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Wills L, Nagarwalla D, Pearson C, McPhail S, Hinchliffe R, Sharpless B, Fardus-Reid F, Ambler L, Harrison S, Shelton J. Estimating surgery, radiotherapy and systemic anti-cancer therapy treatment costs for cancer patients by stage at diagnosis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:763-774. [PMID: 37656260 DOI: 10.1007/s10198-023-01623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The increasing burden of cancer has economic implications for the healthcare system in England. However, there is limited evidence on the cost of cancer treatment. We calculated the costs of initial cancer treatment (resection, radiotherapy, systemic anti-cancer therapy [SACT]) based on stage at diagnosis. METHODS Data from England's National Cancer Registration Dataset were matched to English Hospital, Radiotherapy and SACT data for breast, lung, prostate, colon and rectal cancers diagnosed between 2016 and 2018. Treatment data were matched to National Schedule of Reference Costs data to calculate the cost of each treatment event. RESULTS Breast, colon and rectal cancers treated with resection, radiotherapy or SACT had increasing costs with later stage at diagnosis; costs for lung and prostate cancers were lower at stages 1 and 4 compared to stages 2 and 3. In general, surgery and SACT were the most expensive treatments. Radiotherapy and SACT costs showed little change across stages 1-3; radiotherapy costs decreased in stage 4, while SACT costs increased. CONCLUSIONS This analysis estimates initial treatment costs by stage based on observed data. Future research can build on this to provide more comprehensive costings associated with cancer; this is important for future planning of cancer services.
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Affiliation(s)
- Lorna Wills
- Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
- National Cancer Registration and Analysis Service, NHS Digital, 10 South Colonnade, London, E14 4PU, UK
| | - Diana Nagarwalla
- Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK.
- National Cancer Registration and Analysis Service, NHS Digital, 10 South Colonnade, London, E14 4PU, UK.
| | - Clare Pearson
- Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
- National Cancer Registration and Analysis Service, NHS Digital, 10 South Colonnade, London, E14 4PU, UK
| | - Sean McPhail
- National Cancer Registration and Analysis Service, NHS Digital, 10 South Colonnade, London, E14 4PU, UK
| | | | - Ben Sharpless
- Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
- National Cancer Registration and Analysis Service, NHS Digital, 10 South Colonnade, London, E14 4PU, UK
| | - Fahmina Fardus-Reid
- Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
- National Cancer Registration and Analysis Service, NHS Digital, 10 South Colonnade, London, E14 4PU, UK
| | - Lyndsy Ambler
- Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | | | - Jon Shelton
- Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
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Hayes H, Meacock R, Stokes J, Sutton M. How do family doctors respond to reduced waiting times for cancer diagnosis in secondary care? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:813-828. [PMID: 37787842 DOI: 10.1007/s10198-023-01626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 08/09/2023] [Indexed: 10/04/2023]
Abstract
Reducing waiting times is a priority in public health systems. Efforts of healthcare providers to shorten waiting times could be negated if they simultaneously induce substantial increases in demand. However, separating out the effects of changes in supply and demand on waiting times requires an exogenous change in one element. We examine the impact of a pilot programme in some English hospitals to shorten waiting times for urgent diagnosis of suspected cancer on family doctors' referrals. We examine referrals from 6,666 family doctor partnerships to 145 hospitals between 1st April 2012 and 31st March 2019. Five hospitals piloted shorter waiting times initiatives in 2017. Using continuous difference-in-differences regression, we exploit the pilot as a 'supply shifter' to estimate the effect of waiting times on referral volumes for two suspected cancer types: bowel and lung. The proportion of referred patients breaching two-week waiting times targets for suspected bowel cancer fell by 3.9 percentage points in pilot hospitals in response to the policy, from a baseline of 4.8%. Family doctors exposed to the pilot increased their referrals (demand) by 10.8%. However, the pilot was not successful for lung cancer, with some evidence that waiting times increased, and a corresponding reduction in referrals of -10.5%. Family doctor referrals for suspected cancer are responsive at the margin to waiting times. Healthcare providers may struggle to achieve long-term reductions in waiting times if supply-side improvements are offset by increases in demand.
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Affiliation(s)
- Helen Hayes
- Office of Health Economics (OHE), London, UK.
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - Rachel Meacock
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- MRC/CSO Social & Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- Melbourne Institute of Applied Economic and Social Research, Faculty of Business and Economics, The University of Melbourne, Parkville, VIC, Australia
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3
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Chen J, Huan J, Chen C, Xu W, Jia A. Enhancing hospice care with psychological support and a nomogram to predict delirium in patients with advanced solid tumors. Am J Cancer Res 2024; 14:2478-2492. [PMID: 38859841 PMCID: PMC11162653 DOI: 10.62347/trqo1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/28/2024] [Indexed: 06/12/2024] Open
Abstract
To assesses the impact of integrating hospice care with psychological interventions on patient well-being and to introduce a predictive nomogram model for delirium that incorporates clinical and psychosocial variables, thereby improving the accuracy in hospice care environments. Data from 381 patients treated from September 2018 to February 2023 were analyzed. The patients were divided into a control group (n=177, receiving standard care) and an experimental group (n=204, receiving combined hospice care and psychological interventions) according to the treatment modality. The duration of care extended until the patient's discharge from the hospital or death. The experimental group demonstrated significant improvements in emotional well-being and a lower incidence of delirium compared to the control group. Specifically, emotional well-being assessments revealed marked improvements in the experimental group, as evidenced by lower scores on the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) post-intervention. The nomogram model, developed using logistic regression based on clinical characteristics, effectively predicted the risk of delirium in patients with advanced cancer. Significant predictors in the model included ECOG score ≥3, Palliative Prognostic Index score ≥6, opioid usage, polypharmacy, infections, sleep disorders, organ failure, brain metastases, electrolyte imbalances, activity limitations, pre-care SAS score ≥60, pre-care SDS score ≥63, and pre-care KPS score ≥60. The model's predictive accuracy was validated, showing AUC values of 0.839 for the training cohort and 0.864 for the validation cohort, with calibration and Decision Curve Analysis (DCA) confirming its clinical utility. Integrating hospice care with psychological interventions not only significantly enhanced the emotional well-being of advanced cancer patients but also reduced the actual incidence of delirium. This approach, offering a valuable Nomogram model for precise care planning and risk management, underscores the importance of integrated, personalized care strategies in advanced cancer management.
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Affiliation(s)
- Juan Chen
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Jingjing Huan
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Chunyan Chen
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Wenxia Xu
- Department of Emergency, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
| | - Aiqun Jia
- Department of Oncology, The People’s Hospital of RugaoNantong 226500, Jiangsu, China
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4
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Jackson CE, Green NH, English WR, Claeyssens F. The use of microphysiological systems to model metastatic cancer. Biofabrication 2024; 16:032002. [PMID: 38579739 DOI: 10.1088/1758-5090/ad3b70] [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: 11/13/2023] [Accepted: 04/05/2024] [Indexed: 04/07/2024]
Abstract
Cancer is one of the leading causes of death in the 21st century, with metastasis of cancer attributing to 90% of cancer-related deaths. Therefore, to improve patient outcomes there is a need for better preclinical models to increase the success of translating oncological therapies into the clinic. Current traditional staticin vitromodels lack a perfusable network which is critical to overcome the diffusional mass transfer limit to provide a mechanism for the exchange of essential nutrients and waste removal, and increase their physiological relevance. Furthermore, these models typically lack cellular heterogeneity and key components of the immune system and tumour microenvironment. This review explores rapidly developing strategies utilising perfusable microphysiological systems (MPS) for investigating cancer cell metastasis. In this review we initially outline the mechanisms of cancer metastasis, highlighting key steps and identifying the current gaps in our understanding of the metastatic cascade, exploring MPS focused on investigating the individual steps of the metastatic cascade before detailing the latest MPS which can investigate multiple components of the cascade. This review then focuses on the factors which can affect the performance of an MPS designed for cancer applications with a final discussion summarising the challenges and future directions for the use of MPS for cancer models.
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Affiliation(s)
- Caitlin E Jackson
- Materials Science and Engineering, The Kroto Research Institute, University of Sheffield, Sheffield S3 7HQ, United Kingdom
- Insigneo Institute for In Silico Medicine, The Pam Liversidge Building, University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - Nicola H Green
- Materials Science and Engineering, The Kroto Research Institute, University of Sheffield, Sheffield S3 7HQ, United Kingdom
- Insigneo Institute for In Silico Medicine, The Pam Liversidge Building, University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - William R English
- Norwich Medical School, University of East Anglia, Norwich NR3 7TJ, United Kingdom
| | - Frederik Claeyssens
- Materials Science and Engineering, The Kroto Research Institute, University of Sheffield, Sheffield S3 7HQ, United Kingdom
- Insigneo Institute for In Silico Medicine, The Pam Liversidge Building, University of Sheffield, Sheffield S1 3JD, United Kingdom
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5
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Zhuang Q, Zhou S, Ho S, Neo PSH, Cheung YB, Yang GM. Can an Integrated Palliative and Oncology Co-rounding Model Reduce Aggressive Care at the End of Life? Secondary Analysis of an Open-label Stepped-wedge Cluster-randomized Trial. Am J Hosp Palliat Care 2024; 41:442-451. [PMID: 37246153 DOI: 10.1177/10499091231180460] [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] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Clinical trial evidence on the effect of palliative care models in reducing aggressive end-of-life care is inconclusive. We previously reported on an integrated inpatient palliative care and medical oncology co-rounding model that significantly reduced hospital bed-days and postulate additional effect on reducing care aggressiveness. OBJECTIVES To compare the effect of a co-rounding model vs usual care in reducing receipt of aggressive treatment at end-of-life. METHODS Secondary analysis of an open-label stepped-wedge cluster-randomized trial comparing two integrated palliative care models within the inpatient oncology setting. The co-rounding model involved pooling specialist palliative care and oncology into one team with daily review of admission issues, while usual care constituted discretionary specialist palliative care referrals by the oncology team. We compared odds of receiving aggressive care at end-of-life: acute healthcare utilization in last 30 days of life, death in hospital, and cancer treatment in last 14 days of life between patients in two trial arms. RESULTS 2145 patients were included in the analysis, and 1803 patients died by 4th April 2021. Median overall survival was 4.90 (4.07 - 5.72) months in co-rounding and 3.75 (3.22 - 4.21) months in usual care, with no difference in survival (P = .12). We found no significant differences between both models with respect to receipt of aggressive care at end-of-life. (Odds Ratio .67 - 1.27; all P > .05). CONCLUSION The co-rounding model within an inpatient setting did not reduce aggressiveness of care at end-of-life. This could be due in part to the overall focus on resolving episodic admission issues.
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Affiliation(s)
- Qingyuan Zhuang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Siqin Zhou
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Shirlynn Ho
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Patricia Soek Hui Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Tonini V, Zanni M. Why is early detection of colon cancer still not possible in 2023? World J Gastroenterol 2024; 30:211-224. [PMID: 38314134 PMCID: PMC10835528 DOI: 10.3748/wjg.v30.i3.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
Colorectal cancer (CRC) screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers. Over the years, screening, particularly in those settings where it is well organized, has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them. Despite considerable advancements in screening technologies and strategies, the effectiveness of CRC screening programs remains less than optimal. This paper examined the multifaceted reasons behind the persistent lack of effectiveness in CRC screening initiatives. Through a critical analysis of current methodologies, technological limitations, patient-related factors, and systemic challenges, we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates. While acknowledging the advancements that have improved aspects of screening, we emphasized the necessity of addressing the identified barriers comprehensively. This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease. Screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage. Spending more sooner can mean saving money later.
