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Soilly AL, Aho Glélé LS, Bernard A, Abou Hanna H, Filaire M, Magdaleinat P, Marty-Ané C, Tronc F, Grima R, Baste JM, Thomas PA, Richard De Latour B, Pforr A, Pagès PB. Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01). BMC Health Serv Res 2023; 23:1004. [PMID: 37723516 PMCID: PMC10507914 DOI: 10.1186/s12913-023-09962-y] [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: 06/20/2022] [Accepted: 08/24/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Lungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context. METHODS Two hundred and fifty nine adult patients from 10 French centres were randomised in this prospective multicentre randomised controlled trial, between July 29, 2016, and November 24, 2020. Survival from surgical intervention to day 30 and later was compared with the log-rank test. Total quality-adjusted-life-years (QALYs) were calculated using the EQ-5D-3L®. For medico-economic analyses at 30 days and at 3 months after surgery, resources consumed were valorised (€ 2018) from a hospital perspective. First, since mortality was infrequent and not different between the two arms, cost-minimisation analyses were performed considering only the cost differential. Second, based on complete cases on QALYs, cost-utility analyses were performed taking into account cost and QALY differential. Acceptability curves and the 95% confidence intervals for the incremental ratios were then obtained using the non-parametric bootstrap method (10,000 replications). Sensitivity analyses were performed using multiple imputations with the chained equation method. RESULTS The average cumulative costs of thoracotomy were lower than those of video-thoracoscopy at 30 days (€9,730 (SD = 3,597) vs. €11,290 (SD = 4,729)) and at 3 months (€9,863 (SD = 3,508) vs. €11,912 (SD = 5,159)). In the cost-utility analyses, the incremental cost-utility ratio was €19,162 per additional QALY gained at 30 days (€36,733 at 3 months). The acceptability curve revealed a 64% probability of efficiency at 30 days for video-thoracoscopy, at a widely-accepted willingness-to-pay threshold of €25,000 (34% at 3 months). Ratios increased after multiple imputations, implying a higher cost for video-thoracoscopy for an additional QALY gain (ratios: €26,015 at 30 days, €42,779 at 3 months). CONCLUSIONS Given our results, the economic efficiency of video-thoracoscopy at 30 days remains fragile at a willingness-to-pay threshold of €25,000/QALY. The economic efficiency is not established beyond that time horizon. The acceptability curves given will allow decision-makers to judge the probability of efficiency of this technology at other willingness-to-pay thresholds. TRIAL REGISTRATION NCT02502318.
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Affiliation(s)
- Anne-Laure Soilly
- Direction of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network, CHU Dijon-Bourgogne, 21000, Dijon, France.
| | | | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Halim Abou Hanna
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Marc Filaire
- Department of Thoracic Surgery and Endocrine Surgery, Centre Jean Perrin, Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Charles Marty-Ané
- Department of Thoracic and Cardiovascular Surgery, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France
| | - François Tronc
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | - Renaud Grima
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | | | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, North University Hospital, Aix-Marseille University & APHM, Marseille, France
| | | | - Arnaud Pforr
- Department of Thoracic and Vascular Surgery, Avignon, Avignon, CH, France
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Bonnafous S, Margier J, Bartier S, Tournegros R, Tringali S, Fieux M. Estimated Costs Associated With Management of Otosclerosis With Hearing Aids vs Surgery in Europe. JAMA Netw Open 2022; 5:e2148932. [PMID: 35175343 PMCID: PMC8855228 DOI: 10.1001/jamanetworkopen.2021.48932] [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: 11/17/2022] Open
Abstract
IMPORTANCE Surgery and hearing aids have similar outcomes in terms of hearing acuity but differ in terms of cost, aesthetics, and patient quality of life. The cost-effectiveness and budget impact of otosclerosis treatments have never been studied in Europe. OBJECTIVES To compare the estimated mean costs per patient over 10 years of surgery vs hearing aids for the treatment of otosclerosis and to estimate the budget impact of an increase in the proportion of patients receiving surgical treatment. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation analyzed French and European epidemiological data on the surgical management of symptomatic otosclerosis and compared them with data from the literature to build economic models. The analysis was conducted in January 2021. EXPOSURES Two care pathways were considered in the treatment of otosclerosis, either hearing aid or surgery. MAIN OUTCOMES AND MEASURES Costs were studied over 10 years using Markov models of the 2 care pathways (hearing aid vs surgery). The budget impact analysis was performed over 5 and 10 years, assuming a 1-percentage point yearly increase in the proportion of patients receiving surgical treatment. RESULTS Over 10 years, the estimated mean cost per patient was significantly lower in the surgery group compared with the hearing aid group (€3446.9 vs €6088.4; mean difference, -€2641.5; 95% CI -€4064.8 to -€1379.4 [US $3913.4 vs US $6912.4; mean difference, -US $2999.0; 95% CI, -US $4614.9 to -US $1566.1]). Increasing surgical treatment by 1 percentage point per year for 10 years would lead to overall savings of €1 762 304 (US $2 000 798) in France, with an increase of €1 322 920 (US $1 501 952) at 10 years for the public health insurance system and a decrease of €3 085 224 (US $3 502 750) at 10 years for patients and private health insurers. Sensitivity analyses showed that these results were robust. CONCLUSIONS AND RELEVANCE These results suggest that in France, treating otosclerosis surgically is slightly less expensive over 10 years than using hearing aids, when considering all payers. The proposed models developed in this study could be adjusted to perform the same analysis in other countries.
