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Lira RB, Chulam TC, Kowalski LP. Safe implementation of retroauricular robotic and endoscopic neck surgery in South America. Gland Surg 2017; 6:258-266. [PMID: 28713697 DOI: 10.21037/gs.2017.03.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the last three decades, otolaryngology and head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the Da Vinci robotic surgery system has promoted the development of several surgical approaches with less morbidity and better cosmetic results, including the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. In South America, there are several shortcomings regarding financial resources as well as the lack of support for innovation leading to a significant delay in adoption of numerous technological advances in medical practice. Despite these obstacles, we obtained training in transoral robotic surgery and neck procedures, and then decided to implement neck endoscopic and robotic surgery at our institution. We developed a collaborative training program with Yonsei University that, together with several local measures, allowed for a safe implementation. From June 2014 to December 2016, we have performed a total of 121 retroauricular neck surgeries, of which 65 were robotic-assisted and 56 were endoscopic assisted procedures, with a complication rate that seems to be comparable to conventional procedures in our experience and a smooth learning curve. Safety compliance has been continuously assessed. Aiming to develop and disseminate these techniques, we have ongoing collaborative work with Yonsei University faculty, to continue increasing our clinical experience, and we are now preparing the group and infrastructure to establish a local training program for South American surgeons. We have been presenting our results at national and international medical meetings and started to publish the preliminary results in peer reviewed medical journals. The emphasis is that a retroauricular approach is a therapeutic option to be considered, especially for young patients. Media exposure has been avoided so far. As expected, resistance by our peers is still present and much more work is needed to overcome it, including the generation of data on the outcomes and a critical analysis of the advantages and disadvantages of endoscopic and robotic neck surgery.
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Affiliation(s)
- Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Thiago Celestino Chulam
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
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Oliva-Moreno J, Trapero-Bertran M, Peña-Longobardo LM, Del Pozo-Rubio R. The Valuation of Informal Care in Cost-of-Illness Studies: A Systematic Review. PHARMACOECONOMICS 2017; 35:331-345. [PMID: 27848219 DOI: 10.1007/s40273-016-0468-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND There is a growing interest in incorporating informal care in cost-of-illness studies as a relevant part of the economic impact of some diseases. OBJECTIVE The aim of this paper was to review the recent literature valuating the costs of informal care in a group of selected diseases from 2005 to 2015. METHODS We carried out a systematic review on the economic impact of informal care, focusing on six selected diseases: arthritis or osteoarthritis, cancer, dementia, mental diseases, multiple sclerosis and stroke. RESULTS We selected 91 cost-of-illness articles. The average weight attributed to the informal care cost over the total cost was highly relevant for dementia, stroke, mental diseases, cancer and multiple sclerosis. The most frequent valuation method applied was the opportunity cost method, followed by the proxy good method. The annual cost of informal care presented a high variability depending on the disease and geographic location. Distinguishing by type of illness, the disease with the highest annual value of informal caregiving was dementia, followed by mental illness and multiple sclerosis. The average hourly unit cost was €11.43 (2015 values), varying noticeably depending on the geographic location. CONCLUSION This paper identifies several aspects that should be enhanced to promote comparability between studies and countries, and it sends key messages for incorporating informal care costs to adequately measure the economic impact of diseases.
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Affiliation(s)
- Juan Oliva-Moreno
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, Universidad de Castilla La-Mancha, Toledo, Spain.