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Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| | - Manuel Zanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
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7
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Youk TM, Hong JH, Park BK, Park YM, Park EC. Estimation of the Three Phases by Direct Cost of Care for Non-surviving Patients with Cancer: A National Population-based Patient-level Study. J Cancer 2024; 15:20-29. [PMID: 38164281 PMCID: PMC10751664 DOI: 10.7150/jca.78491] [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: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
Background: Determining the cost structure of medical care from diagnosis to the death of patients with cancer is crucial for establishing budgets to support patients with cancer. The breakdown of the cost estimation in distinct phases of survival is essential for optimizing the allocation of limited funds. Therefore, this study aims to examine the patterns of direct medical costs of cancer care associated with seven major cancer types and estimate cost thresholds to distinguish each phase based on the incurred cost. Methods: In this nationwide, population-based study, we used claims data from the National Health Insurance Service, Korea. Patients newly diagnosed with cancer since 2006 and who died in 2016-2017 were enrolled, and their use of medical services during cancer survival from at least 6 months up to 12 years was observed. The monthly cost exhibited a non-linear function with two unknown thresholds resembling a U-shape; therefore, we fitted three linear segment models. Individual costs were assessed by dividing the survival time into the initial, continuing, and terminal phases by estimated thresholds, and the average medical cost for each phase was calculated. Results: Based on survival durations of 12 years or less, the initial phase occurred within 1.1-4.8 months after diagnosis, while the terminal phase was observed in 1.4-4.7 months before death. The length of these two phases increased with the increased survival time of the patients. Medical costs in these phases ranged from $4067-7431 and $3127-6114 (US dollars), respectively, regardless of the variations in survival time. However, the average costs in the continuing phase were higher for patients with a short survival time. Conclusions: This study highlights the cost dynamics in cancer care through a breakdown of the phases of survival. It suggests that through a more refined definition of the initial and terminal phases, the average cost in these stages increases, indicating the significant implications of the findings for resource allocation and tailored financial support strategies for patients with cancer with varying prognoses.
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Affiliation(s)
- Tae Mi Youk
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Statistics, Korea University, Seoul, Republic of Korea
| | - Jung Hwa Hong
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Byung Kyu Park
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Young Min Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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8
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Willis TA, Neal RD, Walter FM, Foy R. Priorities for implementation research on diagnosing cancer in primary care: a consensus process. BMC Health Serv Res 2023; 23:1308. [PMID: 38012602 PMCID: PMC10683096 DOI: 10.1186/s12913-023-10330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The early detection and diagnosis of cancer to reduce avoidable mortality and morbidity is a challenging task in primary health care. There is a growing evidence base on how to enable earlier cancer diagnosis, but well-recognised gaps and delays exist around the translation of new research findings into routine clinical practice. Implementation research aims to accelerate the uptake of evidence by health care systems and professionals. We aimed to identify priorities for implementation research in early cancer diagnosis in primary care. METHODS We used a RAND/UCLA modified Delphi consensus process to identify and rank research priorities. We asked primary care physicians, patients and researchers to complete an online survey suggesting priorities for implementation research in cancer detection and diagnosis. We summarised and presented these suggestions to an 11-member consensus panel comprising nine primary care physicians and two patients. Panellists independently rated the importance of suggestions on a 1-9 scale (9 = very high priority; 1 = very low priority) before and after a structured group discussion. We ranked suggestions using median ratings. RESULTS We received a total of 115 suggested priorities for implementation research from 32 survey respondents (including 16 primary care professionals, 11 researchers, and 4 patient and public representatives; 88% of respondents were UK-based). After removing duplicates and ineligible suggestions, we presented 37 suggestions grouped within 17 categories to the consensus panel. Following two rounds of rating, 27 suggestions were highly supported (median rating 7-9). The most highly rated suggestions concerned diagnostic support (e.g., access to imaging) interventions (e.g., professional or patient education), organisation of the delivery of care (e.g., communication within and between teams) and understanding variations in care and outcomes. CONCLUSIONS We have identified a set of priorities for implementation research on the early diagnosis of cancer, ranked in importance by primary care physicians and patients. We suggest that researchers and research funders consider these in directing further efforts and resources to improve population outcomes.
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Affiliation(s)
- Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, United Kingdom.
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus Heavitree Road, Exeter, EX1 2LU, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, United Kingdom
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Buja A, Cozzolino C, Zanovello A, Geppini R, Miatton A, Zorzi M, Manfredi M, Bovo E, Del Fiore P, Tropea S, dall’Olmo L, Rossi CR, Mocellin S, Rastrelli M, Rugge M. Cost items in melanoma patients by clinical characteristics and time from diagnosis. Front Oncol 2023; 13:1234931. [PMID: 38023154 PMCID: PMC10666743 DOI: 10.3389/fonc.2023.1234931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Costs related to the care of melanoma patients have been rising over the past few years due to increased disease incidence as well as the introduction of innovative treatments. The aim of this study is to analyse CMM cost items based on stage at diagnosis, together with other diagnostic and prognostic characteristics of the melanoma. Methods Analyses were performed on 2,647 incident cases of invasive CMM that were registered in 2015 and 2017 in the Veneto Cancer Registry (RTV). Direct melanoma-related costs per patient were calculated for each year ranging from 2 years before diagnosis to 4 years after, and were stratified by cost items such as outpatient services, inpatient drug prescriptions, hospital admissions, hospice admissions, and emergency room treatment. Average yearly costs per patient were compared according to available clinical-pathological characteristics. Lastly, log-linear multivariable analysis was performed to investigate potential cost drivers among these clinical-pathological characteristics. Findings Overall, the average direct costs related to melanoma are highest in the first year after diagnosis (€2,903) and then decrease over time. Hospitalization costs are 8 to 16 times higher in the first year than in subsequent years, while the costs of outpatient services and inpatient drugs decrease gradually over time. When stratified by stage it is observed that the higher expenditure associated with more advanced stages of CMM is mainly due to inpatient drug use. Conclusion The results of the present study show that grouping patients according to tumour characteristics can improve our understanding of the different cost items associated with cutaneous malignant melanoma. CMM patients experience higher costs in the first year after diagnosis due to higher hospitalization and outpatient services. Policy makers should consider overall and stage-specific annual costs when allocating resources for the management of CMM patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Claudia Cozzolino
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Anna Zanovello
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Ruggero Geppini
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Andrea Miatton
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - Mariagiovanna Manfredi
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | | | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Luigi dall’Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
- Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
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Hill H, Kearns B, Pashayan N, Roadevin C, Sasieni P, Offman J, Duffy S. The cost-effectiveness of risk-stratified breast cancer screening in the UK. Br J Cancer 2023; 129:1801-1809. [PMID: 37848734 PMCID: PMC10667489 DOI: 10.1038/s41416-023-02461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND There has been growing interest in the UK and internationally of risk-stratified breast screening whereby individualised risk assessment may inform screening frequency, starting age, screening instrument used, or even decisions not to screen. This study evaluates the cost-effectiveness of eight proposals for risk-stratified screening regimens compared to both the current UK screening programme and no national screening. METHODS A person-level microsimulation model was developed to estimate health-related quality of life, cancer survival and NHS costs over the lifetime of the female population eligible for screening in the UK. RESULTS Compared with both the current screening programme and no screening, risk-stratified regimens generated additional costs and QALYs, and had a larger net health benefit. The likelihood of the current screening programme being the optimal scenario was less than 1%. No screening amongst the lowest risk group, and triannual, biennial and annual screening amongst the three higher risk groups was the optimal screening strategy from those evaluated. CONCLUSIONS We found that risk-stratified breast cancer screening has the potential to be beneficial for women at the population level, but the net health benefit will depend on the particular risk-based strategy.
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Affiliation(s)
- Harry Hill
- School of Medicine and Population Health, University of Sheffield, Sheffield, England.
| | - Ben Kearns
- School of Medicine and Population Health, University of Sheffield, Sheffield, England
- Lumanity Inc, Sheffield, England
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, England
| | - Cristina Roadevin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, England
| | - Peter Sasieni
- Life Sciences & Medicine, King's College London, London, England
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Judith Offman
- Life Sciences & Medicine, King's College London, London, England
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Stephen Duffy
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
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Epstein N, Simon-Tuval T, Berchenko Y. Context-Specific Estimation of Future Unrelated Medical Costs and Their Impact on Cost-Effectiveness Analyses. PHARMACOECONOMICS 2023; 41:1275-1286. [PMID: 37329391 DOI: 10.1007/s40273-023-01290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study constructed and applied procedures for the estimation of unrelated future medical costs (UFMC) of women with breast cancer in Israel (as a case study) and examined the influence of including UFMC in cost-effectiveness analyses (CEAs). METHODS Part I consisted of a retrospective cohort study based on patient-level claims data of both patients with breast cancer and matched controls during 14 years of follow-up. UFMC were estimated as (a) the annual average all-cause healthcare costs of the control subjects, and (b) as predicted values based on a generalized linear model (GLM) adjusted to patients' characteristics. Part II consisted of a CEA performed using a Markov simulation model comparing regimens of chemotherapy with/without trastuzumab, both excluding and including UFMC and for each of the UFMC estimates separately. All costs were adjusted to 2019 prices. Costs and QALYs were discounted at a yearly rate of 3%. RESULTS The average annual healthcare costs in the control group were $2328 (± $5662). The corresponding incremental cost-effectiveness ratio (ICER) was $53,411/QALY and $55,903/QALY, when UFMC were excluded or included, respectively. Hence, trastuzumab was not considered cost-effective compared with a threshold of willingness-to-pay of $37,000 per QALY, regardless of the inclusion of UFMC. When UFMC were estimated on the basis of the prediction model, the ICERs were $37,968/QALY and $39,033/QALY, when UFMC were excluded or included, respectively. Thus, in this simulation, trastuzumab was not considered cost-effective, independent of the inclusion of UFMC. CONCLUSION Our case study revealed that the inclusion of UFMC had modest effect on the ICERs, and thus did not alter the conclusion. Thus, we should estimate context-specific UFMC if they are expected to change the ICERs significantly, and transparently report the corresponding assumptions to uphold the integrity and reliability of the economic evaluation.
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Affiliation(s)
- Noga Epstein
- Department of Industrial Engineering and Management, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzahit Simon-Tuval
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O Box 653, 8410501, Beer-Sheva, Israel.
| | - Yakir Berchenko
- Department of Industrial Engineering and Management, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Vargas-Palacios A, Sharma N, Sagoo GS. Cost-effectiveness requirements for implementing artificial intelligence technology in the Women's UK Breast Cancer Screening service. Nat Commun 2023; 14:6110. [PMID: 37777510 PMCID: PMC10542368 DOI: 10.1038/s41467-023-41754-0] [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: 02/16/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023] Open
Abstract
The UK NHS Women's National Breast Screening programme aims to detect breast cancer early. The reference standard approach requires mammograms to be independently double-read by qualified radiology staff. If two readers disagree, arbitration by an independent reader is undertaken. Whilst this process maximises accuracy and minimises recall rates, the procedure is labour-intensive, adding pressure to a system currently facing a workforce crisis. Artificial intelligence technology offers an alternative to human readers. While artificial intelligence has been shown to be non-inferior versus human second readers, the minimum requirements needed (effectiveness, set-up costs, maintenance, etc) for such technology to be cost-effective in the NHS have not been evaluated. We developed a simulation model replicating NHS screening services to evaluate the potential value of the technology. Our results indicate that if non-inferiority is maintained, the use of artificial intelligence technology as a second reader is a viable and potentially cost-effective use of NHS resources.
