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Nicole P, Elizabeth M, Jacqueline KW, Donna M, Hana S, Janakiraman S. Cost of early progression: patients with epidermal growth factor receptor mutated metastatic non-small-cell lung cancer. Future Oncol 2024:1-12. [PMID: 39011928 DOI: 10.1080/14796694.2024.2370186] [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: 10/23/2023] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Aim: Compare healthcare costs for patients with epidermal growth factor receptor mutated (EGFRm) metastatic non-small-cell lung cancer (mNSCLC) with and without progression and estimate costs of progression. Materials & methods: Retrospective claims analysis (2015-2020) from adults with EGFRm mNSCLC initiating EGFR tyrosine kinase inhibitors. Adjusted costs for 12 months were compared (with vs without progression) and cumulative costs for early versus late progression were predicted over 36 months. Results: A total of 228 patients with EGFRm mNSCLC were included. Patients with progression within 12 months incurred significantly higher total costs despite lower treatment costs (vs without progression). Medical costs were significantly higher among early versus late progressors. Conclusion: These data may aid providers aiming to administer quality care in a cost-efficient way.
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Chopra A, Hu K. Are We Choosing the Most Cost-Effective Treatment Option for the Management of Malignant Pleural Effusions? Ann Am Thorac Soc 2024; 21:854-855. [PMID: 38819139 PMCID: PMC11160128 DOI: 10.1513/annalsats.202403-266ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York; and
| | - Kurt Hu
- Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Lam C, Diessner B, Andrade K, Stackland S, Park L, Mehta S, Lin F, Kwong WJ. Cost of disease progression among US patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Comp Eff Res 2024; 13:e230166. [PMID: 38647165 PMCID: PMC11036880 DOI: 10.57264/cer-2023-0166] [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: 11/07/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Aim: The objectives were to investigate the differences in per patient per month (PPPM) healthcare resource utilization (HCRU) and costs among commercially insured and Medicare Advantage patients with human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer (mBC) who experience disease progression in 12 months compared with those who don't investigate the impact of progression timing on cumulative healthcare costs. Patients & methods: This claims-based study included patients diagnosed with mBC between 1 January 2013 and 30 April 2020 and received HER2-targeted therapy. Patients were categorized as progressed or nonprogressed. For objective one, monthly HCRU and costs were assessed for up to two lines of therapy (LOTs). Data were summarized descriptively and compared using a generalized linear model (GLM). For objective two, patients with at least 6 months of follow-up were assessed and cumulative healthcare costs were estimated in the 3 years following the start of LOT1 or LOT2 using a GLM and Kaplan-Meier weighting. Results: Among the 4113 patients in the study sample, 3406 had at least 12 months of follow-up (or less if due to death). Compared with nonprogressed patients, progressed patients had higher mean PPPM healthcare costs (LOT1: $22,014 vs $18,372, p < 0.001; LOT2: $19,643 vs $16,863, p = 0.001), and HCRU, including number of emergency room visits and inpatient stays (both p < 0.001) in the 12 months following LOT start. Progressed patients had higher 3-year mean cumulative healthcare costs than nonprogressed patients following LOT1 and LOT2 and this difference was greater for patients who progressed earlier. Conclusion: Disease progression was associated with significant increases in HCRU and costs. Delays in progression were associated with lower cumulative healthcare costs. Earlier use of more clinically effective treatments to delay progression may reduce the economic burden among these patients.
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Affiliation(s)
- Clara Lam
- AstraZeneca, Gaithersburg, MD 20878, USA
| | | | | | | | - Leah Park
- AstraZeneca, Gaithersburg, MD 20878, USA
| | | | - Feng Lin
- Daiichi–Sankyo, Inc., Basking Ridge, NJ 07920, USA
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Ortendahl JD, Cuyun Carter G, Thakkar SG, Bognar K, Hall DW, Abdou Y. Value of next generation sequencing (NGS) testing in advanced cancer patients. J Med Econ 2024; 27:519-530. [PMID: 38466204 DOI: 10.1080/13696998.2024.2329009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The availability of targeted therapies for oncology patients is increasing. Available genomic tests to identify treatment-eligible patients include single gene tests and gene panel tests, including the whole-exome, whole-transcriptome OncoExTra test. We assessed the costs and clinical benefits of test choice. METHODS A Microsoft Excel-based model was developed to evaluate test choice in patients with advanced/metastatic non-small cell lung cancer (NSCLC), breast, prostate, and colorectal cancer. Treatment pathways were based on NCCN guidelines and medical expert opinion. Inputs were derived from published literature. Annual economic results and lifetime clinical results with OncoExTra testing were projected per-tested-patient and compared with single gene testing and no testing. Separately, results were estimated for a US health plan without the OncoExTra test and with its use in 5% of patients. RESULTS Compared with no genomic testing, OncoExTra test use increased costs by $4,915 per patient; however, 82%-92% of individuals across tumour types were identified as eligible for targeted therapy or a clinical trial. Compared with single gene testing, OncoExTra test use decreased costs by $9,966 per-patient-tested while increasing use of approved or investigational targeted therapies by 20%. When considering a hypothetical health plan with 1 million members, 858 patients were eligible for genomic testing. Using the OncoExTra test in 5% of those eligible, per-member per-month costs decreased by $0.003, ranging from cost-savings of $0.026 in NSCLC patients to a $0.009 increase in prostate cancer patients. Cost-savings were driven by reduced treatment costs with increased clinical trial enrolment and reduced direct and indirect medical costs associated with targeted treatments. LIMITATIONS Limitations include the required simplifications in modelling complex conditions that may not fully reflect evolving real-world testing and treatment patterns. CONCLUSIONS Compared to single-gene testing, results indicate that using next generation sequencing test such as OncoExTra identified more actionable alterations, leading to improved outcomes and reduced costs.
