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Soegaard Ballester JM, Ginzberg SP, Stein J, Wachtel H, Mahmoud NN. Preoperative history and physical update visits offer limited clinical value in colorectal surgery. Am J Surg 2023; 226:324-329. [PMID: 37031041 PMCID: PMC10524396 DOI: 10.1016/j.amjsurg.2023.03.027] [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: 12/20/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND United States regulations require a history and physical (H&P) ≤30 days before planned procedures. We evaluated the impact of H&P update visits in colorectal surgery. METHODS Preoperative H&P update visits conducted in colorectal clinics at our institution during 2019 were identified. Two independent reviewers assessed whether update visits identified interval changes to history, exam, or operative plan. Secondary outcomes included visit times, estimated travel times and distances. RESULTS For 132 visits, interval changes were identified in 39% of histories, but only 4.2% of exams and 6.8% of operative plans. When plans changed, visit goals could have been accomplished via telehealth in 77.8%. Median clinic and round-trip driving time were 61.5 and 62.2 min, respectively. CONCLUSIONS H&P update visits conducted to satisfy the 30-day regulation rarely result in clinically relevant changes yet impose time and travel burdens on patients. Regulations should be revised to provide flexibility in H&P update modalities.
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Affiliation(s)
| | - Sara P Ginzberg
- Department of Surgery, Penn Medicine, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19104, USA.
| | - Jacob Stein
- Department of Surgery, Penn Medicine, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19104, USA.
| | - Heather Wachtel
- Department of Surgery, Penn Medicine, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19104, USA; University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Najjia N Mahmoud
- Department of Surgery, Penn Medicine, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19104, USA; University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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2
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Le Bonniec A, Meade O, Fredrix M, Morrissey E, O'Carroll RE, Murphy PJ, Murphy AW, Mc Sharry J. Exploring non-participation in colorectal cancer screening: A systematic review of qualitative studies. Soc Sci Med 2023; 329:116022. [PMID: 37348182 DOI: 10.1016/j.socscimed.2023.116022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Worldwide, colorectal cancer is a major public health issue. Despite the existence of screening programmes in many countries, global uptake remains low. This meta-ethnography aimed to analyse qualitative literature to explore attitudes towards colorectal cancer screening and reasons for non-participation in eligible people that do not participate when invited. METHODS Systematic searches were conducted in five databases in May 2021. Critical appraisal of included studies was performed using the CASP checklist for qualitative studies. FINDINGS Thirteen studies were included. Three main themes and eight sub-themes were developed across studies: (1) Differences in motivation, with non-participants expressing a lack of knowledge and varying levels of intention to participate but not feeling screening was personally necessary; (2) Active aversion to screening expressed by fear, discomfort, disgust or not wanting to know; and (3) Contextual barriers of the healthcare system such as practical constraints or poor relationships with healthcare professionals. CONCLUSION Findings suggest multiple pathways to non-participation including ambivalence, aversion to the process and consequences of screening or lack of support. Persuasive messages and prompts to action to target ambivalence, reassurance regarding the screening procedures to target negative reactions, and increased support from healthcare professionals may be beneficial in increasing screening uptake.
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Affiliation(s)
- Alice Le Bonniec
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland.
| | - Oonagh Meade
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | | | - Eimear Morrissey
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Ronan E O'Carroll
- Division of Psychology, University of Stirling, Stirling, Scotland, UK
| | - Patrick J Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, University of Galway, Galway, Ireland
| | - Andrew W Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, University of Galway, Galway, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
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3
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Alkabbany I, Ali AM, Mohamed M, Elshazly SM, Farag A. An AI-Based Colonic Polyp Classifier for Colorectal Cancer Screening Using Low-Dose Abdominal CT. SENSORS (BASEL, SWITZERLAND) 2022; 22:9761. [PMID: 36560132 PMCID: PMC9782078 DOI: 10.3390/s22249761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Among the non-invasive Colorectal cancer (CRC) screening approaches, Computed Tomography Colonography (CTC) and Virtual Colonoscopy (VC), are much more accurate. This work proposes an AI-based polyp detection framework for virtual colonoscopy (VC). Two main steps are addressed in this work: automatic segmentation to isolate the colon region from its background, and automatic polyp detection. Moreover, we evaluate the performance of the proposed framework on low-dose Computed Tomography (CT) scans. We build on our visualization approach, Fly-In (FI), which provides "filet"-like projections of the internal surface of the colon. The performance of the Fly-In approach confirms its ability with helping gastroenterologists, and it holds a great promise for combating CRC. In this work, these 2D projections of FI are fused with the 3D colon representation to generate new synthetic images. The synthetic images are used to train a RetinaNet model to detect polyps. The trained model has a 94% f1-score and 97% sensitivity. Furthermore, we study the effect of dose variation in CT scans on the performance of the the FI approach in polyp visualization. A simulation platform is developed for CTC visualization using FI, for regular CTC and low-dose CTC. This is accomplished using a novel AI restoration algorithm that enhances the Low-Dose CT images so that a 3D colon can be successfully reconstructed and visualized using the FI approach. Three senior board-certified radiologists evaluated the framework for the peak voltages of 30 KV, and the average relative sensitivities of the platform were 92%, whereas the 60 KV peak voltage produced average relative sensitivities of 99.5%.
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Affiliation(s)
- Islam Alkabbany
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
| | - Asem M. Ali
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
| | - Mostafa Mohamed
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
| | | | - Aly Farag
- Computer Vision and Image Processing Laboratory, University of Louisville, Louisville, KY 40292, USA
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4
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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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Fang Q, Ma G, Wang Y, Wei J, Zhang Q, Xu X, Wang X. Current curative expenditure of non-communicable diseases changed in Dalian, China from 2017 to 2019: a study based on 'System of Health Accounts 2011'. BMJ Open 2022; 12:e056900. [PMID: 35365532 PMCID: PMC8977744 DOI: 10.1136/bmjopen-2021-056900] [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] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To analyse the current curative expenditure (CCE) of NCDs in China from 2017 to 2019. DESIGN A cross-sectional study. Medical institutions were collected by multistage stratified random sampling from 2017 to 2019. SETTING Dalian, China PARTICIPANTS: 408 institutions and 8 104 233 valid items were included in the study. NCDs patients were selected according to International Classification of Diseases-10. PRIMARY AND SECONDARY OUTCOME MEASURES CCE for NCDs was measured based on the System of Health Accounts 2011. Influenced factors were analysed by linear regression. All analyses and calculations were performed by STATA V.15.0. RESULTS The CCE of NCDs was ¥14.929 billion in 2017, ¥16.377 billion in 2018 and ¥18.055 billion in 2019, which accounted for more than 65% of total expenditure spent each year. More than 60% came from public financing. The proportion of family health financing continued to decline, reaching 31.16% in 2019. The expenditures were mainly in general hospitals, above 70%. Elderly patients account for the majority. Diseases of the circulatory system, diseases of the digestive system and neoplasms were the main NCDs. Year, age, gender, length of stay, surgery, insurance and institution level affected hospitalisation expenses. CONCLUSIONS NCDs are the main CCE of diseases in China, and their resources are not allocated reasonably. To reduce the CCE of NCDs, the government needs to optimise resource allocation and rationalise institutional flows and functions.
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Affiliation(s)
- Quan Fang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Guoliang Ma
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Executive Office, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yuhang Wang
- Finance Section, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jingjing Wei
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qin Zhang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Finance Section, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xinzhou Xu
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Medical Department, Nanjing Medical University Affiliated Wuxi No.2 People's Hospital, Wuxi, Jiangsu, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Research Center for Health Development - Liaoning New Type Think Tank for University, China Medical University, Shenyang, Liaoning, China
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Evaluating the Validity of the Clavien-Dindo Classification in Colectomy Studies: A 90-Day Cost of Care Analysis. Dis Colon Rectum 2021; 64:1426-1434. [PMID: 34623350 PMCID: PMC8502230 DOI: 10.1097/dcr.0000000000001966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Clavien-Dindo classification is widely used to report postoperative morbidity but may underestimate the severity of colectomy complications. OBJECTIVE The purpose of this study was to assess how well the Clavien-Dindo classification represents the severity of all grades of complications after colectomy using cost of care modeling. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted at a comprehensive cancer center. PATIENTS Consecutive patients (N = 1807) undergoing elective colon or rectal resections without a stoma performed at Memorial Sloan Kettering Cancer Center between 2009 and 2014 who were followed up for ≥90 days, were not transferred to other hospitals, and did not receive intraperitoneal chemotherapy were included in the study. MAIN OUTCOME MEASURES Complication severity was measured by the highest-grade complication per patient and attributable outpatient and inpatient costs. Associations were evaluated between patient complication grade and cost during 3 time periods: the 90 days after surgery, index admission, and postdischarge (<90 d). RESULTS Of the 1807 patients (median age = 62 y), 779 (43%) had a complication; 80% of these patients had only grade 1 or 2 complications. Increasing patient complication grade correlated with 90-day cost, driven by inpatient cost differences (p < 0.001). For grade 1 and 2 patients, most costs were incurred after discharge and were the same between these grade categories. Among patients with a single complication (52%), there was no difference in index hospitalization, postdischarge, or total 90-day costs between grade 1 and 2 categories. LIMITATIONS The study was limited by its retrospective design and generalizability. CONCLUSIONS The Clavien-Dindo classification correlates well with 90-day costs, driven largely by inpatient resource use. Clavien-Dindo does not discriminate well among patients with low-grade complications in terms of their substantial postdischarge costs. These patients represent 80% of patients with a complication after colectomy. Examining the long-term burden associated with complications can help refine the Clavien-Dindo classification for use in colectomy studies. See Video Abstract at http://links.lww.com/DCR/B521. EVALUACIN DE LA VALIDEZ DE LA CLASIFICACIN DE CLAVIENDINDO EN ESTUDIOS DE COLECTOMA ANLISIS DEL COSTO DE LA ATENCIN EN DAS ANTECEDENTES:La clasificación de Clavien-Dindo es utilizada ampliamante para conocer la morbilidad posoperatoria, pero puede subestimar la gravedad de las complicaciones de la colectomía.OBJETIVO:Evaluar que tan bien representa la clasificación de Clavien-Dindo la gravedad de todos los grados de complicaciones después de la colectomía utilizando un modelo de costo de la atención.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLÍNICO:Centro oncológico integral.PACIENTES:Pacientes consecutivos (n = 1807) sometidos a resecciones electivas de colon o recto sin estoma realizadas en el Memorial Sloan Kettering Cancer Center entre 2009 y 2014 que fueron seguidos durante ≥ 90 días, no fueron transferidos a otros hospitales y no recibieron quimioterapia intraperitoneal.PRINCIPALES MEDIDAS DE VALORACION:Gravedad de la complicación medida por la complicación de mayor grado por paciente y los costos atribuibles para pacientes ambulatorios y hospitalizados. Se evaluó la asociación entre el grado de complicación del paciente y el costo durante 3 períodos de tiempo: posterior a la cirugía (hasta 90 días), a su ingreso y posterior al egreso (hasta 90 días).RESULTADOS:De los 1807 pacientes (mediana de edad de 62 años), 779 (43%) tuvieron una complicación; El 80% de estos pacientes tuvieron solo complicaciones de grado 1 o 2. El aumento del grado de complicación del paciente se correlacionó con el costo a 90 días, impulsado por las diferencias en el costo de los pacientes hospitalizados (p <0,001). Para los pacientes de grado 1 y 2, la mayoría de los costos se incurrieron después del alta y fueron los mismos entre ambas categorías. Entre los pacientes con una sola complicación (52%), no hubo diferencia en el índice de hospitalización, posterior al alta o en el costo total de 90 días entre las categorías de grado 1 y 2.LIMITACIONES:Diseño retrospectivo, generalizabilidad.CONCLUSIONES:La clasificación de Clavien-Dindo se correlaciona bien con los costos a 90 días, impulsados en gran parte por la utilización de recursos de pacientes hospitalizados. Clavien-Dindo no discrimina entre los pacientes con complicaciones de bajo grado en términos de sus costos sustanciales posterior al alta. Estos pacientes representan el 80% de los pacientes aquellos con una complicación tras la colectomía. Examinar la carga a largo plazo asociada a las complicaciones puede ayudar a mejorar la clasificación de Clavien-Dindo para su uso en estudios de colectomía. Consulte Video Resumen en http://links.lww.com/DCR/B521.