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Affiliation(s)
- Armando Vargas-Palacios
- Academic Unit of Health Economics, University of Leeds, Leeds, UK.
- Centro de Investigación en Ciencias de la Salud, Universidad Anáhuac, Mexico, México.
| | | | - Gurdeep S Sagoo
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Rojas-Díaz D, Puerta-Yepes ME, Medina-Gaspar D, Botero JA, Rodríguez A, Rojas N. Mathematical Modeling for the Assessment of Public Policies in the Cancer Health-Care System Implemented for the Colombian Case. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6740. [PMID: 37754600 PMCID: PMC10531264 DOI: 10.3390/ijerph20186740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/28/2023] [Accepted: 07/20/2023] [Indexed: 09/28/2023]
Abstract
The incidence of cancer has been constantly growing worldwide, placing pressure on health systems and increasing the costs associated with the treatment of cancer. In particular, low- and middle-income countries are expected to face serious challenges related to caring for the majority of the world's new cancer cases in the next 10 years. In this study, we propose a mathematical model that allows for the simulation of different strategies focused on public policies by combining spending and epidemiological indicators. In this way, strategies aimed at efficient spending management with better epidemiological indicators can be determined. For validation and calibration of the model, we use data from Colombia-which, according to the World Bank, is an upper-middle-income country. The results of the simulations using the proposed model, calibrated and validated for Colombia, indicate that the most effective strategy for reducing mortality and financial burden consists of a combination of early detection and greater efficiency of treatment in the early stages of cancer. This approach is found to present a 38% reduction in mortality rate and a 20% reduction in costs (% GDP) when compared to the baseline scenario. Hence, Colombia should prioritize comprehensive care models that focus on patient-centered care, prevention, and early detection.
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Affiliation(s)
- Daniel Rojas-Díaz
- Area of Fundamental Sciences, School of Applied Sciences and Engineering, Universidad EAFIT, Medellin 050022, Colombia
| | - María Eugenia Puerta-Yepes
- Area of Fundamental Sciences, School of Applied Sciences and Engineering, Universidad EAFIT, Medellin 050022, Colombia
| | - Daniel Medina-Gaspar
- School of Finance, Economics, and Government, Universidad EAFIT, Medellin 050022, Colombia
| | - Jesús Alonso Botero
- School of Finance, Economics, and Government, Universidad EAFIT, Medellin 050022, Colombia
| | - Anwar Rodríguez
- Center for Economic Studies, National Association of Financial Institutions (ANIF), Bogota 110231, Colombia
| | - Norberto Rojas
- Center for Economic Studies, National Association of Financial Institutions (ANIF), Bogota 110231, Colombia
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14
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Francisci S, Tursini F, Dal Maso L, Gigli A, Guzzinati S. Projecting cancer prevalence by phase of care: a methodological approach for health service planning. Front Oncol 2023; 13:1201464. [PMID: 37711195 PMCID: PMC10499514 DOI: 10.3389/fonc.2023.1201464] [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: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
Background In most developed countries, the number of cancer survivors is expected to increase in the coming decades because of rising incidence and survival rates and an aging population. These patients are heterogeneous in terms of health service demands: from recently diagnosed patients requiring first-course therapy to patients with extensive care needs and severe disabilities to long-term survivors who only need minimal care. Therefore, in terms of providing healthcare planners and policymakers with useful indicators for addressing policies according to health service demands, it is worth supplying updated measures of prevalence for groups of patients based on the level of care they require. The aim of this paper is to illustrate a new method for estimating short-term projections of cancer prevalence by phase of care that applies to areas covered by cancer registration. Methods The proposed method combines linear regression models to project limited duration prevalence derived from cancer registry data and a session of the freely available software COMPREV to estimate the projected complete prevalence into three distinct clinically relevant phases of care: initial, continuing, and final. The method is illustrated and validated using data from the Veneto region in Italy for breast, colorectal, and lung cancers. Results Prevalence is expected to increase in 2015-2026 for all considered cancer sites and sexes, with average annual variations spanning from 2.6% for women with lung cancer to 0.5% for men with colorectal cancer. The only exception is lung cancer prevalence in men, which shows an average annual decrease of 1.9%. The majority of patients are in the continuing phase of care, followed by the initial and final phases, except for lung cancer, where the final phase of care prevails over the initial one. Discussion The paper proposes a method for estimating (short-term) future cancer healthcare needs that is based on user-friendly and freely available software and linear regression models. Validation results confirm the applicability of our method to the most frequent cancer types, provided that cancer registry data with at least 15 years of registration are available. Evidence from this method is addressed to policymakers for planning future cancer care, thus improving the cancer survivorship experience for patients and caregivers.
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Affiliation(s)
- Silvia Francisci
- National Center for Disease Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Francesco Tursini
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Stefano Guzzinati
- Regional Epidemiological Service, Veneto Cancer Registry (RTV), Azienda Zero, Padova, Italy
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15
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Bradley SH, Francetic I. Don't assume that cutting back on cancer diagnosis would improve other services. BMJ 2023; 382:1698. [PMID: 37491024 DOI: 10.1136/bmj.p1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
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16
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Jang Y, Kim T, Kim BHS, Kim JH, Seong H, Kim YJ, Park B. Economic Burden of Cancer for the First Five Years after Cancer Diagnosis in Patients with Human Immunodeficiency Virus in Korea. J Cancer Prev 2023; 28:53-63. [PMID: 37434797 PMCID: PMC10331032 DOI: 10.15430/jcp.2023.28.2.53] [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: 03/19/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
This study aimed to estimate the medical cost of cancer in the first five years of diagnosis and in the final six months before death in people who developed cancer after human immunodeficiency virus (HIV) infection in Korea. The study utilized the Korea National Health Insurance Service-National Health Information Database (NHIS-NHID). Among 16,671 patients diagnosed with HIV infection from 2004 to 2020 in Korea, we identified 757 patients newly diagnosed with cancer after HIV diagnosis. The medical costs for 60 months after diagnosis and the last six months before death were calculated from 2006 to 2020. The mean annual medical cost due to cancer in HIV-infected people with cancer was higher for acquired immunodeficiency syndrome (AIDS)-defining cancers (48,242 USD) than for non-AIDS-defining cancers (24,338 USD), particularly non-Hodgkin's lymphoma (53,007 USD), for the first year of cancer diagnosis. Approximately 25% of the cost for the first year was disbursed during the first month of cancer diagnosis. From the second year, the mean annual medical cost due to cancer was significantly reduced. The total medical cost was higher for non-AIDS-defining cancers, reflecting their higher incidence rates despite lower mean medical costs. The mean monthly total medical cost per HIV-infected person who died after cancer diagnosis increased closer to the time of death. The estimated burden of medical costs in patients with HIV in the present study may be an important index for defining healthcare policies in HIV patients in whom the cancer-related burden is expected to increase.
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Affiliation(s)
- Yoonyoung Jang
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Program in Regional Information, Department of Agricultural Economics and Rural Development, Seoul National University, Seoul, Korea
| | - Taehwa Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Psychology, Sungkyunkwan University, Seoul, Korea
| | - Brian H. S. Kim
- Program in Regional Information, Department of Agricultural Economics and Rural Development, Seoul National University, Seoul, Korea
- Program in Agricultural and Forest Meteorology, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, Korea
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
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17
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Bhimani N, Wong GY, Molloy C, Dieng M, Kelly PJ, Hugh TJ. Lifetime direct healthcare costs of treating colorectal cancer: a systematic review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:513-537. [PMID: 35844018 DOI: 10.1007/s10198-022-01497-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 06/23/2022] [Indexed: 05/12/2023]
Abstract
Colorectal cancer is a global public health issue and imposes a significant economic burden on populations and healthcare systems. This paper systematically reviews the literature to estimate the direct costs of colorectal cancer incurred during different phases of treatment (initial, continuing and end of life). MEDLINE, EMBASE, Web of science, Evidence-based medicine reviews: National health service economic evaluation database guide, econlit and grey literature from the 1st of January 2000 to the 1st of February 2020. The methodological quality of the included studies was assessed using the Evers' Consensus on health economic criteria checklist. In total, 39,489 records were retrieved, and 17 studies were included. Costs by phase of treatment varied due to heterogeneity. However, studies that examined average costs for each phase of treatment showed a V-shaped distribution where the initial and end of life phases contribute the most and the continuing phase the least. The initial phase ranged from $7,893 to $60,289; the continuing annual phase ranged from $2,323 to $15,744; and the end of life phase ranged from $15,916 to $99,687. Studies that provided the total cost of each phase conversely showed that the continuing phase was the highest contributor to the cost of treating CRC. This study estimates the cost of the contemporary management of colorectal cancer despite the methodological heterogeneity. These costs place a heavy burden on healthcare providers, patients and their families. Identifying these costs can impact health care budgets and guide policymakers in making informed decisions for the future.
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Affiliation(s)
- Nazim Bhimani
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Geoffrey Ym Wong
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Charles Molloy
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Mbathio Dieng
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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18
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Leskelä RL, Korhonen S, Haavisto I, Nuutinen M, Peltonen E, Herse F, Käkelä S, Autere AM, Nolvi K, Tiainen S, Silvoniemi M, Junnila EL, Ahvonen J, Knuuttila A, Koivunen J. Trends in cost of treatment of lung cancer patients in 2014-2019 in Finland - a descriptive register study. Acta Oncol 2023; 62:587-593. [PMID: 37459504 DOI: 10.1080/0284186x.2023.2218040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 04/28/2023] [Indexed: 07/22/2023]
Abstract
AIM The aim of this descriptive study is to analyze the cost for the treatment of NSCLC and SCLC patients (2014-2019) in Finland. The primary objective is to understand recent (2014-2019) cost developments. METHODS The study is retrospective and based on hospital register data. The study population consists of NSCLC and SCLC patients diagnosed in four out of the five Finnish university hospitals. The final sample included 4047 NSCLC patients and 766 SCLC patients. RESULTS Cost of the treatment in lung cancer is increasing. Both the average cost of the first 12 months as well as the first 24 months after diagnosis increases over time. For patients diagnosed in 2014, the average cost of the first 24 months was 19,000 €and for those diagnosed in 2015 22,000 €. The annual increase in the nominal 24-month costs was 10.4% for NSCLC and 7.3% for SCLC patients. CONCLUSION The average cost per patient has increased annually for both NSCLC and SCLC. Possible explanations to the cost increase are increased medicine costs (especially in NSCLC), and the increased percentage of patients being actively treated.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Katja Nolvi
- University of Eastern Finland, an employee of MSD Finland Oy at the time the study was conducted, Kuopio, Finland
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19
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Sullivan R, Aggarwal A. Proposal to scrap England's long term plan for cancer. BMJ 2023; 380:326. [PMID: 36792136 DOI: 10.1136/bmj.p326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, Global Oncology Group, King's College London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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20
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Connal S, Cameron JM, Sala A, Brennan PM, Palmer DS, Palmer JD, Perlow H, Baker MJ. Liquid biopsies: the future of cancer early detection. J Transl Med 2023; 21:118. [PMID: 36774504 PMCID: PMC9922467 DOI: 10.1186/s12967-023-03960-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/13/2023] Open
Abstract
Cancer is a worldwide pandemic. The burden it imposes grows steadily on a global scale causing emotional, physical, and financial strains on individuals, families, and health care systems. Despite being the second leading cause of death worldwide, many cancers do not have screening programs and many people with a high risk of developing cancer fail to follow the advised medical screening regime due to the nature of the available screening tests and other challenges with compliance. Moreover, many liquid biopsy strategies being developed for early detection of cancer lack the sensitivity required to detect early-stage cancers. Early detection is key for improved quality of life, survival, and to reduce the financial burden of cancer treatments which are greater at later stage detection. This review examines the current liquid biopsy market, focusing in particular on the strengths and drawbacks of techniques in achieving early cancer detection. We explore the clinical utility of liquid biopsy technologies for the earlier detection of solid cancers, with a focus on how a combination of various spectroscopic and -omic methodologies may pave the way for more efficient cancer diagnostics.
