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Krawczyk N, Ruckhäberle E, Lux MP, Fehm T, Greiling M, Osygus M. Is the (Neo)adjuvant Therapy of Patients with Primary HER2-positive Breast Cancer Cost-Covering?: Process Cost Analysis of Neoadjuvant and Post-Neoadjuvant Systemic Therapy of Patients with Primary HER2-positive Breast Cancer. Geburtshilfe Frauenheilkd 2023; 83:321-332. [PMID: 36908284 PMCID: PMC9998176 DOI: 10.1055/a-1921-9336] [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: 04/13/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction HER2 positivity is one of the most important predictive factors in the treatment of breast cancer patients. Thanks to new targeted anti-HER2 drugs, the prognosis for HER2-positive breast cancer patients has been significantly improved, and the treatment can now be designed according to the risk situation and the response to treatment. At the same time, these innovative targeted anti-HER2 drugs are associated with high costs and require long and involved patient care. Materials and Methods In this paper, we compare the treatment costs of three post-neoadjuvant treatment regimens (trastuzumab vs. trastuzumab/pertuzumab vs. T-DM1) in early stage HER2-positive breast cancer from the perspective of the oncological outpatient clinic of a certified breast center at a university hospital, and evaluate the cost coverage. Results The highest costs in systemic therapy were the material costs. These were the highest for dual blockade with trastuzumab/pertuzumab, followed by T-DM1 and trastuzumab monotherapy. According to our study, all three of these post-neoadjuvant therapy variants achieve a positive contribution margin. While all three models have similar contribution margins, the treatment pathway with T-DM1 is associated with a 30% lower contribution margin. Conclusions Although these model calculations are associated with limitations in view of the introduction of biosimilar antibodies, it can be shown that modern therapeutic approaches do not always have to be associated with lower profits.
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Affiliation(s)
- Natalia Krawczyk
- Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Eugen Ruckhäberle
- Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Frauen- und Kinderklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Paderborn, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Michael Greiling
- Institut für Workflow-Management im Gesundheitswesen (IWiG), c/o Europäische Fachhochschule - University of Applied Sciences - Hochschule für Gesundheit, Soziales und Pädagogik, Rheine, Germany
| | - Michael Osygus
- Institut für Workflow-Management im Gesundheitswesen (IWiG), c/o Europäische Fachhochschule - University of Applied Sciences - Hochschule für Gesundheit, Soziales und Pädagogik, Rheine, Germany
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Lux M, Hildebrandt T, Beyer-Finkler E, Bani M, Loehberg C, Jud S, Rauh C, Schrauder M, Fasching P, Beckmann M. Relevance of health economics in breast cancer treatment - the view of certified breast centres and their patients. ACTA ACUST UNITED AC 2014; 8:15-21. [PMID: 24715838 DOI: 10.1159/000347098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Breast cancer centres - certified in accordance with the criteria of the German Cancer Association and the German Mastology Association - are established throughout Germany. Although the setting up of centres and the subsequent need for certification are associated with a marked increase in costs, initial data show positive effects on quality. Certified centres are cost-effective from the point of view of health economics - they lead to improved quality in processes and results without creating any increase in costs for the funding bodies. However, the organization of the necessary structures, with interdisciplinary treatment, documentation and quality-assurance measures, requires considerable resources. Increasing consolidation of inpatient services is also involved, while shortening of the patients' hospitalization periods is leading to reduced remuneration from the funding bodies. The current cost deficits, which have resulted from the increased resources required, need to be recouped through additional charges. It will only be possible to maintain the high quality achieved if additional charges become available to cover the centres' added costs. Good data are increasingly becoming available as a basis for negotiations on charges - e.g., with regard to the quality of results and the National Cancer Plan - as well as clear support from patients.