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Atfannezhad M, Sharifi M, Madadizadeh F, Ameri H. Utility Values in Colorectal Cancer Patients Treated with Chemotherapy. Cancer Invest 2021; 40:46-54. [PMID: 34634994 DOI: 10.1080/07357907.2021.1992632] [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: 12/24/2022]
Abstract
Calculating utility values in colorectal cancer (CRC) patients under chemotherapy treatment is important for studies of economic evaluations. The EQ-5D-5L and composite time trade-off (cTTO) were used to calculate utility values in 105 patients with CRC in Iran. The mean EQ-5D-5L index and cTTO values were 0.45 ± 0.03 and 0.51 ± 0.02, respectively. Anxiety and pain were the most common problems reported by the patients. The BetaMix showed that lower mean utility values were significantly associated with females, aging, a low level of income, a greater number of comorbidities, and an advanced stage of cancer.
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Affiliation(s)
- Majid Atfannezhad
- Department of Health Technology Assessment, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehran Sharifi
- Cancer Prevention Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Farzan Madadizadeh
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hosein Ameri
- Department of Health Services Management, Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Spada C, Koulaouzidis A, Hassan C, Amaro P, Agrawal A, Brink L, Fischbach W, Hünger M, Jover R, Kinnunen U, Ono A, Patai Á, Pecere S, Petruzziello L, Riemann JF, Amlani B, Staines H, Stringer AL, Toth E, Antonelli G, Fuccio L. Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group. Endosc Int Open 2021; 9:E1456-E1462. [PMID: 34540535 PMCID: PMC8445680 DOI: 10.1055/a-1486-6729] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires. Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites. Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received. Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively. Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing. Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy,Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anastasios Koulaouzidis
- Pomeranian Medical University in Szczecin-Department of Social Medicine and Public Health, Faculty of Health Sciences, Szczecin, Zachodniopomorskie, Poland
| | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Lene Brink
- Herlev and Gentofte Hospital, Copenhagen University, Gastro Unit, Division of Endoscopy, Herlev, Denmark
| | | | | | - Rodrigo Jover
- Hospital General Universitario de Alicante – Instituto de Investigación Sanitaria ISABIAL – Servicio de Medicina Digestiva, Alicante, Spain
| | - Urpo Kinnunen
- Tampere University Hospital-Gastroenterology, Tampere, Finland
| | - Akiko Ono
- Hospital Clínico Universitario Virgen de la Arrixaca-Gastroenterology, El Palmar, Murcia, Spain
| | - Árpad Patai
- Markusovszky University Teaching Hospital-Gastroenterology, Szombathely, Hungary
| | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | - Ervin Toth
- Skåne University Hospital, Lund University, Department of Gastroenterology, Malmö, Sweden
| | - Giulio Antonelli
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy,Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, Rome, Italy,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
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Cost-Effectiveness of Colorectal Cancer Genetic Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168330. [PMID: 34444091 PMCID: PMC8394708 DOI: 10.3390/ijerph18168330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths worldwide. Approximately 3–5% of CRCs are associated with hereditary cancer syndromes. Individuals who harbor germline mutations are at an increased risk of developing early onset CRC, as well as extracolonic tumors. Genetic testing can identify genes that cause these syndromes. Early detection could facilitate the initiation of targeted prevention strategies and surveillance for CRC patients and their families. The aim of this study was to determine the cost-effectiveness of CRC genetic testing. We utilized a cross-sectional design to determine the cost-effectiveness of CRC genetic testing as compared to the usual screening method (iFOBT) from the provider’s perspective. Data on costs and health-related quality of life (HRQoL) of 200 CRC patients from three specialist general hospitals were collected. A mixed-methods approach of activity-based costing, top-down costing, and extracted information from a clinical pathway was used to estimate provider costs. Patients and family members’ HRQoL were measured using the EQ-5D-5L questionnaire. Data from the Malaysian Study on Cancer Survival (MySCan) were used to calculate patient survival. Cost-effectiveness was measured as cost per life-year (LY) and cost per quality-adjusted life-year (QALY). The provider cost for CRC genetic testing was high as compared to that for the current screening method. The current practice for screening is cost-saving as compared to genetic testing. Using a 10-year survival analysis, the estimated number of LYs gained for CRC patients through genetic testing was 0.92 years, and the number of QALYs gained was 1.53 years. The cost per LY gained and cost per QALY gained were calculated. The incremental cost-effectiveness ratio (ICER) showed that genetic testing dominates iFOBT testing. CRC genetic testing is cost-effective and could be considered as routine CRC screening for clinical practice.
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10
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Shih YCT, Dong W, Xu Y, Etzioni R, Shen Y. Incorporating Baseline Breast Density When Screening Women at Average Risk for Breast Cancer : A Cost-Effectiveness Analysis. Ann Intern Med 2021; 174:602-612. [PMID: 33556275 PMCID: PMC8171124 DOI: 10.7326/m20-2912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Breast density classification is largely determined by mammography, making the timing of the first screening mammogram clinically important. OBJECTIVE To evaluate the cost-effectiveness of breast cancer screening strategies that are stratified by breast density. DESIGN Microsimulation model to generate the natural history of breast cancer for women with and those without dense breasts and assessment of the cost-effectiveness of strategies tailored to breast density and nontailored strategies. DATA SOURCES Model parameters from the literature; statistical modeling; and analysis of Surveillance, Epidemiology, and End Results-Medicare data. TARGET POPULATION Women aged 40 years or older. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION No screening; biennial or triennial mammography from age 50 to 75 years; annual mammography from age 50 to 75 years for women with dense breasts at age 50 years and biennial or triennial mammography from age 50 to 75 years for those without dense breasts at age 50 years; and annual mammography at age 40 to 75 years for women with dense breasts at age 40 years and biennial or triennial mammography at age 50 to 75 years for those without dense breasts at age 40 years. OUTCOME MEASURES Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. RESULTS OF BASE-CASE ANALYSIS Baseline screening at age 40 years followed by annual screening at age 40 to 75 years for women with dense breasts and biennial screening at age 50 to 75 years for women without dense breasts was effective and cost-effective, yielding an incremental cost-effectiveness ratio of $36 200 per QALY versus the biennial strategy at age 50 to 75 years. RESULTS OF SENSITIVITY ANALYSIS At a societal willingness-to-pay threshold of $100 000 per QALY, the probability that the density-stratified strategy at age 40 years was optimal was 56% compared with 6 other strategies. LIMITATION Findings may not be generalizable outside the United States. CONCLUSION The study findings advocate for breast density-stratified screening with baseline mammography at age 40 years. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Ya-Chen Tina Shih
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
| | - Wenli Dong
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
| | - Ying Xu
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
| | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington (R.E.)
| | - Yu Shen
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
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11
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Redwood DG, Dinh TA, Kisiel JB, Borah BJ, Moriarty JP, Provost EM, Sacco FD, Tiesinga JJ, Ahlquist DA. Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People. Mayo Clin Proc 2021; 96:1203-1217. [PMID: 33840520 DOI: 10.1016/j.mayocp.2020.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults. PATIENTS AND METHODS A Markov model was used to evaluate the 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence and mortality, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The study incorporated updated evidence on screening test performance and adherence and was conducted from December 15, 2016, through November 6, 2019. RESULTS With perfect adherence, CRC incidence was reduced by 52% (95% CI, 46% to 56%) using colonoscopy, 61% (95% CI, 57% to 64%) using annual FIT, and 66% (95% CI, 63% to 68%) using MT-sDNA. Compared with no screening, perfect adherence screening extends life by 0.15, 0.17, and 0.19 QALYs per person with colonoscopy, FIT, and MT-sDNA, respectively. Colonoscopy is the most expensive strategy: approximately $110 million more than MT-sDNA and $127 million more than FIT. With imperfect adherence (best case), MT-sDNA resulted in 0.12 QALYs per person vs 0.05 and 0.06 QALYs per person by FIT and colonoscopy, respectively. Probabilistic sensitivity analyses supported the base-case analysis. Under varied adherence scenarios, MT-sDNA either dominates or is cost-effective (ICERs, $1740-$75,868 per QALY saved) compared with FIT and colonoscopy. CONCLUSION Each strategy reduced costs and increased QALYs compared with no screening. Screening by MT-sDNA results in the largest QALY savings. In Markov model analysis, screening by MT-sDNA in the Alaska Native population was cost-effective compared with screening by colonoscopy and FIT for a wide range of adherence scenarios.
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12
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Storey S, Zhang Z, Luo X, Von Ah D, Metzger M, Zhang J, Jakka A, Huang K. Association of Comorbid Diabetes With Clinical Outcomes and Healthcare Utilization in Colorectal Cancer Survivors. Oncol Nurs Forum 2021; 48:195-206. [PMID: 33600395 DOI: 10.1188/21.onf.195-206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare clinical outcomes and healthcare utilization in colorectal cancer (CRC) survivors with and without diabetes. SAMPLE & SETTING CRC survivors (N = 3,287) were identified from a statewide electronic health record database using International Classification of Diseases (ICD) codes. Data were extracted on adults aged 21 years or older with an initial diagnosis of stage II or III CRC with diabetes present before CRC diagnosis or no diagnosis of diabetes (control). METHODS & VARIABLES ICD codes were used to extract diabetes diagnosis and clinical outcome variables. Healthcare utilization was determined by encounter type. Data were analyzed using descriptive statistics, multivariable logistic, and Cox regression. RESULTS CRC survivors with diabetes were more likely to develop anemia and infection than CRC survivors without diabetes. In addition, CRC survivors with diabetes were more likely to utilize emergency resources sooner than CRC survivors without diabetes. IMPLICATIONS FOR NURSING Oncology nurses can facilitate the early identification of high-risk survivor groups, reducing negative clinical outcomes and unnecessarily high healthcare resource utilization in CRC survivors with diabetes.
