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Aye PS, Win SS, Tin Tin S, Elwood JM. 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. Cancer Control 2023; 30:10732748231152330. [PMID: 37150819 PMCID: PMC10170599 DOI: 10.1177/10732748231152330] [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: 05/09/2023] Open
Abstract
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.
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Affiliation(s)
- Phyu Sin Aye
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Shwe Sin Win
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - J Mark Elwood
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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2
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Morris M, Seguin M, Landon S, McKee M, Nolte E. Exploring the Role of Leadership in Facilitating Change to Improve Cancer Survival: An Analysis of Experiences in Seven High Income Countries in the International Cancer Benchmarking Partnership (ICBP). Int J Health Policy Manag 2022; 11:1756-1766. [PMID: 34380203 PMCID: PMC9808244 DOI: 10.34172/ijhpm.2021.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The differences in cancer survival across countries and over time are well recognised, with progress varying even among high-income countries with comparable health systems. Previous research has examined several possible explanations, but the role of leadership in systems providing cancer care has attracted little attention. As part of the International Cancer Benchmarking Partnership (ICBP), this study looked at diverse aspects of leadership to identify drivers of change and opportunities for improvement across seven high-income countries. METHODS Key informants in 13 jurisdictions were interviewed: Australia (2 states), Canada (3 provinces), Denmark, Ireland, New Zealand, Norway and United Kingdom (4 countries). Participants represented a range of stakeholders at different tiers of the system. They were recruited through a combination of purposive and 'snowball' strategies and participated in semi-structured telephone interviews. Interview transcripts were analysed thematically drawing on the World Health Organization (WHO) health systems framework and previous work analysing national cancer control programmes (NCCPs). RESULTS Several facets of leadership were perceived as important for improving outcomes. These included political leadership to initiate and maintain progress, intellectual leadership to support those engaged in local implementation of national policies and drive change, and a coherent vision from leaders at different levels of the system. Clinical leadership was also viewed as vital for translating policy into action. CONCLUSION Certain aspects of cancer care leadership emerged as underpinning and sustaining improvements, such as appointing a central agency, involving clinicians at every stage, ensuring strong leadership of cancer care with a consistent political mandate. Improving cancer outcomes is challenging and complex, but it is unlikely to be achieved without effective leadership, both political and clinical.
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Affiliation(s)
- Melanie Morris
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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3
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Lucarelli C, Nicholson S, Tilipman N. Price Indices and the Value of Innovation with Heterogenous Patients. JOURNAL OF HEALTH ECONOMICS 2022; 84:102625. [PMID: 35561551 DOI: 10.1016/j.jhealeco.2022.102625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/31/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Many countries use uniform cost-effectiveness criteria to determine whether to adopt a new medical technology for the entire population. This approach assumes homogeneous preferences for expected health benefits and side effects. We examine whether new prescription drugs generate welfare gains when accounting for heterogeneous preferences by constructing quality-adjusted price indices in the market for colorectal cancer drug treatments. We find that while the efficacy gains from newer drugs do not justify high prices for the population as a whole, innovation improves the welfare of sicker, late-stage cancer patients. A uniform evaluation criterion would not permit these innovations despite welfare gains to a subpopulation.
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Affiliation(s)
- Claudio Lucarelli
- Department of Health Care Management, The Wharton School, University of Pennsylvania.
| | - Sean Nicholson
- Department of Policy Analysis & Management, Cornell University.
| | - Nicholas Tilipman
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago.
