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Soliman R, Bolous N, Heneghan C, Oke J, Boylan AM, Eweida W, Abouelnaga S, Elhaddad A. An overview of childhood cancer care and outcomes in Egypt: a narrative review. Ecancermedicalscience 2024; 18:1676. [PMID: 38439811 PMCID: PMC10911675 DOI: 10.3332/ecancer.2024.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Indexed: 03/06/2024] Open
Abstract
Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children's Cancer Hospital Egypt-57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.
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Affiliation(s)
- Ranin Soliman
- Health Economics and Value Unit, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Centre for Evidence-Based Medicine, University of Oxford, OX1 2JD Oxford, UK
- Co-first authors
| | - Nancy Bolous
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Co-first authors
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Jason Oke
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Anne-Marie Boylan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
| | - Sherif Abouelnaga
- Chief Executive Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
- Paediatric Oncology Department, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
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Nabukalu D, Gordon LG, Lowe J, Merollini KMD. Healthcare costs of cancer among children, adolescents, and young adults: A scoping review. Cancer Med 2024; 13:e6925. [PMID: 38214042 PMCID: PMC10905233 DOI: 10.1002/cam4.6925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To collate and critically review international evidence on the direct health system costs of children and adolescents and young adults (AYA) with cancer. METHODS We conducted searches in PubMed, MEDLINE, CINAHL, and Scopus. Articles were limited to studies involving people aged 0-39 years at cancer diagnosis and published from 2012 to 2022. Two reviewers screened the articles and evaluated the studies using the Consolidated Health Economic Evaluation Reporting Standards checklist. The reviewers synthesized the findings using a narrative approach and presented the costs in 2022 US dollars for comparability. RESULTS Overall, the mean healthcare costs for all cancers in the 5 years post diagnosis ranged from US$36,670 among children in Korea to US$127,946 among AYA in the USA. During the first year, the mean costs among children 0-14 years ranged from US$34,953 in Chile to over US$130,000 in Canada. These were higher than the costs for AYA, estimated at US$61,855 in Canada. At the end of life, the mean costs were estimated at over US$300,000 among children and US$235,265 among adolescents in Canada. Leukemia was the most expensive cancer type, estimated at US$50,133 in Chile, to US$152,533 among children in Canada. Overall, more than a third of the total cost is related to hospitalizations. All the included studies were of good quality. CONCLUSIONS Healthcare costs associated with cancer are substantial among children, and AYA. More research is needed on the cost of cancer in low- and middle-income countries and harmonization of costs across countries.
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Affiliation(s)
- Doreen Nabukalu
- School of HealthUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
- Population Health ProgramQIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Louisa G. Gordon
- Population Health ProgramQIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
- School of NursingQueensland University of TechnologyKelvin GroveQueenslandAustralia
- School of Public HealthThe University of QueenslandHerstonQueenslandAustralia
| | - John Lowe
- School of HealthUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
| | - Katharina M. D. Merollini
- School of HealthUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
- Sunshine Coast Health InstituteSunshine Coast University HospitalBirtinyaQueenslandAustralia
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Soliman R, Oke J, Sidhom I, Bhakta N, Bolous NS, Tarek N, Ahmed S, Abdelrahman H, Moussa E, Zamzam M, Fawzy M, Zekri W, Hafez H, Sedky M, Hammad M, Elzomor H, Ahmed S, Awad M, Abdelhameed S, Mohsen E, Shalaby L, Eweida W, Abouelnaga S, Elhaddad A, Heneghan C. Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidence. EClinicalMedicine 2023; 55:101729. [PMID: 36386036 PMCID: PMC9646894 DOI: 10.1016/j.eclinm.2022.101729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resource-limited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status. METHODS Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disability-adjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality. FINDINGS For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO-CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1-1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio <3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers. INTERPRETATION Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote high-value in care delivery, with implications on practice and policy. FUNDING Egypt Cancer Network; NIHR School for Primary Care Research; ALSAC.
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Affiliation(s)
- Ranin Soliman
- Department of Continuing Education, University of Oxford, UK
- Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt
- Corresponding author. Department for Continuing Education, Kellogg College, University of Oxford, UK; Health Economics and Value Unit, Children's Cancer Hospital 57357–Egypt (CCHE), Cairo, Egypt.