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Affiliation(s)
| | | | - Xiao Luo
- Indiana University-Purdue University Indianapolis
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13
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The Economic Impact of Rectal Cancer: A Population-Based Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020474. [PMID: 33430156 PMCID: PMC7827442 DOI: 10.3390/ijerph18020474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/24/2022]
Abstract
Costs of cancer care are increasing worldwide, and sustainability of cancer burden is critical. In this study, the economic impact of rectal cancer on the Italian healthcare system, measured as public healthcare expenditure related to investigation and treatment of rectal cancer patients is estimated. A cross-sectional cohort of 9358 rectal cancer patients is linked, on an individual basis, to claims associated to rectal cancer diagnosis and treatments. Costs refer mainly to years 2010–2011 and are estimated by phase of care, as healthcare needs vary along the care pathway: diagnostic procedures are mainly provided in the first year, surveillance procedures are addressed to chronically ill patients, and end-of-life procedures are given in the terminal status. Clinical approaches and corresponding costs are specific by cancer type and vary by phase of care, stage at diagnosis, and age. Surgery is undertaken by the great majority of patients. Thus, hospitalization is the main cost driver. The evidence produced can be used to improve planning and allocation of healthcare resources. In particular, early diagnosis of rectal cancer is a gain in healthcare budget. Policies raising spreading of and adherence to screening plans, above all when addressed to people living in Southern Italy, should be strongly encouraged.
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14
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Darbà J, Marsà A. Evaluation of productivity losses due to premature mortality from colorectal cancer. PLoS One 2020; 15:e0244375. [PMID: 33362274 PMCID: PMC7757866 DOI: 10.1371/journal.pone.0244375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/08/2020] [Indexed: 12/30/2022] Open
Abstract
Cancer is responsible annually for around 27% of all deaths in Spain, 15% of which are caused by colorectal cancer. This malignancy has increased its incidence considerably over the past years, which surely impacts global productivity losses. The evaluation of lost productivity due to premature mortality provides valuable information that guides healthcare policies into the establishment of prevention and screening programs. The purpose of this study was to assess the productivity losses from premature deaths due to colorectal cancer over a ten year period (2008–2017). The costs derived from premature mortality due to this highly prevalent cancer were estimated using data on mortality, age- and sex-specific reference salaries and unemployment rates in Spain via the human capital approach. Between 2008 and 2017, 15,103 persons died per year from colorectal cancer, representing almost 15% of all cancer-related deaths. Annually, 25,333 years of potential productive life were estimated to be lost on average, 14,992 in males and 10,341 in females. Productivity losses summed €510.8 million in in 2017, and the cancers of the colon and rectum accounted for 9.6% of cancer-related productivity losses in 2017 in Spain. Colorectal cancer has an important weight in terms of productivity losses within the Spanish population, consequently, prevention and early detection programmes should be promoted and implemented to achieve significant reductions in mortality and productivity losses.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L., Barcelona, Spain
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15
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The Direct and Indirect Costs of Colorectal Cancer in Vietnam: An Economic Analysis from a Social Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010012. [PMID: 33375113 PMCID: PMC7792935 DOI: 10.3390/ijerph18010012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 12/16/2022]
Abstract
The incidence and mortality of colorectal cancer (CRC) has increased rapidly in Vietnam, but the economic burden of this disease has never been estimated. We estimate the direct and indirect cost of CRC patients in Vietnam in 2018 using a prevalence-based approach and human capital method. The total economic cost of CRC was VND 3041.88 billion (~$132.9 million), representing 0.055% of the 2018 gross domestic product. Notably, indirect costs comprised 83.58 % of the total cost, 82.61% of which is future income loss, because CRC occurs during productive years. The economic burden of CRC in Vietnam is substantial. The medical cost for CRC diagnosis and treatment is higher for younger patients and for those in advanced stages. Strategies to decrease the economic burden of CRC at the patient and national level, such as screening programs, should be developed and implemented in Vietnam.
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16
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Pöhlmann J, Norrbacka K, Boye KS, Valentine WJ, Sapin H. Costs and where to find them: identifying unit costs for health economic evaluations of diabetes in France, Germany and Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1179-1196. [PMID: 33025257 PMCID: PMC7561572 DOI: 10.1007/s10198-020-01229-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health economic evaluations require cost data as key inputs. Many countries do not have standardized reference costs so costs used often vary between studies, thereby reducing transparency and transferability. The present review provided a comprehensive overview of cost sources and suggested unit costs for France, Germany and Italy, to support health economic evaluations in these countries, particularly in the field of diabetes. METHODS A literature review was conducted across multiple databases to identify published unit costs and cost data sources for resource items commonly used in health economic evaluations of antidiabetic therapies. The quality of unit cost reporting was assessed with regard to comprehensiveness of cost reporting and referencing as well as accessibility of cost sources from published cost-effectiveness analyses (CEA) of antidiabetic medications. RESULTS An overview of cost sources, including tariff and fee schedules as well as published estimates, was developed for France, Germany and Italy, covering primary and specialist outpatient care, emergency care, hospital treatment, pharmacy costs and lost productivity. Based on these sources, unit cost datasets were suggested for each country. The assessment of unit cost reporting showed that only 60% and 40% of CEAs reported unit costs and referenced them for all pharmacy items, respectively. Less than 20% of CEAs obtained all pharmacy costs from publicly available sources. CONCLUSIONS This review provides a comprehensive account of available costs and cost sources in France, Germany and Italy to support health economists and increase transparency in health economic evaluations in diabetes.
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Affiliation(s)
- J Pöhlmann
- Ossian Health Economics and Communications, Basel, Switzerland
| | | | - K S Boye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W J Valentine
- Ossian Health Economics and Communications, Basel, Switzerland
| | - H Sapin
- Lilly France, 24 Bd Vital Bouhot, CS 50004, 92521, Neuilly-sur-Seine Cedex, France.
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17
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Yezefski TA, Le D, Chen L, Speers CH, Chennupati S, Snider J, Gill S, Ramsey SD, Kennecke HF, Shankaran V. Comparison of Treatment, Cost, and Survival in Patients With Metastatic Colorectal Cancer in Western Washington, United States, and British Columbia, Canada. JCO Oncol Pract 2020; 16:e425-e432. [PMID: 32298222 DOI: 10.1200/jop.19.00719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Few studies have directly compared health care utilization, costs, and outcomes between patients treated in the US multipayer health system and Canada's single-payer system. Using cancer registry and claims data, we assessed treatment types, costs, and survival for patients with metastatic colorectal cancer (mCRC) in Western Washington State (WW) and British Columbia (BC). MATERIALS AND METHODS Patients age ≥ 18 years diagnosed with mCRC in 2010 and later were identified from the BC Cancer database and a regional database linking WW SEER to claims from Medicare and two large commercial insurers. Demographics, treatment characteristics, costs of systemic therapy, and survival data were obtained from these databases and compared between the two regions. RESULTS A total of 1,592 patients from BC and 901 from WW were included in the study. Median age was similar (BC, 66 years; WW, 63 years), but patients in BC were more likely to be male (57.1% v 51.2%; P ≤ .01) and to have de novo metastatic disease (61.0% v 38.3%; P ≤ .01). The use of radiation therapy was similar between regions (BC, 31.2%; WW, 33.9%; P = .18), but primary tumor resection was more common in BC (74.1% v 66.3%; P ≤ .01) as was hepatic metastasectomy (12.4% v 2.3%; P ≤ .01). Similar percentages of patients received systemic therapy (BC, 68.8%; WW, 67.1%; P = .40), but costs were significantly higher for first-line systemic therapy in WW ($6,226 v $15,792 per patient per month; P ≤ .01). Median overall survival was similar (BC, 16.9 months; WW, 18 months). CONCLUSION Cost of systemic therapy for mCRC was significantly higher for patients in WW than in BC, but this did not translate to a difference in overall survival.
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Affiliation(s)
| | - Dan Le
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Leo Chen
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | | | - Sharlene Gill
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Veena Shankaran
- University of Washington School of Medicine, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA
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18
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Mendelsohn RB, Winawer SJ, Ahnen DJ. Incidence of Colorectal Cancer Matters. Gastroenterology 2020; 158:1191-1195. [PMID: 31863742 DOI: 10.1053/j.gastro.2019.11.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/12/2019] [Accepted: 11/24/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Dennis J Ahnen
- University of Colorado Anschutz Medical Center, Aurora, Colorado and Gastroenterology of the Rockies, Boulder, Colorado
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19
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Joranger P, Nesbakken A, Sorbye H, Hoff G, Oshaug A, Aas E. Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:321-334. [PMID: 31707584 DOI: 10.1007/s10198-019-01130-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
New and emerging advances in colorectal cancer (CRC) treatment combined with limited healthcare resources highlight the need for detailed decision-analytic models to evaluate costs, survival and quality-adjusted life years. The objectives of this article were to estimate the expected lifetime treatment cost of CRC for an average 70-year-old patient and to test the applicability and flexibility of a model in predicting survival and costs of changing treatment scenarios. The analyses were based on a validated semi-Markov model using data from a Norwegian observational study (2049 CRC patients) to estimate transition probabilities and the proportion resected. In addition, inputs from the Norwegian Patient Registry, guidelines, literature, and expert opinions were used to estimate resource use. We found that the expected lifetime treatment cost for a 70-year-old CRC patient was €47,300 (CRC stage I €26,630, II €38,130, III €56,800, and IV €69,890). Altered use of palliative chemotherapy would increase the costs by up to 29%. A 5% point reduction in recurrence rate for stages I-III would reduce the costs by 5.3% and increase overall survival by 8.2 months. Given the Norwegian willingness to pay threshold per QALY gained, society's willingness to pay for interventions that could result in such a reduction was on average €28,540 per CRC patient. The life years gained by CRC treatment were 6.05 years. The overall CRC treatment costs appear to be low compared to the health gain, and the use of palliative chemotherapy can have a major impact on cost. The model was found to be flexible and applicable for estimating the cost and survival of several CRC treatment scenarios.
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Affiliation(s)
- Paal Joranger
- Norwegian University of Life Sciences, Ås, Norway.
- Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0130, Oslo, Norway.
| | - Arild Nesbakken
- Department of Gastrointestinal Surgery, Oslo University Hospital, 0424, Oslo, Norway
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, 0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Halfdan Sorbye
- Department of Oncology and Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
- University of Bergen, 5020, Bergen, Norway
| | - Geir Hoff
- Telemark Hospital, Skien, Norway
- The Cancer Registry of Norway, Oslo, Norway
- University of Oslo, 0316, Oslo, Norway
| | - Arne Oshaug
- Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0130, Oslo, Norway
| | - Eline Aas
- Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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20
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May T, Evans JP. Addressing perceived economic obstacles to genetic testing as a way to mitigate disparities in family health history for adoptees. HEALTH ECONOMICS, POLICY, AND LAW 2020; 15:277-287. [PMID: 30567613 DOI: 10.1017/s1744133118000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this paper, we ask whether or not we can afford to realize the potential benefits of genetic testing as a screening tool for adoptees. Our method is to provide reasonable cost and savings estimates. We argue that the prospect of cost neutrality should be sufficient to explore the targeted screening for a population who will otherwise suffer an avoidable health disparity in access to inherited disease information. Our goal here is to establish that the investment needed to attain these benefits is not beyond our means.
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Affiliation(s)
- Thomas May
- Floyd and Judy Rogers Endowed Professor, Elson S. Floyd College of Medicine, Washington State University, Vancouver, WA, USA
- Ethics and Genomics Program, HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
- Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA
| | - James P Evans
- Bryson Distinguished Professor of Genetics & Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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21
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Spugnini EP, Fais S. Drug repurposing for anticancer therapies. A lesson from proton pump inhibitors. Expert Opin Ther Pat 2019; 30:15-25. [PMID: 31847622 DOI: 10.1080/13543776.2020.1704733] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Worldwide, the annual expenditure on anticancer drugs is grossly calculated to be in the order of US$100 billion, and is expected to escalate up to $150 billion by 2020. It is evident that the vast majority of the most recently devised anticancer drugs are unaffordable in economically developing nations, frequently resulting in subpar therapies. In this complex medical and economic scenario, the repurposing of older drugs for anticancer therapies becomes a necessity. The repurposing of antiacid drugs such as the proton pump inhibitors as antitumoral agents and chemosensitizers is probably one of the most recent and promising phenomenon in oncology.Areas covered: Important research articles and patents focusing on proton pump inhibitors as a potential class of therapeutics, published between the period of 2006-2019, have been covered. This review mainly focuses on the therapeutic applications, as direct anticancer agents as well as modifiers of the tumor microenvironment and modulator of chemoresistance.Expert opinion: PPIs have significant anticancer applications and are proving to be safe, effective and inexpensive. Here the authors review the current knowledge regarding the influence of PPIs on the efficacy and safety of cancer chemotherapeutics through the regulation of targets other than the H+/K+-ATPase.
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Affiliation(s)
| | - Stefano Fais
- Department of Oncology and Molecular Medicine Istituto Superiore di Sanità, National Institute of Health, Rome, Italy
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22
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Heavener T, McStay FW, Jaeger V, Stephenson K, Sager L, Sing J. Assessing adherence and cost-benefit of colorectal cancer screening for accountable providers. Proc AMIA Symp 2019; 32:490-497. [PMID: 31656403 DOI: 10.1080/08998280.2019.1647702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/07/2023] Open
Abstract
The objective of this study was to assess adherence and costs-benefits of colorectal cancer (CRC) screenings from an accountable care organization/population health perspective. We performed a retrospective review of 94 patients (50-75 years of age) in an integrated safety net system for whom fecal CRC screening was abnormal for the period of June 1, 2014, to June 1, 2016. A cost-benefit model was constructed using Medicare payment rates and a sensitivity analysis. Most patients included in the study (64/94, 68%) received or were offered a colonoscopy. Of those receiving a colonoscopy, 24 of 45 (53%) had an abnormal finding. Total direct medical costs avoided by screening the patient panel was $32,926 but could have exceeded $63,237 had more patients received follow-up colonoscopies. A sensitivity analysis with 1000 patients demonstrated total monetary benefits between $2.2 million and $8.16 million when follow-up and colonoscopy rates were allowed to vary. Although the resulting rates of follow-up were within the range reported in the literature, there is room for improvement, especially considering the monetary benefit that could be used on other diseases. Health systems and payers should work cooperatively to structure payment models to better incentivize CRC screenings.
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Affiliation(s)
- Trace Heavener
- Department of Internal Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Frank W McStay
- Center for Healthcare Policy, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Victoria Jaeger
- Department of Internal Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Kristen Stephenson
- Department of Internal Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Lauren Sager
- Office of Biostatistics, Baylor Scott & White Medical Center-TempleTempleTexas
| | - James Sing
- Department of Gastroenterology, Baylor Scott & White Medical Center-TempleTempleTexas
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Effects of Aspirin or Clopidogrel on Colorectal Cancer Chemoprevention in Patients with Type 2 Diabetes Mellitus. Cancers (Basel) 2019; 11:cancers11101468. [PMID: 31569587 PMCID: PMC6827090 DOI: 10.3390/cancers11101468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 12/24/2022] Open
Abstract
Background: The effect of clopidogrel, whose mechanism of action differs from that of aspirin, on CRC risk remains unknown. We investigated the effects of clopidogrel and aspirin, either as monotherapy or combined, on colorectal cancer (CRC) risk in patients with Type 2 diabetes mellitus (T2DM). Methods: We conducted a cohort study using Taiwan National Health Insurance Research Database. Four groups comprising 218,903 patients using aspirin monotherapy, 20,158 patients using clopidogrel monotherapy, 42,779 patients using dual antiplatelet therapy, and 281,840 nonuser matched controls were created using propensity score matching. Cox proportional hazards regression was used to evaluate the CRC risk during follow-up. Results: During the 13-year follow-up period, we found 9431 cases of CRC over 3,409,522 person-years. The overall incidence rates of CRC were 2.04, 3.45, 1.55, and 3.52 per 1000 person-years in the aspirin, clopidogrel, dual antiplatelet, and nonuser cohorts, respectively. The adjusted hazard ratios (aHRs) were 0.59 (95% confidence interval [CI], 0.56–0.61), 0.77 (95% CI, 0.68–0.87), and 0.37 (95% CI, 0.33–0.40) for the aspirin, clopidogrel, and dual antiplatelet cohorts, respectively. Dose- and duration-dependent chemopreventive effects were observed in the three cohorts.
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Zheng Z, Han X, Zhao J, Yabroff KR. What can we do to help young cancer survivors minimize financial hardship in the United States? Expert Rev Anticancer Ther 2019; 19:655-657. [PMID: 31408395 DOI: 10.1080/14737140.2019.1656398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society , Atlanta , GA , USA
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society , Atlanta , GA , USA
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society , Atlanta , GA , USA
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society , Atlanta , GA , USA
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Zwolsman S, Kastelein A, Daams J, Roovers JP, Opmeer BC. Heterogeneity of cost estimates in health economic evaluation research. A systematic review of stress urinary incontinence studies. Int Urogynecol J 2019; 30:1045-1059. [PMID: 30715575 PMCID: PMC6586692 DOI: 10.1007/s00192-018-3814-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
Abstract
Introduction and hypothesis There is increased demand for an international overview of cost estimates and insight into the variation affecting these estimates. Understanding of these costs is useful for cost-effectiveness analysis (CEA) research into new treatment modalities and for clinical guideline development. Methods A systematic search was conducted in Ovid MEDLINE & other non-indexed materials and Ovid Embase for articles published between 1995 and 2017. The National Health Service Economic Evaluation Database (NHS-EED) filter and the McMaster sensitive therapy filter were combined with a bespoke search strategy for stress urinary incontinence (SUI). We extracted unit cost estimates, assessed variability and methodology, and determined transferability. Results We included 37 studies in this review. Four hundred and eighty-two cost estimates from 13 countries worldwide were extracted. Descriptive analysis shows that hospital stay in gynecology ranged between €82 and €1,292 per day. Costs of gynecological consultation range from €30 in France to €158 in Sweden. In the UK, costs are estimated at €228 per hour. Costs of a tension-free vaginal tape (TVT) device range from €431 in Finland to €994 in Canada. TVT surgery per minute costs €25 in France and €82 in Sweden. Total costs of TVT range from €1,224 in Ireland to €5,809 for inpatient care in France. Variation was explored. Conclusions Heterogeneity was observed in cost estimates for all units at all levels of health care. CEAs of SUI interventions cannot be interpreted without bias when the base of these analyses—namely costs—cannot be compared and generalized.
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Affiliation(s)
- Sandra Zwolsman
- Department of Gynaecology and Obstetrics, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. .,Gynaecology and Obstetrics, Amsterdam UMC, Room H4-232, Postbox 22770, 1100 DE, Amsterdam, the Netherlands.
| | - Arnoud Kastelein
- Department of Gynaecology and Obstetrics, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Joost Daams
- Medical Library, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - Jan-Paul Roovers
- Department of Gynaecology and Obstetrics, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - B C Opmeer
- Clinical Research Unit, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
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Tina Shih YC, Dong W, Xu Y, Shen Y. Assessing the Cost-Effectiveness of Updated Breast Cancer Screening Guidelines for Average-Risk Women. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:185-193. [PMID: 30711063 DOI: 10.1016/j.jval.2018.07.880] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Several specialty societies have recently updated their breast cancer screening guidelines in late 2015/early 2016. OBJECTIVES To evaluate the cost-effectiveness of US-based mammography screening guidelines. METHODS We developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease. We used the model to assess the cost-effectiveness of screening strategies, including annual screening starting at the age of 40 years, biennial screening starting at the age of 50 years, and a hybrid strategy that begins screening at the age of 45 years and transitions to biennial screening at the age of 55 years, combined with three cessation ages: 75 years, 80 years, and no upper age limit. Findings were summarized as incremental cost-effectiveness ratio (cost per quality-adjusted life-year [QALY]) and cost-effectiveness acceptability frontier. RESULTS The screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective, yielding an incremental cost-effectiveness ratio of $40,135/QALY. Probabilistic analysis showed that the hybrid strategy had the highest probability of being optimal when the societal willingness to pay was between $44,000/QALY and $103,500/QALY. Within the range of commonly accepted societal willingness to pay, no optimal strategy involved screening with a cessation age of 80 years or older. CONCLUSIONS The screening strategy built on a hybrid design is the most cost-effective for average-risk women. By considering the balance between benefits and harms in forming its recommendations, this hybrid screening strategy has the potential to optimize the health care system's investment in the early detection and treatment of breast cancer.
