Is chest X-ray screening for lung cancer in smokers cost-effective? Evidence from a population-based study in Italy

Irish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study

BACKGROUND

Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors.

AIMS

Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative.

METHODS

A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs.

RESULTS

Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines.

CONCLUSIONS

GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.

Impact of enhancing GP access to diagnostic imaging: A scoping review

BACKGROUND

Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care.

METHODS

A search was conducted of 'PubMed', 'Cochrane Library', 'Embase' and 'Google Scholar' for papers published between 2012-2022 using Arksey and O'Malley's scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR).

RESULTS

Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process.

CONCLUSION

Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.

Comparison of value of biomarkers in diagnosing lung cancer: An overview of systematic reviews protocol

BACKGROUND

In both sexes combined, lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death. Furthermore, the incidence rate is increasing in many countries. Many lung cancer patients have a poor prognosis because they are usually diagnosed at an advanced stage. Therefore, there is an urgent need to develop effective methods for early diagnosis of lung cancer. Some systematic reviews have evaluated the value of biomarkers for diagnosing lung cancer. However, it remains unclear which biomarker has superior performance for early and accurate detection of lung cancer. This overview aims to assess the methodological and reporting quality of available systematic reviews and to find an optimal biomarker for diagnosing lung cancer.

METHODS

We searched PubMed, Embase.com, the Cochrane Library of Systematic Reviews, and Web of Science to identify relevant systematic reviews including randomized controlled trials, cross-sectional studies, case-control studies, or cohort studies that reported the value of biomarkers for diagnosing lung cancer. The methodological quality will be assessed using AMASAR-2 checklist, and the reporting quality will be assessed using PRISMA-DTA checklist. Bubble plot will be generated to map the biomarkers, methodological and reporting quality. The pairwise meta-analysis and indirect comparisons will be performed using STATA 13.0.

RESULTS

The results of this study will be published in a peer-reviewed journal CONCLUSION:: This overview will provide comprehensive evidence of different biomarkers for the diagnosis of lung cancer.

ETHICS AND DISSEMINATION

Ethics approval and patient consent are not required as this study is an overview based on published systematic reviews.

Adherence to Monitoring Guidelines of Amiodarone Adverse Reactions

Background:

Amiodarone treatment frequently causes adverse reactions. Clinical guidelines warrant a comprehensive assessment prior to chronic treatment with amiodarone and repeated monitoring for the appearance of adverse reactions.

Objective:

To evaluate adherence to these guidelines.

Methods:

A retrospective chart review of electronic medical records of adult patients treated with oral amiodarone for at least 12 months.

Results:

One hundred patient records were analyzed; 97% of patients were evaluated for thyroid and liver functions prior to treatment. Liver functions were properly monitored every 6 months in 96% of patients and thyroid function in only 59%. Most (84%) patients completed a chest X-ray before treatment; only 2% completed a respiratory function test. None have performed a chest X-ray annually. Sixty-four percent of the patients were examined by an ophthalmologist prior to treatment; periodic ophthalmic surveillance was not consistent. Neurological and dermatological evaluations were not recorded for any of the patients, unless symptoms appeared. Only 50% were adherent to annual cardiac reassessment.

Conclusions:

Adherence to recommended clinical guidelines for monitoring amiodarone adverse reactions is poor. Interventions to improve compliance with these guidelines are needed.

P16INK4a gene promoter methylation as a biomarker for the diagnosis of non-small cell lung cancer: An updated meta-analysis

BACKGROUND

This meta-analysis was conducted to investigate the diagnostic performance of P16INK4a gene promoter methylation as a biomarker of non-small cell lung cancer (NSCLC).

METHODS

Two reviewers independently searched the Web of Science, PubMed, Cochrane, Embase, China National Knowledge Infrastructure, and Chinese Biomedical Literature databases. Publications relevant to P16INK4a gene promoter methylation in serum or bronchoalveolar fluid/sputum were screened and included in this meta-analysis. Pooled diagnostic sensitivity, specificity, and symmetric receiver operating characteristic curve were calculated.

RESULTS

Twenty-six publications with 1768 lung cancer cases and 1323 controls were included. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.46 (95% confidence interval [CI] 0.43-0.48), 0.90 (95% CI 0.88-0.91), 6.33 (95% CI 3.89-10.30), 0.57 (95% CI 0.50-0.65) and 10.72 (95% CI 6.94-16.56), respectively, for P16INK4a gene promoter methylation as a biomarker for the diagnosis of NSCLC. The area under the symmetric receiver operating characteristic curve was 0.75 with a standard error of 0.004. No publication bias was detected via line regression test (t = 0.95; P = 0.35) and Begg's funnel plot.