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Affiliation(s)
- Jesse D Ortendahl
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, CA, USA
| | | | | | - Katalin Bognar
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, CA, USA
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Paly VF, Li S, Khanduri P, Asfaw AA, Zou D, Hernandez L. Budget impact analysis of introducing fruquintinib for metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy and biologics in the United States from the payer perspective. J Med Econ 2024; 27:1076-1085. [PMID: 39102473 DOI: 10.1080/13696998.2024.2389005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/02/2024] [Accepted: 08/02/2024] [Indexed: 08/07/2024]
Abstract
AIMS Fruquintinib is a selective small molecule tyrosine kinase inhibitor of vascular endothelial growth factor receptor (VEGFR)-1, -2, and -3 recently approved in the United States (US) for the treatment of adult patients with metastatic colorectal cancer (CRC) who have previously been treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, an anti-VEGF biological therapy, and if RAS wild-type and medically appropriate, anti-epidermal growth factor receptor therapy. This study aimed to estimate the 5-year budget impact of fruquintinib from a US payer perspective (commercial and Medicare). MATERIALS AND METHODS A budget impact model was developed to compare two scenarios: a reference scenario in which patients received regorafenib, trifluridine/tipiracil, or trifluridine/tipiracil with bevacizumab and an alternative scenario in which patients received reference scenario treatments or fruquintinib. Market shares were evenly divided across available options. A 5-year time horizon and a hypothetical health plan of 1 million members was assumed. The model included epidemiological inputs to estimate the eligible population; clinical inputs for treatment duration, progression-free survival, overall survival, and adverse event (AE) frequency; and cost inputs for treatment, AEs, disease management, subsequent therapy, and terminal care costs. Budget impact was reported as total, per member per year (PMPY), and per member per month (PMPM). RESULTS The model estimated an eligible population of 194 patients (39 per year) over 5 years. In the base case, the estimated 5-year budget impact of fruquintinib was $4,077,073 ($0.82 PMPY and 0.07 PMPM) for a commercial health plan. During the first year, the estimated budget impact was $627,570 ($0.63 PMPY and 0.05 PMPM). Results were robust across sensitivity analyses. PMPM costs from the Medicare perspective were greater than the base-case (commercial) ($0.17 vs. $0.07) due to higher incidence of CRC in that population. CONCLUSIONS Fruquintinib is associated with a low budget impact for payers based on proposed thresholds in the US.
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El Harch I, Guendaoui S, Charkaoui M, Benmaamar S, Omari M, El Youbi M, Belakhhel L, Abouselham L, Hachri H, El Menchay I, El Fakir S, Berraho M, Benchekroun N, Tachfouti N. Economic burden of lung cancer in Morocco: A cost of illness study. J Cancer Policy 2023; 37:100428. [PMID: 37353003 DOI: 10.1016/j.jcpo.2023.100428] [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: 03/02/2023] [Revised: 05/04/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Lung cancer is the most common cancer in men and the second most common cancer in women. It is associated with substantial economic impact in terms of direct and indirect costs. The main objective of this study is to estimate the direct medical cost of lung cancer management in Morocco MATERIALS AND METHODS: A cost-of-illness study was conducted among patients treated at the Mohammed VI Center of Cancer (Casablanca) in 2019. The costs were estimated from the societal perspective using a bottom-up approach. The materials and procedures used were identified and quantified retrospectively from the information system and files. Their monetary value was calculated according to official prices published by the national health insurance agency. The horizon time adopted was 12 months. RESULTS The study included 271 patients, with an average age of 62.5 ± 9.5 years. Of these, 93.4 % were men and 92.1 % were former smokers. In terms of cancer staging, 68.3 % of patients were in stage IV while 28.8 % were in stage III. Adenocarcinoma was present in 43.5 % of cases. Patients underwent an average of 10.6 ± 5.1 radiological investigations, 56.1 ± 30.9 biological tests, and 24.1 ± 11.7 consultations. The average direct medical cost was 4455.3 USD (95 % CI: 4037.4-4873.2). Chemotherapy accounted for 19.9 % of the total cost, while radiological investigations and drugs accounted for 18.7 % and 17.6 %, respectively. Diagnostic tests and radiotherapy each accounted for 7.6 % of the total cost, while biological tests accounted for 7.5 % and hospitalizations accounted for 7.1 %. The cost was statistically higher in young patients (p = 0.017), in patients with adenocarcinoma (p < 0.0001), in patients with stage II tumor (< 0.00001), in patients who have undergone surgery (p = 0.002), chemotherapy (p < 0.0001), radiotherapy (p < 0.001) and in those without metastases (p < 0.0001). CONCLUSION These results provide evidence to support the ratification of the Framework Convention on Tobacco Control and the full adherence of the Kingdom of Morocco to the MPOWER measures.
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Affiliation(s)
- I El Harch
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco.
| | - S Guendaoui
- Moahammed VI Center for Cancer Care, Casablanca, Morocco
| | - M Charkaoui
- Moahammed VI Center for Cancer Care, Casablanca, Morocco
| | - S Benmaamar
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - M Omari
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - M El Youbi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - L Belakhhel
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - L Abouselham
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - H Hachri
- World Health Oranization Country of Morocco, Morocco
| | - I El Menchay
- World Health Oranization Country of Morocco, Morocco
| | - S El Fakir
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - M Berraho
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - N Benchekroun
- Moahammed VI Center for Cancer Care, Casablanca, Morocco
| | - N Tachfouti
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
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Guadamuz JS, Wang X, Ryals CA, Miksad RA, Snider J, Walters J, Calip GS. Socioeconomic status and inequities in treatment initiation and survival among patients with cancer, 2011-2022. JNCI Cancer Spectr 2023; 7:pkad058. [PMID: 37707536 PMCID: PMC10582690 DOI: 10.1093/jncics/pkad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. Most studies examining cancer inequities across area-level socioeconomic status tend to use less granular or unidimensional measures and pre-date the COVID-19 pandemic. Here, we examined the association of area-level socioeconomic status on real-world treatment initiation and overall survival among adults with 20 common cancers. METHODS This retrospective cohort study used electronic health record-derived deidentified data (Flatiron Health Research Database, 2011-2022) linked to US Census Bureau data from the American Community Survey (2015-2019). Area-level socioeconomic status quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their mailing address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type. RESULTS This cohort included 291 419 patients (47.7% female; median age = 68 years). Patients from low-SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) than those in high-SES areas. Living in low-SES areas (vs high) was associated with lower treatment rates (hazard ratio = 0.94 [95% confidence interval = 0.93 to 0.95]) and reduced survival (median real-world overall survival = 21.4 vs 29.5 months, hazard ratio = 1.20 [95% confidence interval = 1.18 to 1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-level socioeconomic inequities in treatment and survival remained statistically significant in the COVID-19 era (after March 2020). CONCLUSION To reduce inequities in cancer outcomes, efforts that target marginalized, low-socioeconomic status neighborhoods are necessary.