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Affiliation(s)
- Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zheng Z, Jemal A, Han X, Guy GP, Li C, Davidoff AJ, Banegas MP, Ekwueme DU, Yabroff KR. Medical financial hardship among cancer survivors in the United States. Cancer 2019; 125:1737-1747. [DOI: 10.1002/cncr.31913] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
| | - Gery P. Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Atlanta Georgia
| | - Chunyu Li
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Atlanta Georgia
| | - Amy J. Davidoff
- Department of Health Policy and Management Yale School of Public Health New Haven Connecticut
| | | | - Donatus U. Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Atlanta Georgia
| | - K. Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
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Ritzwoller DP, Fishman PA, Banegas MP, Carroll NM, O'Keeffe‐Rosetti M, Cronin AM, Uno H, Hornbrook MC, Hassett MJ. Medical Care Costs for Recurrent versus De Novo Stage IV Cancer by Age at Diagnosis. Health Serv Res 2018; 53:5106-5128. [PMID: 30043542 PMCID: PMC6232408 DOI: 10.1111/1475-6773.13014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To address the knowledge gap regarding medical care costs for advanced cancer patients, we compared costs for recurrent versus de novo stage IV breast, colorectal, and lung cancer patients. DATA SOURCES/STUDY SETTING Virtual Data Warehouse (VDW) information from three Kaiser Permanente regions: Colorado, Northwest, and Washington. STUDY DESIGN We identified patients aged ≥21 with de novo or recurrent breast (nde novo = 352; nrecurrent = 765), colorectal (nde novo = 1,072; nrecurrent = 542), and lung (nde novo = 4,041; nrecurrent = 340) cancers diagnosed 2000-2012. We estimated average total monthly and annual costs in the 12 months preceding, month of, and 12 months following the index de novo/recurrence date, stratified by age at diagnosis (<65, ≥65). Generalized linear repeated-measures models controlled for demographics and comorbidity. PRINCIPAL FINDINGS In the pre-index period, monthly costs were higher for recurrent than for de novo breast (<65: +$2,431; ≥65: +$1,360), colorectal (<65: +$3,219; ≥65: +$2,247), and lung cancer (<65: +$3,086; ≥65: +$2,260) patients. Conversely, during the index and post-index periods, costs were higher for de novo patients. Average total annual pre-index costs were five- to ninefold higher for recurrent versus de novo patients <65. CONCLUSIONS Cost differences by type of advanced cancer and by age suggest heterogeneous patterns of care that merit further investigation.
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Affiliation(s)
| | - Paul A. Fishman
- Department of Health ServicesUniversity of WashingtonSeattleWA
- Kaiser Permanente Washington Health Research InstituteSeattleWA
| | | | | | | | | | - Hajime Uno
- Dana‐Farber Cancer InstituteBostonMA
- Harvard Medical SchoolBostonMA
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Mafiana RN, Al Lawati AS, Waly MI, Al Farsi Y, Al Kindi M, Al Moundhri M. Association between Dietary and Lifestyle Indices and Colorectal Cancer in Oman: A Case-Control Study. Asian Pac J Cancer Prev 2018; 19:3117-3122. [PMID: 30486551 PMCID: PMC6318402 DOI: 10.31557/apjcp.2018.19.11.3117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Colorectal cancer (CRC) represents a heterogeneous group of diseases characterized by uncontrolled growth and spread of abnormal cells in the body. CRC vary on the basis of both the biologic features of the disease and its associated lifestyle characteristics. The risk of CRC increases with several modifiable factors including obesity, physical inactivity, a diet high in red or processed meat, heavy alcohol consumption, and possibly inadequate intake of fruits and vegetables. We aimed to establish a baseline data for dietary and lifestyle characteristics of Omani adults diagnosed with CRC. Methods: A Case control study conducted at Sultan Qaboos University Hospital, a referral hospital for CRC patients in Oman, and included 279 subjects (109 diagnosed CRC cases and 170 matched controls). All study subjects were recruited on volunteer basis and personally interviewed for preset questions related to sociodemographic data, anthropometric assessment, dietary intake and physical activity. Results: There was no significant difference between cases and controls regarding smoking, alcohol intake, physical activity and dietary fiber intake. However the enrolled cases were more overweight (OR =3.27. 95% CI: 1.91, 7.27), and, had a higher caloric (p =0.001) and macronutrient intake (carbohydrate: p = 0.001; protein: p = 0.017; saturated fat: P = 0.034) than the controls. In addition, the dietary pattern of the cases was characterized by a trend towards low vegetables and fruits intake. Conclusion: CRC maybe prevented through dietary management of high risk groups. This primary prevention approach will ultimately reduce the burden of CRC in Oman.
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Affiliation(s)
- Rose N Mafiana
- Department of Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Oman.
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30
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Saffarzadeh M, Eckert CE, Nagle D, Weaner LS, Waters GS, Levine EA, Weaver AA. Pelvic and Lower Gastrointestinal Tract Anatomical Characterization of the Average Male. Surg Innov 2018; 26:180-191. [PMID: 30417742 DOI: 10.1177/1553350618812317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Colorectal surgeons report difficulty in positioning surgical devices in males, particularly those with a narrower pelvis. The objectives of this study were to (1) characterize the anatomy of the pelvis and surrounding soft tissue from magnetic resonance and computed tomography scans from 10 average males (175 cm, 78 kg) and (2) develop a model representing the mean configuration to assess variability. METHODS The anatomy was characterized from existing scans using segmentation and registration techniques. Size and shape variation in the pelvis and soft tissue morphology was characterized using the Generalized Procrustes Analysis to compute the mean configuration. RESULTS There was considerable variability in volume of the psoas, connective tissue, and pelvis and in surface area of the mesorectum, pelvis, and connective tissue. Subject height was positively correlated with mesorectum surface area (P = .028, R2 = 0.47) and pelvis volume ( P = .041, R2 = 0.43). The anterior-posterior distance between the inferior pelvic floor muscle and pubic symphysis was positively correlated with subject height ( P = .043, r = 0.65). The angle between the superior mesorectum and sacral promontory was negatively correlated with subject height ( P = .042, r = -0.65). The pelvic inlet was positively correlated with subject weight ( P = .001, r = 0.89). CONCLUSIONS There was considerable variability in organ volume and surface area among average males with some correlations to subject height and weight. A physical trainer model created from these data helped surgeons trial and assess device prototypes in a controllable environment.
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Affiliation(s)
- Mona Saffarzadeh
- 1 Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA.,2 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | | | - Ashley A Weaver
- 1 Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA.,2 Wake Forest School of Medicine, Winston-Salem, NC, USA
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Khushalani JS, Qin J, Cyrus J, Lunsford NB, Rim SH, Han X, Yabroff KR, Ekwueme DU. Systematic review of healthcare costs related to mental health conditions among cancer survivors. Expert Rev Pharmacoecon Outcomes Res 2018; 18:505-517. [PMID: 29869568 PMCID: PMC6103822 DOI: 10.1080/14737167.2018.1485097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/03/2018] [Indexed: 01/18/2023]
Abstract
INTRODUCTION This systematic review examines healthcare costs associated with mental health conditions among cancer survivors in the United States. AREAS COVERED Ten published studies were identified. Studies varied substantially in terms of population, mental health conditions examined, data collection methods, and type of cost reported. Cancer survivors with mental health conditions incurred significantly higher total medical costs and costs of most service types compared to cancer survivors without a mental health condition. Additionally, the total healthcare expenditure related to mental health was higher among cancer survivors compared with people without history of cancer. EXPERT COMMENTARY Mental health conditions are associated with increased healthcare costs among cancer survivors. Future examination of other components of economic burden, including patient out-of-pocket costs, nonmedical costs, such as transportation, childcare, and productivity losses for patients and their caregivers, will be important. Additionally, evaluation of economic burden by cancer site, stage at diagnosis, duration of survivorship, and treatment(s) will increase understanding of the overall impact of mental health conditions on cancer survivors and on the healthcare system.
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Affiliation(s)
| | - Jin Qin
- Division of Cancer Prevention and Control, CDC, Atlanta, United States
| | - John Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, Richmond, Virginia, United States
| | | | - Sun Hee Rim
- Division of Cancer Prevention and Control, CDC, Atlanta, United States
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Briggs ADM, Scarborough P, Wolstenholme J. Estimating comparable English healthcare costs for multiple diseases and unrelated future costs for use in health and public health economic modelling. PLoS One 2018; 13:e0197257. [PMID: 29795586 PMCID: PMC5967835 DOI: 10.1371/journal.pone.0197257] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/28/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Healthcare interventions, and particularly those in public health may affect multiple diseases and significantly prolong life. No consensus currently exists for how to estimate comparable healthcare costs across multiple diseases for use in health and public health cost-effectiveness models. We aim to describe a method for estimating comparable disease specific English healthcare costs as well as future healthcare costs from diseases unrelated to those modelled. METHODS We use routine national datasets including programme budgeting data and cost curves from NHS England to estimate annual per person costs for diseases included in the PRIMEtime model as well as age and sex specific costs due to unrelated diseases. RESULTS The 2013/14 annual cost to NHS England per prevalent case varied between £3,074 for pancreatic cancer and £314 for liver disease. Costs due to unrelated diseases increase with age except for a secondary peak at 30-34 years for women reflecting maternity resource use. CONCLUSIONS The methodology described allows health and public health economic modellers to estimate comparable English healthcare costs for multiple diseases. This facilitates the direct comparison of different health and public health interventions enabling better decision making.
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Affiliation(s)
- Adam D. M. Briggs
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, United States of America
- * E-mail:
| | - Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Jane Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
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Vahdatimanesh Z, Zendehdel K, kbari Sari AA, Farhan F, Nahvijou A, Delavari A, Daroudi R. Economic burden of colorectal cancer in Iran in 2012. Med J Islam Repub Iran 2017; 31:115. [PMID: 29951416 PMCID: PMC6014770 DOI: 10.14196/mjiri.31.115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Colorectal cancer is one of the most common cancers in Iran. However little is known about the economic burden associated with this cancer in Iran. The aim of this study was to estimate the economic burden of colorectal cancer in Iran in the year 2012. Methods: We used the prevalence-based approach and estimated direct and indirect costs of all colorectal cancer cases in 2012. To estimate the total direct costs, we model the treatment process of colorectal cancer patients in initial and continuing phase in Iran. Then the average cost of each treatment in each phase was multiplied by the number of patients who received the treatment in the country in 2012. We used the human capital method to estimate the indirect costs. We extracted data from several sources, including national cancer registry reports, hospital records, literature review, occupational data, and interviews with experts. Results: The incidence and 5-year prevalence of colorectal cancer in Iran in 2012 were 7,163 and 22,591 individuals respectively. The economic burden of colorectal cancer in Iran was US$298,148,718 in 2012. Most of the cost (58%) was attributed to the mortality cost, and the direct medical cost accounted for 32.14 percent of the estimated total cost. The majority of the direct medical cost was associated with chemotherapy costs (50%). Conclusion: The economic burden of colorectal cancer in Iran is substantial and will increase in the future years.
