caregiver burden, lower physical health, and care for a patient with greater functional limitations. Conclusions Decreasing physical health was evident among caregivers who were initially healthier and reported less assistance from secondary caregivers. Increasing depression was seen in white, female spouses with higher subjective burden. Sample heterogeneity revealed hidden groups unexpectedly at risk in the primary cancer caregiver role to which the oncology care team should be alert.
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Liu Y, Wang S, Li L, Xu Y, Shen Y, Tina Shih YC. Comparisons of Medical Cost Trajectories Between Non-Hispanic Black and Non-Hispanic White Patients With Newly Diagnosed Localized Prostate Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1444-1452. [PMID: 37348833 PMCID: PMC10527436 DOI: 10.1016/j.jval.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/04/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES This study applied a recently developed statistical method to compare the mean cost trajectories between non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients with localized prostate cancer conditioning on patients' survival. METHODS In this observational study, we modeled cost trajectories of NHW and NHB patients with localized prostate cancer for 3 survival durations: 24, 48, and 72 months. We also compared the cost trajectories between NHW and NHB, stratified by comorbidities scores. RESULTS We find that the mean cost trajectories of NHB were significantly higher than the trajectories of NHW in the last 12 months before death, regardless of the survival duration and patients' baseline comorbidity scores. For patients with comorbidity score ≥2, mean cost trajectories within the first year of diagnosis for NHB were significantly higher than those for NHW, except for the subgroup of patients with comorbidity 2-3 and whose survival length was 72 months. CONCLUSIONS Our results suggested that a higher proportion of NHB patients with high comorbidity scores are likely contribute to their higher end-of-life costs than those for NHW patients. To narrow the gap in healthcare-related financial burden between NHB and NHW patients with localized prostate cancer, policy makers need to explore different strategies to better manage comorbidities.
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Affiliation(s)
- Yu Liu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Public Health, College of Health Sciences Sam Houston State University, Huntsville, TX
| | - Shikun Wang
- Department of Biostatistics, Columbia University, New York City, NY, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020220. [PMID: 36837422 PMCID: PMC9968035 DOI: 10.3390/medicina59020220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients' features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options.
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Tariq MR, Ali SW, Fatima N, Jabeen A, Qazi AS, Hameed A, Safdar W. Radiation Therapies in Cancer. Cancer Treat Res 2023; 185:59-77. [PMID: 37306904 DOI: 10.1007/978-3-031-27156-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A crucial element of cancer treatment is radiation therapy that is used to destroy tumors and cancer cells through radiation. Another essential component is immunotherapy that helps immune system to combat cancer. The combination of both radiation therapy and immunotherapy is being focused recently for the treatment of many tumors. Chemotherapy includes the use of some chemical agent to control the growth of cancer, whereas irradiation involves the use of radiations of high energy to kill cancer cells. The union of both became the strongest practice in cancer treatment techniques. Specific chemotherapies are combined with radiation in the treatment of cancer after proper preclinical assessment of their effectiveness. Some classes of compounds include platinum-based drugs, antimicrotubules, antimetabolites (5-Fluorouracil, Capecitabine, Gemcitabine, Pemetrexed), topoisomerase I inhibitors, alkylating agents (Temozolomide), and other agents (Mitomycin-C, Hypoxic Sensitizers, Nimorazole).
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Affiliation(s)
- Muhammad Rizwan Tariq
- Department of Food Sciences, University of the Punjab, Quid-I-Azam Campus, Lahore, Pakistan.
| | - Shinawar Waseem Ali
- Department of Food Sciences, University of the Punjab, Quid-I-Azam Campus, Lahore, Pakistan
| | - Noor Fatima
- Department of Food Sciences, University of the Punjab, Quid-I-Azam Campus, Lahore, Pakistan
| | - Aqsa Jabeen
- Department of Food Sciences, University of the Punjab, Quid-I-Azam Campus, Lahore, Pakistan
| | - Asma Saleem Qazi
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Amna Hameed
- Department of Diet and Nutritional Sciences, Ibadat International University, Islamabad, Pakistan
| | - Waseem Safdar
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
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Li J, Chan NB, Xue J, Tsoi KKF. Time series models show comparable projection performance with joinpoint regression: A comparison using historical cancer data from World Health Organization. Front Public Health 2022; 10:1003162. [PMID: 36311591 PMCID: PMC9614249 DOI: 10.3389/fpubh.2022.1003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023] Open
Abstract
Background Cancer is one of the major causes of death and the projection of cancer incidences is essential for future healthcare resources planning. Joinpoint regression and average annual percentage change (AAPC) are common approaches for cancer projection, while time series models, traditional ways of trend analysis in statistics, were considered less popular. This study aims to compare these projection methods on seven types of cancers in 31 geographical jurisdictions. Methods Using data from 66 cancer registries in the World Health Organization, projection models by joinpoint regression, AAPC, and autoregressive integrated moving average with exogenous variables (ARIMAX) were constructed based on 20 years of cancer incidences. The rest of the data upon 20-years of record were used to validate the primary outcomes, namely, 3, 5, and 10-year projections. Weighted averages of mean-square-errors and of percentage errors on predictions were used to quantify the accuracy of the projection results. Results Among 66 jurisdictions and seven selected cancers, ARIMAX gave the best 5 and 10-year projections for most of the scenarios. When the ten-year projection was concerned, ARIMAX resulted in a mean-square-error (or percentage error) of 2.7% (or 7.2%), compared with 3.3% (or 15.2%) by joinpoint regression and 7.8% (or 15.0%) by AAPC. All the three methods were unable to give reasonable projections for prostate cancer incidence in the US. Conclusion ARIMAX outperformed the joinpoint regression and AAPC approaches by showing promising accuracy and robustness in projecting cancer incidence rates. In the future, developments in projection models and better applications could promise to improve our ability to understand the trend of disease development, design the intervention strategies, and build proactive public health system.
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Affiliation(s)
- Jinhui Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Nicholas B. Chan
- SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jiashu Xue
- SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kelvin K. F. Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China,SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China,*Correspondence: Kelvin K. F. Tsoi
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Kent EE, Lee S, Asad S, Dobbins EE, Aimone EV, Park EM. "If I wasn't in a rural area, I would definitely have more support": social needs identified by rural cancer caregivers and hospital staff. J Psychosoc Oncol 2022; 41:393-410. [PMID: 36214743 PMCID: PMC10083183 DOI: 10.1080/07347332.2022.2129547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The social needs of rural families facing cancer warrant investigation to inform psychosocial care planning and policy development. METHODS Using purposive sampling, we interviewed 24 rural caregivers and 17 hospital staff from an academic cancer center in the U.S. South. Social needs were defined as the support needed to effectively provide informal caregiving across economic, physical, interpersonal, and service domains. We used the framework method to code and synthesize findings. FINDINGS Caregiver economic and physical needs were interconnected and most pressing, including common examples of distance to care and transportation barriers. Caregivers desired additional support from the health system, insurance providers, and community resources. Staff identified similar need patterns and gaps in health system capacity. CONCLUSIONS Rural cancer caregivers experience multiple unmet social needs. Supportive interventions for this population will benefit from flexible implementation and multilevel, multisector approaches. In particular, interventions that address financial hardship and limited internet access are needed.
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Affiliation(s)
- Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sejin Lee
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Asad
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin E Dobbins
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth V Aimone
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eliza M Park
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Torkki P, Leskelä RL, Bugge C, Torfadottir JE, Karjalainen S. Cancer-related costs should be allocated in a comparable way-benchmarking costs of cancer in Nordic countries 2012-2017. Acta Oncol 2022; 61:1216-1222. [PMID: 36151990 DOI: 10.1080/0284186x.2022.2124883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND High costs of cancer, and especially the increase in treatment costs, have raised concerns about the financial sustainability of publicly funded health care systems around the world. As cancers get more prevalent with age, treatment costs are expected to keep rising with aging populations. The objective of the study is to analyze the changes in cost of cancer care broken down into separate cost components and outcomes of cancer treatment in the Nordic countries 2012-2017. MATERIALS AND METHODS We estimated direct costs of cancer based on retrospective data from national registers: outpatient care and inpatient care in primary care and specialized care as well as medicine costs. The number of cancer cases and survival data was obtained from NORDCAN. Cancer was defined as ICD-10 codes C00-C97. RESULTS Healthcare costs of cancer in real terms increased in all countries: CAGR was between 1 and 6% depending on the country. Medicine costs have increased rapidly (37-125%) in all countries during the observation period. In Finland and Denmark, inpatient care costs have decreased, whereas in Iceland, Norway, and Sweden, they have increased, although the number of inpatient days has decreased everywhere. The age-standardized cancer mortality has decreased constantly over time. CONCLUSION Cancer care in Nordic countries has significant differences in both cost structures and in the development of cost drivers, indicating differences in the organization of care and different focus in health policy. It is important to compare the cancer care costs internationally on a detailed level to understand the reasons for cost development. The registration of cost data, especially medicine costs, should be more standardized to enable better cost and outcomes comparisons between countries in the future.