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Affiliation(s)
- Jenny S Guadamuz
- Flatiron Health, New York, NY, USA
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, CA, USA
- Program on Medicines and Public Health, University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | | | | | - Rebecca A Miksad
- Flatiron Health, New York, NY, USA
- Department of Hematology and Oncology, Boston University School of Medicine, Boston, MA, USA
| | | | | | - Gregory S Calip
- Flatiron Health, New York, NY, USA
- Program on Medicines and Public Health, University of Southern California School of Pharmacy, Los Angeles, CA, USA
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Cui Z, Wu Y, Zhang QH, Wang SG, He Y, Huang DS. MV-CVIB: a microbiome-based multi-view convolutional variational information bottleneck for predicting metastatic colorectal cancer. Front Microbiol 2023; 14:1238199. [PMID: 37675425 PMCID: PMC10477591 DOI: 10.3389/fmicb.2023.1238199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Imbalances in gut microbes have been implied in many human diseases, including colorectal cancer (CRC), inflammatory bowel disease, type 2 diabetes, obesity, autism, and Alzheimer's disease. Compared with other human diseases, CRC is a gastrointestinal malignancy with high mortality and a high probability of metastasis. However, current studies mainly focus on the prediction of colorectal cancer while neglecting the more serious malignancy of metastatic colorectal cancer (mCRC). In addition, high dimensionality and small samples lead to the complexity of gut microbial data, which increases the difficulty of traditional machine learning models. Methods To address these challenges, we collected and processed 16S rRNA data and calculated abundance data from patients with non-metastatic colorectal cancer (non-mCRC) and mCRC. Different from the traditional health-disease classification strategy, we adopted a novel disease-disease classification strategy and proposed a microbiome-based multi-view convolutional variational information bottleneck (MV-CVIB). Results The experimental results show that MV-CVIB can effectively predict mCRC. This model can achieve AUC values above 0.9 compared to other state-of-the-art models. Not only that, MV-CVIB also achieved satisfactory predictive performance on multiple published CRC gut microbiome datasets. Discussion Finally, multiple gut microbiota analyses were used to elucidate communities and differences between mCRC and non-mCRC, and the metastatic properties of CRC were assessed by patient age and microbiota expression.
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Affiliation(s)
- Zhen Cui
- Institute of Machine Learning and Systems Biology, College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Yan Wu
- College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Qin-Hu Zhang
- EIT Institute for Advanced Study, Ningbo, Zhejiang, China
| | - Si-Guo Wang
- Institute of Machine Learning and Systems Biology, College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Ying He
- Institute of Machine Learning and Systems Biology, College of Electronics and Information Engineering, Tongji University, Shanghai, China
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Durgapal S, Hanson K, Kurosky SK, Kautz S, Sison S, Cool C. Work productivity among patients with metastatic breast cancer in the United States. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1137-1145. [PMID: 35906806 DOI: 10.1080/14737167.2022.2108409] [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: 02/15/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To characterize workplace productivity measures in patients with metastatic breast cancer (mBC) using line of therapy (LOT) and first line (1 L) regimen. METHODS A retrospective cohort study was conducted using IBM's MarketScan Commercial Claims and Encounters (CCAE) and Health and Productivity Management (HPM) databases. The cohort included patients diagnosed with mBC who initiated 1 L treatment between 2/3/2015 and 6/30/2018. Productivity was measured using days absent from work and short- and long-term disability (STD, LTD) claims by LOT and 1 L regimen (any cyclin-dependent kinase 4/6 inhibitor [CDK4/6i], endocrine monotherapy, chemotherapy only, or other anti-cancer therapy [OACT]). LOT was defined using regimen-based progression. RESULTS Overall, 548 patients were included; 148, 129, 145, and 126 received endocrine monotherapy, CDK4/6i, chemotherapy only, and OACT, respectively. The rate of LTD increased significantly by 3.1 and 2.6 times from 1 L to second line (2 L) and from 2 L to subsequent lines, respectively. Patients receiving 1 L chemotherapy had 2.4- and 2.7-times odds of using STD and LTD compared to patients receiving 1 L CDK4/6i. CONCLUSIONS Regimen-based disease progression is associated with increased use of STD and LTD. Patients with a 1 L regimen of chemotherapy have significantly higher odds of using STD or LTD than patients using 1 L CDK4/6i.
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Affiliation(s)
- Sneha Durgapal
- PRECISIONheor, Precision Value and Health, New York, NY, USA
| | - Kent Hanson
- Patient & Health Impact, Pfizer Inc, New York, NY, USA
| | | | - Sharon Kautz
- PRECISIONheor, Precision Value and Health, New York, NY, USA
| | - Steve Sison
- PRECISIONheor, Precision Value and Health, New York, NY, USA
| | - Christina Cool
- PRECISIONheor, Precision Value and Health, New York, NY, USA
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McGarvey N, Gitlin M, Fadli E, Chung KC. Increased healthcare costs by later stage cancer diagnosis. BMC Health Serv Res 2022; 22:1155. [PMID: 36096813 PMCID: PMC9469540 DOI: 10.1186/s12913-022-08457-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cancer represents a significant source of disease burden in the United States (US), both clinically and economically. Diagnosis and treatment of cancer at earlier stages may reduce this burden. To better understand potential impacts of earlier diagnosis, healthcare costs among patients with cancer were assessed by cancer type and stage at diagnosis. Methods A retrospective analysis was conducted using Optum’s de-identified Integrated Claims-Clinical data set with Enriched Oncology, which includes data from Medicare Advantage and commercially insured members. Adult members newly diagnosed with solid tumor cancers, cancer stage at diagnosis (diagnosed 1/1/2016–6/30/2020), and continuous enrollment for at least one month post diagnosis were identified. Patients with breast, cervical, colorectal, lung, ovarian, or prostate cancer were reported. Mean standardized costs (2020 USD) were calculated in each month on an annual and cumulative basis through four years post-cancer diagnosis. In each month, costs were calculated for those with continuous enrollment and no death reported in the month. Mean annual cost per patient was estimated by summing month one to 12 mean costs and stratifying by stage at cancer diagnosis; annual year one to four costs were summed to determine cumulative costs. Results Among members diagnosed 2016–2020 with breast, cervical, colorectal, lung, ovarian, or prostate cancer, 20,422 eligible members were identified. Mean costs increased by stage of diagnosis across all cancers at the annual and cumulative level through year four post diagnosis. Cumulative mean costs grew over time at a relatively similar rate across stages I to III and more dramatically in stage IV, except for cervical and lung cancer where the rate was relatively stable or slightly fluctuated across stages and ovarian cancer where stages III and IV both increased more sharply compared to stages I and II. Conclusions Mean annual and cumulative healthcare costs through year four post cancer diagnosis were significantly higher among those diagnosed at later versus earlier cancer stages. The steeper increase in cumulative costs among those diagnosed in stage IV for many cancer types highlights the importance of earlier cancer diagnosis. Earlier cancer diagnosis may enable more efficient treatment, improve patient outcomes and reduce healthcare costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08457-6.