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Affiliation(s)
- Zahra Vahdatimanesh
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran, Cancer Biology Centre, Cancer Institute of Iran, Tehran Universiy of Medical Sciences, Tehran, Iran
| | - Ali A kbari Sari
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Farhan
- Radiotherapy Oncology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Delavari
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
The economic burden of cancer on the national health expenditure is billions of dollars. The economic cost is measured on direct and indirect medical costs, which vary depending on stage at diagnosis, patient age, type of medical services, and site of service. Costs vary by region, physician behavior, and patient preferences. When analyzing the economic burden of survivors of colon cancer, we cannot forget the societal burden. Post-acute care and readmissions are major economic burdens. People with colon cancer have to be followed for their lifetime. Economic models are being studied to give cost-effective solutions to this problem.
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Affiliation(s)
- Guy R Orangio
- LSU Department of Surgery, 1542 Tulane Avenue, Suite 758, New Orleans, LA 70112, USA.
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Chen CT, Li L, Brooks G, Hassett M, Schrag D. Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer Patients in the Year of Diagnosis and Year of Death. Health Serv Res 2017; 53:2118-2132. [PMID: 28748564 DOI: 10.1111/1475-6773.12745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To characterize spending patterns for Medicare patients with incident breast, prostate, lung, and colorectal cancer. DATA SOURCES/STUDY SETTING/STUDY DESIGN 2007-2012 data from the Surveillance, Epidemiology, and End Results Program linked with Medicare fee-for-service claims. DATA COLLECTION/EXTRACTION METHODS We calculate per-patient monthly and yearly mean and median expenditures, by cancer type, stage at diagnosis, and spending category, over the years of diagnosis and death. PRINCIPAL FINDINGS Over the year of diagnosis, mean spending was $35,849, $26,295, $55,597, and $63,063 for breast, prostate, lung, and colorectal cancer, respectively. Over the year of death, spending was similar across different cancer types and stage at diagnosis. CONCLUSIONS Characterization of Medicare spending according to clinically meaningful categories may assist development of oncology alternative payment models and cost-effectiveness models.
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Affiliation(s)
| | - Ling Li
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA
| | - Gabriel Brooks
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA
| | - Michael Hassett
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA
| | - Deborah Schrag
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA
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Goldstein DA, Chen Q, Ayer T, Chan KKW, Virik K, Hammerman A, Brenner B, Flowers CR, Hall PS. Bevacizumab for Metastatic Colorectal Cancer: A Global Cost-Effectiveness Analysis. Oncologist 2017; 22:694-699. [PMID: 28592621 DOI: 10.1634/theoncologist.2016-0455] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the U.S., the addition of bevacizumab to first-line chemotherapy in metastatic colorectal cancer (mCRC) has been demonstrated to provide 0.10 quality-adjusted life years (QALYs) at an incremental cost-effectiveness ratio (ICER) of $571,000/QALY. Due to variability in pricing, value for money may be different in other countries. Our objective was to establish the cost-effectiveness of bevacizumab in mCRC in the U.S., U.K., Canada, Australia, and Israel. METHODS We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events, and quality of life were considered to be generalizable and therefore identical for all countries. We used country-specific prices for medications, administration, and other health service costs. All costs were converted from local currency to U.S. dollars at the exchange rates in March 2016. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties. RESULTS Base case results demonstrated that the highest ICER was in the U.S. ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, the U.K., and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost-effective in any country at a willingness to pay threshold of $150,000 per QALY. CONCLUSION The addition of bevacizumab to first-line chemotherapy for mCRC consistently fails to be cost-effective in all five countries. There are large differences in cost-effectiveness between countries. This study provides a framework for analyzing the value of a cancer drug from the perspectives of multiple international payers. IMPLICATIONS FOR PRACTICE The cost-effectiveness of bevacizumab varies significantly between multiple countries. By conventional thresholds, bevacizumab is not cost-effective in metastatic colon cancer in the U.S., the U.K., Australia, Canada, and Israel.
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Affiliation(s)
- Daniel A Goldstein
- Davidoff Center, Rabin Medical Center, Petach, Tikvah, Israel
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Qiushi Chen
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Turgay Ayer
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Kelvin K W Chan
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Kiran Virik
- Department of Medicine, University of Tasmania, Tasmania, Australia
| | | | - Baruch Brenner
- Davidoff Center, Rabin Medical Center, Petach, Tikvah, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | | | - Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, United Kingdom
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Hoover S, Subramanian S, Tangka FKL, Cole-Beebe M, Sun A, Kramer CL, Pacillio G. Patients and caregivers costs for colonoscopy-based colorectal cancer screening: Experience of low-income individuals undergoing free colonoscopies. EVALUATION AND PROGRAM PLANNING 2017; 62:81-86. [PMID: 28153341 PMCID: PMC5847315 DOI: 10.1016/j.evalprogplan.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/04/2017] [Indexed: 05/18/2023]
Abstract
Many studies have documented barriers to colorectal cancer screenings. However, there is lack of comprehensive information on the time and costs borne by low-income patients and the persons accompanying the patient (caregiver) for colonoscopies in the United States. We surveyed patients in three health clinics in Philadelphia retrospectively who had undergone free colonoscopies in the previous 18-month period. Participants were asked questions about time and out-of-pockets expenses for themselves and their caregivers. Even when colonoscopies were free to the patient through Colorectal Cancer Control Program funded by the Centers for Disease Control and Prevention, the patient and caregivers still incurred costs in relation to preparing for, undergoing, and recovering from a colonoscopy. These costs can be substantial and may account for some of the low colorectal cancer screening rates especially among the low-income populations. Patients' and caregivers' costs need to be considered when designing and implementing colorectal cancer control programs.
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Affiliation(s)
- Sonja Hoover
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA.
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Maggie Cole-Beebe
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Amy Sun
- RTI International, 307 Waverley Oaks Road, Waltham, MA 02452, USA
| | - Cheryl L Kramer
- Philadelphia Department of Public Health, Health Center 4, 4400 Haverford Avenue, Philadelphia, PA 19104, USA
| | - Gina Pacillio
- Philadelphia Department of Public Health, Health Center 4, 4400 Haverford Avenue, Philadelphia, PA 19104, USA
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Abstract
Colorectal cancer (CRC) is mainly characterized as the malignant and impaired growth of rectal cells in the intestinal region. Direct medical cost is related to resources, which are directly used in treating the patient, that mainly includes the cost of drugs, diagnostic, treatment, follow-up, rehabilitation, and hospital admission. The objective of this study is to estimate and analyze direct medical costs attributable to CRC in Jordan. A retrospective analysis of a cohort patients treated for CRC data has been performed to determine direct medical costs attributable to CRC in Jordan. The prevalence-based approach has been used in addition to the "bottom up" approach to accumulate 1-year time costs of CRC. Demographic, clinical, and economic data have been collected and analyzed using SPSS for windows. Costs were estimated by a bottom-up approach, in which each service component was identified and valued at the most detailed level, to provide greater transparency and reliability in economic evaluation of health care services. This study quantified the economic burden associated with CRC by Jordanian patients in King Abdullah University Hospital from the perspective of health care providers (public sector). Total CRC cost in the year 2014 was estimated to JD 695,608, and the most expensive stage for all sites was stage 4 reaching a cost of JD 5147. Advanced disease stages were associated with an increase in total cost and chemotherapy costs. In conclusion, results of this study propose that direct medical costs associated with CRC are considerable. Most of the cost was devoted for medications, primarily chemotherapy. Advanced stages were associated with higher cost and largest number of patients.
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Affiliation(s)
- Qais Alefan
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Rana Malhees
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Nizar Mhaidat
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Huang HY, Shi JF, Guo LW, Bai YN, Liao XZ, Liu GX, Mao AY, Ren JS, Sun XJ, Zhu XY, Wang L, Song BB, Du LB, Zhu L, Gong JY, Zhou Q, Liu YQ, Cao R, Mai L, Lan L, Sun XH, Ren Y, Zhou JY, Wang YZ, Qi X, Lou PA, Shi D, Li N, Zhang K, He J, Dai M. Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey. CHINESE JOURNAL OF CANCER 2017; 36:41. [PMID: 28454595 PMCID: PMC5410077 DOI: 10.1186/s40880-017-0209-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/08/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China. METHODS We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure. RESULTS A total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3% of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more, whereas those with a lower household income and those who underwent surgery spent less (all P < 0.05). CONCLUSIONS For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic, and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.
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Affiliation(s)
- Hui-Yao Huang
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
| | - Ju-Fang Shi
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
| | - Lan-Wei Guo
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
- Department of Cancer Epidemiology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008 P. R. China
| | - Ya-Na Bai
- Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, Gansu 730000 P. R. China
| | - Xian-Zhen Liao
- Hunan Office for Cancer Control and Research, Hunan Provincial Cancer Hospital, Changsha, Hunan 410006 P. R. China
| | - Guo-Xiang Liu
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, Heilongjiang 150081 P. R. China
| | - A-Yan Mao
- Public Health Information Research Office, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, 100020 P. R. China
| | - Jian-Song Ren
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
| | - Xiao-Jie Sun
- Center for Health Management and Policy, Key Lab of Health Economics and Policy, Shandong University, Jinan, Shandong 250012 P. R. China
| | - Xin-Yu Zhu
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
- Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, Gansu 730000 P. R. China
| | - Le Wang
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
| | - Bing-Bing Song
- Heilongjiang Office for Cancer Control and Research, Affiliated Cancer Hospital of Harbin Medical University, Harbin, Heilongjiang 150081 P. R. China
| | - Ling-Bin Du
- Zhejiang Office for Cancer Control and Research, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022 P. R. China
| | - Lin Zhu
- Teaching and Research Department, Affiliated Cancer Hospital of Xinjiang Medical University, Ürümqi, Xinjiang 830011 P. R. China
| | - Ji-Yong Gong
- Science and Education Department of Public Health Division, Shandong Tumor Hospital, Jinan, Shandong 250117 P. R. China
| | - Qi Zhou
- Chongqing Office for Cancer Control and Research, Chongqing Cancer Hospital, Chongqing, 400030 P. R. China
| | - Yu-Qin Liu
- Cancer Epidemiology Research Center, Gansu Provincial Cancer Hospital, Lanzhou, Gansu 730050 P. R. China
| | - Rong Cao
- Department of Health Policy and Economic Research, Guangdong Provincial Institute of Public Health, Guangzhou, Guangdong 511430 P. R. China
| | - Ling Mai
- Department of Institute of Tumor Research, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008 P. R. China
| | - Li Lan
- Institute of Chronic Disease Prevention and Control, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang 150081 P. R. China
| | - Xiao-Hua Sun
- Ningbo Clinical Cancer Prevention Guidance Center, Ningbo No. 2 Hospital, Ningbo, Zhejiang 315010 P. R. China
| | - Ying Ren
- Urban Office of Cancer Early Detection and Treatment, Tieling Central Hospital, Tieling, Liaoning 112000 P. R. China
| | - Jin-Yi Zhou
- Institute of Chronic Non-communicable Diseases Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009 P. R. China
| | - Yuan-Zheng Wang
- Department of Economic Operation, Kailuan General Hospital, Tangshan, Hebei 063000 P. R. China
| | - Xiao Qi
- Department of Occupational Medicine, Tangshan People’s Hospital, Tangshan, Hebei 063000 P. R. China
| | - Pei-An Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, Jiangsu 221006 P. R. China
| | - Dian Shi
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
- Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, Gansu 730000 P. R. China
| | - Ni Li
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
| | - Kai Zhang
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
| | - Jie He
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
| | - Min Dai
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing, 100021 P. R. China
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Rim SH, Guy GP, Yabroff KR, McGraw KA, Ekwueme DU. The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:579-589. [PMID: 27649815 DOI: 10.1080/14737167.2016.1239533] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This systematic review examines the excess cost of chronic conditions on the economic burden of cancer survivorship among adults in the US. Areas covered: Twelve published studies were identified. Although studies varied substantially in populations, comorbidities examined, methods, and types of cost reported, costs for cancer survivors with comorbidities generally increased with greater numbers of comorbidities or an increase in comorbidity index score. Survivors with comorbidities incurred significantly more in total medical costs, out-of-pocket costs, and costs by service type compared to cancer survivors without additional comorbidities. Expert commentary: Cancer survivors with comorbidities bear significant excess out-of-pocket costs and their care is also more expensive to the healthcare system. On-going evaluation of different payment models, care coordination, and disease management programs for cancer survivors with comorbidities will be important in monitoring impact on healthcare costs.