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Affiliation(s)
- Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Riikka-Leena Leskelä
- Department of Public Health, University of Helsinki, Helsinki, Finland.,NHG Finland Ltd., Helsinki, Finland
| | - Christoffer Bugge
- Oslo Economics AS, Oslo, Norway.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Herriges MJ, Shenhav-Goldberg R, Peck JI, Bhanvadia SK, Morgans A, Chino F, Chandrasekar T, Shapiro O, Jacob JM, Basnet A, Bratslavsky G, Goldberg H. Financial Toxicity and Its Association With Prostate and Colon Cancer Screening. J Natl Compr Canc Netw 2022; 20:981-988. [PMID: 36075394 DOI: 10.6004/jnccn.2022.7036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The term "financial toxicity" or "hardship" is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. METHODS This cross-sectional survey-based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. RESULTS Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867-0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941-0.998; P=.039). CONCLUSIONS Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.
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Affiliation(s)
- Michael J Herriges
- Pediatrics Department, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | | | - Juliet I Peck
- Performing Arts Medicine Department, Shenandoah University, Winchester, Virginia
| | - Sumeet K Bhanvadia
- USC Norris Cancer Center, Keck Medical Center, University of Southern California, Los Angeles, California
| | - Alicia Morgans
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | | | - Alina Basnet
- Hematology/Oncology Department, State University of New York Upstate Medical University, Syracuse, New York
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Silverman C, Ng BP, Baek C, Park C. Prescription drug coverage satisfaction and medication nonadherence among Medicare beneficiaries with cancer. Expert Rev Pharmacoecon Outcomes Res 2022; 22:971-979. [PMID: 35484941 DOI: 10.1080/14737167.2022.2064846] [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: 11/04/2022]
Abstract
BACKGROUND Medication nonadherence among older patients with cancer can have profound health consequences. This study examines the association between prescription drug coverage satisfaction and medication nonadherence among Medicare beneficiaries with cancer. METHODS We analyzed the 2017 Medicare Current Beneficiary Survey Public Use File of beneficiaries aged ≥65 years with reported non-skin cancer (n = 806). Beneficiaries were considered to have medication nonadherence if they reported: skipping doses, taking smaller doses than prescribed, or delaying or not filling a prescription because of cost. A survey-weighted logistic model, adjusted for covariates, was conducted to examine the association between prescription drug coverage satisfaction and medication nonadherence. RESULTS Of study beneficiaries with cancer, 14.7% reported medication nonadherence. Higher proportions of beneficiaries with medication nonadherence were dissatisfied with the amount paid for medications (33.2% vs. 11.0%, p < 0.001) and the medications included on formulary (29.5% vs 5.2%, p < 0.001). In the adjusted analysis, the risk for medication nonadherence was higher among those who were dissatisfied with the amount paid for medications (OR = 2.22; p = 0.050) and the medications included on formulary (OR = 5.03; p = 0.005). CONCLUSIONS Strategic mitigation of these barriers is essential to improving health outcomes in this at-risk population.
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Affiliation(s)
- Ciara Silverman
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, Fl, Usa and Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Chaewon Baek
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, the University of Texas at Austin, Austin, Tx, USA
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Haring CT, Dermody SM, Yalamanchi P, Kang SY, Old MO, Chad Brenner J, Spector ME, Rocco JW. The future of circulating tumor DNA as a biomarker in HPV related oropharyngeal squamous cell carcinoma. Oral Oncol 2022; 126:105776. [DOI: 10.1016/j.oraloncology.2022.105776] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 02/13/2022] [Indexed: 12/30/2022]
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Abstract
OBJECTIVES To provide an overview on the role of family caregivers (FCGs) in the care of older adults with cancer and review quality of life needs for FCGs. DATA SOURCES Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations were used. CONCLUSION The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults have a substantial impact on the quality of life of their FCGs. Practical and efficient models of comprehensive assessment, interventions, and caregiving preparedness support are needed to improve outcomes for both older adults with cancer and their FCGs. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses practicing in clinical and research settings have a responsibility to prepare themselves with evidence-based knowledge and resources to include the needs of FCGs in the care provided to older adults with cancer.
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Yabroff KR, Mariotto A, Tangka F, Zhao J, Islami F, Sung H, Sherman RL, Henley SJ, Jemal A, Ward EM. Annual Report to the Nation on the Status of Cancer, Part 2: Patient Economic Burden Associated With Cancer Care. J Natl Cancer Inst 2021; 113:1670-1682. [PMID: 34698839 PMCID: PMC9891103 DOI: 10.1093/jnci/djab192] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries provide annual information about cancer occurrence and trends in the United States. Part 1 of this annual report focuses on national cancer statistics. This study is part 2, which quantifies patient economic burden associated with cancer care. METHODS We used complementary data sources, linked Surveillance, Epidemiology, and End Results-Medicare, and the Medical Expenditure Panel Survey to develop comprehensive estimates of patient economic burden, including out-of-pocket and patient time costs, associated with cancer care. The 2000-2013 Surveillance, Epidemiology, and End Results-Medicare data were used to estimate net patient out-of-pocket costs among adults aged 65 years and older for the initial, continuing, and end-of-life phases of care for all cancer sites combined and separately for the 21 most common cancer sites. The 2008-2017 Medical Expenditure Panel Survey data were used to calculate out-of-pocket costs and time costs associated with cancer among adults aged 18-64 years and 65 years and older. RESULTS Across all cancer sites, annualized net out-of-pocket costs for medical services and prescriptions drugs covered through a pharmacy benefit among adults aged 65 years and older were highest in the initial ($2200 and $243, respectively) and end-of-life phases ($3823 and $448, respectively) and lowest in the continuing phase ($466 and $127, respectively), with substantial variation by cancer site. Out-of-pocket costs were generally higher for patients diagnosed with later-stage disease. Net annual time costs associated with cancer were $304.3 (95% confidence interval = $257.9 to $350.9) and $279.1 (95% confidence interval = $215.1 to $343.3) for adults aged 18-64 years and ≥65 years, respectively, with higher time costs among more recently diagnosed survivors. National patient economic burden, including out-of-pocket and time costs, associated with cancer care was projected to be $21.1 billion in 2019. CONCLUSIONS This comprehensive study found that the patient economic burden associated with cancer care is substantial in the United States at the national and patient levels.
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Affiliation(s)
- K Robin Yabroff
- Correspondence to: K. Robin Yabroff, PhD, Department of Surveillance and Health Equity Science, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Florence Tangka
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Farhad Islami
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Elizabeth M Ward
- North American Association of Central Cancer Registries, Springfield, IL, USA
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15
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Zaorsky NG, Khunsriraksakul C, Acri SL, Liu DJ, Ba DM, Lin JL, Liu G, Segel JE, Drabick JJ, Mackley HB, Leslie DL. Medical Service Use and Charges for Cancer Care in 2018 for Privately Insured Patients Younger Than 65 Years in the US. JAMA Netw Open 2021; 4:e2127784. [PMID: 34613403 PMCID: PMC8495533 DOI: 10.1001/jamanetworkopen.2021.27784] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Currently, there are limited published data regarding resource use and spending on cancer care in the US. OBJECTIVE To characterize the most frequent medical services provided and the associated spending for privately insured patients with cancer in the US. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the MarketScan database for the calendar year 2018 from a sample of 27.1 million privately insured individuals, including patients with a diagnosis of the 15 most prevalent cancers, predominantly from large insurers and self-insured employers. Overall societal health care spending was estimated for each cancer type by multiplying the mean total spending per patient (estimated from MarketScan) by the number of privately insured patients living with that cancer in 2018, as reported by the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Analyses were performed from February 1, 2018, to July 8, 2021. EXPOSURES Evaluation and management as prescribed by treating care team. MAIN OUTCOMES AND MEASURES Current Procedural Terminology and Healthcare Common Procedure Coding System codes based on cancer diagnosis code. RESULTS The estimated cost of cancer care in 2018 for 402 115 patients with the 15 most prevalent cancer types was approximately $156.2 billion for privately insured adults younger than 65 years in the US. There were a total of 38.4 million documented procedure codes for 15 cancers in the MarketScan database, totaling $10.8 billion. Patients with breast cancer contributed the greatest total number of services (10.9 million [28.4%]), followed by those with colorectal cancer (3.9 million [10.2%]) and prostate cancer (3.6 million [9.4%]). Pathology and laboratory tests contributed the highest number of services performed (11.7 million [30.5%]), followed by medical services (6.3 million [16.4%]) and medical supplies and nonphysician services (6.1 million [15.9%]). The costliest cancers were those of the breast ($3.4 billion [31.5%]), followed by lung ($1.1 billion [10.2%]) and colorectum ($1.1 billion [10.2%]). Medical supplies and nonphysician services contributed the highest total spent ($4.0 billion [37.0%]), followed by radiology ($2.1 billion [19.4%]) and surgery ($1.8 billion [16.7%]). CONCLUSIONS AND RELEVANCE This analysis suggests that patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, whereas patients with breast, lung, lymphoma, and colorectal cancer incurred the greatest costs, particularly for medical supplies and nonphysician services. The cost of cancer care in 2018 for the 15 most prevalent cancer types was estimated to be approximately $156.2 billion for privately insured adults younger than 65 years in the US.