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Affiliation(s)
- Michael Lux
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Thomas Hildebrandt
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | | | - Mayada Bani
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Christian Loehberg
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Sebastian Jud
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Claudia Rauh
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Michael Schrauder
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Peter Fasching
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias Beckmann
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
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Jacobs VR, Bogner G, Schausberger CE, Reitsamer R, Fischer T. Relevance of health economics in breast cancer treatment: integration of economics in the management of breast cancer at the clinic level. ACTA ACUST UNITED AC 2014; 8:7-14. [PMID: 24715837 DOI: 10.1159/000348370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Since the introduction of the diagnosis-related groups (DRG) system with cost-related and entity-specific flat-rate reimbursements for all in-patients in 2004 in Germany, economics have become an important focus in medical care, including breast centers. Since then, physicians and hospitals have had to gradually take on more and more financial responsibilities for their medical care to avoid losses for their institutions. Due to financial limitations of resources, most medical services have to be adjusted to correlating revenues, which results in the development of a variety of active measures to understand, steer, and optimize costs, resources and related processes for breast cancer treatment. In this review, the challenging task to implement microeconomic management at the clinic level for breast cancer treatment is analyzed from breast cancer-specific publications. The newly developed economic management perspective is identified for different stakeholders in the healthcare system, and successful microeconomic projects and future aspects are described.
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Affiliation(s)
- Volker R Jacobs
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Gerhard Bogner
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Christiane E Schausberger
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Roland Reitsamer
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Thorsten Fischer
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
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Thiel FC, Scharl A, Hildebrandt T, Kotziabassis E, Schrauder MG, Bani MR, Müller A, Hauzenberger T, Loehberg CR, Jud SM, Fasching PA, Hartmann A, Schulz-Wendtland R, Strnad V, Beckmann MW, Lux MP. Financing of certified centers: a willingness-to-pay analysis. Arch Gynecol Obstet 2012; 287:495-509. [PMID: 23080545 DOI: 10.1007/s00404-012-2572-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/11/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although care in certified breast centers is now established throughout Germany, numerous services are still not being reimbursed. This also affects other centers involved in the specialty of gynecology such as gynecological cancer centers, perinatal centers, and endometriosis centers. Although a certified center is entitled to charge additional fees, these are in most cases not reimbursed. Calculation of additional costs is limited by the fact that data from the Institute for the Hospital Reimbursement System (Institut für das Entgeltsystem im Krankenhaus, InEK) do not reflect interdisciplinary services and procedures. For decision-makers, society's willingness to pay is an important factor in guiding decisions on the basis of social priorities. A hypothetical maximum willingness to pay can be calculated using a willingness-to-pay analysis, making it possible to identify deficiencies in the arbitrary setting of health budgets at the macro-level. MATERIALS AND METHODS In a multicenter study conducted between November 2009 and December 2010, 2,469 patients at a university hospital and at a non-university hospital were asked about the extent of their awareness of certified centers, the influence of centers on hospital presentation, and about personal attitudes toward quality-oriented reimbursement. A subjective assessment of possible additional charges was calculated using a willingness-to-pay analysis. RESULTS In the overall group, 53.4 % of the patients were aware of what a certified center is and 27.4 % had specific information (obstetrics 40.0/32.3 %; mastology 66.8/23.2 %; gynecological oncology 54.7/27.3 %; P < 0.001). For 43.8 %, a certified center was one reason or the major reason for presentation (obstetrics 26.2 %; mastology 66.8 %; gynecological oncology 46.6 %; P < 0.001). A total of 72.6 % were in favor of quality-oriented reimbursement and 69.7 % were in favor of an additional charge for a certified center amounting to €538.56 (mastology €643.65, obstetrics €474.67, gynecological oncology €532.47). In all, 33.9 % would accept an increase in health-insurance fees (averaging 0.3865 %), and 28.3 % were in favor of reduced remuneration for non-certified centers. CONCLUSIONS The existence of certified centers is being increasingly recognized by patients. Additional charges for certified centers are generally supported. There is therefore a clear demand for them-from patients as well. This may be useful when negotiations are being conducted.