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Affiliation(s)
- Siobhan Connal
- Dxcover Ltd., Royal College Building, 204 George Street, Glasgow, G1 1XW UK ,grid.11984.350000000121138138Department of Pure and Applied Chemistry, Thomas Graham Building, University of Strathclyde, 295 Cathedral Street, Glasgow, G11XL UK
| | - James M. Cameron
- Dxcover Ltd., Royal College Building, 204 George Street, Glasgow, G1 1XW UK
| | - Alexandra Sala
- Dxcover Ltd., Royal College Building, 204 George Street, Glasgow, G1 1XW UK
| | - Paul M. Brennan
- grid.4305.20000 0004 1936 7988Translational Neurosurgery, Centre for Clinical Brain Sciences, 49 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4BS UK
| | - David S. Palmer
- Dxcover Ltd., Royal College Building, 204 George Street, Glasgow, G1 1XW UK ,grid.11984.350000000121138138Department of Pure and Applied Chemistry, Thomas Graham Building, University of Strathclyde, 295 Cathedral Street, Glasgow, G11XL UK
| | - Joshua D. Palmer
- grid.412332.50000 0001 1545 0811Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Haley Perlow
- grid.412332.50000 0001 1545 0811Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Matthew J. Baker
- Dxcover Ltd., Royal College Building, 204 George Street, Glasgow, G1 1XW UK ,grid.11984.350000000121138138Department of Pure and Applied Chemistry, Thomas Graham Building, University of Strathclyde, 295 Cathedral Street, Glasgow, G11XL UK ,grid.7943.90000 0001 2167 3843School of Medicine, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, PR1 2HE UK
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21
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Tralongo P, Cappuccio F, Gori S, Donato V, Beretta G, Elia A, Romano F, Iacono M, Tralongo AC, Bordonaro S, Di Mari A, Giuliano SR, Buccafusca G, Careri MC, Santoro A. Clinicians' and Patients' Perceptions and Use of the Word "Cured" in Cancer Care: An Italian Survey. Curr Oncol 2023; 30:1332-1353. [PMID: 36826064 PMCID: PMC9955737 DOI: 10.3390/curroncol30020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The words "hope" and "cure" were used in a greater number of articles and sentences in narrative and editorial papers than in primary research. Despite concomitant improvements in cancer outcomes, the related reluctance to use these terms in more scientifically oriented original reports may reflect a bias worthy of future exploration. This study aims to survey a group of physicians and cancer patients regarding their perception and use of the word cure. MATERIALS AND METHOD An anonymous online and print survey was conducted to explore Italian clinicians' (the sample includes medical oncologists, radiotherapists, and oncological surgeons) and cancer patients' approach to the perception and use of the word "cure" in cancer care. The participants received an email informing them of the study's purpose and were invited to participate in the survey via a linked form. A portion, two-thirds, of questionnaires were also administered to patients in the traditional paper form. RESULTS The survey was completed by 224 clinicians (54 oncologists, 78 radiotherapists, and 92 cancer surgeons) and 249 patients. The results indicate a favourable attitude for patients in favour of a new language ("cured" vs. "complete remission") of the disease experience. CONCLUSIONS The use of the word cured is substantially accepted and equally shared by doctors and patients. Its use can facilitate the elimination of metaphoric implications and toxic cancer-related connotations registered in all cultures that discourage patients from viewing cancer as a disease with varied outcomes, including cure.
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Affiliation(s)
- Paolo Tralongo
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
- Correspondence:
| | - Francesco Cappuccio
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy
| | - Vittorio Donato
- Radiotherapy Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Giordano Beretta
- Medical Oncology Unit, Santo Spirito Hospital, 65124 Pescara, Italy
| | - Ausilia Elia
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Fabrizio Romano
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Margherita Iacono
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Sebastiano Bordonaro
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Annamaria Di Mari
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Gabriella Buccafusca
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Maria Carmela Careri
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital and Humanitas Cancer Center, 20089 Milan, Italy
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Xu RH, Wang LL, Zhou LM, Wong ELY, Wang D. Assessment of eHealth literacy to reduce financial toxicity and improve shared decision-making in cancer patients: A cross-sectional study. Digit Health 2023; 9:20552076231181475. [PMID: 37334320 PMCID: PMC10272650 DOI: 10.1177/20552076231181475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/25/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives This study aimed to investigate the associations between eHealth literacy, preferences for financial decision-making, and financial toxicity (FT) in a sample of Chinese cancer patients. Methods Eligible cancer patients were invited to participate in a cross-sectional survey from January to April 2021. Three measures (eHealth literacy scale, control preference scale, and COST) were used to analyze patients' eHealth literacy, decisional preferences, and FT, respectively. Wilcoxon signed-rank test and Kruskal-Wallis H test assessed the differences between population subgroups. Binary logistic and multivariate linear regression models were used to assess the relationships between eHealth literacy, decisional preferences, and FT. Results A total of 590 cancer patients completed the questionnaire. We found that high FT was associated with poor ECOG performance, severe cancer stage, and longer cancer duration. Patients who preferred to adopt collaborative attitude toward decision-making showed a significantly higher eHealth literacy. However, there was an inverse relationship between eHealth literacy and a patient-driven attitude toward decision-making in female cancer patients. Regression analysis indicated that patients who were highly educated and actively employed might report a higher eHealth literacy. A significant relationship was found between high eHealth literacy and low FT. However, this relationship became insignificant when the background characteristics of cancer patients were taken into account. Conclusions A relationship between enhanced eHealth literacy, preference for collaborative decision-making, and low risk of FT is identified. Practical implication Interventions to improve patients' ability to use quality and reliable web-based information on cancer care should be encouraged.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ling-ling Wang
- Department of Blood Transfusion Medicine, School of Medicine, Nanjing University, Nanjing, China
| | - Ling-ming Zhou
- Department of Human Resource, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Eliza Lai-yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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Zhuang Q, Chong PH, Ong WS, Yeo ZZ, Foo CQZ, Yap SY, Lee G, Yang GM, Yoon S. Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis. BMC Med 2022; 20:313. [PMID: 36131339 PMCID: PMC9494890 DOI: 10.1186/s12916-022-02513-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Home-based palliative care (HPC) is considered to moderate the problem of rising healthcare utilization of cancer patients at end-of-life. Reports however suggest a proportion of HPC patients continue to experience high care intensity. Little is known about differential trajectories of healthcare utilization in patients on HPC. Thus, we aimed to uncover the heterogeneity of healthcare utilization trajectories in HPC patients and identify predictors of each utilization pattern. METHODS This is a cohort study of adult cancer patients referred by Singapore Health Services to HCA Hospice Service who died between 1st January 2018 and 31st March 2020. We used patient-level data to capture predisposing, enabling, and need factors for healthcare utilization. Group-based multi-trajectory modelling was applied to identify trajectories for healthcare utilization based on the composite outcome of emergency department (ED) visits, hospitalization, and outpatient visits. RESULTS A total of 1572 cancer patients received HPC (median age, 71 years; interquartile range, 62-80 years; 51.1% female). We found three distinct trajectory groups: group 1 (31.9% of cohort) with persistently low frequencies of healthcare utilization, group 2 (44.1%) with persistently high frequencies, and group 3 (24.0%) that begin with moderate frequencies, which dropped over the next 9 months before increasing in the last 3 months. Predisposing (age, advance care plan completion, and care preferences), enabling (no medical subsidy, primary decision maker), and need factors (cancer type, comorbidity burden and performance status) were significantly associated with group membership. High symptom needs increased ED visits and hospitalizations in all three groups (ED visits, group 1-3: incidence rate ratio [IRR] 1.74-6.85; hospitalizations, group 1-3: IRR 1.69-6.60). High home visit intensity reduced outpatient visits in all three groups (group 1-3 IRR 0.54-0.84), while it contributed to reduction of ED visits (IRR 0.40; 95% CI 0.25-0.62) and hospitalizations (IRR 0.37; 95% CI 0.24-0.58) in group 2. CONCLUSIONS This study on HPC patients highlights three healthcare utilization trajectories with implications for targeted interventions. Future efforts could include improving advance care plan completion, supporting care preferences in the community, proactive interventions among symptomatic high-risk patients, and stratification of home visit intensity.
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Affiliation(s)
- Qingyuan Zhuang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
| | | | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Cherylyn Qun Zhen Foo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Su Yan Yap
- Palliative Care Services, Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Guozhang Lee
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Centre for Population Health Research and Implementation, Singapore Regional Health System, Singapore, Singapore
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Francisci S, Capodaglio G, Gigli A, Mollica C, Guzzinati S. Cancer cost profiles: The Epicost estimation approach. Front Public Health 2022; 10:974505. [PMID: 36211660 PMCID: PMC9533128 DOI: 10.3389/fpubh.2022.974505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 01/21/2023] Open
Abstract
Sustainability of cancer burden is becoming increasingly central in the policy makers' debate, and poses a challenge for the welfare systems, due to trends towards greater intensity of healthcare service use, which imply increasing costs of cancer care. Measuring and projecting the economic burden associated with cancer and identifying effective policies for minimising its impact are important issues for healthcare systems. Scope of this paper is to illustrate a novel comprehensive approach (called Epicost) to the estimation of the economic burden of cancer, based on micro-data collected from multiple data sources. It consists of a model of cost analysis to estimate the amount of reimbursement payed by the National Health Service to health service providers (hospitals, ambulatories, pharmacies) for the expenses incurred in the diagnoses and treatments of a cohort of cancer patients; these cancer costs are estimated in various phases of the disease reflecting patients' patterns of care: initial, monitoring and final phase. The main methodological features are illustrated using a cohort of colon cancer cases from a Cancer Registry in Italy. This approach has been successfully implemented in Italy and it has been adapted to other European countries, such as Belgium, Norway and Poland in the framework of the Innovative Partnership for Action Against Cancer (iPAAC) Joint Action, sponsored by the European Commission. It is replicable in countries/regions where population-based cancer registry data is available and linkable at individual level with administrative data on costs of care.