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Affiliation(s)
- Nicholas G. Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Samantha L. Acri
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Dajiang J. Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - John L. Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joel E. Segel
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Health Policy and Administration, Pennsylvania State University, University Park
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Joseph J. Drabick
- Department of Medical Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Heath B. Mackley
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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16
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Kirchhoff A, Jones S. Financial Toxicity in Adolescent and Young Adult Cancer Survivors: Proposed Directions for Future Research. J Natl Cancer Inst 2021; 113:948-950. [PMID: 33839777 DOI: 10.1093/jnci/djab014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Anne Kirchhoff
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, UT, USA
| | - Salene Jones
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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17
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Berta P, Lovaglio PG, Verzillo S. How have casemix, cost and hospital stay of inpatients in the last year of life changed over the past decade? Evidence from Italy. Health Policy 2021; 125:1031-1039. [PMID: 34175137 PMCID: PMC8310922 DOI: 10.1016/j.healthpol.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022]
Abstract
Healthcare utilisation and expenditure are highly concentrated in hospital inpatient services, in particular in end-of-life care with the peak occurring in the very last year of life, regardless of patient age. Few scientific studies have investigated hospital costs and stays of patients at the end of life, and even fewer studies have analysed their evolution over time. In this paper, we exploit hospitalisation data for the Lombardy region of Italy with the aim of studying the evolution of hospital casemix, costs and stays of chronic patients, and compare the last year of life of two cohorts of patients who died in 2005 and 2014. Despite an overall three-year increase in the age at death, the results showed a significant decrease in hospital costs and use due to reduced interventions and length of hospital stays. However, this was not associated with an increase in quality of life/conditions (as indicated by clinical casemix as a proxy) for end-of-life patients; patients' casemix characteristics and clinical condition, as measured by the number of comorbidities, disease severity, prevalence of pulmonary disease and heart failure diagnosis, significantly worsened over the decade. This gives rise to important health policy concerns on how to identify effective policies and possible changes in healthcare system organisation to move from hospital-centred care to a community-centred approach whose value has been demonstrated during the COVID-19 pandemic.
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Affiliation(s)
- Paolo Berta
- CRISP - Interuniversity Research Centre on Public Services, University of Milano Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Pietro Giorgio Lovaglio
- CRISP - Interuniversity Research Centre on Public Services, University of Milano Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Stefano Verzillo
- CRISP - Interuniversity Research Centre on Public Services, University of Milano Bicocca, Milan, Italy; European Commission, Joint Research Centre (JRC), Ispra Italy.
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18
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Raman S, Shafie AA, Abraham MT, Shim CK, Maling TH, Rajendran S, Cheong SC. Provider cost of treating oral potentially malignant disorders and oral cancer in Malaysian public hospitals. PLoS One 2021; 16:e0251760. [PMID: 33984051 PMCID: PMC8118562 DOI: 10.1371/journal.pone.0251760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Oral cancer has been recognized as a significant challenge to healthcare. In Malaysia, numerous patients frequently present with later stages of cancers to the highly subsidized public healthcare facilities. Such a trend contributes to a substantial social and economic burden. This study aims to determine the cost of treating oral potentially malignant disorders (OPMD) and oral cancer from a public healthcare provider’s perspective. Medical records from two tertiary public hospitals were systematically abstracted to identify events and resources consumed retrospectively from August 2019 to January 2020. The cost accrued was used to estimate annual initial and maintenance costs via two different methods- inverse probability weighting (IPW) and unweighted average. A total of 86 OPMD and 148 oral cancer cases were included. The initial phase mean unadjusted cost was USD 2,861 (SD = 2,548) in OPMD and USD 38,762 (SD = 12,770) for the treatment of cancer. Further annual estimate of initial phase cost based on IPW method for OPMD, early and late-stage cancer was USD 3,561 (SD = 4,154), USD 32,530 (SD = 12,658) and USD 44,304 (SD = 16,240) respectively. Overall cost of late-stage cancer was significantly higher than early-stage by USD 11,740; 95% CI [6,853 to 16,695]; p< 0.001. Higher surgical care and personnel cost predominantly contributed to the larger expenditure. In contrast, no significant difference was identified between both cancer stages in the maintenance phase, USD 700; 95% CI [-1,142 to 2,541]; p = 0.457. A crude comparison of IPW estimate with unweighted average displayed a significant difference in the initial phase, with the latter being continuously higher across all groups. IPW method was shown to be able to use data more efficiently by adjusting cost according to survival and follow-up. While cost is not a primary consideration in treatment recommendations, our analysis demonstrates the potential economic benefit of investing in preventive medicine and early detection.
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Affiliation(s)
- Sivaraj Raman
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Pharmacy Department, Hospital Keningau, Ministry of Health, Keningau, Sabah, Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Institutional Planning and Strategic Center, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- * E-mail:
| | - Mannil Thomas Abraham
- Oral and Maxillofacial Surgery Department, Hospital Tengku Ampuan Rahimah, Ministry of Health, Klang, Selangor, Malaysia
| | - Chen Kiong Shim
- Oral and Maxillofacial Surgery Department, Hospital Umum Sarawak, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Thaddius Herman Maling
- Samarahan Divisional Dental Office, Sarawak State Health Department, Ministry of Health, Samarahan, Sarawak, Malaysia
| | - Senthilmani Rajendran
- Head and Neck Cancer Research Team, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Sok Ching Cheong
- Head and Neck Cancer Research Team, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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19
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Halperin EC. Current challenges facing pediatric radiation oncology viewed through an economics lens. Pediatr Blood Cancer 2021; 68 Suppl 2:e28686. [PMID: 32991071 DOI: 10.1002/pbc.28686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/12/2022]
Abstract
This commentary addresses two problems facing pediatric radiation oncology: workforce education and the cost of technology. The tools of economics can help us understand these problems. Because cancer in children is relatively infrequent and the role of pediatric radiotherapy (RT) is limited, there are a small number of cases of children requiring RT in the US compared to the number of radiation oncology trainees. This creates a paucity of necessary clinical training material. Proton RT, rather than photon RT, is being recommended in many situations when RT is indicated in children. Cost, however, is a significant concern. The arguments for and against proton RT continue and a consensus on this matter has not emerged.
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Affiliation(s)
- Edward C Halperin
- Department of Radiation Oncology, Pediatrics, and History, New York Medical College and the Touro College and University System, Valhalla, New York
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20
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The Financial Burden of Cancer on Families in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073790. [PMID: 33916454 PMCID: PMC8038578 DOI: 10.3390/ijerph18073790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022]
Abstract
This study examined the relationship between a diagnosis of cancer and the likelihood of having any out-of-pocket costs (OOPC) and medical debt, and the amounts of OOPC and medical debt, at the household level. We used the 2013 Panel Study of Income Dynamics, a continuous, representative panel survey that collects demographic, economic, and social data in the United States. The analytic sample included head of households and their spouse (if married), 18–64 years old. Two-part models were used. The first part consisted of logistic regression models and the second part consisted of generalized linear models with logarithmic link and a gamma distribution. Logistic regression results showed odds of 2.13 (CI: 1.27, 3.57, p < 0.01) for any OOPC and odds of 1.55 (CI: 0.93, 2.58, p < 0.1) for any medical debt for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to those that did not report a diagnosis of cancer. Likewise, results from the second part of the model for households with a positive amount of OOPC showed an exponentiated coefficient of 1.73 (CI: 1.33, 2.25, p < 0.01) for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to households without a diagnosis of cancer. This study shows that a diagnosis of cancer places a financial burden on families, particularly with all types of debt, in the United States even after controlling for differences between households with a diagnosis of cancer and those without a diagnosis of cancer.
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21
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Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review. Curr Oncol 2021; 28:1216-1248. [PMID: 33804288 PMCID: PMC8025828 DOI: 10.3390/curroncol28020117] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. METHODS A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. RESULTS Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15-400 in Canada, USD 4-609 in Western Europe, and USD 58-438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40-71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. CONCLUSIONS We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.
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Affiliation(s)
- Nicolas Iragorri
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| | - Claire de Oliveira
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M6J 1H4, Canada
| | | | - Beverley Essue
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
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22
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Hanna K, Mayden K. The Use of Real-World Evidence for Oral Chemotherapies in Breast Cancer. J Adv Pract Oncol 2021; 12:13-20. [PMID: 34113475 PMCID: PMC8020943 DOI: 10.6004/jadpro.2021.12.2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Almost all patients with breast cancer will eventually receive chemotherapy drugs, the majority of which are administered as IV infusions. Real-world evidence indicates that while current treatment paradigms vary considerably from guideline recommendations, there is an increasing trend towards a preference for oral oncolytics among patients with breast cancer. Recent data have shown that oral anticancer therapeutics represent 25% of the oncology drug market share and that there is a high demand for these agents. Therefore, oral formulations of chemotherapy agents such as paclitaxel are currently under development. Although oral oncolytics are associated with several advantages over conventional intravenous drugs, maintaining adherence to therapy is a major barrier in achieving improved outcomes with these agents. Advanced practitioners can facilitate improved adherence to oral oncolytics by integrating evidence into practice to support better education and communication strategies to address patient concerns, overcome key hurdles, and ultimately, empower patients.