| | - Jason Oke
- Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Iman Sidhom
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Nickhill Bhakta
- Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
| | - Nancy S. Bolous
- Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
| | - Nourhan Tarek
- Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Sonia Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hany Abdelrahman
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Emad Moussa
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Clinical Oncology Department, Menoufia University, Egypt
| | - Manal Zamzam
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Mohamed Fawzy
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Wael Zekri
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hanafy Hafez
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Mohamed Sedky
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatrics Department, National Research Centre, Cairo, Egypt
| | - Mahmoud Hammad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hossam Elzomor
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Sahar Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Madeha Awad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Sayed Abdelhameed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Enas Mohsen
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Clinical Oncology Department, Beni-suef University, Egypt
| | - Lobna Shalaby
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Wael Eweida
- Chief Operating Office, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Sherif Abouelnaga
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
- Chief Executive Office, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Carl Heneghan
- Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Zhou HZW, Qiao LY, Zhang YJ, Kang WW, Yan X, Jiang YL, Ke YL, Rao YT, Liu GZ, Wang MY, Wang H, Xi YF, Wang SF. Association of Ethnicity, Sex, and Age With Cancer Diagnoses and Health Care Utilization Among Children in Inner Mongolia, China. JAMA Netw Open 2022; 5:e2231182. [PMID: 36094504 PMCID: PMC9468889 DOI: 10.1001/jamanetworkopen.2022.31182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 China is experiencing a sustained increase in childhood cancer. However, whether differences exist in disease burden by ethnicity remains unclear. OBJECTIVE To compare differences in cancer diagnoses and health care utilization in Inner Mongolia among children subgrouped by ethnicity (Han vs Mongolian), sex, and age. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study in Inner Mongolia, China, used data on children aged 0 to 14 years with cancer from the Inner Mongolia Regional Health Information Platform, which comprises the National Basic Medical Insurance database and the Inner Mongolia cause-of-death reporting system, from January 1, 2013, to December 31, 2019. Ethnicities analyzed included Han and Mongolian; patients of other ethnicities were not included in the analysis because of the small sample size. Cancer was broadly defined as a primary malignant tumor or hematologic cancer; benign central nervous system tumors were also included. A 2-year washout period was used to exclude prevalent cases. After diagnosis, the patients were followed up until the date of death or the end of the insured status, whichever came first. EXPOSURES Ethnicity (Han vs Mongolian), sex (male vs female), and age (0-4, 5-9, and 10-14 years). MAIN OUTCOMES AND MEASURES Crude incidence, 5-year prevalence, and survival rates at 1 year and 3 years after diagnosis; health care utilization, represented by medical costs during the first year and first 3 years after diagnosis; and hospital attendance with level (tertiary vs secondary and lower-level hospitals) and location of each unique visit. RESULTS From 2013 to 2019, 1 106 684 (2013), 1 330 242 (2014), 1 763 746 (2015), 2 400 343 (2016), 2 245 963 (2017), 2 901 088 (2018), and 2 996 580 (2019) children aged 0 to 14 years were registered in the NBMI database. Among the 2 996 580 children enrolled in 2019, the mean (SD) age was 6.8 (4.3) years, of whom 1 572 096 (52.5%) were male, 2 572 091 (85.8%) were Han, and 369 400 (12.3%) were Mongolian. A total of 1910 patients with cancer were identified (1048 were male [54.9%]; 1559 were Han [81.6%], and 300 were Mongolian [15.7%]). There were 764 hematologic cancers (40.0%) and 1146 solid tumors (60.0%). The overall crude incidence of cancer from 2015 to 2019 was 129.85 per million children (95% CI, 123.63-136.06), with a higher incidence among Mongolian than among Han children (155.12 [95% CI, 136.81-173.43] vs 134.39 [95% CI, 127.46-141.32]). The 5-year prevalence was 428.97 per million (95% CI, 405.52-452.42) in 2020, with a higher prevalence among Mongolian than among Han children (568.49 [95% CI, 91.62-645.36] vs 404.34 [95% CI, 379.77-428.91]). The combined 1-year (2015-2019) and 3-year (2015-2017) survival rates were 72.5% (95% CI, 67.5%-77.5%) and 66.8% (95% CI, 61.6%-71.9%), respectively. The 1-year (median [IQR], $1991 [$912-$10 181] vs $3991 [$1171-$15 425]) and 3-year (median [IQR], $2704 [$954-$13 909] vs $5375 [$1283-$22 466]) postdiagnosis costs were lower among Mongolian than among Han children. A higher proportion of Mongolian patients attended low-level hospitals (45.9% vs 17.4%). CONCLUSIONS AND RELEVANCE In this cohort study, Mongolian children had a higher incidence and prevalence of cancer but a lower demand for medical care, suggesting that further investigations are needed to identify mechanisms underlying ethnic disparities and ensure that care is equitable.
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Affiliation(s)
- Hu-Zi-Wei Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Li-Ying Qiao
- Department of Chronic Noncommunicable Diseases Prevention and Control, The Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Inner Mongolia, China
| | - Yun-Jing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wei-Wei Kang
- Department of Chronic Noncommunicable Diseases Prevention and Control, The Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Inner Mongolia, China
| | - Xue Yan
- School of Public Health, Baotou Medical College, Baotou, China
| | - Yu-Ling Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ya-Lei Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ying-Ting Rao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Guo-Zhen Liu
- Bigdata Division, Innovation Center, Peking University Health Information Technology, Beijing, China
| | - Ming-Yuan Wang
- Bigdata Division, Innovation Center, Peking University Health Information Technology, Beijing, China
| | - Hui Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing China
| | - Yun-Feng Xi
- Department of Chronic Noncommunicable Diseases Prevention and Control, The Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Inner Mongolia, China
| | - Sheng-Feng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Tsui TCO, Zeitouny S, Bremner KE, Cheung DC, Mulder C, Croxford R, Del Giudice L, Lapointe-Shaw L, Mendlowitz A, Wong WWL, Perlis N, Sander B, Teckle P, Tomlinson G, Walker JD, Malikov K, McGrail KM, Peacock S, Kulkarni GS, Pataky RE, Krahn MD. Initial health care costs for COVID-19 in British Columbia and Ontario, Canada: an interprovincial population-based cohort study. CMAJ Open 2022; 10:E818-E830. [PMID: 36126976 PMCID: PMC9497846 DOI: 10.9778/cmajo.20210328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COVID-19 imposed substantial health and economic burdens. Comprehensive population-based estimates of health care costs for COVID-19 are essential for planning and policy evaluation. We estimated publicly funded health care costs in 2 Canadian provinces during the pandemic's first wave. METHODS In this historical cohort study, we linked patients with their first positive SARS-CoV-2 test result by June 30, 2020, in 2 Canadian provinces (British Columbia and Ontario) to health care administrative databases and matched to negative or untested controls. We stratified patients by highest level of initial care: community, long-term care, hospital (without admission to the intensive care unit [ICU]) and ICU. Mean publicly funded health care costs for patients and controls, mean net (attributable to COVID-19) costs and total costs were estimated from 30 days before to 120 days after the index date, or to July 31, 2020, in 30-day periods for patients still being followed by the start of each period. RESULTS We identified 2465 matched people with a positive test result for SARS-CoV-2 in BC and 28 893 in Ontario. Mean age was 53.4 (standard deviation [SD] 21.8) years (BC) and 53.7 (SD 22.7) years (Ontario); 55.7% (BC) and 56.1% (Ontario) were female. Net costs in the first 30 days after the index date were $22 010 (95% confidence interval [CI] 19 512 to 24 509) and $15 750 (95% CI 15 354 to 16 147) for patients admitted to hospital, and $65 828 (95% CI 58 535 to 73 122) and $56 088 (95% CI 53 721 to 58 455) for ICU patients in BC and Ontario, respectively. In the community and long-term care settings, net costs were near 0. Total costs for all people, from 30 days before to 30 days after the index date, were $22 128 330 (BC) and $175 778 210 (Ontario). INTERPRETATION During the first wave, we found that mean costs attributable to COVID-19 were highest for patients with ICU admission and higher in BC than Ontario. Reducing the number of people who acquire COVID-19 and severity of illness are required to mitigate the economic impact of COVID-19.
