Association Between Spending and Outcomes for Patients With Cancer

Analyzing the cancer mortality-to-incidence ratios and health expenditures in the aging population: a 20-year comparative study across high-income countries

Background

The global burden of cancer is expected to increase by 60% over the next two decades, largely due to population aging. The study aims to examine the association between cancer mortality-to-incidence ratios (MIR) with healthcare expenditures (HE), and human development index score for individuals 70 years old or older.

Method

This is an epidemiological study using publicly available data from the Global Burden of Disease (GBD) for six over the years 1990-2019. A generalized linear model was employed to examine the association between MIR, and health expenditures and health development index score.

Results

Included countries showed a statistically significant negative association between MIR and both HE, and HE, indicating that higher HDI and HE are associated with decreased MIR with the highest decrease was for China, the coefficient for HDI is -1.29 (95% CI: -1.35 to -1.24, p < 0.0001), the coefficient for HE is -0.103 (95% CI: -0.17 to -0.03, p < 0.0001). There are variations exist in MIRs between high and low health expenditure countries for each cancer type.

Conclusion

The study reveals a significant impact of HE and HDI on cancer outcomes in older adults. Variations between high and low HE nations highlight potentially improved cancer outcomes in high HE countries. Considering the anticipated growth in the aging population worldwide, a rise in cancer cases is expected among older individuals. The implications are profound, suggesting an impending strain on healthcare systems, particularly in nations with a high proportion of elderly and low health expenditures.

The Application of Time-Driven Activity-Based Costing in Oncology: A Systematic Review

OBJECTIVES

Time-driven activity-based costing (TD-ABC) holds promise to control costs and enhance value in oncology, but the current landscape of its applications remains uncharted. This study aimed to: (1) document the applications of TD-ABC in oncology and unveil its strengths and limitations, (2) assess the extent to which studies adhere to Kaplan and Porter's method, and (3) appraise study quality.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. To be eligible for inclusion, studies had to provide an empirical application of TD-ABC within oncology. Structured data extraction included key characteristics such as cancer type, perspective, and analysis setting. Quality was assessed using the TD-ABC Healthcare Consortium Consensus Statement checklist.

RESULTS

A total of 59 studies met the inclusion criteria, two-thirds of which were published within the last 5 years. Most studies were conducted in high-income countries and analyzed common cancer types. The provider's perspective (85%) dominated, and studies typically relied on single-institution data (76%). No study assessed costs over a complete cycle of care and most focused on the costs of radiotherapy (56%) or surgery (20%). Articles generally did not adhere to the seven-step method, and average study quality was low (52%), particularly because of inadequate content in methods and results.

CONCLUSIONS

Oncology has emerged as a productive field for TD-ABC analyses, showcasing the effectiveness of TD-ABC in capturing the costs of healthcare processes in which medical devices are integral to care delivery. Nevertheless, concerns arise because of the low overall study quality and the lack of a consistent methodology.

Comparison of Cancer Mortality and Incidence Between New Zealand and Australia and Reflection on Differences in Cancer Care: An Ecological Cross-Sectional Study of 2014-2018

BACKGROUND

Despite many background similarities, New Zealand showed excess cancer deaths compared to Australia in previous studies. This study extends this comparison using the most recent data of 2014-2018.

METHODS

This study used publicly available cancer mortality and incidence data of New Zealand Ministry of Health and Australian Institute of Health and Welfare, and resident population data of Statistics New Zealand. Australian cancer mortality and incidence rates were applied to New Zealand population, by site of cancer, year, age and sex, to estimate the expected numbers, which were compared with the New Zealand observed numbers.

RESULTS

For total cancers in 2014-2018, New Zealand had 780 excess deaths in women (17.1% of the annual total 4549; 95% confidence interval (CI) 15.8-18.4%), and 281 excess deaths in men (5.5% of the annual total 5105; 95% CI 4.3-6.7%) compared to Australia. The excess was contributed by many major cancers including colorectal, melanoma, and stomach cancer in both sexes; lung, uterine, and breast cancer in women, and prostate cancer in men. New Zealand's total cancer incidences were lower than those expected from Australia's in both women and men: average annual difference of 419 cases (-3.6% of the annual total 11 505; 95% CI -4.5 to -2.8%), and 1485 (-11.7% of the annual total 12 669; 95% CI -12.5 to -10.9%), respectively. Comparing time periods, the excesses in total cancer deaths in women were 15.1% in 2000-07, and 17.5% in 1996-1997; and in men 4.7% in 2000-2007 and 5.6% in 1996-1997. The differences by time period were non-significant.

CONCLUSION

Excess mortality from all cancers combined and several common cancers in New Zealand, compared to Australia, persisted in 2014-2018, being similar to excesses in 2000-2007 and 1996-1997. It cannot be explained by differences in incidence, but may be attributable to various aspects of health systems governance and performance.

Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance

IMPORTANCE

With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance.

OBJECTIVE

To examine differences in spending and utilization for patients with private insurance undergoing common cancer surgery at National Cancer Institute (NCI) centers vs community hospitals.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cross-sectional study included adult patients with an incident diagnosis of breast, colon, or lung cancer who underwent cancer-directed surgery from 2011 to 2014. Mean risk-adjusted spending and utilization outcomes were examined for each hospital type using multilevel generalized linear mixed-effects models, adjusting for patient, hospital, and region characteristics. Data were collected from the Health Care Cost Institute's national multipayer commercial claims data set, which encompasses claims paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and UnitedHealthcare). Data analyses were conducted from February 2018 to February 2019.

EXPOSURES

Hospital type at which cancer surgery was performed: NCI, non-NCI academic, or community.