| | - Marta Trapero-Bertran
- Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Luz Maria Peña-Longobardo
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, Universidad de Castilla La-Mancha, Toledo, Spain
| | - Raúl Del Pozo-Rubio
- Department of Economic Analysis and Finance, Faculty of Social Sciences, Universidad de Castilla La-Mancha, Cuenca, Spain
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Haeussler K, Marcellusi A, Mennini FS, Favato G, Picardo M, Garganese G, Bononi M, Costa S, Scambia G, Zweifel P, Capone A, Baio G. Cost-Effectiveness Analysis of Universal Human Papillomavirus Vaccination Using a Dynamic Bayesian Methodology: The BEST II Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:956-68. [PMID: 26686779 DOI: 10.1016/j.jval.2015.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/05/2015] [Accepted: 08/08/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) plays a role in the development of benign and malign neoplasms in both sexes. The Italian recommendations for HPV vaccines consider only females. The BEST II study (Bayesian modelling to assess the Effectiveness of a vaccination Strategy to prevent HPV-related diseases) evaluates 1) the cost-effectiveness of immunization strategies targeting universal vaccination compared with cervical cancer screening and female-only vaccination and 2) the economic impact of immunization on various HPV-induced diseases. OBJECTIVE The objective of this study was to evaluate whether female-only vaccination or universal vaccination is the most cost-effective intervention against HPV. METHODS We present a dynamic Bayesian Markov model to investigate transmission dynamics in cohorts of females and males in a follow-up period of 55 years. We assumed that quadrivalent vaccination (against HPV 16, 18, 6, and 11) is available for 12-year-old individuals. The model accounts for the progression of subjects across HPV-induced health states (cervical, vaginal, vulvar, anal, penile, and head/neck cancer as well as anogenital warts). The sexual mixing is modeled on the basis of age-, sex-, and sexual behavioral-specific matrices to obtain the dynamic force of infection. RESULTS In comparison to cervical cancer screening, universal vaccination results in an incremental cost-effectiveness ratio of €1,500. When universal immunization is compared with female-only vaccination, it is cost-effective with an incremental cost-effectiveness ratio of €11,600. Probabilistic sensitivity analysis shows a relatively large amount of parameter uncertainty, which interestingly has, however, no substantial impact on the decision-making process. The intervention being assessed seems to be associated with an attractive cost-effectiveness profile. CONCLUSIONS Universal HPV vaccination is found to be a cost-effective choice when compared with either cervical cancer screening or female-only vaccination within the Italian context.
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Affiliation(s)
- Katrin Haeussler
- Department of Statistical Science, University College London, London, UK.
| | - Andrea Marcellusi
- Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Department of Demography, University of Rome "La Sapienza," Rome, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Giampiero Favato
- Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Mauro Picardo
- Laboratory of Cutaneous Pathophysiology, San Gallicano Dermatological Institute (IRCCS), Rome, Italy
| | - Giorgia Garganese
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Bononi
- Department of Surgery Pietro Valdoni, University of Rome "La Sapienza," Rome, Italy
| | - Silvano Costa
- Department of Gynecology and Obstetrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Zweifel
- Socioeconomic Institute, University of Zurich, Zurich, Switzerland
| | - Alessandro Capone
- Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
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Langevin SM, Michaud DS, Eliot M, Peters ES, McClean MD, Kelsey KT. Regular dental visits are associated with earlier stage at diagnosis for oral and pharyngeal cancer. Cancer Causes Control 2012; 23:1821-9. [PMID: 22961100 DOI: 10.1007/s10552-012-0061-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/28/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Oral and pharyngeal cancer patients diagnosed at an advanced stage experience increased morbidity and mortality relative to those with localized disease. The aim of this study was to assess the impact of dental insurance status and regularity of dental visits on early detection of oral and pharyngeal cancer. METHODS We examined the relationship of dental insurance and frequency of dental visits with stage at diagnosis among 441 oral and pharyngeal cancer cases from a population-based study of head and neck cancer. Ordinal logistic regression models were used to assess the association with stage, and tumor (T) and nodal (N) classification. RESULTS Never or rarely going to the dentist was associated with being diagnosed at higher stage for oral and pharyngeal cancer (cumulative OR = 2.28, 95 % CI: 1.02-5.10) and oral cancer (cumulative OR = 9.17, 95 % CI: 2.70-31.15) compared to those going to the dentist at least annually. Oral and pharyngeal cancer patients who went to the dentist infrequently (cumulative OR = 1.82, 95 % CI: 1.09-3.05) or rarely/never (cumulative OR = 3.24, 95 % CI: 1.59-6.57) were diagnosed with a higher T classification compared with those who went at least annually. CONCLUSIONS Receipt of regular dental examinations at least annually may reduce the public health burden of oral and pharyngeal cancer by facilitating earlier detection of the disease.