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Affiliation(s)
| | - Kelley Mayden
- Ballad Health Cancer Care-Bristol, Bristol, Tennessee
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23
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Rice DR, Hyer JM, Diaz A, Pawlik TM. End-of-Life Hospice Use and Medicare Expenditures Among Patients Dying of Hepatocellular Carcinoma. Ann Surg Oncol 2021; 28:5414-5422. [PMID: 33528708 DOI: 10.1245/s10434-021-09606-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The increasing incidence of hepatocellular carcinoma (HCC) coupled with rising health care costs contributes to high end-of-life expenditures. The current study aimed to characterize health care expenditures and hospice use among patients with HCC using a large, national database. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database was used to identify patients with HCC. Logistic regression was used to identify factors associated with overall hospice use and end-of-life expenditures among individuals who died of HCC. RESULTS Among 14,369 Medicare beneficiaries with HCC, 8069 (63.7 %) used hospice. Racial/ethnic minority patients were less likely to use hospice services during the last year of life than white patients (no hospice: n = 2034 [44.3 %] vs. hospice: n = 2513 [31.1 %]). Social vulnerability also had an impact on the likelihood of patients using hospice services; in particular, the probability of hospice use among patients declined as social vulnerability increased (P < 0.05). Hospice use was associated with an approximate $10,000 decrease in inpatient expenditures (hospice: US$7900 [IQR, US$0-26,600] vs. no hospice: US$18,000 [IQR $400-49,100]; P < 0.001) and $1300 decrease in outpatient expenditures (hospice: US$900 [IQR, US$0-4500] vs. non-hospice: US$2200 [IQR, US$200-7900; P < 0.001) compared with individuals who did not use hospice. CONCLUSIONS Minority patients and individuals residing in high-vulnerability areas were less likely to use hospice. Patients who used hospice at the end of life had a reduction in inpatient and outpatient Medicare claims. Patients with HCC in need of hospice services should be ensured timely referral regardless of race/ethnicity or social vulnerability.
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Affiliation(s)
- Daniel R Rice
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Adrian Diaz
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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24
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Immune checkpoint inhibitor use, multimorbidity and healthcare expenditures among older adults with late-stage melanoma. Immunotherapy 2021; 13:103-112. [PMID: 33148082 PMCID: PMC8008205 DOI: 10.2217/imt-2020-0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background: The objective of this study is to assess the impact of immune checkpoint inhibitors (ICIs) and multimorbidity on healthcare expenditures among older patients with late-stage melanoma. Materials & methods: A retrospective longitudinal cohort study using Surveillance, Epidemiology and End Results linked with Medicare claims was conducted. Generalized linear mixed models were used to analyze adjusted relationships of ICI, multimorbidity and ICI-multimorbidity interaction on average healthcare expenditures. Results: Patients who received ICI and those who had multimorbidity had significantly higher average total healthcare expenditures compared with ICI nonusers and no multimorbidity. In the fully adjusted model using ICI-multimorbidity interaction, no excess cost was added by multimorbidity. Conclusion: Use of ICIs, regardless of multimorbidity, is associated with increased healthcare expenditures.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research & Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey 17033, PA
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown 26506, WV
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Virginia G Scott
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
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25
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Jones SMW, Henrikson NB, Panattoni L, Syrjala KL, Shankaran V. A theoretical model of financial burden after cancer diagnosis. Future Oncol 2020; 16:3095-3105. [PMID: 32976048 PMCID: PMC7787147 DOI: 10.2217/fon-2020-0547] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.
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Affiliation(s)
- Salene MW Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, King County, Washington 98101, USA
| | - Laura Panattoni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Karen L Syrjala
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Veena Shankaran
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
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Park T, Hwang M. Health care use and expenditures attributable to cancer: A population-based study. Res Social Adm Pharm 2020; 17:1300-1305. [PMID: 33054991 DOI: 10.1016/j.sapharm.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/27/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND As more people are living with cancer due to increases in cancer survival, it is important to understand cancer burden. Studies have examined cancer-related costs using data more than a decade ago. OBJECTIVE To update the economic burden and uniquely provide health care service use attributable to cancer using a nationally representative sample of the U.S. POPULATION METHODS Data were obtained from the 2008-2015 Medical Expenditure Panel Survey (MEPS). Individuals with cancer were matched to those without cancer in terms of demographics and comorbidities based on a propensity score (PS). For outcomes of health care use, a (zero-inflated) negative binomial model was employed. To analyze the outcomes of health care spending, a generalized linear model with a log link function and gamma distributed errors (or a two-part model) was used. RESULTS Compared to the PS-matched noncancer controls, individuals with cancer received 1.05, 1.08, and 1.76 times more frequent annual emergency department (ED) visit care, hospitalization care, and hospital outpatient visit care, respectively. Additionally, people with cancer received prescriptions and office-based visit care about 5 times and 20 times more frequently. An average annual total health care spending among those with cancer was about $4100 higher. Average annual expenses on hospitalizations, office-based visits, hospital outpatient visits, and prescriptions among those with cancer were also about $1,400, $1,400, $700, and $300 higher. However, there was no significant difference in expenses on ED visit and out-of-pocket expenses on prescriptions between people with cancer and noncancer controls. CONCLUSIONS Individuals with cancer used all types of health care services more frequently than noncancer controls. Accordingly, expenditures on various types of health care services among those with cancer were higher.
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Affiliation(s)
- Taehwan Park
- Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, 11439, USA.
| | - Monica Hwang
- Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, 11439, USA
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Look Hong NJ, Liu N, Wright FC, MacKinnon M, Seung SJ, Earle CC, Gradin S, Sati S, Buchman S, Mittmann N. Assessing the Impact of Early Identification of Patients Appropriate for Palliative Care on Resource Use and Costs in the Final Month of Life. JCO Oncol Pract 2020; 16:e688-e702. [DOI: 10.1200/jop.19.00397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE:This study evaluates whether an intervention to identify Canadian patients eligible for a palliative approach changes the use of health care resources and costs within the final month of life.METHODS:Between 2014 and 2017, physicians identified 1,187 patients in family practice units and cancer centers who were likely to die within 1 year based on diagnosis, symptom assessment, and performance status. A multidisciplinary intervention that included activation of community resources and initiation of palliative planning was started. By using propensity-score matching, patients in the intervention group were matched 1:1 with nonintervention controls selected from provincial administrative data. We compared health care use and costs (using 2017 Canadian dollars) for 30 days before death between patients who died within the 1-year follow-up and matched controls.RESULTS:Groups (n = 629 in each group) were well-balanced in sociodemographic characteristics, comorbidities, and previous health care use. In the last 30 days, there was no differences in proportions between the two groups of patients regarding emergency department visits, intensive care unit admissions, or inpatient hospitalizations. However, patients in the intervention group had greater use of palliative physician encounters, community home care visits, and/or physician home visits (92.8% v 88.4%; P = .007). In the 507 pairs with cancer, more patients in the intervention group underwent chemotherapy (44% v 33%; P < .001) and radiation (18.7% v 3.2%; P = .043) in the last 30 days. Mean cost per patient was similar for the intervention group (mean, $17,231; 95% CI, $16,027 to $18,436) and for the control group (mean, $16,951; 95% CI, $15,899 to $18,004).CONCLUSION:Even with the limitations in our observational study design, identification of palliative patients did not significantly change overall costs but may shift resources toward palliative services.
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Affiliation(s)
- Nicole J. Look Hong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Frances C. Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Soo Jin Seung
- Health Outcomes and PharmacoEconomic Research Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Craig C. Earle
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sharon Gradin
- British Columbia Renal Agency, Toronto, Ontario, Canada
| | | | | | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Abstract
BACKGROUND US health care is increasingly defined by over expenditure and inefficiency. Optimizing patient follow-up is critical, especially in cancers treated with high control rates. To optimize patient care, this study assessed time to disease recurrence or toxicity in patients with anal carcinoma. MATERIALS AND METHODS In total, 140 patients with biopsy-proven, nonmetastatic anal carcinoma, treated with chemoradiation utilizing intensity-modulated radiation therapy, were identified from our institutional database. This retrospective study evaluated local recurrence (LR), distant metastasis (DM), overall survival (OS), and late ≥grade 3 toxicity (LG3T). Patients were followed posttreatment every 3 months for 2 years, every 6 months in years 3 to 5, then yearly thereafter per NCCN recommendations. RESULTS The median age and follow-up was 58 years and 27 months, respectively. Patients were categorized into high (n=61; 44%) and low (n=77; 55%) risk groups based on stage. The 2-year LC, DMFS, and OS were 93%, 94%, and 89% and 5-year LC, DMFS, OS were 92%, 87%, and 85%, respectively. Overall, there were 29 events (9 LR, 11 DM, and 9 LG3T), with 62% of events occurring within year 1 and 79% within 2 years. Stratified by event type, at 2 years 89% of LR, 64% of DM, and 89% LG3T were identified. At the remaining follow-up points, the event incidence rate was 1.3%. CONCLUSION With the majority of recurrences/toxicities occurring within the first 2 years, a reduction in follow-up during years 3 to 5 may provide adequate surveillance. Revisions of the current recommendations could maximize resources while improving patient quality of life.