CONCLUSION

P16INK4a gene promoter methylation detection in serum or bronchoalveolar fluid/sputum may be a potential biomarker for NSCLC diagnosis; however, the sensitivity was relatively low, which is not suitable for NSCLC screening.

The Economic Burden of Small Cell Lung Cancer: A Systematic Review of the Literature

BACKGROUND

Small cell lung cancer (SCLC), the most aggressive form of lung carcinoma, represents approximately 15% of all lung cancers; however, the economic and healthcare burden of SCLC is not well-defined.

OBJECTIVE

The aim of this study was to explore the impact of SCLC on healthcare costs through a systematic literature review (SLR).

METHODS

Using the OVID search engine, the SLR was conducted in PubMed, MEDLINE In-Process, EMBASE, EconLIT and the National Health Service Economic Evaluation Database (NHS EED). Searches were limited to studies published between January 2005 and 24 February 2016, and excluded preclinical studies. Additional internet-based searches were conducted. In total, 229 abstracts were retrieved and systematically screened for eligibility, with 17 publications retained.

RESULTS

The majority of publications provided data on limited and extensive disease of SCLC. The reported burden was categorised as direct costs and indirect costs, with the majority of the publications (n = 16) reporting on direct costs and one reporting on both direct and indirect costs. The only indirect costs reported for SCLC were lost productivity (premature mortality costs) and caregiver burden. Chemotherapy, diagnostic costs and treatment costs were identified as significant costs when managing SCLC patients, including the associated treatment costs such as hospitalisation, nurse visits, emergency room visits, follow-up appointments and outpatient care.

CONCLUSIONS

SCLC and its treatment have a substantial impact on costs. The scarcity and heterogeneity of economic cost data negated meaningful cost comparison, highlighting the need for further research. Capturing the economic burden of SCLC may help patients and clinicians make informed treatment choices and improve SCLC management.

Long-term Cost-effectiveness of Two GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus in the Italian Setting: Liraglutide Versus Lixisenatide

PURPOSE

Maintaining glycemic control is the key treatment target for patients with type 2 diabetes mellitus. In addition, the glucagon-like peptide-1 (GLP-1) receptor agonists may be associated with other favorable treatment characteristics, such as reduction in body weight and reduced risk of hypoglycemia compared with traditional diabetes interventions. The aim of the present analysis was to compare the long-term cost-effectiveness of 2 GLP-1 receptor agonists, liraglutide 1.8 mg and lixisenatide 20 μg (both administered once daily), in the treatment of patients with type 2 diabetes failing to achieve glycemic control with metformin monotherapy in the Italian setting.

METHODS

The IMS CORE Diabetes Model was used to project long-term clinical outcomes and subsequent costs (in 2015 Euros [€]) associated with liraglutide 1.8 mg versus lixisenatide 20 μg treatment in a cohort with baseline characteristics derived from the open-label LIRA-LIXI trial (Efficacy and Safety of Liraglutide Versus Lixisenatide as Add-on to Metformin in Subjects With Type 2 Diabetes; NCT01973231) over patient lifetimes from the perspective of a health care payer. Efficacy data were taken from the 26-week end points of the same trial, including changes in glycated hemoglobin, body mass index, serum lipid levels, and hypoglycemic event rates. Outcomes projected included life expectancy, quality-adjusted life expectancy, cumulative incidence and time to onset of diabetes-related complications, and direct medical costs. Outcomes were discounted at 3% annually, and sensitivity analyses were performed.

FINDINGS

Liraglutide 1.8 mg was associated with improved discounted life expectancy (14.07 vs 13.96 years) and quality-adjusted life expectancy (9.18 vs 9.06 quality-adjusted life years [QALYs]) compared with lixisenatide 20 μg. These improvements were mostly attributable to a greater reduction in glycated hemoglobin level with liraglutide 1.8 mg versus lixisenatide 20 μg, leading to reduced incidence and increased time to onset of diabetes-related complications. Compared with lixisenatide 20 μg, liraglutide 1.8 mg was associated with increased total costs over patient lifetimes (€41,623 vs €41,380), but this was offset by lower costs of treating diabetes-related complications (€26,682 vs €27,476). Liraglutide 1.8 mg was associated with an incremental cost-effectiveness ratio of €2001 per QALY gained versus lixisenatide 20 μg. At a willingness-to-pay threshold of €30,000 per QALY gained, liraglutide 1.8 mg had a probability of 77.2% of being cost-effective.

IMPLICATIONS

Based on long-term projections, liraglutide 1.8 mg is likely to be considered cost-effective compared with lixisenatide 20 μg for the treatment of patients with type 2 diabetes in Italy.