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Affiliation(s)
- Sun Hee Rim
- a Division of Cancer Prevention and Control , National Center for Chronic Disease Prevention and Health Promotion, CDC , Atlanta , GA , USA
| | - Gery P Guy
- a Division of Cancer Prevention and Control , National Center for Chronic Disease Prevention and Health Promotion, CDC , Atlanta , GA , USA
| | - K Robin Yabroff
- b U.S. Department of Health and Human Services , Office of Health Policy, Assistant Secretary for Planning and Evaluation , Washington , DC , USA
| | - Kathleen A McGraw
- c Health Sciences Library , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Donatus U Ekwueme
- a Division of Cancer Prevention and Control , National Center for Chronic Disease Prevention and Health Promotion, CDC , Atlanta , GA , USA
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Colorectal cancer in Malaysia: Its burden and implications for a multiethnic country. Asian J Surg 2016; 40:481-489. [PMID: 27492344 DOI: 10.1016/j.asjsur.2016.07.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study aims to provide an analytical overview of the changing burden of colorectal cancer and highlight the implementable control measures that can help reduce the future burden of colorectal cancer in Malaysia. METHODS We performed a MEDLINE search via OVID with the Medical Subject Headings (MeSH) terms "Colorectal Neoplasms"[Mesh] and "Malaysia"[Mesh], and PubMed with the key words "colorectal cancer" and "Malaysia" from 1990 to 2015 for studies reporting any clinical, societal, and economical findings associated with colorectal cancer in Malaysia. Incidence and mortality data were retrieved from population-based cancer registries/databases. RESULTS In Malaysia, colorectal cancer is the second most common cancer in males and the third most common cancer in females. The economic burden of colorectal cancer is substantial and is likely to increase over time in Malaysia owing to the current trend in colorectal cancer incidence. In Malaysia, most patients with colorectal cancer have been diagnosed at a late stage, with the 5-year relative survival by stage being lower than that in developed Asian countries. Public awareness of the rising incidence of colorectal cancer and the participation rates for colorectal cancer screening are low. CONCLUSION The efficiency of different screening approaches must be assessed, and an organized national screening program should be developed in a phased manner. It is essential to maintain a balanced investment in awareness programs targeting general population and primary care providers, focused on increasing the knowledge on symptoms and risk factors of colorectal cancer, awareness on benefits of screening, and promotion of healthy life styles to prevent this important disease.
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Woldemichael A, Onukwugha E, Seal B, Hanna N, Mullins CD. Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients. J Manag Care Spec Pharm 2016; 22:628-39. [PMID: 27231791 PMCID: PMC10397877 DOI: 10.18553/jmcp.2016.22.6.628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Technological advances in colon cancer treatment have significantly increased survival outcomes among metastatic patients. With different chemotherapy and biologic regimens administered in first, second, and subsequent lines of treatments, costs and survival outcomes vary considerably. However, there is little evidence on how the type of regime administered in the first line of treatment affects the costs and survival outcomes of the second line of treatment. OBJECTIVE To examine how the cost-effectiveness of second-line treatment for elderly metastatic colon cancer patients varies by the type of regimen administered in the first line of treatment. METHODS The Surveillance, Epidemiology and End Results (SEER) cancer registry was used, which is linked with the Medicare claims database, to study elderly metastatic patients diagnosed between 2003 and 2009. Average survivals are estimated using the robust nonparametric Kaplan-Meier method. Selection bias was adjusted for using inverse probability weighting and censoring using robust nonparametric methods of estimating the average of total health care costs. RESULTS Mean incremental survival was 6.7 months for patients who received second-line treatment (95% CI = 5.7-7.7) compared with those receiving only first-line treatment. However, the mean incremental survival varied between 4 months (95% CI = 0.0-7.3) and 9 months (95% CI = 6.5-11.0) depending on whether fluorouracil with or without leucovorin, irinotecan, oxaliplatin, or other agents were administered in first-line treatment. The mean incremental cost associated with receipt of second-line treatment was $60,231 (95% CI = 52,461-64,198) but ranged between $55,368 (95% CI = 48,294-61,290) and $71,211 (95% CI = 43,168-99,667), depending on the type of regimen administered in the first-line treatment. Combining survival benefits and costs, the incremental cost-effectiveness ratios per life-year gained associated with the receipt of second-line treatment were $97,368 (95% CI = 80,415-117,965); $110,621 (95% CI = 89,560-133,961); $130,689 (95% CI = 101,459-171,918); and $247,951 (95% CI = 112,629808,976) when irinotican, fluorouracil/leucovorin, oxaliplatin, and "other" combinations were, respectively, administered in first-line treatment. In addition, the results varied depending on which statistical method was used. CONCLUSIONS When therapies are administered in a sequential manner, the cost-effectiveness of the second line of therapy depends on what was administered in the first line of therapy. DISCLOSURES Bayer Healthcare Pharmaceuticals provided funding for this project. Onukwugha has received research funding from Bayer and Amgen and has a consultant/advisory relationship with Jansen Analytics at Johnson & Johnson. Seal was formerly an employee of Bayer and holds stock in Bayer. Mullins has research funding sponsored by Bayer and Pfizer and has a consultant/advisory relationship with Bayer, Amgen, BMS, Genentech, GSK, Novartis, NovoNordisk, and Pfizer. Woldemichael and Nader report no conflicts of interest. All authors contributed to the concept and design of this study. Onukwugha, Seal, and Mullins collected the data, with assistance from Woldemichael and Hanna, while Woldemichael interpreted the data, assisted by the other authors. The manuscript was written primarily by Woldemichael, with assistance from the other authors, and revised by Seal, Hanna, and Mullins, with assistance from Woldemichael and Onukwugha.
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Affiliation(s)
- Andinet Woldemichael
- Department of Pharmaceutical Health Services, University of Maryland School of Pharmacy, Baltimore
| | - Eberechukwu Onukwugha
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Brian Seal
- Bayer Healthcare Pharmaceuticals, Wayne, New Jersey
| | - Nader Hanna
- Department of Surgery, Division of General and Oncologic Surgery, University of Maryland School of Medicine, Baltimore
| | - C. Daniel Mullins
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
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Corral J, Castells X, Molins E, Chiarello P, Borras JM, Cots F. Long-term costs of colorectal cancer treatment in Spain. BMC Health Serv Res 2016; 16:56. [PMID: 26883013 PMCID: PMC4756512 DOI: 10.1186/s12913-016-1297-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 02/09/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Assessing the long-term cost of colorectal cancer (CRC) increases our understanding of the disease burden. The aim of this paper is to estimate the long-term costs of CRC care by stage at diagnosis and phase of care in the Spanish National Health Service. METHODS Retrospective study on resource use and direct medical cost of a cohort of 699 patients diagnosed and treated for CRC in 2000-2006, with follow-up until 30 June 2011, at Hospital del Mar (Barcelona). The Kaplan-Meier sample average estimator was used to calculate observed 11-year costs, which were then extrapolated to 16 years. Bootstrap percentile confidence intervals were calculated for the mean long-term cost per patient by stage. Phase-specific, long-term costs for the entire CRC cohort were also estimated. RESULTS With regard to stage at diagnosis, the mean long-term cost per patient ranged from €20,708 (in situ) to €47,681 (stage III). The estimated costs increased at more advanced stages up to stage III and then substantially decreased in stage IV. In terms of treatment phase, the mean cost of the initial period represented 24.8 % of the total mean long-term cost, whereas the cost of continuing and advanced care phases represented 16.9 and 58.3 %, respectively. CONCLUSIONS This study is the first to provide long-term cost estimates for CRC treatment, by stage at diagnosis and phase of care, based on data from clinical practice in Spain, and it will contribute useful information for future studies on cost-effectiveness and budget impact of different therapeutic innovations in Spain.
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Affiliation(s)
- Julieta Corral
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Doctoral Programme in Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Health, Catalonian Cancer Strategy, Generalitat de Catalunya, Barcelona, Spain.