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Affiliation(s)
- Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Seraphine Zeitouny
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Carol Mulder
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Ruth Croxford
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lisa Del Giudice
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lauren Lapointe-Shaw
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Nathan Perlis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Paulos Teckle
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Jennifer D Walker
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kamil Malikov
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kimberlyn M McGrail
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Stuart Peacock
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Girish S Kulkarni
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Reka E Pataky
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Salsman JM, Kircher SM. Financial Hardship in Adolescent and Young Adult Oncology: The Need for Multidimensional and Multilevel Approaches. JCO Oncol Pract 2022; 18:173-176. [PMID: 34807736 PMCID: PMC8932498 DOI: 10.1200/op.21.00663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine and the Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Sheetal M. Kircher
- Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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Rios JD, Velummailum R, Bennett J, Nobre L, Tsang DS, Bouffet E, Hawkins C, Tabori U, Denburg A, Pechlivanoglou P. Clinical and economic impact of molecular testing for BRAF fusion in pediatric low-grade Glioma. BMC Pediatr 2022; 22:13. [PMID: 34980048 PMCID: PMC8722113 DOI: 10.1186/s12887-021-03069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Treatment personalization via tumor molecular testing holds promise for improving outcomes for patients with pediatric low-grade glioma (PLGG). We evaluate the health economic impact of employing tumor molecular testing to guide treatment for patients diagnosed with PLGG, particularly the avoidance of radiation therapy (RT) for patients with BRAF-fusion. Methods We performed a model-based cost-utility analysis comparing two strategies: molecular testing to determine BRAF fusion status at diagnosis against no molecular testing. We developed a microsimulation to model the lifetime health and cost outcomes (in quality-adjusted life years (QALYs) and 2018 CAD, respectively) for a simulated cohort of 100,000 patients newly diagnosed with PLGG after their initial surgery. Results The life expectancy after diagnosis for individuals who did not receive molecular testing was 39.01 (95% Confidence Intervals (CI): 32.94;44.38) years and 40.08 (95% CI: 33.19;45.76) years for those who received testing. Our findings indicate that patients who received molecular testing at diagnosis experienced a 0.38 (95% CI: 0.08;0.77) gain in QALYs and $1384 (95% CI: $-3486; $1204) reduction in costs over their lifetime. Cost and QALY benefits were driven primarily by the avoidance of long-term adverse events (stroke, secondary neoplasms) associated with unnecessary use of radiation. Conclusions We demonstrate the clinical benefit and cost-effectiveness of molecular testing in guiding the decision to provide RT in PLGG. While our results do not consider the impact of targeted therapies, this work is an example of the value of simulation modeling in assessing the long-term costs and benefits of precision oncology interventions for childhood cancer, which can aid decision-making about health system reimbursement. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03069-1.
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Affiliation(s)
- Juan David Rios
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor - L4 East, Toronto, ON, M5G 0A4, Canada
| | - Russanthy Velummailum
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor - L4 East, Toronto, ON, M5G 0A4, Canada
| | - Julie Bennett
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Liana Nobre
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Derek S Tsang
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Cynthia Hawkins
- Department of Pathology, Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Avram Denburg
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor - L4 East, Toronto, ON, M5G 0A4, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor - L4 East, Toronto, ON, M5G 0A4, Canada. .,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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de Oliveira C, Macpherson A, Hepburn CM, Huang A, Strauss R, Liu N, Fiksenbaum L, Pageau P, Gomez D, Saunders NR. Healthcare utilization and costs following non-fatal powdered and non-powdered firearm injuries for children and youth. Eur J Pediatr 2022; 181:2329-2342. [PMID: 35246737 PMCID: PMC9110444 DOI: 10.1007/s00431-022-04429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023]
Abstract
Little is known about the healthcare and economic burdens of non-fatal firearm injuries for children/youth beyond the initial admission. This study sought to estimate healthcare utilization and total direct healthcare costs of non-fatal powdered and non-powdered (air gun) firearm injuries 1-year post-injury. Using administrative data from 2003 to 2018 on all children/youth 0-24 years old in Ontario, Canada, a matched 1:2 cohort study was conducted to compare children/youth who experienced powdered and non-powdered firearm injuries with those who did not. Mean and median number of healthcare encounters and costs, and respective 95% confidence intervals (CIs) and interquartile ranges (IQRs), were estimated for both weapon type groups and controls and by intent. Children/youth who experienced a powdered and non-powdered firearm injury had a higher number of healthcare encounters and costs per year than those who did not. Mean 1-year costs for those with powdered and non-powdered firearm injuries were $8825 ($8007-$9643) and $2349 ($2118-$2578), respectively, versus $812 ($567-$1058) and $753 ($594-$911), respectively, for those without. Mean 1-year costs were highest for handgun injuries ($12,875 [95% CI $9941-$15,808]), and for intentional assault-related ($13,498 [$11,843-$15,153]; $3287 [$2213-$4362]), and intentional self-injuries ($14,773 [$6893-$22,652]; $6005 [$2193-$9817]) for both powdered and non-powdered firearm injuries, respectively. Conclusion: Firearm injuries have substantial healthcare and economic burdens beyond the initial injury-related admission; this should be accounted for when examining the overall impact of firearm injuries. What is Known: • Child/youth firearm injuries have significant health and economic burdens. • However, existing work has mainly examined healthcare utilization and costs of initial admissions and/or have been limited to single-center studies and no studies have provide cost estimates by weapon type and intent. What is New: • Children/youth who suffered powdered firearm injuries had higher mean healthcare utilization and costs than those with non-powdered firearm injuries as well as comparable healthy children/youth. • Mean 1-year costs were highest for handgun injuries ($12,875), and for intentional assault-related ($13,498; $3287), and intentional self-injuries ($14,773; $6005) for powdered and non-powdered firearm injuries, respectively.