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Affiliation(s)
- Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Guilia Capodaglio
- Screening and Health Impact Assessment Unit, Azienda Zero, Padova, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Cristina Mollica
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Guzzinati
- Regional Epidemiological Service, Veneto Cancer Registry (RTV), Azienda Zero, Padova, Italy,*Correspondence: Stefano Guzzinati
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25
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Garg R, Cheng V, Ellis U, Verma V, McTaggart-Cowan H, Peacock S, Loree JM, Sadatsafavi M, De Vera MA. Direct medical costs of young-onset colorectal cancer: a worldwide systematic review. BMC Health Serv Res 2022; 22:1100. [PMID: 36042470 PMCID: PMC9426038 DOI: 10.1186/s12913-022-08481-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Given the rising incidence of young-onset colorectal cancer (yCRC) among individuals younger than 50 years old, understanding the economic burden of yCRC is required to inform the delivery of healthcare services. Therefore, we conducted a systematic review of studies assessing the direct medical costs of yCRC, and where relevant average-age onset CRC (aCRC). Methods We searched MEDLINE, EMBASE, and Web of Science from inception to May 2022 for original, peer-reviewed studies, that reported direct medical costs (e.g., chemotherapy, radiotherapy, outpatient visits, inpatient care, prescription medications) for yCRC and aCRC. We used a modified version of the Consolidated Health Economic Evaluation Reporting Standards checklist to appraise the studies. Costs were inflation-adjusted to 2020 US dollars. Results We included 14 studies from 10 countries, including the USA, England, France, Korea, Vietnam, China, Italy, Australia, Canada and Japan. Five studies focused on prevalent disease and reported annualized per-capita cost of prevalent yCRC, ranging from $2,263 to $16,801 and $1,412 to $14,997 among yCRC and aCRC cases, respectively. Nine studies estimated the cost of incident disease. Synthesis of per-capita costs incurred 12 months following colorectal cancer diagnosis ranged from $23,368 to $89,945 for yCRC and $19,929 to $67,195 for aCRC. Five studies used multivariable approaches to compare costs associated with yCRC and aCRC, four showed no differences and one suggested greater costs with yCRC. Conclusion Our synthesis of direct medical costs of yCRC across multiple jurisdictions provide relevant information for healthcare decisions, including on-going considerations for expanding CRC screening strategies to younger adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08481-6.
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Affiliation(s)
- Ria Garg
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Vicki Cheng
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Ursula Ellis
- University of British Columbia Library, Vancouver, BC, Canada
| | - Vanay Verma
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Helen McTaggart-Cowan
- BC Cancer, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Stuart Peacock
- BC Cancer, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jonathan M Loree
- BC Cancer, Vancouver, BC, Canada.,Faculty of Medicine, Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada. .,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada.
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26
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Treatment Costs of Colorectal Cancer by Sex and Age: Population-Based Study on Health Insurance Data from Germany. Cancers (Basel) 2022; 14:cancers14153836. [PMID: 35954499 PMCID: PMC9367511 DOI: 10.3390/cancers14153836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Evidence on the cost-effectiveness of screening for colorectal cancer (CRC) in the German general population remains scarce as key input parameters, the costs to treat CRC, are largely unknown. Here, we provide detailed estimates on CRC treatment costs over time. Methods: Using insurance claims data from the Vilua healthcare research database, we included subjects with newly diagnosed CRC and subjects who died of CRC between 2012 and 2016. We assessed annualized CRC-related inpatient, outpatient and medication costs for up to five years after first diagnosis and prior to death, stratified by sex and age. Findings: We identified 1748 and 1117 subjects with follow-up data for at least 1 year after diagnosis and prior to death, respectively. In those newly diagnosed, average costs were highest in the first year after diagnosis (men, EUR 16,375−16,450; women, EUR 10,071−13,250) and dropped steeply in the following years, with no consistent pattern of differences with respect to age. Costs prior to death were substantially higher as compared to the initial phase of care and consistently on a high level even several years before death, peaking in the final year of life, with strong differences by sex and age (men vs. women, <70 years, EUR 34,351 vs. EUR 31,417; ≥70 years, EUR 14,463 vs. EUR 9930). Conclusion: Once clinically manifest, CRC causes substantial treatment costs over time, particularly in the palliative care setting. Strong differences in treatment costs by sex and age warrant further investigation.
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Price S, Landa P, Mujica-Mota R, Hamilton W, Spencer A. Revising the Suspected-Cancer Guidelines: Impacts on Patients' Primary Care Contacts and Costs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022:S1098-3015(22)02095-2. [PMID: 35953398 DOI: 10.1016/j.jval.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to explore the impact of revising suspected-cancer referral guidelines on primary care contacts and costs. METHODS Participants had incident cancer (colorectal, n = 2000; ovary, n = 763; and pancreas, n = 597) codes in the Clinical Practice Research Datalink or England cancer registry. Difference-in-differences analyses explored guideline impacts on contact days and nonzero costs between the first cancer feature and diagnosis. Participants were controls ("old National Institute for Health and Care Excellence [NICE]") or "new NICE" if their index feature was introduced during guideline revision. Model assumptions were inspected visually and by falsification tests. Sensitivity analyses reclassified participants who subsequently presented with features in the original guidelines as "old NICE." For colorectal cancer, sensitivity analysis (n = 3481) adjusted for multimorbidity burden. RESULTS Median contact days and costs were, respectively, 4 (interquartile range [IQR] 2-7) and £117.69 (IQR £53.23-£206.65) for colorectal, 5 (IQR 3-9) and £156.92 (IQR £78.46-£272.29) for ovary, and 7 (IQR 4-13) and £230.64 (IQR £120.78-£408.34) for pancreas. Revising ovary guidelines may have decreased contact days (incidence rate ratio [IRR] 0.74; 95% confidence interval 0.55-1.00; P = .05) with unchanged costs, but parallel trends assumptions were violated. Costs decreased by 13% (equivalent to -£28.05, -£50.43 to -£5.67) after colorectal guidance revision but only in sensitivity analyses adjusting for multimorbidity. Contact days and costs remained unchanged after pancreas guidance revision. CONCLUSIONS The main analyses of symptomatic patients suggested that prediagnosis primary care costs remained unchanged after guidance revision for pancreatic cancer. For colorectal cancer, contact days and costs decreased in analyses adjusting for multimorbidity. Revising ovarian cancer guidelines may have decreased primary care contact days but not costs, suggesting increased resource-use intensity; nevertheless, there is evidence of confounding.
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Affiliation(s)
- Sarah Price
- Discovery Unit, University of Exeter Medical School, University of Exeter, Exeter, England, UK.
| | - Paolo Landa
- Département d'opérations et systèmes de decision, Faculté des sciences de l'administration, Université Laval, Québec City, QC, Canada; Centre Hospitaliere Universitaire (CHU) de Québec - Université Laval, Québec City, QC, Canada
| | - Ruben Mujica-Mota
- Academic Unit of Health Economics, University of Leeds, Leeds, England, UK
| | - Willie Hamilton
- Discovery Unit, University of Exeter Medical School, University of Exeter, Exeter, England, UK
| | - Anne Spencer
- Health Economics Group, University of Exeter, Exeter, England, UK
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28
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Tran PB, Kazibwe J, Nikolaidis GF, Linnosmaa I, Rijken M, van Olmen J. Costs of multimorbidity: a systematic review and meta-analyses. BMC Med 2022; 20:234. [PMID: 35850686 PMCID: PMC9295506 DOI: 10.1186/s12916-022-02427-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multimorbidity is a rising global phenomenon, placing strains on countries' population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What "cost ingredients" are most commonly included in these multimorbidity studies? METHODS We conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$). RESULTS Fifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs. CONCLUSIONS Multimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Joseph Kazibwe
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mieke Rijken
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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29
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Myring G, Mitchell PM, Kernohan WG, McIlfatrick S, Cudmore S, Finucane AM, Graham-Wisener L, Hewison A, Jones L, Jordan J, McKibben L, Muldrew DHL, Zafar S, Coast J. An analysis of the construct validity and responsiveness of the ICECAP-SCM capability wellbeing measure in a palliative care hospice setting. BMC Palliat Care 2022; 21:121. [PMID: 35804325 PMCID: PMC9264696 DOI: 10.1186/s12904-022-01012-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For outcome measures to be useful in health and care decision-making, they need to have certain psychometric properties. The ICECAP-Supportive Care Measure (ICECAP-SCM), a seven attribute measure (1. Choice, 2. Love and affection, 3. Physical suffering, 4. Emotional suffering, 5. Dignity, 6. Being supported, 7. Preparation) developed for use in economic evaluation of end-of-life interventions, has face validity and is feasible to use. This study aimed to assess the construct validity and responsiveness of the ICECAP-SCM in hospice inpatient and outpatient settings. METHODS A secondary analysis of data collated from two studies, one focusing on palliative care day services and the other on constipation management, undertaken in the same national hospice organisation across three UK hospices, was conducted. Other quality of life and wellbeing outcome measures used were the EQ-5D-5L, McGill Quality of Life Questionnaire - Expanded (MQOL-E), Patient Health Questionnaire-2 (PHQ-2) and Palliative Outcomes Scale Symptom list (POS-S). The construct validity of the ICECAP-SCM was assessed, following hypotheses generation, by calculating correlations between: (i) its domains and the domains of other outcome measures, (ii) its summary score and the other measures' domains, (iii) its summary score and the summary scores of the other measures. The responsiveness of the ICECAP-SCM was assessed using anchor-based methods to understand change over time. Statistical analysis consisted of Spearman and Pearson correlations for construct validity and paired t-tests for the responsiveness analysis. RESULTS Sixty-eight participants were included in the baseline analysis. Five strong correlations were found with ICECAP-SCM attributes and items on the other measures: four with the Emotional suffering attribute (Anxiety/depression on EQ-5D-5L, Psychological and Burden on MQOL-E and Feeling down, depressed or hopeless on PHQ-2), and one with Physical suffering (Weakness or lack of energy on POS-S). ICECAP-SCM attributes and scores were most strongly associated with the MQOL-E measure (0.73 correlation coefficient between summary scores). The responsiveness analysis (n = 36) showed the ICECAP-SCM score was responsive to change when anchored to changes on the MQOL-E over time (p < 0.05). CONCLUSIONS This study provides initial evidence of construct validity and responsiveness of the ICECAP-SCM in hospice settings and suggests its potential for use in end-of-life care research.
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Affiliation(s)
- Gareth Myring
- grid.5337.20000 0004 1936 7603Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK ,grid.410421.20000 0004 0380 7336The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Paul Mark Mitchell
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - W. George Kernohan
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Sonja McIlfatrick
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Sarah Cudmore
- grid.104846.fDivision of Nursing, Queen Margaret University, Edinburgh, UK ,grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Anne M. Finucane
- grid.4305.20000 0004 1936 7988Clinical Psychology, University of Edinburgh, Edinburgh, UK ,grid.470550.30000 0004 0641 2540Marie Curie Hospice, Edinburgh, UK
| | - Lisa Graham-Wisener
- grid.4777.30000 0004 0374 7521School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Alistair Hewison
- grid.6572.60000 0004 1936 7486School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Louise Jones
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Joanne Jordan
- grid.10837.3d0000 0000 9606 9301School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Laurie McKibben
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Deborah H. L. Muldrew
- grid.12641.300000000105519715Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Shazia Zafar
- grid.6572.60000 0004 1936 7486School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- grid.5337.20000 0004 1936 7603Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Intensity of care in cancer patients in the last year of life: a retrospective data linkage study. Br J Cancer 2022; 127:712-719. [PMID: 35545681 PMCID: PMC9092325 DOI: 10.1038/s41416-022-01828-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care. Results Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005). Conclusions Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.