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Rice DR, Farooq A, Hyer JM, Paredes AZ, Bae J, Tsilimigras DI, Pawlik TM. Health expenditures and financial burden among patients with major gastrointestinal cancers relative to other common cancers in the United States. Surgery 2020; 167:985-990. [DOI: 10.1016/j.surg.2020.02.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/11/2020] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
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Point-of-care used in the treatment of older patients with cancer. The perception and experience of nurses. Appl Nurs Res 2020; 53:151268. [PMID: 32451011 DOI: 10.1016/j.apnr.2020.151268] [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] [Received: 10/02/2019] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nursing tasks are changing as the proportion of people over the age of 65 years is increasing and is expected to double over the next four decades. New innovative solutions such as Point of Care Treatment (POCT) are being tested in oncological settings in order to optimise treatment, and this changes the nurse management in oncology. There is a need to explore oncology nurses' perception and experience when implementing the innovations in order to understand the implications for nursing and the treatment of older patients with cancer. METHODS Qualitative research with face to face interviews with nurses working in oncology. Sample size (Mean = 8). Data were recorded verbatim, transcribed, and thematic analysis used. RESULTS Three themes were identified: a, A great advantage in nursing, b, Change of practice in nursing care, c, Challenges in shifting roles. A majority of the participants had the perception that POCT treatment was an advantage not only for the nursing profession but for the older patients in cancer treatment as well. Monitoring the older patients with cancer at home would prevent them from accessing the hospital and get exposed to viral infections as well as saving them the journey to the hospital. Involvement from relatives, clear communication and management of the device and data transferred is essential. CONCLUSIONS The use of POCT in oncology will shift the nurses' tasks on the ward as well as improve treatment for older patients with cancer.
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Steckiewicz KP, Inkielewicz-Stepniak I. Modified Nanoparticles as Potential Agents in Bone Diseases: Cancer and Implant-Related Complications. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E658. [PMID: 32244745 PMCID: PMC7221902 DOI: 10.3390/nano10040658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
Materials sized 1-100 nm are the nanotechnology's field of interest. Because of the unique properties such as the ability to penetrate biological barriers and a high surface to volume ratio, nanoparticles (NPs) are a powerful tool to be used in medicine and industry. This review discusses the role of nanotechnology in bone-related issues: osteosarcoma (bone cancer), the biocompatibility of the implants and implant-related infections. In cancer therapy, NPs can be used as (I) cytotoxic agents, (II) drug delivery platforms and (III) in thermotherapy. In implant-related issues, NPs can be used as (I) antimicrobial agents and (II) adjuvants to increase the biocompatibility of implant surface. Properties of NPs depend on (I) the type of NPs, (II) their size, (III) shape, (IV) concentration, (V) incubation time, (VI) functionalization and (VII) capping agent type.
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Affiliation(s)
| | - Iwona Inkielewicz-Stepniak
- Chair and Department of Medical Chemistry, Faculty of Medicine, Medical University of Gdansk, ul. Dębinki 1, 80-211 Gdansk, Poland;
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Park J, Look KA. Health Care Expenditure Burden of Cancer Care in the United States. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019880696. [PMID: 31583928 PMCID: PMC6778988 DOI: 10.1177/0046958019880696] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Using nationwide data, this study estimated and compared annual health care expenditures per person between noncancer and cancer patients, and among patients with the 4 most common cancers. Two-part models were used to estimate mean expenditures for each group by source of payment and by service type. We found that cancer patients had nearly 4 times higher mean expenditures per person ($16 346) than those without cancer ($4484). These differences were larger among individuals aged 18 to 64 years than those ≥65 years. Medicare was the largest source of payment for cancer patients, especially among those ≥65 years. Among the 4 most common cancers, the most costly cancer was lung cancer. Ambulatory care visits accounted for the majority of health care expenditures for those with breast cancer, while for those with other cancers, inpatient services also contributed to a significant portion of expenditures especially among younger patients. This study demonstrates that cancer patients experience a substantially higher health care expenditure burden than noncancer patients, with lung cancer patients having the highest expenditures. Expenditure estimates varied by age group, source of payment, and service type, highlighting the need for comprehensive policies and programs to reduce the costs of cancer care.
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Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A, Horst C, Kaldjian A, Matyasz T, Scott KW, Bui AL, Campbell M, Duber HC, Dunn AC, Flaxman AD, Fitzmaurice C, Naghavi M, Sadat N, Shieh P, Squires E, Yeung K, Murray CJL. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA 2020; 323:863-884. [PMID: 32125402 PMCID: PMC7054840 DOI: 10.1001/jama.2020.0734] [Citation(s) in RCA: 545] [Impact Index Per Article: 136.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time. OBJECTIVE To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016. DESIGN AND SETTING Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition. EXPOSURES Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting. MAIN OUTCOMES AND MEASURES National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016. RESULTS Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP; $9655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion (95% CI, $122.4-$146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion [95% CI, $116.3-$149.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion]), falls ($87.4 billion [95% CI, $75.0-$100.1 billion]), urinary diseases ($86.0 billion [95% CI, $76.3-$95.9 billion]), skin and subcutaneous diseases ($85.0 billion [95% CI, $80.5-$90.2 billion]), osteoarthritis ($80.0 billion [95% CI, $72.2-$86.1 billion]), dementias ($79.2 billion [95% CI, $67.6-$90.8 billion]), and hypertension ($79.0 billion [95% CI, $72.6-$86.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%). CONCLUSIONS AND RELEVANCE Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance. Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.
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Affiliation(s)
| | - Jackie Cao
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Abby Chapin
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Carina Chen
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Zhiyin Li
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Angela Liu
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Cody Horst
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Taylor Matyasz
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Anthony L. Bui
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle
| | | | - Herbert C. Duber
- Institute for Health Metrics and Evaluation, Seattle, Washington
- Department of Emergency Medicine, University of Washington, Seattle
| | - Abe C. Dunn
- Bureau of Economic Analysis, Suitland, Maryland
| | | | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, Seattle, Washington
- Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Peter Shieh
- Bureau of Economic Analysis, Suitland, Maryland
| | | | - Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle
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Massa ST, Osazuwa-Peters N, Adjei Boakye E, Walker RJ, Ward GM. Comparison of the Financial Burden of Survivors of Head and Neck Cancer With Other Cancer Survivors. JAMA Otolaryngol Head Neck Surg 2020; 145:239-249. [PMID: 30789634 DOI: 10.1001/jamaoto.2018.3982] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Head and neck cancer (HNC) is more common among socioeconomically disenfranchised individuals, making financial burden particularly relevant. Objective To assess the financial burdens of HNC compared with other cancers. Design, Setting, and Participants In this retrospective review of nationally representative, publicly available survey, data from the Medical Expenditure Panel Survey were extracted from January 1, 1998, to December 31, 2015. A total of 444 867 adults were surveyed, which extrapolates to a population of 221 503 108 based on the weighted survey design. Data analysis was performed from April 18, 2018, to August 20, 2018. Exposures Of 16 771 patients with cancer surveyed (weighted count of 10 083 586 patients), 489 reported HNC (weighted count of 261 631). Main Outcomes and Measures Patients with HNC were compared with patients with other cancers on demographics, income, employment, and health. Within the HNC group, risk factors for total medical expenses and relative out-of-pocket expenses were assessed with regression modeling. Complex sampling methods were accounted for with weighting using balanced repeated replication. Results A total of 16 771 patients (mean [SD] age, 62.3 [18.9] years; 9006 [53.7%] female) with cancer were studied. Compared with patients with other cancers, patients with HNC were more often members of a minority race/ethnicity, male, poor, publicly insured, and less educated, with lower general and mental health status. Median annual medical expenses ($8384 vs $5978; difference, $2406; 95% CI, $795-$4017) and relative out-of-pocket expenses (3.93% vs 3.07%; difference, 0.86%; 95% CI, 0.06%-1.66%) were higher for patients with HNC than for patients with other cancers. Among patients with HNC, median expenses were lower for Asian individuals compared with white individuals ($5359 vs $10 078; difference, $4719; 95% CI, $1481-$7956]), Westerners ($8094) and Midwesterners ($5656) compared with Northwesterners ($10 549), and those with better health status ($16 990 for those with poor health vs $6714 for those with excellent health). Higher relative out-of-pocket expenses were associated with unemployment (5.13% for employed patients vs 2.35% for unemployed patients; difference, 2.78%; 95% CI, 0.6%-4.95%), public insurance (5.35% for those with public insurance vs 2.87% for those with private insurance; difference, 2.48%; 95% CI, -0.6% to 5.55%), poverty (13.07% for poor patients vs 2.06% for high-income patients), and lower health status (10.2% for those with poor health vs 1.58% for those with excellent health). Conclusions and Relevance According to this study, HNC adds a substantial, additional burden to an already financially strained population in the form of higher total and relative expenses. The financial strain on individuals, assessed as relative out-of-pocket expenses, appears to be driven more by income than by health factors, and health insurance does not appear to be protective.
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Affiliation(s)
- Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St Louis, Missouri
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield.,Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield
| | - Ronald J Walker
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St Louis, Missouri
| | - Gregory M Ward
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St Louis, Missouri
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Recent Health Care Expenditure Trends Among Adult Cancer Survivors in United States, 2009-2016. Am J Clin Oncol 2020; 43:349-355. [PMID: 31990757 DOI: 10.1097/coc.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to understand recent trends in direct health care expenditures among cancer survivors using novel cost-estimation methods and a nationally representative database. MATERIALS AND METHODS This study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during the years 2009-2016. Manning and Mullahy two-part model was used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates. RESULTS The mean direct annual health care expenditure among cancer survivors ($13,025.0 [$12,572.0 to $13,478.0]) was nearly 3 times greater than noncancer participants ($4689.3 [$4589.2 to $4789.3]) and were mainly spent on inpatient services, office-based visits, and prescription medications. Cancer survivors had an additional health care expenditure of $4407.6 ($3877.6, $4937.6) per person per year, compared with noncancer participants after adjusting for covariates (P<0.001). The total mean annual direct health care expenditure for cancer survivors increased from $12,960.0 (95% confidence interval: $12,291.0-$13,628.0) in 2009-2010 to $13,807.0 ($12,828.0 to $14,787.0) in 2015-2016. CONCLUSIONS Given the higher health care expenditures among cancer survivors and the increasing prevalence of cancers, cost-saving measures should be planned through multidisciplinary initiatives, collaborative research, and importantly, health care planning and policy changes. Our findings could be helpful in streamlining health care resources and interventions, developing national health care coverage policies, and possibly considering radically new insurance strategies for cancer survivors.