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Affiliation(s)
| | | | - Ela Fadli
- BluePath Solutions, Los Angeles, CA, USA
| | - Karen C Chung
- GRAIL LLC, a subsidiary of Illumina Inc currently held separate from Illumina Inc under the terms of the Interim Measures Order of the European Commission dated 20 October 2021, 1525 O'Brien Dr, Menlo Park, CA, 94025, USA.
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11
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Bhimani N, Wong GYM, Molloy C, Pavlakis N, Diakos CI, Clarke SJ, Dieng M, Hugh TJ. Cost of treating metastatic colorectal cancer: a systematic review. Public Health 2022; 211:97-104. [PMID: 36063775 DOI: 10.1016/j.puhe.2022.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/26/2022] [Accepted: 06/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The cost of treating metastatic colorectal cancer places a significant economic burden on individuals, populations, and health care. However, there is a paucity of information on the costs of the contemporary management of metastatic colorectal cancer. This systematic review aims to review the literature to estimate the direct cost of treating metastatic colorectal cancer. STUDY DESIGN Systematic review. METHODS MEDLINE, Embase, Web of Science, Evidence-Based Medicine Reviews: National Health Service Economic Evaluation Database Guide, EconLit, and grey literature from the 1st of January 2000 to the 1st of February 2020 were all searched for studies reporting the direct costs of treating metastatic colorectal cancer. The methodological quality of the included studies was assessed using the Evers' Consensus on Health Economic Criteria checklist. RESULTS In total, 39,489 records were retrieved, and 29 studies were included. Costs of treating metastatic colorectal cancer varied because of the heterogeneity of treatment. Studies reported average costs ranged from $12,346 to $293,461. Studies that included the cost of systemic therapy reported an estimated cost of almost $300,000. CONCLUSION The existing evidence indicates that the cost of treating metastatic colorectal cancer places a significant economic burden on healthcare systems despite differences in methodology and treatment heterogeneity. Future research needs to define the cost components of treating metastatic colorectal cancer to improve comparability and examine the relationship between spending, overall survival, and quality of life. Identifying these costs and their impact on health care budgets can help policymakers plan health system expenditure.
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Affiliation(s)
- N Bhimani
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - G Y M Wong
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - C Molloy
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - N Pavlakis
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - C I Diakos
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S J Clarke
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - M Dieng
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - T J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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Mahtani R, Oestreicher N, Lalla D, Ogbonnaya A, Saundankar V, Willey J, Coutinho AD, McCann K. Healthcare Resource Utilization and Costs for Metastatic Breast Cancer Patients Newly Treated with Human Epidermal Growth Factor Receptor 2 (HER2)-Targeted Agents. Clin Breast Cancer 2021; 22:e488-e496. [DOI: 10.1016/j.clbc.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/03/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
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Lo BD, Caturegli G, Stem M, Biju K, Safar B, Efron JE, Rajput A, Atallah C. The Impact of Surgical Delays on Short- and Long-Term Survival Among Colon Cancer Patients. Am Surg 2021; 87:1783-1792. [PMID: 34666557 DOI: 10.1177/00031348211047511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study was to assess the impact of surgical delays on short- and long-term survival among colon cancer patients. METHODS Adult patients undergoing surgery for stage I, II, or III colon cancer were identified from the National Cancer Database (2010-2016). After categorization by wait times from diagnosis to surgery (<1 week, 1-3 weeks, 3-6 weeks, 6-9 weeks, 9-12 weeks, and >12 weeks), 30-day mortality, 90-day mortality, and 5-year overall survival were compared between patients both overall and after stratification by pathological disease stage. RESULTS Among 187 394 colon cancer patients, 24.2% waited <1 week, 30.5% waited 1-3 weeks, 29.0% waited 3-6 weeks, 9.7% waited 6-9 weeks, 3.3% waited 9-12 weeks, and 3.3% waited >12 weeks for surgery. Patients undergoing surgery 3-6 weeks after colon cancer diagnosis exhibited the best 30-day mortality (1.3%), 90-day mortality (2.3%), and 5-year overall survival (71.8%) (P < .001 for all). After risk-adjusting for confounders, all wait times beyond 6 weeks were associated with worse 5-year overall survival (6-9 weeks: HR 1.10, 95% CI 1.06-1.15; 9-12 weeks: HR 1.25, 95% CI 1.18-1.33; >12 weeks: HR 1.43, 95% CI 1.35-1.52; P < .001 for all). Subgroup analysis after stratification by disease stage demonstrated that patients with stage III colon cancer were able to wait up to 9 weeks before exhibiting worse 5-year overall survival, compared to 6 weeks for patients with stage I or II disease. CONCLUSIONS Colon cancer patients should undergo surgery 3-6 weeks after diagnosis, as all surgical delays beyond 6 weeks were associated with worse 30-day mortality, 90-day mortality, and 5-year overall survival.
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Affiliation(s)
- Brian D Lo
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Giorgio Caturegli
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Biju
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bashar Safar
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashwani Rajput
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chady Atallah
- Colorectal Research Unit, Department of Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Laing S, Johnston S. Estimated impact of COVID-19 on preventive care service delivery: an observational cohort study. BMC Health Serv Res 2021; 21:1107. [PMID: 34656114 PMCID: PMC8520349 DOI: 10.1186/s12913-021-07131-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 has caused significant healthcare service disruptions. Surgical backlogs have been estimated but not for other healthcare services. This study aims to estimate the backlog of preventive care services caused by COVID-19. METHODS This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were crudely estimated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada. RESULTS The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (- 0.3% to - 14.7%; 95% CI), colorectal cancer decreased by 8.1% (- 0.3% to - 15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (- 0.2% to - 8.7%; 95% CI). Crude estimates imply 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI) may be overdue in Ontario. Nationally the deficits may be tripled these numbers. Re-opening measures have not reversed these trends. INTERPRETATION COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.