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Affiliation(s)
- Scott M Langevin
- Department of Epidemiology, Brown University, 70 Ship Street, Box G-E5, Providence, RI 02912, USA
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Langevin SM, Koestler DC, Christensen BC, Butler RA, Wiencke JK, Nelson HH, Houseman EA, Marsit CJ, Kelsey KT. Peripheral blood DNA methylation profiles are indicative of head and neck squamous cell carcinoma: an epigenome-wide association study. Epigenetics 2012; 7:291-9. [PMID: 22430805 DOI: 10.4161/epi.7.3.19134] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Head and neck cancer accounts for an estimated 47,560 new cases and 11,480 deaths annually in the United States, the majority of which are squamous cell carcinomas (HNSCC). The overall 5 year survival is approximately 60% and declines with increasing stage at diagnosis, indicating a need for non-invasive tests that facilitate the detection of early disease. DNA methylation is a stable epigenetic modification that is amenable to measurement and readily available in peripheral blood. We used a semi-supervised recursively partitioned mixture model (SS-RPMM) approach to identify novel blood DNA methylation markers of HNSCC using genome-wide methylation array data for peripheral blood samples from 92 HNSCC cases and 92 cancer-free control subjects. To assess the performance of the resultant markers, we constructed receiver operating characteristic (ROC) curves and calculated the corresponding area under the curve (AUC). Cases and controls were best differentiated by a methylation profile of six CpG loci (associated with FGD4, SERPINF1, WDR39, IL27, HYAL2 and PLEKHA6), with an AUC of 0.73 (95% CI: 0.62-0.82). After adjustment for subject age, gender, smoking, alcohol consumption and HPV16 serostatus, the AUC increased to 0.85 (95% CI: 0.76-0.92). We have identified a novel blood-based methylation profile that is indicative of HNSCC with a high degree of accuracy. This profile demonstrates the potential of DNA methylation measured in blood for development of non-invasive applications for detection of head and neck cancer.
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Affiliation(s)
- Scott M Langevin
- Department of Epidemiology, Brown University, Providence, RI, USA
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Moore EJ, Hinni ML, Olsen KD, Price DL, Laborde RR, Inman JC. Cost Considerations in the Treatment of Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2012; 146:946-51. [DOI: 10.1177/0194599812437534] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. To determine the cost of treatment of oropharyngeal squamous cell carcinoma (OP SCCA) with transoral surgery with concomitant neck dissection (TOS), TOS with adjuvant radiation therapy (TOS + RT), TOS with adjuvant chemoradiation therapy (TOS + CRT), and primary chemoradiation therapy (CRT). Study Design. Case series. Setting. Two tertiary care teaching hospitals. Subjects and Methods. Using the databases of 2 teaching hospitals, patients were identified who had OP SCCA treated with TOS, TOS + RT, TOS + CRT, and primary CRT in 2009 to 2010. Costs were analyzed from an institutional perspective looking at reimbursement. Patients with government payers and patients with private payers in each group were identified, and net revenue data obtained for the 3-month period from diagnosis were calculated and averaged for each group. Cost was defined as the reimbursement for all charges surrounding the 3-month episode of treatment. All revenue associated with inpatient and outpatient care, including pharmacy charges, was included. Results. The mean cost of TOS (private payers/government payers) was $37,435/$15,664 (range, $22,486-$48,746/$13,325-$16,885). The mean cost of TOS + RT (private payers/government payers) was $74,484/$34,343 (range, $72,400-$84,825/$31,565-$40,810). The mean cost of TOS + CRT (private payers/government payers) was $191,780/$53,245 (range, $145,450-$217,220/$49,400-$58,325). The mean cost of CRT (private payers/government payers) was $198,285/$57,429 (range, $168,216-$298,945/$52,900-$59,545). Conclusion. An algorithm of transoral surgical treatment of OP SCCA with adjuvant treatment as indicated by pathology is more cost conscious than an algorithm of treatment of all OP SCCA with CRT.