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4
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Seguin M, Morris M, McKee M, Nolte E. "There's Not Enough Bodies to Do the Demand": An Exploration of Key Stakeholder Views on the Role of Health Service Capacity in Shaping Cancer Outcomes in 7 International Cancer Benchmarking Partnership Countries. Int J Health Policy Manag 2022; 11:1024-1034. [PMID: 33589567 PMCID: PMC9808162 DOI: 10.34172/ijhpm.2020.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Differences in cancer survival are shaped by differences in health system capacity in workforce and infrastructure. Part of the International Cancer Benchmarking Partnership (ICBP), this study explored stakeholders' perceptions of the role of health system capacity necessary for cancer care in influencing cancer survival in 7 high-income countries. METHODS We conducted semi-structured interviews with 79 key informants from national, regional, and local tiers of health systems, professional bodies, patient associations, and academic experts in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the United Kingdom. Data collection was guided by a conceptual model linking characteristics of health systems and cancer survival along the cancer patient journey, from recognition of symptoms at pre-diagnostic stages through to survivorship or death. Data were analysed using a thematic approach. RESULTS We identified 3 themes as important in shaping cancer outcomes: primary care and access to diagnostic evaluation, specialist care and access to treatment, and workforce pertaining to diagnostic and treatment phases. Improved infrastructure for diagnosis and treatment had improved cancer outcomes in all jurisdictions. However, this was seen as insufficient if staffing was inadequate. Consolidation of services and greater surgical specialisation was important in some jurisdictions if accompanied by a reconfiguration of services, in particular the creation of specialist multidisciplinary teams, along with supporting capacity in the wider health system. Staff shortages were commonly cited as reasons why some jurisdictions lagged behind others. CONCLUSION Continued improvement in cancer outcomes will require sustained investment in plans to deliver and maintain the workforce engaged in cancer care and in the infrastructure on which they depend. However, strategic plans must recognise that systems for cancer care do not work in isolation from the rest of the health system and a whole systems approach is essential if we are to improve outcomes for an ageing, increasingly multimorbid population.
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Affiliation(s)
| | | | | | - Ellen Nolte
- Department of Health Services Research & Policy, London School of Hygiene & Topical Medicine, London, UK
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5
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Chow RD, Bradley EH, Gross CP. Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries. JAMA HEALTH FORUM 2022; 3:e221229. [PMID: 35977250 PMCID: PMC9142870 DOI: 10.1001/jamahealthforum.2022.1229] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/06/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ryan D. Chow
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | | | - Cary P. Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut
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6
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Dupoiron D. Cancer Pain Management-A European Perspective. Cancer Treat Res 2021; 182:39-55. [PMID: 34542875 DOI: 10.1007/978-3-030-81526-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cancer pain management is a major challenge in both Europe and the United States. Recent studies show that the incidence of cancer pain remains high and even increases at an advanced stage of the disease.
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest, Rue Boquel, 49055, Angers, France.
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7
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MacEwan JP, Dennen S, Kee R, Ali F, Shafrin J, Batt K. Changes in mortality associated with cancer drug approvals in the United States from 2000 to 2016. J Med Econ 2020; 23:1558-1569. [PMID: 33161782 DOI: 10.1080/13696998.2020.1834403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS To estimate the extent to which the approvals of new pharmacological therapies were associated with cancer mortality in the USA between 2000 and 2016. MATERIALS AND METHODS The analysis quantified cancer drug approvals across the 15 tumor types with the highest incidence. Number of approvals in a given time period for each tumor was translated into a treatment stock measure, defined as a weighted sum of new indication approvals since 1976. The primary outcome was the annual tumor-specific cancer mortality, defined as the number of deaths per 100,000 U.S. population. The analysis used a multivariable ordinary least squares and a fixed effects model, controlling for incidence (new cases per 100,000 U.S. population) and the primary exposure, the treatment stock measure by year. RESULTS Between 2000 and 2016, deaths per 100,000 population across the 15 most common tumor types declined by 24%. Additionally, 10.2 new indications were approved per year across the 15 most common tumor types. Cancer drug approvals were associated with statistically significant deaths averted in 2016 for colorectal cancer (4,991, p = 0.004), lung cancer (33,825, p < 0.001), breast cancer (11,502, p < 0.001), non-Hodgkin's lymphoma (6,636, p < 0.001), leukemia (4,011, p < 0.001), melanoma (1,714, p < 0.001), gastric cancer (758, p = 0.019), and renal cancer (739, p < 0.001). Between 2000 and 2016, new cancer treatments were correlated with 1,291,769 (p < 0.001) total deaths prevented across the 15 most common tumor types. LIMITATIONS AND CONCLUSIONS Cancer drug approvals between 2000 and 2016 were associated with significant reduction in deaths from the most common cancers in the USA. Mortality changes were largest in prevalent tumor types with relatively more approvals, i.e. lung cancer, breast cancer, melanoma, lymphoma and leukemia. Future research evaluating the relationship between drug approvals and cancer mortality post 2016 is needed.