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barcelona, Spain
| | - Eduard Molins
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Pietro Chiarello
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Josep Maria Borras
- Department of Health, Catalonian Cancer Strategy, Generalitat de Catalunya, Barcelona, Spain.,Department of Clinical Sciences, Bellvitge Biomedical Research Institute (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Francesc Cots
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barcelona, Spain
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Zheng Z, Yabroff KR, Guy GP, Han X, Li C, Banegas MP, Ekwueme DU, Jemal A. Annual Medical Expenditure and Productivity Loss Among Colorectal, Female Breast, and Prostate Cancer Survivors in the United States. J Natl Cancer Inst 2015; 108:djv382. [PMID: 26705361 DOI: 10.1093/jnci/djv382] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/06/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are limited nationally representative estimates of the annual economic burden among survivors of the three most prevalent cancers (colorectal, female breast, and prostate) in both nonelderly and elderly populations in the United States. METHODS The 2008 to 2012 Medical Expenditure Panel Survey data were used to identify colorectal (n = 540), female breast (n = 1568), and prostate (n = 1170) cancer survivors and individuals without a cancer history (n = 109 423). Excess economic burden attributable to cancer included per-person excess annual medical expenditures and productivity losses (employment disability, missed work days, and days stayed in bed). All analyses were stratified by cancer site and age (nonelderly: 18-64 years vs elderly: ≥ 65 years). Multivariable analyses controlled for age, sex, race/ethnicity, marital status, education, number of comorbidities, and geographic region. All statistical tests were two-sided. RESULTS Compared with individuals without a cancer history, cancer survivors experienced annual excess medical expenditures (for the nonelderly population, colorectal: $8647, 95% confidence interval [CI] = $4932 to $13 974, P < .001; breast: $5119, 95% CI = $3439 to $7158, P < .001; prostate: $3586, 95% CI = $1792 to $6076, P < .001; for the elderly population, colorectal: $4913, 95% CI = $2768 to $7470, P < .001; breast: $2288, 95% CI = $814 to $3995, P = .002; prostate: $3524, 95% CI = $1539 to $5909, P < .001). Nonelderly colorectal and breast cancer survivors experienced statistically significant annual excess employment disability (13.6%, P < .001, and 4.8%, P = .001) and productivity loss at work (7.2 days, P < .001, and 3.3 days, P = .002) and at home (4.5 days, P < .001, and 3.3 days, P = .003). In contrast, elderly survivors of all three cancer sites had comparable productivity losses as those without a cancer history. CONCLUSIONS Colorectal, breast, and prostate cancer survivors experienced statistically significantly higher economic burden compared with individuals without a cancer history; however, excess economic burden varies by cancer site and age. Targeted efforts will be important in reducing the economic burden of colorectal, breast, and prostate cancer.
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Affiliation(s)
- Zhiyuan Zheng
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
| | - K Robin Yabroff
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
| | - Gery P Guy
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
| | - Xuesong Han
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
| | - Chunyu Li
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
| | - Matthew P Banegas
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
| | - Donatus U Ekwueme
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
| | - Ahmedin Jemal
- Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB)
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Lo TKT, Parkinson L, Cunich M, Byles J. Cost of arthritis: a systematic review of methodologies used for direct costs. Expert Rev Pharmacoecon Outcomes Res 2015; 16:51-65. [PMID: 26618446 DOI: 10.1586/14737167.2016.1126513] [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: 01/28/2023]
Abstract
A substantial amount of healthcare and costs are attributable to arthritis, which is a very common chronic disease. This paper presents the results of a systematic review of arthritis cost studies published from 2008 to 2013. MEDLINE, Embase, EconLit databases were searched, as well as governmental and nongovernmental organization websites. Seventy-one reports met the inclusion/exclusion criteria, and 24 studies were included in the review. Among these studies, common methods included the use of individual-level data, bottom-up costing approach, use of both an arthritis group and a control group to enable incremental cost computation of the disease, and use of regression methods such as generalized linear models and ordinary least squares regression to control for confounding variables. Estimates of the healthcare cost of arthritis varied considerably across the studies depending on the study methods, the form of arthritis and the population studied. In the USA, for example, the estimated healthcare cost of arthritis ranged from $1862 to $14,021 per person, per year. The reviewed study methods have strengths, weaknesses and potential improvements in relation to estimating the cost of disease, which are outlined in this paper. Caution must be exercised when these methods are applied to cost estimation and monitoring of the economic burden of arthritis.
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Affiliation(s)
- T K T Lo
- a Research Centre for Gender, Health and Ageing , The University of Newcastle , Callaghan , Australia
| | - Lynne Parkinson
- b Central Queensland University , School of Human Health and Social Sciences , Rockhampton , Australia
| | - Michelle Cunich
- c Faculty of Pharmacy , Charles Perkins Centre, The University of Sydney , Camperdown , Australia.,d School of Medicine and Public Health, Faculty of Health and Medicine , The University of Newcastle , Callaghan , Australia
| | - Julie Byles
- a Research Centre for Gender, Health and Ageing , The University of Newcastle , Callaghan , Australia
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Goldstein DA, Ahmad BB, Chen Q, Ayer T, Howard DH, Lipscomb J, El-Rayes BF, Flowers CR. Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer. J Clin Oncol 2015; 33:3727-32. [PMID: 26304904 PMCID: PMC4737857 DOI: 10.1200/jco.2015.61.9569] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. METHODS We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. RESULTS Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. CONCLUSION Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing.
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Affiliation(s)
- Daniel A Goldstein
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
| | - Bilal B Ahmad
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Qiushi Chen
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Turgay Ayer
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - David H Howard
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Joseph Lipscomb
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Bassel F El-Rayes
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Christopher R Flowers
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
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Goldstein DA, Zeichner SB, Bartnik CM, Neustadter E, Flowers CR. Metastatic Colorectal Cancer: A Systematic Review of the Value of Current Therapies. Clin Colorectal Cancer 2015; 15:1-6. [PMID: 26541320 DOI: 10.1016/j.clcc.2015.10.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022]
Abstract
To evaluate, from a US payer perspective, the cost-effectiveness of treatment strategies for metastatic colorectal cancer (mCRC), we performed a systematic review of published cost-effectiveness analyses. We identified 14 papers that fulfilled our search criteria and revealed varying levels of value among current treatment strategies. Older agents such as 5-fluorouracil, irinotecan, and oxaliplatin provide high-value treatments. More modern agents targeting the EGFR or VEGF pathways, such as bevacizumab, cetuximab, and panitumumab, do not appear to be cost-effective treatments at their current costs. The analytical methods used within the papers varied widely, and this variation likely plays a significant role in the heterogeneity in incremental cost-effectiveness ratios. The cost-effectiveness of current treatment strategies for mCRC is highly variable. Drugs recently approved by the US Food and Drug Administration for mCRC are not cost-effective, and this is primarily driven by high drug costs.
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Affiliation(s)
- Daniel A Goldstein
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| | - Simon B Zeichner
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Eli Neustadter
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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Knobf M, Cooley M, Duffy S, Doorenbos A, Eaton L, Given B, Mayer D, McCorkle R, Miaskowski C, Mitchell S, Sherwood P, Bender C, Cataldo J, Hershey D, Katapodi M, Menon U, Schumacher K, Sun V, Ah D, LoBiondo-Wood G, Mallory G. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum 2015; 42:450-65. [DOI: 10.1188/15.onf.450-465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marti J, Hall PS, Hamilton P, Hulme CT, Jones H, Velikova G, Ashley L, Wright P. The economic burden of cancer in the UK: a study of survivors treated with curative intent. Psychooncology 2015; 25:77-83. [PMID: 26087260 DOI: 10.1002/pon.3877] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aim to describe the economic burden of UK cancer survivorship for breast, colorectal and prostate cancer patients treated with curative intent, 1 year post-diagnosis. METHODS Patient-level data were collected over a 3-month period 12-15 months post-diagnosis to estimate the monthly societal costs incurred by cancer survivors. Self-reported resource utilisation data were obtained via the electronic Patient-reported Outcomes from Cancer Survivors system and included community-based health and social care, medications, travel costs and informal care. Hospital costs were retrieved through data linkage. Multivariate regression analysis was used to examine cost predictors. RESULTS Overall, 298 patients were included in the analysis, including 136 breast cancer, 83 colorectal cancer and 79 prostate cancer patients. The average monthly societal cost was $ US 409 (95%CI: $ US 316-$ US 502) [mean: £ 260, 95%CI: £ 198-£ 322] and was incurred by 92% of patients. This was divided into costs to the National Health Service (mean: $ US 279, 95%CI: $ US 207-$ US 351) [mean: £ 177, 95%CI: £ 131-£ 224], patients' out-of-pocket (OOP) expenses (mean: $ US 40, 95%CI: $ US 15-$ US 65) [mean: £ 25, 95%CI: £ 9-£ 42] and the cost of informal care (mean: $ US 110, 95%CI: $ US 57-$ US 162) [mean: £ 70, 95%CI: £ 38-£ 102]. The distribution of costs was skewed with a small number of patients incurring very high costs. Multivariate analyses showed higher societal costs for breast cancer patients. Significant predictors of OOP costs included age and socioeconomic deprivation. CONCLUSIONS This study found the economic burden of cancer survivorship is unevenly distributed in the population and that cancer survivors may still incur substantial costs over 1 year post-diagnosis. In addition, this study illustrates the feasibility of using an innovative online data collection platform to collect patient-reported resource utilisation information.
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Affiliation(s)
- Joachim Marti
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Peter S Hall
- Academic Unit of Health Economics, University of Leeds, Leeds, UK.,Edinburgh Cancer Research Centre, University of Edinburgh, UK
| | - Patrick Hamilton
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Claire T Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Helen Jones
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Laura Ashley
- Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
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Novel cancer chemotherapy hits by molecular topology: dual Akt and Beta-catenin inhibitors. PLoS One 2015; 10:e0124244. [PMID: 25910265 PMCID: PMC4409212 DOI: 10.1371/journal.pone.0124244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/27/2015] [Indexed: 01/12/2023] Open
Abstract
Background and Purpose Colorectal and prostate cancers are two of the most common types and cause of a high rate of deaths worldwide. Therefore, any strategy to stop or at least slacken the development and progression of malignant cells is an important therapeutic choice. The aim of the present work is the identification of novel cancer chemotherapy agents. Nowadays, many different drug discovery approaches are available, but this paper focuses on Molecular Topology, which has already demonstrated its extraordinary efficacy in this field, particularly in the identification of new hit and lead compounds against cancer. This methodology uses the graph theoretical formalism to numerically characterize molecular structures through the so called topological indices. Once obtained a specific framework, it allows the construction of complex mathematical models that can be used to predict physical, chemical or biological properties of compounds. In addition, Molecular Topology is highly efficient in selecting and designing new hit and lead drugs. According to the aforementioned, Molecular Topology has been applied here for the construction of specific Akt/mTOR and β-catenin inhibition mathematical models in order to identify and select novel antitumor agents. Experimental Approach Based on the results obtained by the selected mathematical models, six novel potential inhibitors of the Akt/mTOR and β-catenin pathways were identified. These compounds were then tested in vitro to confirm their biological activity. Conclusion and Implications Five of the selected compounds, CAS n° 256378-54-8 (Inhibitor n°1), 663203-38-1 (Inhibitor n°2), 247079-73-8 (Inhibitor n°3), 689769-86-6 (Inhibitor n°4) and 431925-096 (Inhibitor n°6) gave positive responses and resulted to be active for Akt/mTOR and/or β-catenin inhibition. This study confirms once again the Molecular Topology’s reliability and efficacy to find out novel drugs in the field of cancer.
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