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Affiliation(s)
- Eric J. Moore
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael L. Hinni
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kerry D. Olsen
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L. Price
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca R. Laborde
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jared C. Inman
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Scottsdale, Arizona, USA
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Amonkar MM, Chastek B, Samant N, Teitelbaum A. Economic burden of resected squamous cell carcinoma of the head and neck in a US managed-care population. J Med Econ 2011; 14:421-32. [PMID: 21619455 DOI: 10.3111/13696998.2011.584096] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Squamous cell carcinoma of the head and neck (SCCHN) places a high burden on society and poses complex challenges to healthcare providers. METHODS Retrospective claims-based analysis of commercially insured patients identified between 01-31-04 and 12-31-07 with diagnostic evidence of cancer of the lip, tongue, oral cavity, pharynx, or larynx who underwent surgical resection during identification period. Outcomes included treatment patterns, healthcare utilization, and costs. All study variables were analyzed descriptively. RESULTS Among the 1104 patients in the final study sample, 71.9% were male, with mean age 56.6 years. On average, patients were followed for 830 days (range of mean days: 805 for lip or tongue cancer to 847 for pharyngeal cancer). About half received radiation therapy during follow-up, whereas only 16.2% received chemotherapy. Patients with pharyngeal cancer were most likely to undergo chemotherapy. After their index surgery, 57.9% of patients had ≥1 inpatient stay, 44.9% had ≥1 ER visit, and all had ≥1 ambulatory visit. The percentage with ≥1 inpatient stay post-index was highest among patients with pharyngeal cancer (73.0%) and lowest in the laryngeal cancer cohort (49.5%). Mean number of hospitalized days, ER visits, and ambulatory visits was 0.45, 0.69, and 27.4, respectively, per-patient per-year. Overall, patients incurred ~$94 million in cost following index surgery ($85,000 per-person, on average). Mean total healthcare cost was $34,450 per-patient per-year, the bulk of which comprised medical expenses ($32,401). The highest mean healthcare cost was incurred by the pharyngeal cancer cohort ($40,214). CONCLUSIONS Patients with resected SCCHN incur substantial healthcare costs and have high utilization rates. Results of this analysis are primarily applicable to resected SCCHN in a managed-care setting, and therefore may not be generalizable to the entire US population. Furthermore, disease stage is an important factor impacting outcomes, but these analyses did not stratify patients according to disease stage.
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Affiliation(s)
- Mayur M Amonkar
- Global Health Outcomes (Oncology), GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, PA 19426-0989, USA
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Han S, Chen Y, Ge X, Zhang M, Wang J, Zhao Q, He J, Wang Z. Epidemiology and cost analysis for patients with oral cancer in a university hospital in China. BMC Public Health 2010; 10:196. [PMID: 20398380 PMCID: PMC2864212 DOI: 10.1186/1471-2458-10-196] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 04/16/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although several studies have reported the direct cost of oral cancer (OC), little research has invested the factors that could influence the costs of OC patient. This study analyzes the epidemiological characteristics and the direct cost of OC. More specifically, the study examines the relationship between patients' medical costs and influencing factors of epidemiology. METHODS All patients encountered from January 2007 to December 2007 at the School of Stomatology of the Fourth Military Medical University (FMMU) in China with diagnosis of oral cancer have been selected. Medical hospitalization days (MHD) and cost per patient (CPP) of the samples have been calculated for different patient groups, and the results have been compared using statistical methods. RESULTS A total of 456 oral cancer patients have been selected in this study. The epidemical characteristics are as follows: female/male 176/280; squamous cell carcinoma (SCC)/adenocarcinoma/sarcoma/lymphoma/other types 246/127/40/27/16; stage I/II/III/IV 90/148/103/115; smoker/non-smoker 136/320; rural/urban patients 82/374. Of all the patients, 82.24% were over 40 years of age. Rural patients were significantly younger than urban patients. SCC was the majority histology in older patients, while sarcoma was more common in younger patients. 372 of the patients received treatment and 84 gave up any treatment after diagnosis. Treatment cost accounted for majority of the payment. The CPP and MHD of patients in late clinical stage were higher than that of patient in early stage. CONCLUSION Gender, smoking habit and age older than 40 years are the epidemiological risk factors for oral cancer. Lack of medicare, smoking habit, late clinical stage and SCC are the high economic factors for patient medical cost.
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Affiliation(s)
- Sheng Han
- Department of Information Center, School of Stomatology, the Fourth Military Medical University, Xi'an PR China
| | - Yan Chen
- Department of Oncology, Xi'Jing Hospital, the Fourth Military Medical University, Xi'an PR China
| | - Xu Ge
- Administration of Clinical Research and Teaching, School of Stomatology, the Fourth Military Medical University, Xi'an PR China
| | - Ming Zhang
- Administration of Clinical Research and Teaching, School of Stomatology, the Fourth Military Medical University, Xi'an PR China
| | - Jinwei Wang
- Department of Logistics, School of Stomatology, the Fourth Military Medical University, Xi'an PR China
| | - Qingbo Zhao
- Department of physics and mathematics, the Fourth Military Medical University, Xi'an PR China
| | - Jianjun He
- Administration of Clinical Research and Teaching, School of Stomatology, the Fourth Military Medical University, Xi'an PR China
| | - Zhenghong Wang
- Training Department, the Fourth Military Medical University, Xi'an PR China
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