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Affiliation(s)
- Claire de Oliveira
- ICES, Toronto, Canada ,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada ,Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Alison Macpherson
- ICES, Toronto, Canada ,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, ON Canada ,Department of Pediatrics, University of Toronto, Toronto, Canada ,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Ning Liu
- ICES, Toronto, Canada ,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- The Hospital for Sick Children, Toronto, ON Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - David Gomez
- ICES, Toronto, Canada ,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada ,Division of General Surgery, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada ,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Natasha Ruth Saunders
- ICES, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,The Hospital for Sick Children, Toronto, ON, Canada. .,Department of Pediatrics, University of Toronto, Toronto, Canada. .,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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Hoag JA, Bingen K, Karst J, Palou A, Yan K, Zhang J. Playing With a Purpose: The Impact of Therapeutic Recreation During Hospitalization. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:6-14. [PMID: 35722870 DOI: 10.1177/27527530211059437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Youth undergoing cancer treatment and hematopoietic stem cell transplant (HSCT) spend significant time in the hospital, which is disruptive to their physical, social, and emotional development. Therapeutic recreation (TR) can help individuals with an illness maintain or improve their health, quality of life, and physical functioning. TR is an understudied intervention, particularly with youth in the hospital setting. Methods: Forty-nine children (median age = 12 years, interquartile range [IQR] 11-15 years) hospitalized for cancer treatment or HSCT were assigned to participate in either the historical control or TR intervention. Participants wore a Fitbit charge HR for three days to measure movement. At the end of the study participation, they completed self-report measures of mood, social connectedness, and health-related quality of life. Results: Compared with historical controls, the TR intervention group had improved positive affect and decreased mood disturbance (p = 0.03); had better sleep quality (p = 0.003); and was more satisfied with the leisure activities offered in the hospital (p = 0.01). There were no differences in the number of steps taken per day, somatic distress, cooperation with cares, or interaction with medical personnel or caregivers. Both groups reported poor availability and support of peer companions. Discussion: TR is one avenue to increase leisure activities and positively impact mood. More thought needs to be given to how TR programs can be leveraged to increase physical activity and social connectedness.
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Affiliation(s)
| | | | - Jeffrey Karst
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Akasha Palou
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ke Yan
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jian Zhang
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
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10
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Soliman R, Elhaddad A, Oke J, Eweida W, Tarek N, Hamza M, Yang Y, Abouelnaga S, Heneghan C. Childhood cancer hospital resource utilization and costs in Egypt, 2013-2017; patterns, trends, and associated factors for 8886 patients from Children's Cancer Hospital, Egypt. Pediatr Blood Cancer 2021; 68:e29347. [PMID: 34520099 DOI: 10.1002/pbc.29347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION There is a lack ofevidence about resource use and costs of childhood cancer care in Egypt. Knowledge about resource use/costs can help in better resource planning to improve care and outcomes efficiently. In this study, we estimated patterns and trends of hospital resource use and costs for children with cancer (n = 8886, aged 0-18 years) treated at Children's Cancer Hospital, Egypt (CCHE), between 2013 and 2017, by ICCC-3 groups, at one and three years post-diagnosis. METHODS We estimated costs from the healthcare provider perspective, expressed in USD 2019. We also studied resource use/cost trends, and factors associated with inpatient days and costs. RESULTS For all cancers combined, median costs were $14,774 (IQR: $6,559-$23,738) at one year and $19,799 (IQR: $8,921-$34,204) at three years post-diagnosis. Median inpatient days were 38 days (IQR: 17-60) at one year, and 43 days (IQR: 20-74) at three years post-diagnosis. Patients with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and neuroblastoma imposed the greatest financial burden on CCHE, representing 53.1% of total costs. AML patients had the highest costs/resource use of all childhood cancers. Cost trends decreased by 2.9% (P < 0.001) for all cancers combined, due to economic instability in Egypt between 2013 and 2017. The use of IV supportive drugs increased by 24.3% (P < 0.001) over time for children with solid tumors. CONCLUSION These findings will inform hospital resource planning and budgeting to promote value in care delivery, with implications for pediatric oncology practice and policy in Egypt/CCHE. Estimated costs provide the foundation for cost-effectiveness analysis.