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Smith WH, Parikh AB, Li L, Sanderson M, Liu M, Mazumdar M, Isola LM, Dharmarajan KV. Estimating cost implications of potentially avoidable hospitalizations among Oncology Care Model patients with prostate cancer. J Cancer Policy 2020; 23. [PMID: 32351875 DOI: 10.1016/j.jcpo.2020.100218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose/Objectives We sought to estimate the expected cost savings generated if a set of potentially avoidable hospitalizations (PAHs) among oncology care model (OCM) patients with prostate cancer were shifted to an acute care model in the outpatient setting. Methods We previously identified a set of 28 PAHs among OCM prostate cancer patients. Outpatient management costs for a characteristically similar cohort of cancer patients were obtained from our institution's ambulatory acute-care Oncology Care Unit (OCU). We excluded OCU visits resulting in hospitalization, involving non-cancer diagnoses, and those missing clinical/financial information. Exact-matching based on the strata of age, categorically-defined presenting complaint, and systemic disease was used to match PAHs to OCU acute care visits. PAH costs obtained from OCM data were compared to costs from matched OCU visits. Results We identified 130 acute care OCU visits, of which 47 met inclusion criteria. Twenty-four PAHs (89%) matched to 26 of these OCU visits. PAHs accounted for 5.8% of OCM expenditures during our study period. The mean inpatient cost among matched PAHs was $15,885 compared to $6,227 for matched OCU visits. Boot strapping within each match stratum produced a mean estimated cost savings of $12,151 (95% CI $10,488 to $13,814) per PAH. We estimate this per event savings to yield a 4.4% (95% CI 3.8% to 5.0%) an overall spending decrement for OCM prostate cancer episodes. Conclusions PAHs contribute meaningfully to costs of care in oncology. Investment in specialized ambulatory acute care services for oncology patients could lead to substantial cost savings.
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Affiliation(s)
- William H Smith
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anish B Parikh
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lihua Li
- Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Sanderson
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Liu
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luis M Isola
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kavita V Dharmarajan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Steckiewicz KP, Barcinska E, Sobczak K, Tomczyk E, Wojcik M, Inkielewicz-Stepniak I. Assessment of Anti-Tumor potential and safety of application of Glutathione stabilized Gold Nanoparticles conjugated with Chemotherapeutics. Int J Med Sci 2020; 17:824-833. [PMID: 32218704 PMCID: PMC7085271 DOI: 10.7150/ijms.40827] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/08/2020] [Indexed: 12/24/2022] Open
Abstract
Due to the high toxicity of currently used chemotherapeutics, novel methods of cancer treatment are needed. Gold nanoparticles (AuNPs) seem to be an interesting alternative due to penetration through biological membranes and systemic barriers. AuNPs as carriers of chemotherapeutics allow for reduced concentrations whilst maintaining the expected effect, and thus reducing the costs of therapy and adverse effects. We synthesized AuNPs stabilized with reduced glutathione (GSH) and conjugated with doxorubicin (DOX), gemcitabine (GEM) or cytarabine (CTA). This is the first study in which cytarabine-AuNPs were synthesized and characterized. Transmission electron microscopy (TEM), thermogravimetric analysis (TGA), nuclear magnetic resonance spectroscopy (NMR) and high-performance liquid chromatography (HPLC) were used to chemically characterize obtained nanoparticles. Antitumor activity and safety of application were assessed by MTT assay in in vitro model (human osteosarcoma cells -143B, human osteoblast- hFOB1.19, breast cancer cells - MCF7, breast epithelial cells - MCF10A, pancreatic cancer cells - PANC-1, and pancreatic cells - hTERT-HPNE cells). We have shown that cellular response varies according to the type and concentration of AuNPs. At some concentrations, we were able to show selective cytotoxicity of our AuNPs conjugates only to cancer cell lines. Synthesized nanoparticles were more cytotoxic to tumor cell lines than chemotherapeutics alone.
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Affiliation(s)
- Karol P Steckiewicz
- Chair and Department of Medical Chemistry, Medical University of Gdansk, Debinki street 1, 80-211 Gdansk, Poland
| | - Ewelina Barcinska
- Chair and Department of Medical Chemistry, Medical University of Gdansk, Debinki street 1, 80-211 Gdansk, Poland
| | - Katarzyna Sobczak
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland
| | - Ewelina Tomczyk
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland
| | - Michał Wojcik
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland
| | - Iwona Inkielewicz-Stepniak
- Chair and Department of Medical Chemistry, Medical University of Gdansk, Debinki street 1, 80-211 Gdansk, Poland
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Mustapha M, Ali-Gombe M, Abdullahi A, Adenipekun A, Campbell O. Financial burden of cancer on patients treated at a tertiary health facility in South West Nigeria. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:23-29. [PMID: 35814963 PMCID: PMC9267039 DOI: 10.4103/jwas.jwas_4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/01/2022] [Indexed: 12/04/2022]
Abstract
Background: Cancer is a growing health concern in the world. The financial burden of cancer affects not only cancer patients and their families, but also the society as a whole. In Nigeria there is a dearth of information about the financial burden of cancer on patients. Hence, there is need to estimate the cost of cancer treatment and to show the resources being allocated to the problem. Objectives: The aim of this study was to estimate the financial burden of cancer on patients treated at a tertiary heath facility in South West Nigeria. Materials and Methods: The study was a cross-sectional study and patients were interviewed using a set of questionnaires that addresses sociodemographic and economic questions involving medical and nonmedical costs (direct medical costs). Data Analysis: Data obtained were analyzed using the Statistical Package for Social Sciences (SPSS), version 21.0. Descriptive statistics such as frequencies (%), mean, standard deviation, median, range and P-value were used to highlight important and relevant features of the data. For ease of analysis some of the variables such as sociodemographic, medical, and nonmedical costs were grouped or categorized. Results: Two hundred and twenty cancer patients participated in the study. The mean age of the patients was 54.1 (standard deviation [SD] = 13.4) years and majority were females (81.4%). Approximately one-third of the respondents were those with breast (35.9%) and cervical (35.5%) cancers, respectively. Majority perceived financial burden as a result of cancer to be significant (82.7%). The mean annual income of patients was $5,548.7(SD = $7,245.4). The main sources of income for their treatments were from their children (26.8%). The mean total cost incurred by patients with cancer was $5306.9 (SD = $5045.7), with medical costs accounting for the highest percentage $3889.4 (SD = $4372.9); 73.0% and nonmedical costs of $1417.5 (SD = $1085.6); 27.0%. Patients with colorectal cancer incurred the highest cost, whereas cervical cancer patients incurred the least cost. Conclusion: Financing cancer management is a major challenge for both patients and their caregivers. Cancer care also results in a loss of economic income available to the community/country.
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Trogdon JG, Falchook AD, Basak R, Carpenter WR, Chen RC. Total Medicare Costs Associated With Diagnosis and Treatment of Prostate Cancer in Elderly Men. JAMA Oncol 2019; 5:60-66. [PMID: 30242397 DOI: 10.1001/jamaoncol.2018.3701] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Importance Localized prostate cancer diagnosis and treatment among elderly men who are not likely to benefit represents a potential source of low-value health care services. Objective To quantify the costs to the Medicare program associated with detection and treatment of prostate cancer among elderly men in the United States. Design, Setting, and Participants This nationwide, population-based, retrospective cohort study uses the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to identify men 70 years or older diagnosed with localized prostate cancer between 2004 and 2007 and to ascertain Medicare costs associated with diagnosis and workup, treatment, follow-up, and morbidity management of the disease. National Medicare costs were estimated using per-person costs, stage-adjusted prostate cancer incidence rates by age from SEER 2007 through 2011, and 2010 Census population estimates by age. Main Outcomes and Measures Estimated costs to the Medicare program overall, and in each (mutually exclusive) category related to diagnosis and workup, treatment, follow-up, and morbidity management. Results This nationwide, population-based, retrospective cohort study included 49 692 men with nonmetastatic prostate cancer from the SEER-Medicare database (all participants were 70 years or older; 25 981 [52.3%] were 76 years or older). The median per-patient cost within 3 years after prostate cancer diagnosis was $14 453 (interquartile range [IQR], $4887-$27 899). The majority of this cost was attributable to treatment costs (median, $10 558; IQR, $1990-$23 718). Patients with a Gleason score of 6 or lower who pursued initial conservative management (no treatment within 12 months of diagnosis) had a 3-year median total cost of $1914 per patient. The estimated total 3-year cost to the Medicare program associated with the annual detection of prostate cancer in men 70 years or older is approximately $1.2 billion. Increasing active surveillance use in those with Gleason score of 6 or lower could reduce this cost by $320 million. Conclusions and Relevance There is substantial cost to the Medicare program associated with the diagnosis and treatment of localized prostate cancer among elderly men in the United States, despite the fact that these men are unlikely to die of prostate cancer. The majority of costs are related to treatment. Reducing provision of low-value health care services among this patient population could result in significant health care savings.