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8
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Understanding the link between health systems and cancer survival: A novel methodological approach using a system-level conceptual model. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Baumgardner JR, Brauer MS, Zhang J, Hao Y, Liu Z, Lakdawalla DN. CAR-T therapy and historical trends in effectiveness and cost–effectiveness of oncology treatments. J Comp Eff Res 2020; 9:327-340. [DOI: 10.2217/cer-2019-0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aim: This study examines how chimeric antigen receptor T-cell (CAR-T) therapy’s incremental effectiveness and cost–effectiveness profile fits into the recent history of anticancer treatments. Materials & methods: We conducted graphical and multivariable analyses using data from the Cost–Effectiveness Analysis Registry of the Tufts Medical Center and the Institute for Clinical and Economic Review’s analysis of CAR-T therapies. We collected additional information including the US FDA approval years for pharmacologic innovations. Results: CAR-T provided 5.03 (95% CI: 3.88–6.18) more incremental quality-adjusted life-years than the average pharmaceutical intervention and 4.61 (95% CI: 1.67–7.56) more than the average nonpharmaceutical intervention, while retaining similar cost–effectiveness. There was evidence of worsening cost–effectiveness by approval year for pharmaceutical interventions. Limitations: Analysis is limited to anticancer treatments studied in cost–utility analyses, estimated to cover approximately 60% of FDA-approved antineoplastic agents. Conclusion: CAR-T therapy breaks a pattern of stagnant efficacy growth in pharmaceutical innovation and demonstrates significantly greater incremental effectiveness and similar cost–effectiveness to prior innovations.
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Affiliation(s)
| | | | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936-1080, USA
| | - Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936-1080, USA
| | - Zhimei Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936-1080, USA
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10
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Li M, Lakdawalla DN, Goldman DP. Association Between Spending and Outcomes for Patients With Cancer. J Clin Oncol 2019; 38:323-331. [PMID: 31804868 DOI: 10.1200/jco.19.01451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Meng Li
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Darius N Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA.,School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Dana P Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA.,School of Pharmacy, University of Southern California, Los Angeles, CA
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11
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Weber DC, Grau C, Lim PS, Georg D, Lievens Y. Bringing Europe together in building clinical evidence for proton therapy - the EPTN-ESTRO-EORTC endeavor. Acta Oncol 2019; 58:1340-1342. [PMID: 31241391 DOI: 10.1080/0284186x.2019.1624820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- University of Bern, Bern, Switzerland
- University of Zürich, Zürich, Switzerland
| | - Cai Grau
- Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus C, Denmark
| | - Pei S. Lim
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Dietmar Georg
- Department of Radiation Therapy, Medical University of Vienna/AKH, Wien, Austria
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
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12
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Tom MC, Ross RB, Koyfman SA, Adelstein DJ, Lorenz RR, Burkey BB, Shah C, Suh JH, Bolwell BJ, Savage C, Platz S, Ward MC. Clinical Factors Associated With Cost in Head and Neck Cancer: Implications for a Bundled Payment Model. J Oncol Pract 2019; 15:e560-e567. [DOI: 10.1200/jop.18.00665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: To determine which factors influence cost in head and neck cancer (HNC) to inform the development of a bundled payment model (BPM). METHODS: Patients with stages 0 to IVB (by American Joint Commission on Cancer, 7th edition) HNC of various sites and histology treated definitively at a single tertiary care center during 2013 were included. Clinical variables and direct cost data were obtained, and their associations were investigated using χ2, t, Wilcoxon rank sum, and analysis of variance testing. Results were used to develop a BPM. RESULTS: One hundred fifty patients were included; 87% were white, 74% were men, 48% had oropharyngeal cancer, and 