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Affiliation(s)
- Ranin Soliman
- Department of Continuing Education, University of Oxford, Oxford, UK.,Health Economics and Value Unit, Children's Cancer Hospital, Egypt (CCHE), 57357, Egypt
| | - Alaa Elhaddad
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.,Pediatric Oncology Department, Children's Cancer Hospital, Egypt (CCHE), 57357, Egypt
| | - Jason Oke
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children's Cancer Hospital, Egypt (CCHE), 57357, Egypt
| | - Nourhan Tarek
- Health Economics and Value Unit, Children's Cancer Hospital, Egypt (CCHE), 57357, Egypt
| | - Mahmoud Hamza
- Research Department, Children's Cancer Hospital, Egypt (CCHE), 57357, Egypt
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sherif Abouelnaga
- Pediatric Oncology Department, Children's Cancer Hospital, Egypt (CCHE), 57357, Egypt.,Chief Executive Office, Children's Cancer Hospital, Egypt (CCHE), 57357, Egypt
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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11
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Kishimoto K, Kunisawa S, Fushimi K, Imanaka Y. Individual and Nationwide Costs for Cancer Care During the First Year After Diagnosis Among Children, Adolescents, and Young Adults in Japan. JCO Oncol Pract 2021; 18:e351-e359. [PMID: 34570620 DOI: 10.1200/op.21.00364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE There has been limited information on the economic evaluation of children, adolescents, and young adults (AYAs) with cancer. The aim of this study was to estimate the individual and nationwide costs for cancer care during the first year after diagnosis among children and AYAs in Japan. MATERIALS AND METHODS We estimated the direct health care costs for children (0-14 years old) and AYAs (15-29 years old) from the perspective of the public payer. Children and AYAs with newly diagnosed cancer between April 2016 and March 2018 were identified from the Diagnosis Procedure Combination Study Group database to calculate the cost per patient. The nationwide cost was estimated by the bottom-up approach, using stratification by age group, sex, and cancer classification, based on Population Estimates and Cancer Statistics data. RESULTS A total of 2,939 children and 5,512 AYAs were identified. The median 1-year cost per patient after diagnosis was 2,832,840 (interquartile range, 927,490-9,222,780) JPY (in USD: median, 28,047; interquartile range, 9,183-91,310). The median 1-year cost per patient was higher in children than in AYAs in all cancer classifications. Leukemia, treatment in cancer centers, and early death as well as longer hospital stay were identified to have an impact on 1-year cost per patient after diagnosis. The 1-year nationwide cost after diagnosis was estimated as 34.83 × 109 JPY (344.8 × 106 USD). CONCLUSION We showed that cancer treatments for both children and AYAs were highly cost-intensive in Japan. Our results suggest the need for further financial and policy evaluation.
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Affiliation(s)
- Kenji Kishimoto
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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12
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Ribeiro ILA, de Castro RD, Costa RC, Damascena LCL, de Lucena NNN, Maracajá PMB, Dos Santos FG, de Medeiros Serpa EB, Sousa SA, Valença AMG. Integrated oral care contributes positively to the course of treatment of oncopediatric patients. Eur J Pediatr 2021; 180:2757-2764. [PMID: 33754206 DOI: 10.1007/s00431-021-04024-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to implement a model of permanent oral health care for oncopediatric patients and to observe its effects on severe oral mucositis and subsequent treatment interruptions. We performed a quasi-experimental study in the Pediatric Department of Napoleão Laureano Hospital, in the city of João Pessoa, Brazil. A integrated oral care was implemented by a dentistry team for prevention of comorbidities, such as infections, oral pain, oral function maintenance, oral mucositis, and interventions for lesions due to severe oral mucositis. The oral comorbidities were compared before and after the implementation. The duration of severe oral mucositis (SOM) before and after the interventions and the interruptions in treatment due to SOM were the main outcome measures. Permanent oral health care reduced the duration of SOM and reduced pediatric chemotherapy interruptions due to SOM by 81.8%.Conclusion: The permanent oral health care to offer to oncopediatric patients increased surveillance regarding oral comorbidities and reduced chemotherapy interruptions due to severe oral mucositis. This care plan could be adopted anywhere around the world. What is Known: • Several studies on oral care for pediatric oncology patients, especially regarding both prevention of and treatment for oral mucositis during antineoplastic therapy, have been published. What is New: • This study describes the benefits of permanent oral care with daily oral surveillance for pediatric patients, which reduced the duration of severe oral mucositis, increased surveillance and the efficiency in diagnostic for signs of oral mucositis, enabling early intervention, and decreased chemotherapy interruptions, contributing positively to the course of treatment.
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Affiliation(s)
| | - Ricardo Dias de Castro
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus I, João Pessoa, PB, 58051900, Brazil
| | - Raphael Cavalcante Costa
- Postgraduate Program in Clinical Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | | | | | | | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus I, João Pessoa, PB, 58051900, Brazil
| | | | - Simone Alves Sousa
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus I, João Pessoa, PB, 58051900, Brazil
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13
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Tan O, Schofield DJ, Shrestha R. An Analysis of Hospital Costs for Childhood Cancer Care. J Natl Compr Canc Netw 2021; 20:126-135. [PMID: 34359019 DOI: 10.6004/jnccn.2020.7802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study used a linked dataset consisting of all childhood cancers recorded over the course of 10 years in New South Wales (NSW), Australia, to evaluate the hospital and emergency department costs (from a payer perspective) and resources used by patients with childhood cancer. We also analyzed determinants responsible for high-frequency hospital admissions, hospital length of stay (LoS), and hospital costs. METHODS We analyzed linked data at the individual patient level for a retrospective cohort of 2,966 patients with cancer aged <18 years with a diagnosis date between 2001 and 2012 from the NSW Central Cancer Registry, Australia. We reported costs and use of hospitalization and emergency department presentation 1 year before the date of diagnosis, 1 year after diagnosis, and 2 to 5 years after diagnosis. We also examined the association between cancer types and hospital admission and hospital costs from the payer perspective. Patient characteristics associated with the frequency of hospital admissions, hospital LoS, and hospital costs were also determined using a generalized linear model. RESULTS Most hospital admission costs occurred in the first year after diagnosis, accounting for >70% of hospital costs within 5 years after diagnosis. The estimated median annual cost of hospitalization in the first year after diagnosis was A$88,964 (interquartile range [IQR], A$34,399-A$163,968) for patients diagnosed at age 0 to 14 years and A$23,384 (IQR, A$5,585-A$91,565) for those diagnosed at age 15 to 17 years. Higher frequency of hospital admissions, hospital LoS, and hospital costs were significantly associated with younger age at cancer diagnosis, cancer metastases, and living in remote/disadvantaged socioeconomic areas. CONCLUSIONS Our study represents one of the first in Australia to include detailed hospitalization cost information for all childhood cancer cases. This study highlights the high hospital use by pediatric patients and the importance of early diagnosis. Our findings also demonstrate the health inequities experienced by patients from remote areas and the lowest socioeconomic areas.