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31
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Buja A, Rugge M, De Luca G, Zorzi M, De Toni C, Cozzolino C, Vecchiato A, Del Fiore P, Tropea S, Spina R, Baldo V, Rossi CR, Mocellin S. Malignant Melanoma: Direct Costs by Clinical and Pathological Profile. Dermatol Ther (Heidelb) 2022; 12:1157-1165. [PMID: 35426606 PMCID: PMC9110572 DOI: 10.1007/s13555-022-00715-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction A number of studies have examined the impact of tumor stage on direct health care costs of patients with melanoma. This study aimed to investigate the association between the direct costs for melanoma and the patients’ clinical and histological characteristics. Methods The present analysis included 1368 patients diagnosed with melanoma in 2017 in the Veneto Region (northeast Italy) and recorded in a regional population-based melanoma registry. The costs were assessed taking monthly and total direct costs into account. Log-linear multivariable analysis was used to identify the clinical and histological cost drivers, focusing on monthly and total direct costs per patient incurred during the first 2 years after a patient’s diagnosis. Results On multivariable analysis, besides the stage of melanoma, also the presence of mitoses (> 2) was associated with higher monthly direct costs [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.15–2.08, p = 0.004] in respect to cases with 0–2 mitoses. Vertical growth was associated with higher costs compared with radial growth (OR 1.28, 95% CI 1.00–1.64, p = 0.055). Moreover, the association between the absence of tumor-infiltrating lymphocytes (TILs) and higher monthly direct costs reached statistical significance (OR 1.31, 95% CI 1.05–1.64, p = 0.017). There were no differences in monthly direct costs by patients’ sex or age, ulceration, or tumor site. Conclusion This study showed that not only tumor stage but also other clinical and histopathologic characteristics have an impact on the direct monthly and total costs of treating melanoma. Further studies on the cost-effectiveness of the various options for managing this disease should take these variables into account, as well as tumor stage, as cost drivers.
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Torres GF, Amaya JA, Buitrago G. Attributable Costs of Lung Cancer for the Colombian Health System: A Cost-of-Illness Study. Value Health Reg Issues 2022; 30:120-126. [PMID: 35344754 DOI: 10.1016/j.vhri.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/29/2021] [Accepted: 02/18/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Lung cancer imposes a significant economic burden on most countries. Nevertheless, there is scarce information about this burden on health systems in low- and middle-income countries. This study aims to estimate the economic burden of lung cancer on the Colombian health system, a middle-income country with universal health coverage in Latin America. METHODS We conducted a cost-of-illness study that included all direct costs generated by prevalent cases of lung cancer in Colombia during 2017. We used administrative databases containing patient-level information on consumption of healthcare services and reports on healthcare spending published by the Colombian Ministry of Health. To decrease the probability of misallocation of costs, we used propensity score matching to estimate the marginal costs of delivering healthcare services to patients with lung cancer. Additionally, ordinary least squares and variations in case definitions were used to assess the robustness of all estimates. RESULTS Total costs attributable to lung cancer in 2017 ranged from $50 039 588 to $74 468 111, with important differences across insurance regimes (from $4 629 938 for the subsidized regime to $55 342 357 for the contributory regime). Notably, 43% of all costs ($27 081 348) were caused by the consumption of services not included in the health benefit package. There were no significant differences between inpatient and outpatient costs. CONCLUSIONS Lung cancer imposes a significant economic burden on the Colombian health system. Although all affiliates are entitled to a unique health benefit package, there were important differences in costs across insurance regimes. Further research is needed to identify the main mechanisms underlying these differences.
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Affiliation(s)
- Gabriel F Torres
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Javier A Amaya
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Giancarlo Buitrago
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia
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Han KT, Kim W, Kim S. Disparities in healthcare expenditures according to economic status in cancer patients undergoing end-of-life care. BMC Cancer 2022; 22:303. [PMID: 35317774 PMCID: PMC8939210 DOI: 10.1186/s12885-022-09373-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Backgrounds A desire for better outcome influences cancer patients’ willingness to pay. Whilst cancer-related costs are known to have a u-shaped distribution, the actual level of healthcare utilized by patients may vary depending on income and ability to pay. This study examined patterns of healthcare expenditures in the last year of life in patients with gastric, colorectal, lung, and liver cancer and analyzed whether differences exist in the level of end-of-life costs for cancer care according to economic status. Methods This study is a retrospective cohort study which used data from the Korean National Elderly Sampled Cohort, 2002 to 2015. End-of-life was defined as 1 year before death. Economic status was classified into three categorical variables according to the level of insurance premium (quantiles). The relationship between the dependent and independent variables were analyzed using multiple gamma regression based on the generalized estimated equation (GEE) model. Results This study included 3083 cancer patients, in which total healthcare expenditure was highest in the high-income group. End-of-life costs increased the most in the last 3 months of life. Compared to individuals in the ‘middle’ economic status group, those in the ‘high’ economic status group (RR 1.095, 95% CI 1.044–1.149) were likely to spend higher amounts. The percentage of individuals visiting a general hospital was highest in the ‘high’ economic status group, followed by the ‘middle’ and ‘low’ economic status groups. Conclusion Healthcare costs for cancer care increased at end-of-life in Korea. Patients of higher economic status tended to spender higher amounts of end-of-life costs for cancer care. Further in-depth studies are needed considering that end-of-life medical costs constitute a large proportion of overall expenditures. This study offers insight by showing that expenditures for cancer care tend to increase noticeably in the last 3 months of life and that differences exist in the amount spent according economic status. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09373-y.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Woorim Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Seungju Kim
- Department of Nursing, College of Nursing, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Seongnam, Republic of Korea.
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Mavranezouli I, Varley-Campbell J, Stockton S, Francis J, Macdonald C, Sharma S, Fleming P, Punter E, Barry C, Kallioinen M, Khazaezadeh N, Jewell D. The cost-effectiveness of antenatal and postnatal education and support interventions for women aimed at promoting breastfeeding in the UK. BMC Public Health 2022; 22:153. [PMID: 35062928 PMCID: PMC8783468 DOI: 10.1186/s12889-021-12446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service. Breastfeeding rates in the UK are low for various reasons including cultural barriers, inadequate support to initiate and sustain breastfeeding, lack of information, or choice not to breastfeed. Education and support interventions have been developed aiming at promoting breastfeeding rates. The objective of this study was to assess the cost-effectiveness of such interventions for women, initiated antenatally or in the first 8 weeks postnatally, aiming at improving breastfeeding rates, in the UK.
Methods
A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of a breastfeeding intervention from the perspective of health and personal social services in England. Data on intervention effectiveness and the benefits of breastfeeding were derived from systematic reviews. Other model input parameters were obtained from published sources, supplemented by expert opinion.
Results
The incremental cost-effectiveness ratio (ICER) of the modelled intervention added on standard care versus standard care was £51,946/QALY, suggesting that the intervention is not cost-effective under National Institute for Health and Care Excellence (NICE) criteria in England. Sensitivity analysis suggested that the cost-effectiveness of the intervention improved as its effectiveness increased and intervention cost decreased. At the base-case effect (increase in breastfeeding rates 16–26 weeks after birth by 19%), the intervention was cost-effective (<£20,000/QALY) if its cost per woman receiving the intervention became ≈£40–£45. At the base-case cost (£84), the intervention was cost-effective if it increased breastfeeding rates by at least 35–40%.
Conclusions
Available breastfeeding interventions do not appear to be cost-effective under NICE criteria in England. Future breastfeeding interventions need to have higher effectiveness or lower cost compared with currently available interventions in order to become cost-effective. Public health and other societal interventions that protect, promote and support breastfeeding may be key in improving breastfeeding rates in the UK.
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Amin HA, Kaewsri P, Yiorkas AM, Cooke H, Blakemore AI, Drenos F. Mendelian randomisation analyses of UK Biobank and published data suggest that increased adiposity lowers risk of breast and prostate cancer. Sci Rep 2022; 12:909. [PMID: 35042869 PMCID: PMC8766553 DOI: 10.1038/s41598-021-04401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/08/2021] [Indexed: 12/24/2022] Open
Abstract
Breast (BCa) and prostate (PrCa) cancer are the first and second most common types of cancer in women and men, respectively. We aimed to explore the causal effect of adiposity on BCa and PrCa risk in the UK Biobank and published data. We used Mendelian randomisation (MR) to assess the causal effect of body mass index (BMI), body fat percentage (BFP), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) on BCa and PrCa risk. We found that increased BMI, WC and HC decreased the risk of breast cancer (OR 0.70 per 5.14 kg/m2 [0.59-0.85, p = 2.1 × 10-4], 0.76 per 12.49 cm [60-0.97, p = 0.028] and 0.73 per 10.31 cm [0.59-0.90, p = 3.7 × 10-3], respectively) and increased WC and BMI decreased the risk of prostate cancer (0.68 per 11.32 cm [0.50-0.91, p = 0.01] and 0.76 per 10.23 kg/m2 [0.61-0.95, p = 0.015], respectively) in UK Biobank participants. We confirmed our results with a two-sample-MR of published data. In conclusion, our results suggest a protective effect of adiposity on the risk of BCa and PrCa highlighting the need to re-evaluate the role of adiposity as cancer risk factor.
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Affiliation(s)
- Hasnat A Amin
- Department of Life Sciences, College of Health, Medical and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | - Pimpika Kaewsri
- Department of Life Sciences, College of Health, Medical and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | - Andrianos M Yiorkas
- Department of Life Sciences, College of Health, Medical and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | - Heather Cooke
- Department of Life Sciences, College of Health, Medical and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | - Alexandra I Blakemore
- Department of Life Sciences, College of Health, Medical and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | - Fotios Drenos
- Department of Life Sciences, College of Health, Medical and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK.
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Munakata T, Handa Y, Mizuno T, Tomiuchi N, LoPresti M, Shimizu J. The relationship between cost and the recommendation, refusal, and discontinuation of treatment for chronic myeloid leukemia and multiple myeloma in Japan: a cross-sectional exploratory survey. J Med Econ 2022; 25:552-560. [PMID: 35410568 DOI: 10.1080/13696998.2022.2062951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS This study aimed to ascertain the number of patients with chronic myelogenous leukemia (CML) and transplant-ineligible patients with multiple myeloma (MM) not recommended by their physicians for optimal drug treatment or who refuse, discontinue, reduce, or skip treatment owing to cost in Japan. METHODS A cross-sectional survey was conducted among hematologists, hematologic oncologists, and oncologists in Japan treating ≥1 patient with CML or ≥5 transplant-ineligible patients with MM per year. RESULTS A total of 212 physicians participated: 105 treating patients with CML and 107 treating transplant-ineligible patients with MM. While treatment cost did not lead to non-optimal treatment most patients, physicians reported that they recommended non-optimal treatment to 6.53% of their patients with CML and 1.41% of their transplant-ineligible patients with MM, that 1.51 and 0.35% of their patients, respectively, refused treatment and that 1.97 and 0.71% discontinued treatment owing to treatment cost. However, no significant differences in the effect of treatment cost on recommendation, discontinuation, refusal, or reduction of treatment were observed. Non-recommendation of optimal treatment owing to treatment cost was most common for third-line CML and fourth-line transplant-ineligible MM treatment. Discontinuation due to treatment cost was most common in third-line treatment for both. CONCLUSION Our results show that non-optimal treatment due to treatment cost occurs among some physicians in Japan for patients with CML and transplant-ineligible patients with MM, but it may be limited to a small percentage of patients. Further research is needed to identify the drivers of treatment decisions for physicians and patients, including those involving treatment cost.