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Affiliation(s)
- Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill.,Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Aaron D Falchook
- Department of Radiation Oncology, Memorial Cancer Institute, Memorial Healthcare System, Pembroke Pines, Florida
| | - Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill
| | - William R Carpenter
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ronald C Chen
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.,Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
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Sherman SK, Lange JJ, Dahdaleh FS, Rajeev R, Gamblin TC, Polite BN, Turaga KK. Cost-effectiveness of Maintenance Capecitabine and Bevacizumab for Metastatic Colorectal Cancer. JAMA Oncol 2019; 5:236-242. [PMID: 30489611 DOI: 10.1001/jamaoncol.2018.5070] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Unregulated drug prices increase cancer therapy costs. After induction chemotherapy, patients with metastatic colon cancer can receive maintenance capecitabine and bevacizumab therapy based on improved progression-free survival, but whether this treatment's cost justifies its benefits has not been evaluated in the United States. Objective This study sought to determine the influence of capecitabine and bevacizumab drug prices on cost-effectiveness from a Medicare payer's perspective. Design, Setting, and Participants The incremental cost-effectiveness of capecitabine and bevacizumab maintenance therapy was determined with a Markov model using a quality-of-life penalty based on outcomes data from the CAIRO phase 3 randomized clinical trial (RCT), which included 558 adults in the Netherlands with unresectable metastatic colorectal cancer who had stable disease or better following induction chemotherapy. The outcomes were modeled using Markov chains to account for patients who had treatment complications or cancer progression. Transition probabilities between patient states were determined, and each state's costs were determined using US Medicare data on payments for capecitabine and bevacizumab treatment. Deterministic and probabilistic sensitivity analyses identified factors affecting cost-effectiveness. Main Outcomes and Measures Life-years gained were adjusted using CAIRO3 RCT quality-of-life data to determine quality-adjusted life-years (QALYs). The primary end point was the incremental cost-effectiveness ratio, representing incremental costs per QALY gained using a capecitabine and bevacizumab maintenance regimen compared with observation alone. Results Markov model estimated survival and complication outcomes closely matched those reported in the CAIRO3 RCT, which included 558 adults (n = 197 women, n = 361 men; median age, 64 and 63 years for patients in the observation and maintenance therapy groups, respectively) in the Netherlands with unresectable metastatic colorectal cancer who had stable disease or better following induction chemotherapy. Incremental costs for a 3-week maintenance chemotherapy cycle were $6601 per patient. After 29 model iterations corresponding to 60 months of follow-up, mean per-patient costs were $105 239 for maintenance therapy and $21.10 for observation. Mean QALYs accrued were 1.34 for maintenance therapy and 1.20 for observation. The incremental cost-effectiveness ratio favored maintenance treatment, at an incremental cost of $725 601 per QALY. The unadjusted ratio was $438 394 per life-year. Sensitivity analyses revealed that cost-effectiveness varied with changes in drug costs. To achieve an incremental cost-effectiveness ratio of less than $59 039 (median US household income) per unadjusted life-year would require capecitabine and bevacizumab drug costs to be reduced from $6173 (current cost) to $452 per 3-week chemotherapy cycle. Conclusions and Relevance Antineoplastic therapy is expensive for payers and society. The price of capecitabine and bevacizumab maintenance therapy would need to be reduced by 93% to make it cost-effective, a finding useful for policy decision making and payment negotiations.
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Affiliation(s)
- Scott K Sherman
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Joel J Lange
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Fadi S Dahdaleh
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Rahul Rajeev
- Department of Surgery, University of Texas Rio Grande Valley, Edinburg
| | - T Clark Gamblin
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Blase N Polite
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, Illinois
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Crew KD, Silverman TB, Vanegas A, Trivedi MS, Dimond J, Mata J, Sin M, Jones T, Terry MB, Tsai WY, Kukafka R. Study protocol: Randomized controlled trial of web-based decision support tools for high-risk women and healthcare providers to increase breast cancer chemoprevention. Contemp Clin Trials Commun 2019; 16:100433. [PMID: 31497674 PMCID: PMC6722284 DOI: 10.1016/j.conctc.2019.100433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chemoprevention using selective estrogen receptor modulators and aromatase inhibitors has been shown to reduce invasive breast cancer incidence in high-risk women. Despite this evidence, few high-risk women who are eligible for chemoprevention utilize it as a risk-reducing strategy. Reasons for low uptake include inadequate knowledge about chemoprevention among patients and healthcare providers, concerns about side effects, time constraints during the clinical encounter, and competing comorbidities. METHODS/DESIGN We describe the study design of a randomized controlled trial examining the effect of two web-based decision support tools on chemoprevention decision antecedents and quality, referral for specialized counseling, and chemoprevention uptake among women at an increased risk for breast cancer. The trial is being conducted at a large, urban medical center. A total of 300 patients and 50 healthcare providers will be recruited and randomized to standard educational materials alone or in combination with the decision support tools. Patient reported outcomes will be assessed at baseline, one and six months after randomization, and after their clinic visit with their healthcare provider. DISCUSSION We are conducting this trial to provide evidence on how best to support personalized breast cancer risk assessment and informed and shared decision-making for chemoprevention. We propose to integrate the decision support tools into clinical workflow, which can potentially expand quality decision-making and chemoprevention uptake. TRIAL REGISTRATION NCT03069742.
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Affiliation(s)
- Katherine D. Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Thomas B. Silverman
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alejandro Vanegas
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Meghna S. Trivedi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Jill Dimond
- Sassafras Tech Collective, Ann Arbor, MI, USA
| | - Jennie Mata
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Margaret Sin
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Tarsha Jones
- Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rita Kukafka
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Otto Mattsson T, Lindhart CL, Schöley J, Friis‐Hansen L, Herrstedt J. Patient self‐testing of white blood cell count and differentiation: A study of feasibility and measurement performance in a population of Danish cancer patients. Eur J Cancer Care (Engl) 2019; 29:e13189. [DOI: 10.1111/ecc.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/26/2019] [Accepted: 10/24/2019] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Jonas Schöley
- Department of Public Health University of Southern Denmark Odense Denmark
| | | | - Jørn Herrstedt
- Department of Clinical Oncology Zealand University Hospital Roskilde Denmark
- University of Copenhagen Copenhagen Denmark
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Swedler DI, Miller TR, Ali B, Waeher G, Bernstein SL. National medical expenditures by smoking status in American adults: an application of Manning's two-stage model to nationally representative data. BMJ Open 2019; 9:e026592. [PMID: 31315859 PMCID: PMC6661572 DOI: 10.1136/bmjopen-2018-026592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To assess the medical expenditures of American adults by their smoking status-Current, Former or Never smokers. We update these expenditures through 2015 controlling for personal characteristics and medical history and assess the impact of years-since-quitting and decade of life. SETTING AND PARTICIPANTS Weighted sample of American adults, 2011-2015. The linked National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS) are annual weighted representations of approximately 250 million adults. Sampling of NHIS is multistage with data collected throughout the year. PRIMARY OUTCOME MEASURES Using data from NHIS and MEPS, we collected demographic data, self-reported medical history and current smoking status. Smoking status was designated as Never, Current and Former, along with years-since-quitting. Total medical expenditures were collected from MEPS for 2011-2015. We used Manning's two-part model to estimate average expenditures per individual and marginal costs for individuals at all levels of smoking status. RESULTS American adults averaged US$4830 in average medical expenditures. Never smokers (US$4360, 95% CI 4154.3 to 4566.3), had lower expenditures than Current (US$5244, 95% CI 4707.9 to 5580.3) and Former (US$5590, 95% CI 5267.4 to 5913.5) smokers. CI for Current and Former smokers overlapped. Results were similarly significant when controlling for disease history. Years-since-quitting did not affect expenditures. In each decade of adult life, Former smokers had the highest annual medical expenditures, followed by Current and then Never smokers. CONCLUSIONS We updated annual medical expenditures during the Affordable Care Act era by smoking status using the current best practice model. While we identify Former smokers as having higher medical expenditures than Current smokers, we do not examine how care-seeking behaviour varies between levels of each risk factor.
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Affiliation(s)
- David I Swedler
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Bina Ali
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
| | - Geetha Waeher
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
| | - Steven L Bernstein
- Department of Emergency Medicine; Department of Health Policy, Yale University, New Haven, Connecticut, USA
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Sam D, Cheung WY. A population-level comparison of cancer-related and non-cancer-related health care costs using publicly available provincial administrative data. ACTA ACUST UNITED AC 2019; 26:94-97. [PMID: 31043809 DOI: 10.3747/co.26.4399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Costs associated with cancer care are increasing. Cancer costs in the context of other common non-cancer diagnoses have not been extensively studied at the population level. Knowledge from such analyses can inform health care resource allocation and highlight strategies to reduce overall costs. Methods Using cross-sectional data from publicly available population-level administrative data sources (health insurance claims, physician billing, and hospital discharge abstracts), we calculated incidence-adjusted health care costs (in 2014 Canadian dollars) for cancers and common non-cancer diagnoses in the adult population in a large Canadian province. Subgroup analyses were also performed for various provincial health administrative regions. Results Total costs related to cancer care amounted to $495 million for the province, of which at least $67 million (14%) was attributable to radiation and chemotherapy. Of the various cancer subtypes, hematologic malignancies were most costly at $70 million, accounting for 14% of the total cancer budget. Colon cancer followed at $51 million (10%), and lung cancer, at $44 million (9%). Cancer costs (with and without costs for radiation and chemotherapy) exceeded those for cardiovascular disease, diabetes mellitus, mental health, and trauma (p < 0.001). In addition, the costs of specific cancer subtypes varied by region, but hematologic and lung cancers were typically the most costly no matter the health region. Conclusions Using provincial administrative data to establish cost trends can help to inform health care allocation and budget decisions, and can facilitate comparisons between provinces.