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Affiliation(s)
- Owen Tan
- 1GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, Australia
| | - Deborah J Schofield
- 1GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, Australia
| | - Rupendra Shrestha
- 1GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, Australia
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Abstract
BACKGROUND Although retinoblastoma (Rb) is considered to have a good prognosis, economical stress is still a huge problem for patients' families. Besides, doctors, the government, and social foundation staff do not precisely know how much is truly required for complete Rb therapy, especially the non-medical costs and indirect costs. This study was conducted to estimate the economic burden of Rb patients. METHODS This was a retrospective study. Fifty Rb patients were finally enrolled in the study. The questionnaire survey was conducted with surviving Rb patient' main family caregivers to collect the information on costs during illness through the phone. Costs included direct and indirect cost; direct costs included medical and non-medical costs. Medical costs include drug costs, surgery costs, treatment fees, lab tests, non-lab tests costs, and medical consumptive stuff costs (including hospital expenses and outpatient fees). RESULTS The total direct cost was $27,814.62 ± 15,137.73, and the average medical cost was $15,034.48 ± 8,224.19 ($3,963.99-36,826.53). The total non-medical expenses averaged $12,252.93 ± 9,872.64 ($728.86-48,104.95). The average reduced working time was 11.50 ± 8.06 months, and the average lost income was $13,512.23 ± 11,545.83. Among the non-medical expenses, the average non-medical expenses for children in Beijing and surrounding areas was $6,557.68 ± 6,385.42, and the average non-medical expenses for children in other provinces and was $14,502.29 ± 10,484.86, t-test p-value = 0.011. The average transportation cost for children in Beijing and surrounding areas (Hebei, Tianjin) was $1,871.09 ± 1,428.91, other provinces was $4,909.62 ± 3,697.02. Of children in Beijing and surrounding areas the average accommodation fee was $2,788.42 ± 3,065.00, in other provinces it was $6,599.27 ± 3,065.00. CONCLUSION Children with Rb have a heavy economic burden. Direct non-medical expenses are higher. Getting medical treatment nearby can help reduce the economic burden of the disease. Besides, work-related issues are also a major financial problem for families with Rb, and the government should properly provide economic subsidies. Simplifying the national health insurance process and purchasing commercial supplementary medical insurance will increase the family's ability to afford the cost of cancer treatment.
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Affiliation(s)
- Yuchen Zhou
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National center for children's health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing, China
| | - Siyu Cai
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National center for children's health, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Mei Jin
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National center for children's health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing, China
| | - Chiyi Jiang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National center for children's health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing, China
| | | | - Chao Duan
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National center for children's health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National center for children's health, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Junyang Zhao
- Ophthalmology Department, Beijing Children's Hospital, Capital Medical University, National center for children's health, Beijing, China
| | - Xiaoli Ma
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National center for children's health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing, China
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15
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Jiang C, Cai S, Duan C, Xu N, Zhou Y, Peng X, Ma X. Analysis of treatment cost for neuroblastoma to the family: a single-center cross-sectional study in China. J Med Econ 2020; 23:961-966. [PMID: 32568600 DOI: 10.1080/13696998.2020.1786392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Neuroblastoma (NB) is notorious in childhood cancer because of its high incidence and poor prognosis. The Children's Oncology Group reported that the 3-year OS in the high-risk (HR) group is 50%, and the HR-NB with bone marrow metastasis in our center is 43.1%. Thousands of families in China suffer from the cost of NB, but the true costs of therapy are unknown; to date, no study has ever performed a detailed therapy costs analysis for NB. The objective of this study was to assess the economic burden of NB treatment in children to the family, to ultimately reduce related expenses for patients and promote the establishment of NB management policy. MATERIALS AND METHODS Data in this cross-sectional study were collected via questionnaires completed by parents at the outpatient clinic and was verified via a computer system. Therapy costs of children with NB of differing risks were analyzed through descriptive statistics (1 CNY ≈ 0.1412 USD). RESULTS Median direct medical costs of low risk (LR), middle risk (MR), and HR NB during treatment were 180.0 (120.0, 300.0), 200.0 (166.0, 300.0), and 650.0 (415.5, 850.0) thousand Chinese yuan (CNY), respectively. Direct non-medical costs including transportation, food, and accommodation were 60.0 (37.0, 100.0), 80.0 (60.0, 120.0), and 100.0 (80.0, 157.5) thousand CNY in the LR, MR, and HR groups, respectively. Additionally, parents accrued work absences to attend treatment, and lost a total of 100.0 (50.0, 150.0) thousand CNY in indirect costs. LIMITATIONS Families whose children had relapsed or died were excluded from this analysis and therefore limited the conclusions drawn. Parents were asked to recall costs since initial diagnosis (1-6 years in the past), but this extended time period may have introduced recall bias. CONCLUSIONS Direct non-medical and indirect costs play an important role in the total treatment costs of NB. Children with NB treated in local hospitals and followed up in hospital specialized in childhood oncology may save many unnecessary expenses. China's healthcare system should establish mechanisms and provide financial support for children with NB.
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Affiliation(s)
- Chiyi Jiang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Siyu Cai
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chao Duan
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Na Xu
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuchen Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoli Ma
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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16
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The Financial Burden Associated with Medical Costs among Childhood Cancer Patients and Their Families Related to Their Socioeconomic Status: The Perspective of National Health Insurance Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176020. [PMID: 32824940 PMCID: PMC7503756 DOI: 10.3390/ijerph17176020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
The number of cancer survivors is increasing as a consequence of improved therapeutic options. Many families are suffering from the resultant financial burden. Our study aims to determine the total medical cost for 5 years after the initial diagnosis of childhood cancers. A customized dataset from the Korean National Health Insurance Claims Database was requested for this study. A total of 7317 patients were selected to determine the total medical cost. The costs are presented as the 2% trimmed mean value to exclude extreme costs. The medical costs were further classified according to cancer type, treatment phase, and socioeconomic status. Multiple linear regression analyses were performed. The average total medical cost per patient is 36.8 million Korean Wons or 32,157 United States Dollars. Analysis of socioeconomic status revealed that the higher income group demonstrated higher medical expenditure when compared to other groups. Analysis of the treatment phase showed that costs associated with the early phase of treatment are the highest, especially in the first 3 months after initial diagnosis. To alleviate the financial burden and reduce the socioeconomic disparities associated with medical care and costs, a better understanding of the current experience of patients and their families is required.