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Affiliation(s)
| | | | | | | | - Michael LoPresti
- Health Economics and Outcomes Research, INTAGE Healthcare Inc., Tokyo, Japan
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Mantzari E, Reynolds JP, Jebb SA, Hollands GJ, Pilling MA, Marteau TM. Public support for policies to improve population and planetary health: A population-based online experiment assessing impact of communicating evidence of multiple versus single benefits. Soc Sci Med 2022; 296:114726. [PMID: 35093794 PMCID: PMC8907862 DOI: 10.1016/j.socscimed.2022.114726] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
Abstract
Background Effective interventions for reducing the consumption of products that harm population and planetary health often lack public support, impeding implementation. Communicating evidence of policies’ effectiveness can increase public support but there is uncertainty about the most effective ways of communicating this evidence. Some policies have multiple benefits such as both improving health and the environment. This study assesses whether communicating evidence of multiple versus single benefits of a policy increases its support. Method Participants (n = 4616) nationally representative of the British population were randomised to one of 24 groups in an online experiment with a 4 × 3 × 2 between-subjects factorial design. The messages that participants viewed differed according to the evidence they communicated (no message, effectiveness for changing behaviour, effectiveness for changing behaviour + one policy benefit, effectiveness for changing behaviour + three policy benefits), type of policy (taxation, availability) and the target behaviour (consumption of energy-dense food, alcohol, or meat). The primary outcome was policy support. Results In a full factorial ANOVA, there was a significant main effect of communicating evidence of effectiveness on policy support, which was similar across policies and behaviours. Communicating three benefits increased support relative to communicating one benefit (d = 0.15; p = 0.01). Communicating one benefit increased support compared to providing evidence for changing behaviour alone (d = 0.13; p = 0.004) or no message (d = 0.11 p = 0.022). Conclusion Communicating evidence of a policy's benefits increases support for policy action across different behaviours and policies. Presenting multiple benefits of policies enhances public support. Providing evidence of policies effectiveness at achieving policy goals increases public support. Uncertainty exists about the most effective ways of communicating this evidence. Evidence about multiple policy benefits increases support more than evidence for a single benefit. Effects are evident across behaviours and policies.
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James P Reynolds
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mark A Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Goldsbury DE, Feletto E, Weber MF, Haywood P, Pearce A, Lew JB, Worthington J, He E, Steinberg J, O’Connell DL, Canfell K. Health system costs and days in hospital for colorectal cancer patients in New South Wales, Australia. PLoS One 2021; 16:e0260088. [PMID: 34843520 PMCID: PMC8629237 DOI: 10.1371/journal.pone.0260088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Colorectal cancer (CRC) care costs the Australian healthcare system more than any other cancer. We estimated costs and days in hospital for CRC cases, stratified by site (colon/rectal cancer) and disease stage, to inform detailed analyses of CRC-related healthcare. Methods Incident CRC patients were identified using the Australian 45 and Up Study cohort linked with cancer registry records. We analysed linked hospital admission records, emergency department records, and reimbursement records for government-subsidised medical services and prescription medicines. Cases’ health system costs (2020 Australian dollars) and hospital days were compared with those for cancer-free controls (matched by age, sex, geography, smoking) to estimate excess resources by phase of care, analysed by sociodemographic, health, and disease characteristics. Results 1200 colon and 546 rectal cancer cases were diagnosed 2006–2013, and followed up to June 2016. Eighty-nine percent of cases had surgery, chemotherapy or radiotherapy, and excess costs were predominantly for hospitalisations. Initial phase (12 months post-diagnosis) mean excess health system costs were $50,434 for colon and $60,877 for rectal cancer cases, with means of 16 and 18.5 excess hospital days, respectively. The annual continuing mean excess costs were $6,779 (colon) and $8,336 (rectal), with a mean of 2 excess hospital days each. Resources utilised (costs and days) in these phases increased with more advanced disease, comorbidities, and younger age. Mean excess costs in the year before death were $74,952 (colon) and $67,733 (rectal), with means of 34 and 30 excess hospital days, respectively–resources utilised were similar across all characteristics, apart from lower costs for cases aged ≥75 at diagnosis. Conclusions Health system costs and hospital utilisation for CRC care are greater for people with more advanced disease. These findings provide a benchmark, and will help inform future cost-effectiveness analyses of potential approaches to CRC screening and treatment.
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Affiliation(s)
- David E. Goldsbury
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Marianne F. Weber
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Philip Haywood
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Alison Pearce
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jie-Bin Lew
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Joachim Worthington
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Emily He
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Gastroenterology and Liver Department, Concord Hospital, Sydney, NSW, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Dianne L. O’Connell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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Narine N, Rana D, Shelton D, Awad D, O'Flynn H, Jones ER, Ryan NAJ, Crosbie EJ. Synchronous uterine and bladder cancers detected in urine and vaginal samples by cytology. Diagn Cytopathol 2021; 50:E86-E91. [PMID: 34783454 DOI: 10.1002/dc.24906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022]
Abstract
Novel diagnostics for uterine cancer are urgently needed to reduce the burden of invasive testing for the majority of healthy women with postmenopausal bleeding. We have previously shown that uterine cancer cells can be detected by cytology in urine and vaginal samples with high diagnostic accuracy. Here, we demonstrate its potential to distinguish malignant cells of different aetiologies in the same urogenital biofluid sample according to their distinctive morphology and immunoprofiles. Synchronous tumours of the urogenital tract are uncommon but can cause diagnostic confusion, delays and poor outcomes. A 79-year-old woman presented to accident and emergency with postmenopausal bleeding. Voided urine and Delphi screener-collected vaginal samples were assessed by cytology and immunocytochemistry. Two malignant cell populations with distinct morphology and immunophenotypes consistent with synchronous uterine and urothelial tumours were identified. Subsequent routine diagnostics confirmed concurrent uterine carcinosarcoma and high-grade urothelial carcinoma of the bladder. This case demonstrates that cytology and adjunctive immunocytochemistry can simultaneously identify and phenotype cancers of different aetiologies from a single urogenital biofluid sample. This can help rationalise diagnostic pathways in complex, unusual cases of dual urogenital primaries.
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Affiliation(s)
- Nadira Narine
- Manchester Cytology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Durgesh Rana
- Manchester Cytology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - David Shelton
- Manchester Cytology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Dina Awad
- Radiology Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Helena O'Flynn
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Eleanor R Jones
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Neil A J Ryan
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Emma J Crosbie
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK.,Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Medical costs according to the stages of colorectal cancer: an analysis of health insurance claims in Hachioji, Japan. J Gastroenterol 2021; 56:903-913. [PMID: 34215929 DOI: 10.1007/s00535-021-01798-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the effect of the early detection of colorectal cancer (CRC) on medical costs needs to be clarified, there are few reports on the actual medical costs of CRC patients in Japan. We aimed to identify medical costs according to CRC stage, using health insurance claims. METHODS This observational study included CRC patients who had received specific treatment for CRC, which was defined by the procedure code and the claim computer processing system code associated with the treatment of CRC. CRC patients who underwent endoscopic or radical surgical treatment were defined as the curable group and those with palliative treatment, including palliative chemotherapy, as the non-curable group. Total medical costs and medical costs of specific treatments for CRC for 3 years were measured using the claims held by Hachioji City from May 2014 to July 2019. RESULTS This study included 442 patients in the curable group, including 267 patients who underwent endoscopic treatment, and 175 patients who underwent radical surgical treatment, and 161 patients in the non-curable group. The mean (standard deviation) total medical costs in the curable and non-curable groups were 2,130 (2,494) and 8,279 (5,600) thousand Japanese Yen (JPY), respectively. The mean (standard deviation) medical costs for the specific treatment of CRC in the curable and non-curable groups were 408 (352) and 3,685 (3,479) thousand JPY, respectively. CONCLUSIONS We clarified the actual medical costs of CRC in curable and non-curable groups. These results suggest the effect of early detection of CRC in reducing medical costs.
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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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White BE, Mujica-Mota R, Snowsill T, Gamper EM, Srirajaskanthan R, Ramage JK. Evaluating cost-effectiveness in the management of neuroendocrine neoplasms. Rev Endocr Metab Disord 2021; 22:647-663. [PMID: 33155118 PMCID: PMC8346405 DOI: 10.1007/s11154-020-09608-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 10/27/2022]
Abstract
The rapid evolution of novel, costly therapies for neuroendocrine neoplasia (NEN) warrants formal high-quality cost-effectiveness evaluation. Costs of individual investigations and therapies are high; and examples are presented. We aimed to review the last ten years of standalone health economic evaluations in NEN. Comparing to published standards, EMBASE, Cochrane library, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database and the Health Technology Assessment (HTA) Database were searched for health economic evaluations (HEEs) in NEN published between 2010 and October 2019. Of 12 economic evaluations, 11 considered exclusively pharmacological treatment (3 studies of SSAs, 7 studies of sunitinib, everolimus and/or 177Lu-DOTATATE and 1 study of telotristat ethyl) and 1 compared surgery with intraarterial therapy. 7 studies of pharmacological treatment had placebo or best supportive care as the only comparator. There remains a paucity of economic evaluations in NEN with the majority industry funded. Most HEEs reviewed did not meet published health economic criteria used to assess quality. Lack of cost data collected from patient populations remains a significant factor in HEEs where clinical expert opinion is still often substituted. Further research utilizing high-quality effectiveness data and rigorous applied health economic analysis is needed.
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Affiliation(s)
- B E White
- Department of Gastroenterology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
- Kings Health Partners Neuroendocrine Tumour Centre of Excellence, London, UK
| | - R Mujica-Mota
- Department of Health Economics, University of Leeds, Leeds, UK
| | - T Snowsill
- Department of Health Economics, University of Exeter, Exeter, UK
| | - E M Gamper
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - R Srirajaskanthan
- Kings Health Partners Neuroendocrine Tumour Centre of Excellence, London, UK
| | - J K Ramage
- Department of Gastroenterology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK.
- Kings Health Partners Neuroendocrine Tumour Centre of Excellence, London, UK.
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Lemmon E, Hanna CR, Hall P, Morris EJA. Health economic studies of colorectal cancer and the contribution of administrative data: A systematic review. Eur J Cancer Care (Engl) 2021; 30:e13477. [PMID: 34152043 DOI: 10.1111/ecc.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/23/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Several forces are contributing to an increase in the number of people living with and surviving colorectal cancer (CRC). However, due to the lack of available data, little is known about the implications of these forces. In recent years, the use of administrative records to inform research has been increasing. The aim of this paper is to investigate the potential contribution that administrative data could have on the health economic research of CRC. METHODS To achieve this aim, we conducted a systematic review of the health economic CRC literature published in the United Kingdom and Europe within the last decade (2009-2019). RESULTS Thirty-seven relevant studies were identified and divided into economic evaluations, cost of illness studies and cost consequence analyses. CONCLUSIONS The use of administrative data, including cancer registry, screening and hospital records, within the health economic research of CRC is commonplace. However, we found that this data often come from regional databases, which reduces the generalisability of results. Further, administrative data appear less able to contribute towards understanding the wider and indirect costs associated with the disease. We explore several ways in which various sources of administrative data could enhance future research in this area.
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Affiliation(s)
- Elizabeth Lemmon
- Edinburgh Health Economics, University of Edinburgh, Edinburgh, UK
| | - Catherine R Hanna
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Peter Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Pethick J, Chen C, Charnock J, Bowden R, Tzala E. Inpatient admissions and outpatient appointments in the first year post cancer diagnosis: A population based study from England. Cancer Epidemiol 2021; 74:102003. [PMID: 34425383 DOI: 10.1016/j.canep.2021.102003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Time spent in hospital (length of stay) is an important component of patient experience and the financial cost of cancer care. This study documents the length of stay across English cancer diagnoses at a national level and reports on variation by patient demographics and tumour characteristics. METHODS Data on all diagnoses of malignant neoplasms from the English National Cancer Registration and Analysis Service for 252,202 patients first diagnosed in 2015 was linked with NHS Digital's Admitted Patient Care and Outpatient Hospital Episode Statistics datasets to quantify length of stay within one year following diagnosis. Length of stay was modelled using linear regression adjusted for sex, age, tumour type, stage, time spent alive during the study period, vital status at end of study period, region, deprivation and ethnicity. RESULTS Patients spend a mean of 25 days (median = 17 days; IQR = 8-34 days) in hospital in their first year. Tumour type, stage, age and vital status corrections had the strongest effects in the model adjusting for other independent variables. Younger patients tended towards longer stays. CONCLUSION Length of stay varies among patients by tumour type, age and stage. Estimating future health service demands should account for changes in incident tumour characteristics.