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Affiliation(s)
- Scott Laing
- University of Ottawa Department of Family Medicine, Telfer School of Management, Ottawa, Canada
| | - Sharon Johnston
- University of Ottawa Department of Family Medicine, Institut du Savoir Montfort, Bruyère Research Institute, Ottawa, Canada
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15
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Aly A, Lingohr-Smith M, Lin J, Seal B. Locoregional therapy patterns and healthcare economic burden of patients with hepatocellular carcinoma in the USA. Hepat Oncol 2021; 8:HEP37. [PMID: 34408847 PMCID: PMC8369525 DOI: 10.2217/hep-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: To examine the locoregional therapy (LRT) patterns and the healthcare economic burden of patients with hepatocellular carcinoma (HCC) in the USA. Patients & methods: Patients with newly diagnosed HCC were identified from the MarketScan® databases (1 July 2015–31 May 2018). The LRTs received and all-cause and HCC-related healthcare costs were measured. Results: Among 2101 patients with HCC, most received embolization therapy as their first LRT treatment (57.8%, n = 1215); 17.1% (n = 360) received ablative therapy and 8.7% (n = 182) radiation therapy; 16.4% (n = 344) received multiple LRTs. After patients received their first LRT treatment, total all-cause healthcare costs averaged $20,316 per patient per month; 70.7% ($14,359) were HCC related. Conclusion: Among newly diagnosed HCC patients treated with LRT in the USA, the economic burden is high.
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Affiliation(s)
- Abdalla Aly
- AstraZeneca Pharmaceuticals LP, US Medical Affairs: Evidence Generation, Gaithersburg, MD 20878, USA
| | | | - Jay Lin
- Novosys Health, Green Brook, NJ 08812, USA
| | - Brian Seal
- AstraZeneca Pharmaceuticals LP, US Medical Affairs: Evidence Generation, Gaithersburg, MD 20878, USA
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16
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Morgans AK, Hepp Z, Shah SN, Shah A, Petrilla A, Small M, Sonpavde G. Real-world burden of illness and unmet need in locally advanced or metastatic urothelial carcinoma following discontinuation of PD-1/L1 inhibitor therapy: A Medicare claims database analysis. Urol Oncol 2021; 39:733.e1-733.e10. [PMID: 34238657 DOI: 10.1016/j.urolonc.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/26/2021] [Accepted: 05/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several programmed death-1 or death-ligand 1 (PD-1/L1) inhibitors are approved first- or second-line therapies for locally advanced or metastatic urothelial carcinoma (la/mUC); however, clinical trials show that only ∼20% of patients respond and all ultimately progress. This study elucidated real-world treatment patterns, healthcare resource utilization (HRU), and economic burden among Medicare beneficiaries with la/mUC who discontinue PD-1/L1 inhibitor therapies. METHODS We conducted a retrospective claims analysis of patients aged ≥65 years diagnosed with la/mUC (2015-2017) who initiated and subsequently discontinued PD-1/L1 inhibitor therapy (index=date of last administration) using Medicare Fee-for-Service Research Identifiable Files. Included patients had ≥12 months pre- and ≥3 months post-index continuous Medicare enrollment, and were followed until disenrollment, death, or data cutoff. RESULTS Among 28,063 patients, 17% (n=4652) received ≥1 PD-1/L1 inhibitor following la/mUC diagnosis. Of these, 791 discontinued PD-1/L1 inhibitor therapy and met inclusion criteria (study cohort); 73% male, median age 76 years. Post-discontinuation, 3% received a different PD-1/L1 inhibitor, 46% chemotherapy, and 51% no further systemic treatment. HRU was high during follow-up: 97% had ≥1 outpatient visit and 52% ≥1 hospitalization. Healthcare costs per-patient-per-month were $7153 pre- and $7745 (adjusted) post-index; systemic therapy costs were higher pre- vs. post-index ($2978 vs. $1195) but other costs were higher post-index: hospitalization ($1120 vs. $2200), outpatient ($1437 vs. $2064), hospice ($3 vs. $536), skilled nursing facility ($106 vs. $384). CONCLUSIONS Over half of Medicare beneficiaries with la/mUC received no disease-directed therapy post-PD-1/L1 inhibitor treatment. Patients who discontinued PD-1/L1 inhibitor therapy had intensive HRU unrelated to therapy costs, highlighting the significant burden of la/mUC and need for treatments that extend survival.
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Affiliation(s)
- Alicia K Morgans
- Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL.
| | | | | | | | | | - Mary Small
- Astellas Pharma Global Development Inc., Northbrook, IL
| | - Guru Sonpavde
- Genitourinary Oncology Division, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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17
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Mueller V, Wardley A, Paplomata E, Hamilton E, Zelnak A, Fehrenbacher L, Jakobsen E, Curtit E, Boyle F, Harder Brix E, Brenner A, Crouzet L, Ferrario C, Muñoz-Mateu M, Arkenau HT, Iqbal N, Aithal S, Block M, Cold S, Cancel M, Hahn O, Poosarla T, Stringer-Reasor E, Colleoni M, Cameron D, Curigliano G, Siadak M, DeBusk K, Ramos J, Feng W, Gelmon K. Preservation of quality of life in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer treated with tucatinib or placebo when added to trastuzumab and capecitabine (HER2CLIMB trial). Eur J Cancer 2021; 153:223-233. [PMID: 34214937 DOI: 10.1016/j.ejca.2021.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
AIMS In HER2CLIMB, tucatinib significantly improved progression-free and overall survival in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer. We evaluated the impact of tucatinib on health-related quality of life (HR-QoL) in HER2CLIMB. METHODS Patients were randomised 2:1 to tucatinib or placebo combined with trastuzumab and capecitabine. Starting with protocol version 7, the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS) were administered at day 1 of cycle 1, every two cycles during cycles 3-9, every three cycles during cycle 12 and thereafter and at each patient's 30-day follow-up visit. RESULTS Among 364 patients eligible for HR-QoL assessment, 331 (91%) completed ≥1 assessment. EQ-VAS scores were similar for both arms at baseline and maintained throughout treatment. EQ-5D-5L scores were similar between the treatment arms, stable throughout therapy and worsened after discontinuing treatment. Risk of meaningful deterioration (≥7 points) on EQ-VAS was reduced 19% in the tucatinib vs. placebo arm (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.55, 1.18); the median (95% CI) time to deterioration was not reached in the tucatinib arm and was 5.8 months (4.3, -) in the placebo arm. Among patients with brain metastases (n = 164), risk of meaningful deterioration on EQ-VAS was reduced 49% in the tucatinib arm (HR: 0.51; 95% CI: 0.28, 0.93); the median (95% CI) time to deterioration was not reached in the tucatinib arm and was 5.5 months (4.2, -) in the placebo arm. CONCLUSIONS HR-QoL was preserved for patients with HER2+ metastatic breast cancer who were treated with tucatinib added to trastuzumab and capecitabine and maintained longer with tucatinib therapy than without it among those with brain metastases. CLINICAL TRIAL REGISTRATION NCT02614794.