MAIN OUTCOMES AND MEASURES

Spending outcomes were surgery-specific insurer prices paid and 90-day postdischarge payments. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days of discharge.

RESULTS

The study included 66 878 patients (51 569 [77.1%] women; 31 585 [47.2%] aged ≥65 years) with incident breast (35 788 [53.5%]), colon (21 378 [32.0%]), or lung (9712 [14.5%]) cancer undergoing cancer surgery at 2995 hospitals (5522 [8.3%] at NCI centers; 10 917 [16.3%] at non-NCI academic hospitals; 50 439 [75.4%] at community hospitals). Treatment at NCI centers was associated with higher surgery-specific insurer prices paid compared with community hospitals ($18 526 [95% CI, $16 650-$20 403] vs $14 772 [95% CI, $14 339-$15 204]; difference, $3755 [95% CI, $1661-$5849]; P < .001) and 90-day postdischarge payments ($47 035 [95% CI, $43 289-$50 781] vs $41 291 [95% CI, $40 350-$42 231]; difference, $5744 [95% CI, $1659-9829]; P = .006). There were no significant differences in LOS, ED use, or hospital readmission within 90 days of discharge.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, surgery at NCI centers vs community hospitals was associated with higher insurer spending for a surgical episode without differences in care utilization among patients with private insurance undergoing cancer surgery. A better understanding of the factors associated with prices and spending at NCI cancer centers is needed.

Tumour markers with clinically controlled cut-offs for suspected cancer

BACKGROUND

Due to insufficient scientific evidence, panels of tumour markers (TMs) are currently not recommended for use in suspected cancer. However, recent well-designed studies have revealed a potential clinical value in lung cancer. We analysed the diagnostic accuracy of a panel of 11 circulating TMs with clinically controlled thresholds in the differentiation of cancer from nonmalignant diseases.

METHODS

We prospectively recruited 4776 consecutive patients presenting with focal or nonspecific symptoms suggestive of cancer who underwent testing for 11 serum TMs before diagnosis was known. The study abided by 2015 STARD guidelines. Tumour markers included, among others, carbohydrate antigen 19-9, carcinoembryonic antigen, alpha-fetoprotein, squamous cell carcinoma-associated antigen, prostate-specific antigen (males), neuron-specific enolase, progastrin-releasing peptide and carbohydrate antigen 125. Thresholds were adjusted for the presence of kidney failure, liver disease, effusions and dermatological disorders. Results showing ≥1 TMs with concentrations above threshold were considered positive.

RESULTS

Benign diseases were diagnosed in 3281 (68.7%) patients and cancer in 1495 (31.3%), with epithelial cancers in 1214 (77% at stage IV). When applying criteria for controlled thresholds, overall specificity was 98%. Overall sensitivity of the panel in epithelial cancers was 72.2%, positive predictive value 93% and negative predictive value 90.5%. The area under the receiver operating characteristic curve was 0.920 (95% confidence interval, 0.902-0.924).

CONCLUSIONS

By using clinically controlled cut-offs, the combined panel demonstrated an excellent ability to discriminate epithelial cancers from nonmalignant diseases. However, its use in clinical practice would need formal validation through a multicentre controlled trial assessing a panel-guided strategy vs. standard diagnosis.

Spending On Targeted Therapies Reduced Mortality In Patients With Advanced-Stage Breast Cancer

Costly targeted therapies are playing an increasingly important role in treating cancer. To characterize trends in spending on targeted therapies for breast cancer and to estimate the association of these therapies with cancer mortality, we analyzed cancer diagnoses in the Surveillance, Epidemiology, and End Results Program-Medicare linked database. We categorized total cancer spending into spending on targeted therapies, spending on nontargeted therapies, and spending on other cancer care. Diagnosis-year spending on targeted therapies increased from $1,024 per patient in 2000 to $18,809 per patient in 2015 for patients with advanced-stage cancer and from $82 to $3,289 for patients with early-stage cancer. For patients with advanced-stage cancer, a $1,000 increase in spending on targeted therapies in the diagnosis year was associated with a 0.55-percentage-point decrease in adjusted three-year cancer mortality, whereas for patients with early-stage cancer, there was no association. The other two types of spending (on nontargeted therapies and other cancer care) were not associated with mortality among patients with either advanced- or early-stage cancer. Our results indicate that among various types of cancer treatments, only targeted therapies generated meaningful survival gains for patients with advanced-stage breast cancer.

Unemployment and Health-Related Quality of Life in Melanoma Patients During the COVID-19 Pandemic

The outbreak of coronavirus disease-2019 (COVID-19) ineluctably caused social distancing and unemployment, which may bring additional health risks for patients with cancer. To investigate the association of the pandemic-related impacts with the health-related quality of life (HRQoL) among patients with melanoma during the COVID-19 pandemic, we conducted a cross-sectional study among Chinese patients with melanoma. A self-administered online questionnaire was distributed to melanoma patients through social media. Demographic and clinical data, and pandemic-related impacts (unemployment and income loss) were collected. HRQoL was determined by the Functional Assessment of Cancer Therapy-General (FACT-G) and its disease-specific module (the melanoma subscale, MS). A total of 135 patients with melanoma completed the study. The mean age of the patients was 55.8 ± 14.2 years, 48.1% (65/135) were male, and 17.04% (34/135) were unemployed since the epidemic. Unemployment of the patients and their family members and income loss were significantly associated with a lower FACT-G score, while the MS score was associated with the unemployment of the patients' family members. Our findings suggested that unemployment is associated with impaired HRQoL in melanoma patients during the COVID-19 epidemic.