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17
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Kelada L, Wakefield CE, Vetsch J, Schofield D, Sansom-Daly UM, Hetherington K, O'Brien T, Cohn RJ, Anazodo A, Viney R, Zeppel MJB. Financial toxicity of childhood cancer and changes to parents' employment after treatment completion. Pediatr Blood Cancer 2020; 67:e28345. [PMID: 32333636 DOI: 10.1002/pbc.28345] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Childhood cancer can have short- and long-term impacts on parents' finances and employment. It is important to understand how families adjust to the financial and employment changes caused by childhood cancer, the ongoing impacts after treatment completion, and which families need more targeted support. Qualitative research is necessary to facilitate an in-depth understanding of the employment and financial impacts on families and to capture parents' complex and nuanced experiences and perspectives. METHODS We interviewed 56 parents of childhood cancer survivors (M = 2.13 years after treatment completion; 89% mothers) using the vocational and financial impact section of the Psychosocial Adjustment to Illness Scale-Carer Interview Form. We analyzed interviews using content analysis. RESULTS Parents reported multiple sources of financial toxicity including travel to and from the hospital and needing to reduce their working hours during their child's cancer treatment. Workplace flexibility was an important factor to protect against unwanted vocational changes. After treatment completion, families living in low socioeconomic areas commonly reported ongoing financial difficulties. Mothers, particularly those who were on maternity leave when their child was diagnosed with cancer, reported ongoing employment impacts including unemployment. CONCLUSIONS Clinical staff including social workers could more consistently assess families' financial distress and refer to professional services who can offer guidance for financial decision-making as standard care. Flexible workplace agreements appear important for parents of children with cancer. Our findings can assist organizations to understand that cancer-related disruptions are likely to continue after treatment completion, and therefore should offer benefits to parents where possible.
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Affiliation(s)
- Lauren Kelada
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia.,Institute for Applied Nursing Sciences IPW-FHS, University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Kate Hetherington
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Tracey O'Brien
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High Street, Randwick, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales, Australia
| | - Melanie J B Zeppel
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, New South Wales, Australia
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18
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McBride ML, de Oliveira C, Duncan R, Bremner KE, Liu N, Greenberg ML, Nathan PC, Rogers PC, Peacock SJ, Krahn MD. Comparing Childhood Cancer Care Costs in Two Canadian Provinces. ACTA ACUST UNITED AC 2020; 15:76-88. [PMID: 32176612 PMCID: PMC7075448 DOI: 10.12927/hcpol.2020.26129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Cancer in children presents unique issues for diagnosis, treatment and survivorship care. Phase-specific comparative cost estimates are important for informing healthcare planning. Objectives: The aim of this paper is to compare direct medical costs of childhood cancer by phase of care in British Columbia (BC) and Ontario (ON). Methods: For cancer patients diagnosed at <15 years of age and propensity-score-matched non-cancer controls, we applied standard costing methodology using population-based healthcare administrative data to estimate and compare phase-based costs by province. Results: Phase-specific cancer-attributable costs were 2%–39% higher for ON than for BC. Leukemia pre-diagnosis costs and annual lymphoma continuing care costs were >50% higher in ON. Phase-specific in-patient hospital costs (the major cost category) represented 63%–82% of ON costs, versus 43%–73% of BC costs. Phase-specific diagnostic tests and procedures accounted for 1.0%–3.4% of ON costs and 2.8%–13.0% of BC costs. Conclusions: There are substantial cost differences between these two Canadian provinces, BC and ON, possibly identifying opportunities for healthcare planning improvement.
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Affiliation(s)
- Mary L McBride
- Emerita Scientist, Cancer Control Research, British Columbia Cancer, Vancouver, BC
| | - Claire de Oliveira
- Independent Scientist and Health Economist, Center for Addiction and Mental Health, Toronto, ON
| | - Ross Duncan
- Graduate Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Karen E Bremner
- Research Associate, Toronto General Hospital Research Institute, University Health Network, Toronto, ON
| | - Ning Liu
- Senior Research Analyst, Institute for Clinical Evaluative Sciences, Toronto, ON
| | - Mark L Greenberg
- Chair in Childhood Cancer Control and Professor of Paediatrics and Surgery, Pediatric Oncology Group of Ontario, Toronto, ON
| | - Paul C Nathan
- Staff Oncologist and Director, Aftercare Program, The Hospital for Sick Children, Toronto, ON
| | - Paul C Rogers
- Clinical Professor, Division of Hematology, Oncology & Bone Marrow Transplant, BC Children's Hospital, Vancouver, BC
| | - Stuart J Peacock
- Distinguished Scientist, Leslie Diamond Chair in Cancer Survivorship, Cancer Control Research, British Columbia Cancer, Vancouver, BC
| | - Murray D Krahn
- Senior Scientist and Director, THETA Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON
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19
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Morales JS, Santana‐Sosa E, Santos‐Lozano A, Baño‐Rodrigo A, Valenzuela PL, Rincón‐Castanedo C, Fernández‐Moreno D, González Vicent M, Pérez‐Somarriba M, Madero L, Lassaletta A, Fiuza‐Luces C, Lucia A. Inhospital exercise benefits in childhood cancer: A prospective cohort study. Scand J Med Sci Sports 2019; 30:126-134. [DOI: 10.1111/sms.13545] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/26/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Javier S. Morales
- Faculty of Sport Sciences Universidad Europea de Madrid Madrid Spain
| | | | - Alejandro Santos‐Lozano
- Research Institute of the Hospital 12 de Octubre (i+12) Madrid Spain
- i+HeALTH Department of Health ScienceEuropean University Miguel de Cervantes Valladolid Spain
| | | | - Pedro L. Valenzuela
- Physiology Unit Systems Biology Department University of Alcalá Madrid Spain
| | | | | | - Marta González Vicent
- Pediatric Hematology and Oncology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Marta Pérez‐Somarriba
- Pediatric Hematology and Oncology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Luis Madero
- Pediatric Hematology and Oncology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Alvaro Lassaletta
- Pediatric Hematology and Oncology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | | | - Alejandro Lucia
- Faculty of Sport Sciences Universidad Europea de Madrid Madrid Spain
- Research Institute of the Hospital 12 de Octubre (i+12) Madrid Spain
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20
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Barr RD, Feeny DA. Health-related quality of life in adolescents and young adults with cancer - Including a focus on economic evaluation. Pediatr Blood Cancer 2019; 66:e27808. [PMID: 31081602 DOI: 10.1002/pbc.27808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 04/27/2019] [Accepted: 04/27/2019] [Indexed: 11/12/2022]
Abstract
Health-related quality of life (HRQL) is an amalgam of three elements - the opportunities that a person's health status affords, the constraints that it places upon the person and the value that a person places on his/her health status. HRQL measures are specific, for example for a disease, or generic with broad applicability. The latter include preference-based measures that can be used to generate quality-adjusted life years and so contribute to economic evaluation. Measures of HRQL in adolescents and young adults (AYAs) with cancer may fail to capture some important dimensions, for example sexual health. However, the use of HRQL measures in this population has identified burdens of morbidity according to disease, treatment status and duration of follow-up. There are few economic evaluations of the treatment of cancer in AYAs but preliminary evidence suggests that this is a cost-effective undertaking. Opportunities abound to include measurement of HRQL in routine clinical care.