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Affiliation(s)
- Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Andrew Wardley
- Manchester Breast Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | - Elisavet Paplomata
- Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Erika Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA
| | | | | | | | - Elsa Curtit
- University Hospital of Besançon, Besançon, France
| | | | | | - Andrew Brenner
- Mays Cancer Center at the UT Health San Antonio, San Antonio, TX, USA
| | | | | | - Montserrat Muñoz-Mateu
- Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics, Institut d'Investigacions Biomèdiques Pi i Sunyer-IDIBAPS, Barcelona, Spain
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute UK and Cancer Institute, University College London, London, UK
| | - Nayyer Iqbal
- Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada
| | - Sramila Aithal
- Cancer Treatment Centers of America / Eastern Regional Medical Center, Philadelphia, PA, USA
| | | | | | | | - Olwen Hahn
- University of Chicago Medical Center, Chicago, IL, USA
| | - Teja Poosarla
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Erica Stringer-Reasor
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marco Colleoni
- IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - David Cameron
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, Scotland
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, and University of Milano, Milan, Italy
| | | | - Kendra DeBusk
- Health Economics Outcome Research, Seagen Inc., Bothell, WA, USA
| | - Jorge Ramos
- Clinical Development, Seagen Inc., Bothell, WA, USA
| | | | - Karen Gelmon
- British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC, Canada
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Mehrens D, Unterrainer M, Corradini S, Niyazi M, Manapov F, Westphalen CB, Froelich MF, Wildgruber M, Seidensticker M, Ricke J, Rübenthaler J, Kunz WG. Cost-Effectiveness Analysis of Local Treatment in Oligometastatic Disease. Front Oncol 2021; 11:667993. [PMID: 34211842 PMCID: PMC8239286 DOI: 10.3389/fonc.2021.667993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In certain malignancies, patients with oligometastatic disease benefit from radical ablative or surgical treatment. The SABR-COMET trial demonstrated a survival benefit for oligometastatic patients randomized to local stereotactic ablative radiation (SABR) compared to patients receiving standard care (SC) alone. Our aim was to determine the cost-effectiveness of SABR. MATERIALS AND METHODS A decision model based on partitioned survival simulations estimated costs and quality-adjusted life years (QALY) associated with both strategies in a United States setting from a health care perspective. Analyses were performed over the trial duration of six years as well as a long-term horizon of 16 years. Model input parameters were based on the SABR-COMET trial data as well as best available and most recent data provided in the published literature. An annual discount of 3% for costs was implemented in the analysis. All costs were adjusted to 2019 US Dollars according to the United States Consumer Price Index. SABR costs were reported with an average of $11,700 per treatment. Deterministic and probabilistic sensitivity analyses were performed. Incremental costs, effectiveness, and cost-effectiveness ratios (ICER) were calculated. The willingness-to-pay (WTP) threshold was set to $100,000/QALY. RESULTS Based on increased overall and progression-free survival, the SABR group showed 0.78 incremental QALYs over the trial duration and 1.34 incremental QALYs over the long-term analysis. Treatment with SABR led to a marginal increase in costs compared to SC alone (SABR: $304,656; SC: $303,523 for 6 years; ICER $1,446/QALY and SABR: $402,888; SC: $350,708 for long-term analysis; ICER $38,874/QALY). Therapy with SABR remained cost-effective until treatment costs of $88,969 over the trial duration (i.e. 7.6 times the average cost). Sensitivity analysis identified a strong model impact for ongoing annual costs of oligo- and polymetastatic disease states. CONCLUSION Our analysis suggests that local treatment with SABR adds QALYs for patients with certain oligometastatic cancers and represents an intermediate- and long-term cost-effective treatment strategy.
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Affiliation(s)
- Dirk Mehrens
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Unterrainer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Feizi N, Tavakoli M, Patel RV, Atashzar SF. Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision. Front Robot AI 2021; 8:610677. [PMID: 33937347 PMCID: PMC8079974 DOI: 10.3389/frobt.2021.610677] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022] Open
Abstract
The unprecedented shock caused by the COVID-19 pandemic has severely influenced the delivery of regular healthcare services. Most non-urgent medical activities, including elective surgeries, have been paused to mitigate the risk of infection and to dedicate medical resources to managing the pandemic. In this regard, not only surgeries are substantially influenced, but also pre- and post-operative assessment of patients and training for surgical procedures have been significantly impacted due to the pandemic. Many countries are planning a phased reopening, which includes the resumption of some surgical procedures. However, it is not clear how the reopening safe-practice guidelines will impact the quality of healthcare delivery. This perspective article evaluates the use of robotics and AI in 1) robotics-assisted surgery, 2) tele-examination of patients for pre- and post-surgery, and 3) tele-training for surgical procedures. Surgeons interact with a large number of staff and patients on a daily basis. Thus, the risk of infection transmission between them raises concerns. In addition, pre- and post-operative assessment also raises concerns about increasing the risk of disease transmission, in particular, since many patients may have other underlying conditions, which can increase their chances of mortality due to the virus. The pandemic has also limited the time and access that trainee surgeons have for training in the OR and/or in the presence of an expert. In this article, we describe existing challenges and possible solutions and suggest future research directions that may be relevant for robotics and AI in addressing the three tasks mentioned above.