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Affiliation(s)
- Falk C Thiel
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Gesundheitsökonomische Aspekte und finanzielle Probleme in den zertifizierten Strukturen des Fachgebietes. DER GYNÄKOLOGE 2011. [DOI: 10.1007/s00129-011-2807-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Taki K, Tsuruta Y, Niwa T. Cardiac troponin T and advanced glycation end-products in hemodialysis patients. Am J Nephrol 2008; 28:701-6. [PMID: 18431051 DOI: 10.1159/000127431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 03/04/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) is used as a biomarker of myocardial damage for the diagnosis of acute myocardial infarction and acute coronary syndrome. The aim was to investigate the association between advanced glycation end products (AGEs) and cTnT in hemodialysis (HD) patients. METHODS The plasma level of cTnT in 224 HD patients was measured using the electrochemiluminescence immunoassay. The plasma levels of N(epsilon)-(carboxymethyl)lysine (CML) and pentosidine were measured using an enzyme-linked immunosorbent assay. RESULTS The cTnT-positive group (>0.1 ng/ml) showed significantly high plasma levels of calcium, CML and pentosidine as compared with the cTnT-negative group. In multiple logistic regression analysis, the prevalence of patients with high plasma calcium (>median) was increased in the cTnT-positive group as compared with the cTnT-negative group (OR: 5.08, 95% CI: 1.62-15.92, p < 0.01). The prevalence of high plasma CML (>median) was increased in the cTnT-positive group (OR: 4.45, 95% CI: 1.41-14.03, p < 0.05). Further, the prevalence of high plasma pentosidine (>median) was also increased in the cTnT-positive group (OR: 4.94, 95% CI: 1.55-15.70, p < 0.01). CONCLUSION In addition to calcium, AGEs such as CML and pentosidine were associated with cTnT, a marker of myocardial damage, in HD patients.
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Affiliation(s)
- Kentaro Taki
- Department of Clinical Preventive Medicine, Nagoya University Hospital, Nagoya, Japan
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Trapali M, Liapi C, Perelas A, Perrea D, Stroubini T, Dontas I, Couvari E, Mavri M, Galanopoulou P. Effect of isocaloric diets and sibutramine on food intake, body mass variation and serum TNF-alpha levels in rats. Pharmacology 2008; 82:15-21. [PMID: 18434760 DOI: 10.1159/000127363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 11/14/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM The effect of isocaloric diets and sibutramine on dietary behaviour and TNF-alpha is poorly understood. The aim of the study was to investigate the effects of isocaloric diets and sibutramine on food intake, body mass variation and serum TNF-alpha in free-feeding rats. METHODS Three groups of male Wistar rats (n = 63) were fed a high-fat diet, high-carbohydrate diet or high-protein diet for 13 weeks. In the last 3 weeks, each group was divided into 3 subgroups. Each subgroup received sibutramine 5 mg/kg, sibutramine 10 mg/kg or vehicle. Food intake was measured daily during the last week of the experiment; serum TNF-alpha was assayed and the body weight increasing rate was calculated. RESULTS The high-fat diet was associated with increased food intake, a greater weight gain ratio and increased TNF-alpha levels. Sibutramine treatment did not affect the dietary behaviour of high-protein- or high-carbohydrate-fed rats, while it significantly attenuated the daily food intake and body weight gain rate in the high-fat group, at the dose of 10 mg/kg. TNF-alpha levels were not affected by sibutramine. CONCLUSIONS High-fat feeding was associated with an increase in daily food intake, TNF-alpha levels and body weight gain rate, as well as with enhanced responsiveness to the anorectic effects of sibutramine. However, sibutramine did not affect TNF-alpha.
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Affiliation(s)
- M Trapali
- Department of Pharmacology, Medical School, University of Athens, Athens, Greece
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