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Affiliation(s)
- Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - David A Feeny
- Department of Economics, McMaster University, Hamilton, Ontario, Canada.,Health Utilities Incorporated, Dundas, Ontario, Canada
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21
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Nathan PC, Bremner KE, Liu N, Gupta S, Greenberg ML, McBride ML, Krahn MD, de Oliveira C. Resource Utilization and Costs in Adolescents Treated for Cancer in Pediatric vs Adult Institutions. J Natl Cancer Inst 2019; 111:322-330. [PMID: 30053118 PMCID: PMC6410950 DOI: 10.1093/jnci/djy119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Adolescents with cancer can receive care in pediatric or adult institutions. Survival often differs by locus, but little is known about relative health care utilization and costs. We estimated these in a population-based cohort of adolescents. METHODS All Ontario adolescents (15.0-17.9 years) diagnosed with cancer between 1995 and 2010 were identified from provincial cancer registries. We compared health care resource utilization (hospitalizations, emergency department visits, same-day surgeries, outpatient chemotherapy, radiation, diagnostic/laboratory tests, physician services, home care) and costs (2012 Canadian dollars) during four discrete care phases-prediagnosis (60 days), initial (360 days), continuing (variable), and terminal (360 days)-between adolescents treated in pediatric vs adult institutions, for the whole cohort and within seven diagnostic categories. All statistical tests were two-sided. RESULTS Of 1356 eligible adolescents, 691 and 665 were treated in adult and pediatric institutions, respectively. Hospitalization rates were higher in pediatric institutions during prediagnosis (14.9% vs 6.9%, P < .001), initial (95.1% vs 73.3%, P < .001), and continuing phases (43.2% vs 34.4%, P = .002), but similar (96.1% vs 96.3%, P = .93) during the terminal phase. Average length of stay was higher at pediatric institutions within most diagnoses and phases. For all diagnoses, median initial phase costs were higher in pediatric than adult institutions (eg, leukemia: $153 926 vs $102 418 per 360 days, P < .001; lymphoma: $65 025 vs $19 846, P < .001, respectively). CONCLUSIONS The costs of caring for adolescents with the same malignancy are considerably higher in pediatric than adult institutions during most phases. Resource utilization, particularly hospitalization, drives much of the cost difference, making these data applicable to other jurisdictions.
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Affiliation(s)
- Paul C Nathan
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Mark L Greenberg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Mary L McBride
- British Columbia Cancer Agency, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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22
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de Oliveira C, Bremner KE, Liu N, Greenberg ML, Nathan PC, McBride ML, Krahn MD. Costs of cancer care in children and adolescents in Ontario, Canada. Pediatr Blood Cancer 2017; 64. [PMID: 28500732 DOI: 10.1002/pbc.26628] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/22/2017] [Accepted: 04/11/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cancer in children and adolescents presents unique issues regarding treatment and survivorship, but few studies have measured economic burden. We estimated health care costs by phase of cancer care, from the public payer perspective, in population-based cohorts. METHODS Children newly diagnosed at ages 0 days-14.9 years and adolescents newly diagnosed at 15-19.9 years, from January 1, 1995 to June 30, 2010, were identified from Ontario cancer registries, and each matched to three noncancer controls. Data were linked with administrative records describing resource use for cancer and other health care. Total and net (patients minus controls) resource-specific costs ($CAD2012) were estimated using generalized estimating equations for four phases of care: prediagnosis (60 days), initial (360 days), continuing (variable), final (360 days). RESULTS Mean ages at diagnosis were 6 years for children (N = 4,606) and 17 years for adolescents (N = 2,443). Mean net prediagnosis phase 60-day costs were $6,177 for children and $1,018 for adolescents. Costs for initial, continuing, and final phases were $138,161, $15,756, and $316,303 per 360 days for children, and $62,919, $7,071, and $242,008 for adolescents. The highest initial phase costs were for leukemia patients ($156,225 per 360 days for children and $171,275 for adolescents). The final phase was the most costly ($316,303 per 360 days for children and $242,008 for adolescents). CONCLUSIONS Costs for children with cancer are much higher than for adolescents and much higher than those reported in adults. Comprehensive population-based long-term estimates of cancer costs are useful for health services planning and cost-effectiveness analysis.
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Affiliation(s)
- Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mark L Greenberg
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary L McBride
- Cancer Control Research Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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