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Affiliation(s)
- Sophie Bonnafous
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’oto-rhino-laryngologie, d’otoneurochirurgie et de chirurgie cervico-faciale, Lyon, France
| | - Jennifer Margier
- Hospices Civils de Lyon, Pôle de Santé Publique, Service d’ Évaluation Économique en Santé, Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Sophie Bartier
- Service d’oto-rhino-laryngologie, de chirurgie cervico faciale, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
- Univ Paris Est Creteil, INSERM, Institut Mondor de Recherche Biomédicale, Créteil, France
- Centre National de la Recherche Scientifique, Equipe Mixte de Recherche 7000, Créteil, France
| | - Romain Tournegros
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’oto-rhino-laryngologie, d’otoneurochirurgie et de chirurgie cervico-faciale, Lyon, France
| | - Stéphane Tringali
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’oto-rhino-laryngologie, d’otoneurochirurgie et de chirurgie cervico-faciale, Lyon, France
- Université de Lyon, Université Lyon 1, Lyon, France
| | - Maxime Fieux
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’oto-rhino-laryngologie, d’otoneurochirurgie et de chirurgie cervico-faciale, Lyon, France
- Univ Paris Est Creteil, INSERM, Institut Mondor de Recherche Biomédicale, Créteil, France
- Centre National de la Recherche Scientifique, Equipe Mixte de Recherche 7000, Créteil, France
- Université de Lyon, Université Lyon 1, Lyon, France
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Monirul S, Rigal M, Chouahnia K, Le Jouan M, Apparuit M, Paix A, Jacolot A, Zelek L, Duchemann B. Budget Impact Analysis of Fixed Dose Versus Weight-Based Dosing Regimen of Nivolumab and Pembrolizumab in the Treatment of Non-Small Cell Lung Cancer. Vaccines (Basel) 2020; 8:E730. [PMID: 33287161 PMCID: PMC7761677 DOI: 10.3390/vaccines8040730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022] Open
Abstract
In 2018, dosing regimens of the two most prescribed immune check point inhibitors (ICI), nivolumab (Opdivo®) and pembrolizumab (Keytruda®), in the treatment of lung cancer were changed from weight-based dosing to fixed dosing. The aim of this study was to compare the economic impact of this change in our university hospital group and then across Ile-de-France, the most inhabited French region. A budget impact analysis (BIA) has been performed on the French public health insurance data. The duration of treatment and the weight of the patients were calculated using data from the patients treated at our health facility and from clinical studies. The cost of treatment was calculated at the local level of our health facility and then for Ile-de-France. Our model demonstrates an additional cost of €550,115 in our hospital and €9,704,778 in Ile-de-France for a fixed dose prescription in 2018. In 2019, the BIA concluded an additional cost, according to the respective low and high assumptions, of €556,969 and €756,544 locally and € 10,201,027 to €14,486,141 for Ile-de-France for an equivalent efficacy between the two different drug dosing regimens of nivolumab and pembrolizumab. The adoption of the fixed dose regimen would lead, according to the least expensive hypothesis, to an additional cost of 26% for the ICI. These results encourage reflection on the strict adoption of this dosage modification. The option of maintaining the free choice between a prescription adapted to weight or in a fixed dose seems a relevant option and should be considered.
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Affiliation(s)
- Sanjana Monirul
- Department of Pharmacy, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine Saint-Denis, 93000 Bobigny, France; (S.M.); (M.R.); (M.A.); (A.J.)
| | - Marthe Rigal
- Department of Pharmacy, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine Saint-Denis, 93000 Bobigny, France; (S.M.); (M.R.); (M.A.); (A.J.)
| | - Kader Chouahnia
- Department of Medical and Thoracic Oncology, Hôpitaux Universitaires Paris Seine Saint-Denis, 93000 Bobigny, France; (K.C.); (L.Z.)
| | | | - Maxime Apparuit
- Department of Pharmacy, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine Saint-Denis, 93000 Bobigny, France; (S.M.); (M.R.); (M.A.); (A.J.)
| | - Adrien Paix
- Institut de Radiothérapie de Bobigny, rue Lautréamont, 93000 Bobigny, France;
| | - Anne Jacolot
- Department of Pharmacy, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine Saint-Denis, 93000 Bobigny, France; (S.M.); (M.R.); (M.A.); (A.J.)
| | - Laurent Zelek
- Department of Medical and Thoracic Oncology, Hôpitaux Universitaires Paris Seine Saint-Denis, 93000 Bobigny, France; (K.C.); (L.Z.)
| | - Boris Duchemann
- Department of Medical and Thoracic Oncology, Hôpitaux Universitaires Paris Seine Saint-Denis, 93000 Bobigny, France; (K.C.); (L.Z.)