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Affiliation(s)
- Joanna Pethick
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK.
| | - Cong Chen
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Health Data Insight (HDI) Community Interest Company (CIC), CPC4, Capital Park, Fulbourn, Cambridge, CB21 5XE, UK
| | - James Charnock
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
| | - Rachel Bowden
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
| | - Evangelia Tzala
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
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Gigli A, Francisci S, Guzzinati S, Hall A, Hachey M, Scoppa S, Mariotto A. Cancer prevalence by phase of care: an indicator for assessing health service needs. TUMORI JOURNAL 2021; 107:311-317. [PMID: 33095121 PMCID: PMC8326901 DOI: 10.1177/0300891620961839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/24/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cancer prevalence (people alive on a certain date in a population who previously had a cancer diagnosis) is expected to increase in the United States and Europe due to improvements in survival and population aging. Examination of prevalence by phase of care allows us to identify subgroups of patients according to their care trajectories, thus allowing us to improve health care planning, resource allocation, and calculation of costs. METHODS A new method to estimate prevalence by phase of care using grouped data is illustrated. Prevalence is divided into 3 mutually exclusive phases: initial, continuing, and end-of-life. An application to US and Italian data is applied to prevalent cases diagnosed with colon-rectum, stomach, lung, or breast cancer. RESULTS The distribution of phase of care prevalence estimated by cancer type and sex and results from the two datasets are very similar. Most survivors are in the continuing phase; the end-of-life phase is larger for cancers with worse prognosis. All phases prevalence is generally higher in the Italian than in the US dataset, except for lung cancer in women, where prevalence proportion in the Italian dataset is 30% lower than in the United States. DISCUSSION Incidence, survival, and population age structure are the main determinants of prevalence and they can affect differences in all phases of prevalence, as well as in discrete phases. Incidence is the most influential determinant. Ours is the first study that compares prevalence by phase of care between two populations in Italy and the United States. Despite great differences in health care management in the two countries, we found extremely similar distribution of survivors by phase of care for most cancer sites under study.
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Affiliation(s)
- Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Lazio, Italy
| | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Health Institute, Rome, Italy
| | | | - Aaron Hall
- Information Management Services, Calverton, MD, USA
| | - Mark Hachey
- Information Management Services, Calverton, MD, USA
| | - Steve Scoppa
- Information Management Services, Calverton, MD, USA
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Bugge C, Saether EM, Kristiansen IS. Men receive more end-of-life cancer hospital treatment than women: fact or fiction? Acta Oncol 2021; 60:984-991. [PMID: 33979241 DOI: 10.1080/0284186x.2021.1917000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND An important goal of health care systems is equitable access to health care. Previous research, however, indicates that men receive more cancer care and health care resources than women. The aim of this study was to investigate whether there is a gender difference in terms of end-of-life cancer treatment in hospitals in Norway. MATERIAL AND METHODS We used nationwide patient-level data from the Norwegian Patient Registry (2013-2017, n = 64,694), and aggregated data from the Norwegian Cause of Death Registry (2013-2018, n = 66,534). We described direct medical costs and utilization of cancer treatment in hospitals (in-patient stays and out-patient clinics) and specialized palliative home care teams by the means of the following variables: gender, type of cancer, age, region of residence, place of death, and use of pharmaceutical anti-cancer treatment last month before death. Generalized linear models with a gamma distribution and log-link function were fitted to identify determinants of direct medical costs in hospital's last year of life. RESULTS Women aged 0-69 years had an average direct medical cost in hospitals of €26,117 during the last year of life, compared to €29,540 for men, while they were respectively €19,889 and €22,405 for those aged 70 years or older. These gender differences were confirmed in regression models with gender as the only covariate. Adjusted additionally for the type of cancer, the difference was 11%, while including age as a covariate reduced the difference to 6%. When the place of death was also included, the difference was down to 4%. DISCUSSION The gender difference in hospital costs last year of life can largely be explained by age at death and the proportion dying in hospitals. When adjusting for confounding factors, the differences in end-of-life costs in hospitals are minimal.
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Affiliation(s)
- Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo, Norway
- Oslo Economics, Oslo, Norway
| | | | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Norway
- Oslo Economics, Oslo, Norway
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47
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Thomas C, Mandrik O, Saunders CL, Thompson D, Whyte S, Griffin S, Usher-Smith JA. The Costs and Benefits of Risk Stratification for Colorectal Cancer Screening Based On Phenotypic and Genetic Risk: A Health Economic Analysis. Cancer Prev Res (Phila) 2021; 14:811-822. [PMID: 34039685 PMCID: PMC7611464 DOI: 10.1158/1940-6207.capr-20-0620] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 01/07/2023]
Abstract
Population-based screening for colorectal cancer is an effective and cost-effective way of reducing colorectal cancer incidence and mortality. Many genetic and phenotypic risk factors for colorectal cancer have been identified, leading to development of colorectal cancer risk scores with varying discrimination. However, these are not currently used by population screening programs. We performed an economic analysis to assess the cost-effectiveness, clinical outcomes, and resource impact of using risk-stratification based on phenotypic and genetic risk, taking a UK National Health Service perspective. Biennial fecal immunochemical test (FIT), starting at an age determined through risk-assessment at age 40, was compared with FIT screening starting at a fixed age for all individuals. Compared with inviting everyone from age 60, using a risk score with area under the receiver operating characteristic curve of 0.721 to determine FIT screening start age, produces 418 QALYs, costs £247,000, and results in 218 fewer colorectal cancer cases and 156 fewer colorectal cancer deaths per 100,000 people, with similar FIT screening invites. There is 96% probability that risk-stratification is cost-effective, with net monetary benefit (based on £20,000 per QALY threshold) estimated at £8.1 million per 100,000 people. The maximum that could be spent on risk-assessment and still be cost-effective is £114 per person. Lower benefits are produced with lower discrimination risk scores, lower mean screening start age, or higher FIT thresholds. Risk-stratified screening benefits men more than women. Using risk to determine FIT screening start age could improve the clinical outcomes and cost effectiveness of colorectal cancer screening without using significant additional screening resources. PREVENTION RELEVANCE: Colorectal cancer screening is essential for early detection and prevention of colorectal cancer, but implementation is often limited by resource constraints. This work shows that risk-stratification using genetic and phenotypic risk could improve the effectiveness and cost-effectiveness of screening programs, without using substantially more screening resources than are currently available.
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Affiliation(s)
- Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Catherine L Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Deborah Thompson
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Sophie Whyte
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Downing A, Hall P, Birch R, Lemmon E, Affleck P, Rossington H, Boldison E, Ewart P, Morris EJA. Data Resource Profile: The COloRECTal cancer data repository (CORECT-R). Int J Epidemiol 2021; 50:1418-1418k. [PMID: 34255059 PMCID: PMC8580263 DOI: 10.1093/ije/dyab122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy Downing
- Cancer Epidemiology Group, Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Peter Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Edinburgh, UK.,Edinburgh Health Economics, University of Edinburgh, NINE BioQuarter, Edinburgh, UK
| | - Rebecca Birch
- Cancer Epidemiology Group, Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Elizabeth Lemmon
- Edinburgh Health Economics, University of Edinburgh, NINE BioQuarter, Edinburgh, UK
| | - Paul Affleck
- Cancer Epidemiology Group, Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Hannah Rossington
- Cancer Epidemiology Group, Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Emily Boldison
- Cancer Epidemiology Group, Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Paul Ewart
- Cancer Epidemiology Group, Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
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Bugge C, Brustugun OT, Sæther EM, Kristiansen IS. Phase- and gender-specific, lifetime, and future costs of cancer: A retrospective population-based registry study. Medicine (Baltimore) 2021; 100:e26523. [PMID: 34190187 PMCID: PMC8257845 DOI: 10.1097/md.0000000000026523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/04/2021] [Indexed: 01/04/2023] Open
Abstract
Valid estimates of cancer treatment costs are import for priority setting, but few studies have examined costs of multiple cancers in the same setting.We performed a retrospective population-based registry study to evaluate phase-specific (initial, continuing, and terminal phase) direct medical costs and lifetime costs for 13 cancers and all cancers combined in Norway. Mean monthly cancer attributable costs were estimated using nationwide activity data from all Norwegian hospitals. Mean lifetime costs were estimated by combining phase-specific monthly costs and survival times from the national cancer registry. Scenarios for future costs were developed from the lifetime costs and the expected number of new cancer cases toward 2034 estimated by NORDCAN.For all cancers combined, mean discounted per patient direct medical costs were Euros (EUR) 21,808 in the initial 12 months, EUR 4347 in the subsequent continuing phase, and EUR 12,085 in the terminal phase (last 12 months). Lifetime costs were higher for cancers with a 5-year relative survival between 50% and 70% (myeloma: EUR 89,686, mouth/pharynx: EUR 66,619, and non-Hodgkin lymphoma: EUR 65,528). The scenario analyses indicate that future cancer costs are highly dependent on future cancer incidence, changes in death risk, and cancer-specific unit costs.Gender- and cancer-specific estimates of treatment costs are important for assessing equity of care and to better understand resource consumption associated with different cancers.Cancers with an intermediate prognosis (50%-70% 5-year relative survival) are associated with higher direct medical costs than those with relatively good or poor prognosis.
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Affiliation(s)
- Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo
- Oslo Economics, Oslo
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway
| | | | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo
- Oslo Economics, Oslo
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
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50
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Cheng CY, Datzmann T, Hernandez D, Schmitt J, Schlander M. Do certified cancer centers provide more cost-effective care? A health economic analysis of colon cancer care in Germany using administrative data. Int J Cancer 2021; 149:1744-1754. [PMID: 34213799 DOI: 10.1002/ijc.33728] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022]
Abstract
Hospital certification has become an important measure to improve cancer care quality, with the potential effect of prolonging patient survival and reducing medical spending. However, yet to be explored is the cost-effectiveness of cancer care provided in certified hospitals, considering significant additional costs incurred from certification requirements. We performed a cost-effectiveness analysis (CEA) using two colon cancer populations (N = 1909) treated in different levels of certified hospitals (CHs) vs noncertified hospitals (NCHs) from a healthcare system's perspective. We matched patient-level data of incident colon cancer cases, diagnosed between 2008 and 2013 from a large statutory health insurance in Saxony, Germany, to calculate net treatment costs by phase (initial, continuing and terminal phase). The costs were supplemented with extra costs from 31 additional services required for certification. Effectiveness measure was total survival time in life-years. Outcome of interest was incremental costs per additional life-year. The annualized net colon cancer treatment costs by phase showed a U shape with high costs in the initial (mean €26 855; 95% CI €25 058-€28 652) and the terminal phases (mean €30 096; 95% CI €26 199-€33 993). The base-case CEA results and all sensitivity analyses consistently demonstrated longer survival and lower costs for the colon cancer cohort treated in CHs vs NCHs. To conclude, we used administrative data to derive the first cost-effectiveness evidence supporting that colon cancer care delivered in the certified cancer centers in Germany improves survival outcomes and saves costs from a healthcare system's perspective. Generalization of the study results should be exercised with caution.
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Affiliation(s)
- Chih-Yuan Cheng
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Thomas Datzmann
- Center for Evidence-based Healthcare (ZEGV), University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Diego Hernandez
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare (ZEGV), University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.,Alfred Weber Institute, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
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