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Affiliation(s)
- D Sam
- Department of Medicine, University of Calgary, Calgary, AB
| | - W Y Cheung
- Department of Oncology, University of Calgary, Calgary, AB
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Parikh AB, Smith W, Sanderson M, Dharmarajan K, Liu M, Isola L, Ennis RD. Identifying Potentially Avoidable Hospitalizations in Medicare Patients With Prostate Cancer: A Retrospective Analysis. J Oncol Pract 2019; 15:e187-e194. [PMID: 30742550 DOI: 10.1200/jop.18.00560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: If identifiable, potentially avoidable hospitalizations (PAHs) can serve as an important target for cost containment efforts in oncology. METHODS: PAHs among a cohort of Medicare patients with prostate cancer were identified using a two-stage consensus-driven review process. In stage 1, two clinicians independently evaluated admissions records using a case review form, which we modified from a previous study to assess for PAHs. In stage 2, any admissions that the reviewers disagreed on or were unsure of were re-examined in a larger group of clinicians to yield a consensus determination regarding avoidability. Univariable and multivariable regression analyses were performed to identify factors predictive of PAH. RESULTS: There were 160 admissions among this cohort of 210 patients from January 2012 to June 2015, of which 99 were evaluable. Consensus-driven clinical review yielded an overall PAH rate of 28.3%. Factors associated with increased PAH risk were admission for symptoms related to cancer (odds ratio [OR], 7.33; P < .001), presence of a social contributor to admission (OR, 4.40; P = .014), and history of alcohol or drug abuse (OR, 4.93; P = .025). Admission for a noncancer condition was associated with decreased PAH risk (OR, 0.32; P = .011). On multivariable analysis, presence of a social contributor to admission (OR, 9.35; P = .002) and admission as a result of a noncancer condition (OR, 0.16; P = .038) remained predictive of PAH risk. CONCLUSION: A significant proportion of hospitalizations among patients with prostate cancer are potentially avoidable. Understanding factors predictive of risk for PAH can help inform programs aimed at avoiding such admissions to improve overall care quality and value.
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Affiliation(s)
- Anish B Parikh
- 1 Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William Smith
- 2 Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Mark Liu
- 1 Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Luis Isola
- 1 Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ronald D Ennis
- 3 Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
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Frois C, Howe A, Jarvis J, Grice K, Wong K, Zacker C, Sasane R. Drug Treatment Value in a Changing Oncology Landscape: A Literature and Provider Perspective. J Manag Care Spec Pharm 2019; 25:246-259. [PMID: 30698093 PMCID: PMC10397715 DOI: 10.18553/jmcp.2019.25.2.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The U.S. health care system's transition to a value-based reimbursement model holds important implications for medical innovation, care delivery, and value-based assessments of therapeutic interventions. This transition has been especially noteworthy in oncology, with substantial ongoing changes to payer reimbursement and the provider landscape, as well as the introduction of value frameworks to guide drug treatment decision making. The implications of these changes for provider assessments of drug value and evidence needs remain unclear. OBJECTIVES To understand provider perspectives on drug value assessment and the utility of existing oncology value frameworks by identifying (a) key value-based trends in the evolving oncology landscape, (b) provider definitions of drug value, (c) the role of existing value frameworks in provider decision making, and (d) future provider evidence needs for making value-based treatment decisions. METHODS We conducted a literature review to identify existing oncology value frameworks and definitions of drug treatment value in oncology. Using a structured discussion guide informed by this literature review, we conducted 12 telephone-based in-depth interviews in November and December 2017 with U.S. oncology providers involved in organizational drug treatment and formulary decision making within their practices. Responses to interview questions were analyzed and reported as averages and percentages across participants. RESULTS Of 293 publications identified by keyword searches, 35 relevant articles were identified. Among these, the literature review identified no common definition for providers to assess drug value. Interview research participants described large ongoing changes in the oncology provider landscape, with economic pressures from payers as the foremost leading factor. Although 5 value frameworks were found in the literature, interviews found that in practice few providers consider these value frameworks to be key influences when evaluating treatment or formulary decisions. Furthermore, while 83% of participants' organizations employed some form of internal clinical pathways, only the minority (25%) with pathways integrated in their electronic medical record (EMR) systems saw these pathways as significantly affecting clinicians' drug treatment decision making. To aid the ongoing shift from volume-based to value-based care, we found that, rather than value frameworks, providers are looking for patient-level tools to make more appropriate drug decisions. CONCLUSIONS Payer reimbursement pressures are leading to radical changes in the oncology provider landscape, and there is a need for improved guidance for providers in assessing drug value. In particular, this study identifies the need for a timely and multifaceted summary of information required to assess the value of alternative treatment options for a given patient. Manufacturers also need to make significant strides to help generate and improve the dissemination of evidence to support the value of their therapies. DISCLOSURES Funding for this work was provided by Novartis Pharmaceuticals. The study sponsor was involved in study design, data interpretation, and data review. All authors contributed to the development of the manuscript and maintained control over the final content. Sasane, Howe, Wong, and Zacker were employees of Novartis at the time of this study. Frois, Jarvis, and Grice are or have been employed by Analysis Group, which received a grant from Novartis for this research. At the time of this study, Analysis Group received funding from multiple manufacturers with oncology products in their portfolio during this time period, including, but not limited to, Astellas and Genentech.
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Affiliation(s)
| | - Andrew Howe
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | | | - Ken Wong
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | - Rahul Sasane
- Novartis Pharmaceuticals, East Hanover, New Jersey
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Rendell V, Schmocker R, Abbott DE. Expanding the Scope of Evidence-Based Cancer Care. Surg Oncol Clin N Am 2018; 27:727-743. [PMID: 30213416 DOI: 10.1016/j.soc.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article explores how oncology research can be expanded to ensure that research spending results in maximum benefit. The focus has shifted to the value and quality of care, which view cancer care with the perspective of the patient at the center and cover the spectrum of care. Because there is no agreed-upon definition for value in cancer care, we overview various contributions to defining value and quality in oncology. We outline how cancer care costs are measured in the United States and explore outcome measures that have been proposed and implemented to enable us to assess value in oncology.
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Affiliation(s)
- Victoria Rendell
- Division of General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Ryan Schmocker
- Division of General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Box 7375, Madison, WI 53792, USA; Division of General Surgery, Department of Surgery, Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Box 7375, Madison, WI 53792, USA.
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van Waart H, van Dongen JM, van Harten WH, Stuiver MM, Huijsmans R, Hellendoorn-van Vreeswijk JAJH, Sonke GS, Aaronson NK. Cost-utility and cost-effectiveness of physical exercise during adjuvant chemotherapy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:893-904. [PMID: 29086085 DOI: 10.1007/s10198-017-0936-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION A home-based, low-intensity physical activity program (Onco-Move) and a supervised, moderate-to-high intensity, combined resistance and aerobic exercise program (OnTrack) have proven to be effective in maintaining physical fitness and reducing fatigue among breast cancer patients undergoing adjuvant chemotherapy. This study evaluated the cost-utility and cost-effectiveness of Onco-Move and OnTrack. METHODS A total of 230 patients were randomized to Onco-Move, OnTrack, or usual care (UC). Health outcomes included quality-adjusted life years (QALYs), general and physical fatigue, and physical fitness measured at baseline, end of chemotherapy, and 6-month follow-up. Societal costs included professional and informal health care, work absenteeism, and unpaid productivity costs. Cost data were based on 3-monthly questionnaires, supplemented by medication data obtained from pharmacies. RESULTS Onco-Move is not likely to be cost-effective due to the relatively high willingness-to-pay necessary to reach reasonable probabilities of cost-effectiveness (QALY, general and physical fatigue). Incremental cost-effectiveness ratios for OnTrack compared to UC were €26,916/QALY, €788/1-point decrease in general fatigue and €1402/1-point decrease in physical fatigue. The probability of OnTrack being cost-effective ranged from 31% at a willingness-to-pay (WTP) of €0-79% at a WTP of €80,000/QALY, 97% at a WTP of €15,000/1-point decrease in general fatigue, and 86% at a WTP of €24,000/1-point decrease in physical fatigue. Both interventions had a low probability of being cost-effective for physical fitness. The probability of cost-effectiveness for both interventions was greater among compliant participants. CONCLUSIONS Onco-Move is not likely to be cost-effective. Depending on the decision-makers' willingness-to-pay, OnTrack could be considered cost-effective in comparison with UC. Trial registration Clinical trial registration number of the Netherlands Trial Register-NTR2159.
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Affiliation(s)
- Hanna van Waart
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University Twente, Enschede, The Netherlands
| | - Martijn M Stuiver
- Department of Physical Therapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
- ACHIEVE Center for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Rosalie Huijsmans
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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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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