- Gustave Roussy Cancer Campus, Laboratoire D’immunomonitoring en Oncologie, CNRS-UMS 3655 and INSERM-US23, 94805 Villejuif, France
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Pöhlmann J, Norrbacka K, Boye KS, Valentine WJ, Sapin H. Costs and where to find them: identifying unit costs for health economic evaluations of diabetes in France, Germany and Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1179-1196. [PMID: 33025257 PMCID: PMC7561572 DOI: 10.1007/s10198-020-01229-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health economic evaluations require cost data as key inputs. Many countries do not have standardized reference costs so costs used often vary between studies, thereby reducing transparency and transferability. The present review provided a comprehensive overview of cost sources and suggested unit costs for France, Germany and Italy, to support health economic evaluations in these countries, particularly in the field of diabetes. METHODS A literature review was conducted across multiple databases to identify published unit costs and cost data sources for resource items commonly used in health economic evaluations of antidiabetic therapies. The quality of unit cost reporting was assessed with regard to comprehensiveness of cost reporting and referencing as well as accessibility of cost sources from published cost-effectiveness analyses (CEA) of antidiabetic medications. RESULTS An overview of cost sources, including tariff and fee schedules as well as published estimates, was developed for France, Germany and Italy, covering primary and specialist outpatient care, emergency care, hospital treatment, pharmacy costs and lost productivity. Based on these sources, unit cost datasets were suggested for each country. The assessment of unit cost reporting showed that only 60% and 40% of CEAs reported unit costs and referenced them for all pharmacy items, respectively. Less than 20% of CEAs obtained all pharmacy costs from publicly available sources. CONCLUSIONS This review provides a comprehensive account of available costs and cost sources in France, Germany and Italy to support health economists and increase transparency in health economic evaluations in diabetes.
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Affiliation(s)
- J Pöhlmann
- Ossian Health Economics and Communications, Basel, Switzerland
| | | | - K S Boye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W J Valentine
- Ossian Health Economics and Communications, Basel, Switzerland
| | - H Sapin
- Lilly France, 24 Bd Vital Bouhot, CS 50004, 92521, Neuilly-sur-Seine Cedex, France.
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El Khal M, Perrier L, Carretier J, Touillaud M, Hureau M, Pérol D, Fervers B. [The cost of the therapeutic education program "Eat better, move more through nutrition education" in patients with breast cancer]. Bull Cancer 2020; 107:1252-1259. [PMID: 33012504 DOI: 10.1016/j.bulcan.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Since the life expectancy of women with breast cancer has increased, tertiary prevention, through the Therapeutic Patient Education (TPE), is now a part of patient support. The main objective of this pilot study is to evaluate the cost of a nutrition and physical activity TPE program intended to help women with breast cancer in the management of their weight. METHODS This study is a description of costs, based on the micro-costing method, of the first two years of the program, conducted on an outpatient basis, at the Cancer Center Leon Berard, Lyon, France, with the involvement of a dietician and a physical activity trainer. Only the direct costs were taken into account, from the hospital's perspective, in Euro 2016. Sensitivity analyses were also conducted. RESULTS Sixty-five patients were included in the study in 2014/2015. Their mean age was 52 years, the majority of them were in sick leave (65 %). In most cases, they had undergone surgery (95 %) and chemotherapy (71 %). The average cost per patient of the program was 541.04€ (SD 88.44€; 95 % IC [520.06-562.03]) excluding overhead costs, i.e. 687.13€ overhead costs included. The unit cost of the dietician was the most sensitive parameters. CONCLUSION This cost study, an accurate estimate of the production costs, allows to inform the decision-maker in term of pricing of such a program and to make the necessary adjustments in order to optimize the organization of this activity.
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Affiliation(s)
- Mariam El Khal
- Centre Léon-Bérard, département prévention cancer et environnement, 28, rue Laënnec, 69008 Lyon, France
| | - Lionel Perrier
- Université de Lyon, centre Léon-Bérard, GATE L-SE UMR, 5824, 28, rue Laënnec, 69008 Lyon, France; Centre Léon-Bérard, direction de la recherche clinique et de l'innovation, 28, rue Laënnec, 69008 Lyon, France
| | - Julien Carretier
- Centre Léon-Bérard, département prévention cancer et environnement, 28, rue Laënnec, 69008 Lyon, France.
| | - Marina Touillaud
- Centre Léon-Bérard, département prévention cancer et environnement, 28, rue Laënnec, 69008 Lyon, France; Unité Inserm UA8 « radiations : défense, santé, environnement », 28, rue Laënnec, 69008 Lyon, France
| | - Magalie Hureau
- Centre Léon-Bérard, direction de la recherche clinique et de l'innovation, 28, rue Laënnec, 69008 Lyon, France
| | - David Pérol
- Centre Léon-Bérard, direction de la recherche clinique et de l'innovation, 28, rue Laënnec, 69008 Lyon, France
| | - Béatrice Fervers
- Centre Léon-Bérard, département prévention cancer et environnement, 28, rue Laënnec, 69008 Lyon, France; Unité Inserm UA8 « radiations : défense, santé, environnement », 28, rue Laënnec, 69008 Lyon, France
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