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Affiliation(s)
- Navid Feizi
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre, and School of Biomedical Engineering, University of Western Ontario, London, ON, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Rajni V. Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre, and School of Biomedical Engineering, University of Western Ontario, London, ON, Canada
- Department of Electrical and Computer Engineering, University of Western Ontario, London, ON, Canada
- Department of Surgery, University of Western Ontario, London, ON, Canada
| | - S. Farokh Atashzar
- Department of Electrical and Computer Engineering, New York University, New York, NY, United States
- Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
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20
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Le V, Zhong L, Narsipur N, Hays E, Tran DK, Rosario K, Wilson L. Cost-effectiveness of ribociclib plus endocrine therapy versus placebo plus endocrine therapy in HR-positive, HER2-negative breast cancer. J Manag Care Spec Pharm 2021; 27:327-338. [PMID: 33645243 PMCID: PMC10390904 DOI: 10.18553/jmcp.2021.27.3.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The 2015 American Society of Clinical Oncology guidelines recommend first-line treatment of hormone receptor (HR)-positive breast cancer with endocrine therapy plus or minus palbociclib, a selective cyclin-dependent kinase (CDK)4/6 inhibitor. In 2018, the U.S. Food and Drug Administration approved ribociclib, a new orally available selective CDK4/6 inhibitor. While gains in progression-free survival (PFS) and overall survival (OS) from ribociclib are important for clinical and treatment outcomes, trade-offs in adverse events (AEs) and additional costs necessitate cost-effectiveness analysis (CEA) to assist consideration by third-party payer systems, physicians, and patients. OBJECTIVES: To (a) develop a Markov model and (b) determine the cost-effectiveness of ribociclib plus endocrine therapy versus endocrine therapy alone as treatment for premenopausal and perimenopausal patients with HR-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. METHODS: A lifetime 3-state Markov model ("stable," "progressed," and "dead" health states) was developed using a U.S. payer perspective. Transition probabilities were calculated based on OS and PFS outcomes from the randomized controlled phase 3 trial MONALEESA-7. These Kaplan-Meier curves were extended to lifetime by estimating best-fit distributions using loglogistic distribution for ribociclib curves and Weibull distribution for placebo curves. Costs were obtained from national data sources using 2019 U.S. dollars (USD) and discounted by 3%. Utilities were obtained via published breast cancer literature and were included for each health state and for time spent with each AE. Results were expressed as an incremental cost-effectiveness ratio (ICER) expressed as USD per quality-adjusted life-year (QALY) saved. Treatments were assumed to be cost-effective based on a willingness-to-pay (WTP) threshold of $150,000 per QALY gained. Base-case, 1-way sensitivity tornado diagrams and probabilistic sensitivity analyses demonstrated changes in the ICER and were driven by the cost of ribociclib and the utility of remaining in the stable health state. RESULTS: Ribociclib plus endocrine therapy was cost-effective at an ICER of $124,513 per QALY when compared with endocrine therapy alone at a WTP threshold of $150,000. The ribociclib plus endocrine therapy arm had an effectiveness of 5.28 QALYs and a total cost of $385,112, while placebo plus endocrine therapy provided only 2.46 QALYs at a lower total cost of $67.246. The model was sensitive to the cost of ribociclib and the utility of time spent in the stable health state. Probabilistic sensitivity analysis demonstrated that endocrine therapy alone was cost-effective until a WTP of $125,000 and was cost-effective 72% of the time at the WTP threshold. CONCLUSIONS: Ribociclib plus endocrine therapy is more cost-effective than endocrine therapy alone. Professionals in managed care settings should consider the pharmacoeconomic benefits of ribociclib for the treatment of HR-positive, HER2-negative breast cancer as they make value-based formulary decisions. Further CEAs should be considered as direct treatment comparison trials between CDK4/6 inhibitors are completed in the future. DISCLOSURES: No outside funding supported this study. The authors have nothing to disclose.
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Affiliation(s)
- Vivian Le
- Department of Clinical Pharmacy, University of California, San Francisco
| | | | - NihaL Narsipur
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Elizabeth Hays
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Daniel Khuong Tran
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Kimberly Rosario
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco
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21
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Abderrahman B, Maximov PY, Curpan RF, Fanning SW, Hanspal JS, Fan P, Foulds CE, Chen Y, Malovannaya A, Jain A, Xiong R, Greene GL, Tonetti DA, Thatcher GRJ, Jordan VC. Rapid Induction of the Unfolded Protein Response and Apoptosis by Estrogen Mimic TTC-352 for the Treatment of Endocrine-Resistant Breast Cancer. Mol Cancer Ther 2020; 20:11-25. [PMID: 33177154 DOI: 10.1158/1535-7163.mct-20-0563] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/30/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022]
Abstract
Patients with long-term estrogen-deprived breast cancer, after resistance to tamoxifen or aromatase inhibitors develops, can experience tumor regression when treated with estrogens. Estrogen's antitumor effect is attributed to apoptosis via the estrogen receptor (ER). Estrogen treatment can have unpleasant gynecologic and nongynecologic adverse events; thus, the development of safer estrogenic agents remains a clinical priority. Here, we study synthetic selective estrogen mimics (SEM) BMI-135 and TTC-352, and the naturally occurring estrogen estetrol (E4), which are proposed as safer estrogenic agents compared with 17β-estradiol (E2), for the treatment of endocrine-resistant breast cancer. TTC-352 and E4 are being evaluated in breast cancer clinical trials. Cell viability assays, real-time PCR, immunoblotting, ERE DNA pulldowns, mass spectrometry, X-ray crystallography, docking and molecular dynamic simulations, live cell imaging, and Annexin V staining were conducted in 11 biologically different breast cancer models. Results were compared with the potent full agonist E2, less potent full agonist E4, the benchmark partial agonist triphenylethylene bisphenol (BPTPE), and antagonists 4-hydroxytamoxifen and endoxifen. We report ERα's regulation and coregulators' binding profiles with SEMs and E4 We describe TTC-352's pharmacology as a weak full agonist and antitumor molecular mechanisms. This study highlights TTC-352's benzothiophene scaffold that yields an H-bond with Glu353, which allows Asp351-to-helix 12 (H12) interaction, sealing ERα's ligand-binding domain, recruiting E2-enriched coactivators, and triggering rapid ERα-induced unfolded protein response (UPR) and apoptosis, as the basis of its anticancer properties. BPTPE's phenolic OH yields an H-Bond with Thr347, which disrupts Asp351-to-H12 interaction, delaying UPR and apoptosis and increasing clonal evolution risk.
