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Stucki M, Dosch S, Gnädinger M, Graber SM, Huber CA, Lenzin G, Strebel RT, Zwahlen DR, Omlin A, Wieser S. Real-world treatment patterns and medical costs of prostate cancer patients in Switzerland - A claims data analysis. Eur J Cancer 2024; 204:114072. [PMID: 38678761 DOI: 10.1016/j.ejca.2024.114072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Prostate cancer (PC) is the most prevalent cancer in men in Switzerland. However, evidence on the real-world health care use of PC patients is scarce. The aim of this study is to describe health care utilization, treatment patterns, and medical costs in PC patients over a period of five years (2014-2018). METHOD We used routinely collected longitudinal individual-level claims data from a major provider of mandatory health insurance in Switzerland. Due to the lack of diagnostic coding in the claims data, we identified treated PC patients based on the treatments received. We described health care utilization and treatment pathways for patients with localized and metastatic PC. Costs were calculated from a health care system perspective. RESULTS A total of 5591 PC patients met the inclusion criteria. Between 2014 and 2018, 1741 patients had outpatient radiotherapy for localized or metastatic PC and 1579 patients underwent radical prostatectomy. 3502 patients had an androgen deprivation therapy (ADT). 9.5% of these patients had a combination therapy with docetaxel, and 11.0% had a combination with abiraterone acetate. Docetaxel was the most commonly used chemotherapy (first-line; n = 413, 78.4% of all patients in chemotherapy). Total medical costs of PC in Switzerland were estimated at CHF 347 m (95% CI 323-372) in 2018. CONCLUSION Most PC patients in this study were identified based on the use of ADT. Medical costs of PC in Switzerland amounted to 0.45% of total health care spending in 2018. Treatment of metastatic PC accounted for about two thirds of spending.
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Affiliation(s)
- Michael Stucki
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland.
| | - Stephanie Dosch
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland; Helsana Group, Zurich, Switzerland
| | | | | | | | - Golda Lenzin
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Räto T Strebel
- Kantonsspital Graubünden, Department of Urology, Chur, Switzerland
| | - Daniel R Zwahlen
- Kantonsspital Winterthur, Department of Radiation Oncology, Winterthur, Switzerland
| | - Aurelius Omlin
- Onkozentrum Zürich und Uroonkologisches Zentrum, Hirslanden Zürich, Zurich, Switzerland; Universität Zürich, Zurich, Switzerland
| | - Simon Wieser
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
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[Prostate cancer screening with Prostate-Specific Antigen (PSA) to men over 70 years old in an urban health zone, 2018-2020: A cross-sectional study]. Semergen 2023; 49:101876. [PMID: 36462252 DOI: 10.1016/j.semerg.2022.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/28/2022] [Accepted: 10/15/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone. METHODS A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list. RESULTS Two thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €. CONCLUSIONS The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature.
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Ulyte A, Wei W, Dressel H, Gruebner O, von Wyl V, Bähler C, Blozik E, Brüngger B, Schwenkglenks M. Variation of colorectal, breast and prostate cancer screening activity in Switzerland: Influence of insurance, policy and guidelines. PLoS One 2020; 15:e0231409. [PMID: 32298325 PMCID: PMC7162274 DOI: 10.1371/journal.pone.0231409] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/23/2020] [Indexed: 11/21/2022] Open
Abstract
Variation in utilization of healthcare services is influenced by patient, provider and healthcare system characteristics. It could also be related to the evidence supporting their use, as reflected in the availability and strength of recommendations in clinical guidelines. In this study, we analyzed the geographic variation of colorectal, breast and prostate cancer screening utilization in Switzerland and the influence of available guidelines and different modifiers of access. Colonoscopy, mammography and prostate specific antigen (PSA) testing use in eligible population in 2014 was assessed with administrative claims data. We ran a multilevel multivariable logistic regression model and calculated Moran's I and regional level median odds ratio (MOR) statistics to explore residual geographic variation. In total, an estimated 8.1% of eligible persons received colonoscopy, 22.3% mammography and 31.3% PSA testing. Low deductibles, supplementary health insurance and enrollment in a managed care plan were associated with higher screening utilization. Cantonal breast cancer screening programs were also associated with higher utilization. Spatial clustering was observed in the raw regional utilization of all services, but only for prostate cancer screening in regional residuals of the multilevel model. MOR was highest for prostate cancer screening (1.24) and lowest for colorectal cancer screening (1.16). The reasons for the variation of the prostate cancer screening utilization, not recommended routinely without explicit shared decision-making, could be further investigated by adding provider characteristics and patient preference information. This first cross-comparison of different cancer screening patterns indicates that the strength of recommendations, mediated by specific health policies facilitating screening, may indeed contribute to variation.
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Affiliation(s)
- Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gruebner
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Caroline Bähler
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
- Division of General Practice, University Medical Centre Freiburg, Freiburg, Germany
| | - Beat Brüngger
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Dubendorf, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
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