58% had stage IVA disease. Treatment consisted of surgery alone (17%), radiation alone (11%), surgery plus radiation (14%), chemoradiation (45%), and surgery plus chemoradiation (13%). On multivariable analysis, both increasing group stage and number of treatment modalities used were significantly associated with higher cost. Given that stage often dictates treatment, we developed three cost tiers that were based on overall treatment modality. Tier A, the least costly, consisted of single-modality therapy with either surgery alone or radiation alone (median cost divided by the median overall cost of treatment, 0.54; 25th to 75th percentile range, 0.29 to 1.02), followed by tier B, which consisted of bimodality therapy with either chemoradiation or surgery plus radiation (1.03; range, 0.81 to 1.35), followed by tier C, which consisted of trimodality therapy with surgery plus chemoradiation (1.43; range, 1.10 to 1.96). CONCLUSION: The number of treatment modalities required is the primary driver of cost in HNC. These data can simplify development of a comprehensive HNC BPM.
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Affiliation(s)
| | - Richard B. Ross
- Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | | | | | | | | | | | | | | | - Matthew C. Ward
- Levine Cancer Institute, Atrium Health, Charlotte, NC
- Southeast Radiation Oncology Group, Charlotte, NC
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13
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Weber DC, Lim PS, Tran S, Walser M, Bolsi A, Kliebsch U, Beer J, Bachtiary B, Lomax T, Pica A. Proton therapy for brain tumours in the area of evidence-based medicine. Br J Radiol 2019; 93:20190237. [PMID: 31067074 DOI: 10.1259/bjr.20190237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
ADVANCES IN KNOWLEDGE This review details the indication of brain tumors for proton therapy and give a list of the open prospective trials for these challenging tumors.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,University of Bern, Bern, Switzerland.,University of Zürich, Zürich, Switzerland
| | - Pei S Lim
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Sebastien Tran
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Jürgen Beer
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Tony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,Department of Physics, ETH, Zürich, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
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14
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Medenwald D, Vordermark D, Dietzel CT. Number of radiotherapy treatment machines in the population and cancer mortality: an ecological study. Clin Epidemiol 2018; 10:1249-1273. [PMID: 30288122 PMCID: PMC6163015 DOI: 10.2147/clep.s156764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives The aim of this study was to assess the association between the number of radiotherapy treatment machines (RTMs) in the population and incidence-adjusted cancer mortality. Methods Data on cancer incidence and mortality were obtained from the GLOBOCAN project (only high-quality data, C3, or higher according to GLOBOCAN quality label), information on the number of RTMs from the Directory of Radiotherapy Centers database, and remaining data from the World Bank and World Health Organization database. We used linear regression models to assess the associations between RTM per 10,000,000 inhabitants (logarithmized) and the log-transformed mortality/incidence ratio. Models were adjusted for public health variables. To assess the bias due to unobserved confounders, mortality from leukemia was considered as a negative control. Here radiotherapy treatment is less frequently applied, but a common set of confounders is shared with cancer types where radiotherapy plays a stronger role, enabling us to estimate the bias due to confounding of unmeasured parameters. To assess an exposure–effect size relationship, estimated cancer type-specific estimates were related to the proportion of subjects receiving radiotherapy. Results We found an inverse linear relationship between RTM in the population and the cancer mortality to incidence ratio for prostate cancer (14.1% per doubling of RTM; 95% CI: 0.1%–26.1%), female breast cancer (12.3%; 95% CI: 2.7%–20.9%), and lung cancer in women (11.2%; 95% CI: 4.3%–17.6%). There was no evidence for bias due to unobserved confounders after covariate adjustment. For women, an exposure-effect size relationship was found (P=0.02). Conclusion In this ecological study, we found evidence that the population density of RTM is related to cancer mortality independently of other public health parameters.