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Affiliation(s)
- Balkees Abderrahman
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Philipp Y Maximov
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ramona F Curpan
- Coriolan Dragulescu Institute of Chemistry, Romanian Academy, Timisoara, Romania
| | - Sean W Fanning
- Ben May Department for Cancer Research, University of Chicago, Chicago, Illinois
| | - Jay S Hanspal
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Fan
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles E Foulds
- Center for Precision Environmental Health and Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Yue Chen
- Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana
| | - Anna Malovannaya
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Mass Spectrometry Proteomics Core, Baylor College of Medicine, Houston, Texas
| | - Antrix Jain
- Mass Spectrometry Proteomics Core, Baylor College of Medicine, Houston, Texas
| | - Rui Xiong
- Pharmacology and Toxicology, University of Arizona, Tucson, Arizona
| | - Geoffrey L Greene
- Ben May Department for Cancer Research, University of Chicago, Chicago, Illinois
| | - Debra A Tonetti
- Pharmacology and Toxicology, University of Arizona, Tucson, Arizona
| | | | - V Craig Jordan
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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22
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Park SK, Park JA, Yang SY, Shin JY, Koh H. The economic impact of disease progression and death in hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer patients: using Korean nationwide health insurance claims data. Curr Med Res Opin 2020; 36:1825-1833. [PMID: 32965131 DOI: 10.1080/03007995.2020.1826917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Recognizing the value of anticancer treatments based on progression-free survival and overall survival may help decision making in healthcare policy. We aimed to measure and compare the impact of disease progression and terminal state prior to death on healthcare costs in HR+, HER2- ABC patients. METHODS We conducted a retrospective study using Korean nationwide health insurance claims database between 1 September 2012 and 31 August 2017. The impact of disease progression was estimated by measuring the average incremental monthly cost per patient during 1 year after progression compared to 1 year before progression. Death-related costs per patient per month (PPPM) were measured for those who died within 1 year after progression. Generalized estimating equation (GEE) was used to estimate the variations in PPPM costs by progression and death with adjustment for clinical factors. RESULTS After progression, 1,636 patients expensed $2,892 per month more on average than before progression ($3762 vs. $870). The GEE analysis with adjustment for baseline characteristics showed that PPPM costs increased by 3.46 folds (95% CI = 3.06-3.93) after progression. Also, PPPM costs were 1.74 (95%CI = 1.43-2.12) times higher in patients who died within 1 year after progression relative to survived patients. When considering the interaction between progression and death, deceased patients showed higher increased ratio of PPPM costs after progression (4.91; p=value<.0001) than survived patients (2.95; 95% CI = 2.61-3.34). CONCLUSIONS From the payer's perspective, more healthcare costs incurred during the progression state than terminal state in HR+, HER2- ABC patients. The impact of disease progression emphasizes the importance of effectively treating HR+, HER2- ABC patients.
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Affiliation(s)
- Sun-Kyeong Park
- College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Jae-A Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - So-Young Yang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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23
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Kumar A, Straka C, Courtney PT, Vitzthum L, Riviere P, Murphy JD. Cost-Effectiveness Analysis of Stereotactic Ablative Radiation Therapy in Patients With Oligometastatic Cancer. Int J Radiat Oncol Biol Phys 2020; 109:1185-1194. [PMID: 33002541 DOI: 10.1016/j.ijrobp.2020.09.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The Stereotactic Ablative Radiation therapy for Comprehensive Treatment of Oligometastatic Tumors phase 2 randomized clinical trial found that stereotactic ablative radiation therapy (SABR) improved outcomes among cancer patients with oligometastatic disease. Yet, the cost of SABR along with the large number of patients with oligometastatic disease raises the important question of value. This study sought to evaluate the cost-effectiveness of the addition of SABR compared with standard therapy alone among cancer patients with oligometastatic disease. METHODS AND MATERIALS We constructed a Markov model to simulate treatment with stereotactic ablative radiation therapy or standard therapy among patients with oligometastatic cancers. The model derived transition probabilities from Stereotactic Ablative Radiation therapy for Comprehensive Treatment of Oligometastatic Tumors clinical trial data to estimate risks of toxicity, disease progression and survival. Health care costs and health utilities were estimated from the literature. Probabilistic and one-way sensitivity analyses evaluate model uncertainty. Cost-effectiveness was estimated from both the health care sector and societal perspectives with an incremental cost-effectiveness ratio (ICER) defined as dollars per quality-adjusted life year (QALY). An ICER less than $100,000/QALY was considered cost-effective. One-way and probabilistic sensitivity analyses were used to examine model uncertainty. RESULTS The addition of SABR increased total costs by $54,260 (health care sector perspective) or $72,799 (societal perspective) and improved effectiveness by 1.88 QALYs compared with standard therapy, leading to an ICER of $28,906/QALY (health care sector perspective) or $38,783/QALY (societal perspective). The model was modestly sensitive to assumptions about tumor progression, although the model was not sensitive to assumptions about survival or cost of treatment. Probabilistic sensitivity analyses demonstrated that SABR was the cost-effective treatment option 99.8% (health care sector perspective) or 98.7% (societal perspective) of the time. CONCLUSIONS The addition of SABR increased costs and improved quality adjusted survival, overall leading to a cost-effective treatment strategy for patients with oligometastatic cancer.
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Affiliation(s)
- Abhishek Kumar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Christopher Straka
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Patrick T Courtney
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Lucas Vitzthum
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
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24
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Fu SJ, George EL, Maggio PM, Hawn M, Nazerali R. The Consequences of Delaying Elective Surgery: Surgical Perspective. Ann Surg 2020; 272:e79-e80. [PMID: 32675504 PMCID: PMC7224620 DOI: 10.1097/sla.0000000000003998] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sue J Fu
- Department of Surgery, Division of General Surgery, Stanford University, Stanford, CA
- Center for Innovation to Implementation, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Elizabeth L George
- Center for Innovation to Implementation, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Surgery, Division of Vascular Surgery, Stanford University, Stanford, CA
| | - Paul M Maggio
- Department of Surgery, Division of General Surgery, Stanford University, Stanford, CA
| | - Mary Hawn
- Department of Surgery, Division of General Surgery, Stanford University, Stanford, CA
| | - Rahim Nazerali
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
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