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Affiliation(s)
- Daniel Medenwald
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany, .,Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany,
| | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany,
| | - Christian T Dietzel
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany,
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15
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Joyce DP, O'Neill C, Heneghan HM, Curran C, Barry K, Sweeney K, Malone C, McLaughlin R, Kerin MJ. The changing cost of breast cancer care: lessons from a centralised modern cancer centre. Ir J Med Sci 2018; 188:409-414. [PMID: 30032478 DOI: 10.1007/s11845-018-1872-4] [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: 07/24/2017] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The cost of new cancer technologies has been the subject of intense debate in recent years. There have been significant advances in therapeutic techniques for breast cancer over the past 20 years. This has been accompanied by the concentration of services in designated cancer centres. The aim of this study was to examine the changing cost of breast cancer management over an 18-year period and identify factors underlying this. METHODS We use breast cancer services data from Galway University Hospital in 1995-1996, 2005-2006 and 2011-2012 to examine the changing pattern of care costs and survival. RESULTS The number of patients treated for breast cancer rose from 200 in 1995-1996, to 411 in 2005-2006 and 563 in 2011-2012. Two-year survival rose in line with national figures from 84 to 89.78 and 92.07%, in the three-time periods respectively. Adjusting for inflation, the average cost per patient rose from €14,710 (95% C.I., €13,398 to €16,022) in 1995-1996 to €30,405 (95% C.I., €38,620 to €32,189) in 2005-2006, before falling to €14,458 (C.I., €13,343 to €15,572) in 2011-2012. We found significant changes in the pattern of costs, with some rising in relative and absolute terms while others fell as new therapies became available and/or moved off patent. CONCLUSION Within an evolving context where services are centralised, new therapies emerge and subsequently come off patent, our understanding of the value of cancer therapies continues to evolve. This has important implications for the evaluation of new therapies and broader policy initiatives in this area.
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Affiliation(s)
- Doireann P Joyce
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland.
| | - Ciaran O'Neill
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Helen M Heneghan
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Catherine Curran
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Kevin Barry
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Karl Sweeney
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Carmel Malone
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Ray McLaughlin
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
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16
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Andreano A, Peake MD, Janes SM, Valsecchi MG, Pritchard-Jones K, Hoag JR, Gross CP. The Care and Outcomes of Older Persons with Lung Cancer in England and the United States, 2008–2012. J Thorac Oncol 2018; 13:904-914. [DOI: 10.1016/j.jtho.2018.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022]
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17
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Hutson TE, Thoreson GR, Figlin RA, Rini BI. The Evolution of Systemic Therapy in Metastatic Renal Cell Carcinoma. Am Soc Clin Oncol Educ Book 2017; 35:113-7. [PMID: 27249692 DOI: 10.1200/edbk_158892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The treatment landscape for renal cell carcinoma (RCC) is a dynamic process that has seen considerable change in recent years. We have seen a rebirth of original breakthroughs with immune checkpoint inhibitors showing promise in patients with treatment-refractory disease. The optimal sequencing of treatments and incorporation of novel therapeutics are actively being investigated and have yet to be determined. The clinical challenges of this evolving treatment paradigm can be attributed to cost considerations, toxicity, and defining endpoints in the management of advanced RCC. As novel therapeutics emerge, finding the optimal treatment regimen for patients will have an increasing focus on patient-centered outcomes and improvement in quality of life in addition to improving survival.
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Affiliation(s)
- Thomas E Hutson
- From the Texas A&M Health Science Center, Bryan TX; Baylor-Sammons Cancer Center, Dallas, TX; US Oncology, Texas Oncology, Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Gregory R Thoreson
- From the Texas A&M Health Science Center, Bryan TX; Baylor-Sammons Cancer Center, Dallas, TX; US Oncology, Texas Oncology, Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Robert A Figlin
- From the Texas A&M Health Science Center, Bryan TX; Baylor-Sammons Cancer Center, Dallas, TX; US Oncology, Texas Oncology, Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Brian I Rini
- From the Texas A&M Health Science Center, Bryan TX; Baylor-Sammons Cancer Center, Dallas, TX; US Oncology, Texas Oncology, Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
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Lachgar A, Tazi M, Afif M, Er-Raki A, Kebdani T, Benjaafar N. Lung cancer: Incidence and survival in Rabat, Morocco. Rev Epidemiol Sante Publique 2016; 64:391-395. [DOI: 10.1016/j.respe.2016.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 01/03/2016] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
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Hess LM, Cinfio FN, Wetmore S, Churchill C, Fausel C, Ale-Ali A, Gelwicks S, Bly CA, Perk S, Klein RW. Enhancing the Budget Impact Model for Institutional Use: A Tool with Practical Applications for the Hospital Oncology Pharmacy. Hosp Pharm 2016; 51:452-60. [PMID: 27354746 DOI: 10.1310/hpj5106-452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The cost of cancer care is increasing, and tools are needed to understand the economic impact of new drugs on the hospital pharmacy budget. OBJECTIVE To develop an interactive budget impact model (BIM) through a collaborative effort of industry, academia, and modeling experts to evaluate the use of a new agent in non-small cell lung cancer (NSCLC); this BIM included an institutional module specific to the needs of practices that purchase medications for use in institutional settings. METHODS Treatment regimens, doses, duration of therapy, toxicity, and cost data are from published sources. All input data may be modified to match the local population. Outputs include cost of care, reimbursement, and margin overall and by treatment regimen. RESULTS The base case assumes 20 NSCLC patients progressing after initial therapy (3 receiving ramucirumab+docetaxel, 2 bevacizumab+erlotinib, 3 docetaxel, 6 erlotinib, and 6 pemetrexed), wholesale acquisition cost (WAC) purchase price, and reimbursement at WAC+4.3%. The model estimated the total cost and reimbursement for the institutional oncology pharmacy to be $699,413 and $729,487, respectively, resulting in a margin of $30,075 (difference due to rounding) for the year for regimens utilized in the treatment of NSCLC in the post-progression setting. Results will vary depending on the input data. CONCLUSIONS There is an increasing need for institutional pharmacies to plan ahead and anticipate the impact of new drugs on their oncology budgets. This interactive Excel-based institutional BIM may provide evidence-based support for pharmacy decision making.
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Abstract
Biomedicine has made enormous progress in the last half century in treating common diseases. However, we are becoming victims of our own success. Causes of death strongly associated with biological aging, such as heart disease, cancer, Alzheimer's disease, and stroke-cluster within individuals as they grow older. These conditions increase frailty and limit the benefits of continued, disease-specific improvements. Here, we show that a "delayed-aging" scenario, modeled on the biological benefits observed in the most promising animal models, could solve this problem of competing risks. The economic value of delayed aging is estimated to be $7.1 trillion over 50 years. Total government costs, including Social Security, rise substantially with delayed aging--mainly caused by longevity increases--but we show that these can be offset by modest policy changes. Expanded biomedical research to delay aging appears to be a highly efficient way to forestall disease and extend healthy life.
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Affiliation(s)
- Dana Goldman
- USC Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California 90089
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21
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Ramsey SD. How State And Federal Policies As Well As Advances In Genome Science Contribute To The High Cost Of Cancer Drugs. Health Aff (Millwood) 2015; 34:571-5. [DOI: 10.1377/hlthaff.2015.0112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Scott D. Ramsey
- Scott D. Ramsey ( ) is director of the Hutchinson Institute for Cancer Outcomes Research (HICOR), at the Fred Hutchinson Cancer Research Center, in Seattle, Washington
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